Competence: its boundaries, emergencies and lifelong upkeep

Transcript

RyanIt's two in the morning in a high school gym that's become a storm shelter. Families are on cots. A teenager is shaking and can't stop crying. The only psychologist in the building does memory testing for a living. She's never been trained in crisis work.

SoheeNobody else is coming until morning. And she's wondering, am I even allowed to help? I'm not trained for this.

RyanToday is about that question: competence. Where it starts, where it stops, and how you keep it alive across a whole career. Welcome to EPPP Prep, the podcast. I'm Ryan.

SoheeI'm Sohee. And competence is one of those topics where two standards look alike and the exam makes you tell them apart. So let's build the foundation first.

RyanStandard 2.01, Boundaries of Competence. Part a. Psychologists provide services, teach, and conduct research only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience.

SoheePart b is about diversity. When psychology's knowledge establishes that understanding factors like age, gender identity, culture, disability, language, or socioeconomic status is essential to effective services, psychologists have or obtain the training, experience, consultation, or supervision they need, or they make appropriate referrals.

RyanPart c covers new territory. Psychologists planning to work with populations, areas, techniques, or technologies new to them undertake relevant education, training, supervised experience, consultation, or study.

SoheeAnd part f, briefly. When psychologists take on forensic roles, they are or become reasonably familiar with the judicial or administrative rules governing those roles.

RyanNow the two look-alikes. First, part d of 2.01. When psychologists are asked to serve people for whom appropriate mental health services are not available, psychologists with closely related prior training or experience may provide those services, so that services are not denied.

SoheeBut only if they make a reasonable effort to obtain the competence required, using relevant research, training, consultation, or study.

RyanThe second look-alike is Standard 2.02, Providing Services in Emergencies. In emergencies, when other mental health services are not available and the psychologist hasn't obtained the necessary training, they may provide services so that services are not denied.

SoheeAnd then the time limit. The services are discontinued as soon as the emergency has ended or appropriate services are available.

RyanSo, back to the gym at two in the morning. A real emergency, no other mental health help within reach. She may help. And her help ends when the emergency passes, or when appropriate services arrive, like the crisis team in the morning.

SoheeThe study notes for our practice questions put the clue nicely. Look for two things together: a real emergency, and no other mental health help within reach. And the wrong answers are refusing to help, requiring training first, or continuing after proper services arrive.

RyanPause and think. Different psychologist, different town. She's treated obsessive-compulsive disorder for years. A family asks her to treat their father's hoarding. There's no specialist anywhere nearby, and nothing about it is an emergency. Which rule applies, and what does she do?

SoheeNot the emergency rule. It's 2.01d. No appropriate services available, closely related training, no emergency. She may provide the treatment while making a reasonable effort, through research, training, consultation, or study, to obtain competence in treating hoarding.

RyanAnd the traps for that one are declining the case outright, serving with no added preparation, or invoking the emergency provision when there's no emergency.

SoheeSo, a memory hook. Emergency: help now, stop when it's over. Underserved: help, and build the competence while you do.

RyanAnd 2.01d shows up in many costumes. In our practice questions, it's a child-anxiety specialist asked to treat selective mutism, an addiction specialist facing gambling disorder, or a psychologist with years of cognitive behavioral therapy with older adults asked to treat insomnia. Same structure every time: closely related experience, nothing appropriate nearby, and study and consultation to close the gap.

SoheeTwo more Code standards round this out. Standard 2.04 says psychologists' work is based on established scientific and professional knowledge of the discipline.

RyanAnd then the most human standard in this whole section.

SoheeStandard 2.06, Personal Problems and Conflicts. Part a. Psychologists refrain from starting an activity when they know or should know there's a substantial likelihood their personal problems will prevent them from performing competently.

RyanPart b. When psychologists become aware of personal problems that may interfere with their work, they take appropriate measures, such as obtaining professional consultation or assistance, and they determine whether they should limit, suspend, or terminate their work-related duties.

SoheePause and think, round two. A psychologist is in the middle of a painful divorce. She notices she's distracted in sessions and snapping at a supervisee. What does 2.06 ask of her?

RyanNot to push through silently, and not necessarily to close her practice overnight. She takes appropriate measures, like consultation or getting help for herself, and then decides whether to limit, suspend, or end some of her duties.

SoheeThe Canadian Code says something similar in its competence and self-knowledge standards. Psychologists seek appropriate help, or discontinue activity for an appropriate period, if a physical or psychological condition reduces their ability to benefit and not harm others.

RyanAnd the Canadian Code has a line I find bracing. Psychologists consider incompetent action to be unethical in itself, because it's unlikely to benefit and likely to harm.

SoheeIt also says that when a client's issues turn out to be beyond their competence, psychologists take immediate steps to get consultation or supervision, or to refer, whichever is more likely to give the client competent service.

RyanNow, the part of the blueprint people forget. Continuing professional development. The APA's Standard 2.03 is one sentence. Psychologists undertake ongoing efforts to develop and maintain their competence.

SoheeOngoing. Not, finish the degree and you're done. The Canadian Code spells out how. Keep up to date with relevant knowledge, methods, techniques, and technologies through reading the literature, peer consultation, and continuing education activities.

RyanAnd it adds self-knowledge. Psychologists evaluate how their own experiences, attitudes, culture, beliefs, values, and personal needs might influence how they see and interact with others.

SoheeResearchers have looked at how psychologists actually do this. One recent interview study of twelve psychologists in Australia noted that competence models describe competencies continuing to develop beyond formal training and into the career, something called continuing competency.

RyanAnd that same paper points out a tricky fact. Psychologists often practice without direct supervision, so they need a degree of self-monitoring. Yet the literature it reviews notes psychologists at times fail to adequately evaluate their own competencies.

SoheeWhich makes sense. Grading yourself is hard. The study's participants described barriers like their own knowledge and biases shaping their self-assessment, and uncomfortable thoughts and feelings that came up while doing it.

RyanAnd participants described a structured self-assessment, rating themselves on a set measure of competencies, as helping them set considered goals. Notice the gaps, then plan the learning.

SoheeThe authors also suggest their findings may help supervisors guide supervisees toward more effective self-assessment. So if you supervise someday, teaching honest self-assessment becomes part of the job.

RyanThe last piece of keeping competence alive is keeping yourself alive. The Canadian Code asks psychologists to engage in self-care activities that help avoid conditions like burnout and addictions that could impair judgment.

SoheeAnd a 2020 article by Norcross and Phillips offered nine research-supported, practitioner-friendly self-care methods for psychologists during the pandemic. One of their points: nurturing relationships reliably emerge as effective and popular self-care in the psychotherapist research.

RyanAnd they were clear that quick techniques aren't the whole answer. Their two-minute methods, they wrote, must be embedded within broader self-care regimens and resilience strategies.

SoheeThey put it simply. We need to take care while giving care.

RyanLet's recap.

Sohee2.01: work within competence built from education, training, supervised experience, consultation, study, or professional experience. Get training for diversity factors or refer. Prepare before new areas. Know the rules for forensic roles.

Ryan2.01d, underserved: with closely related training and no appropriate services, you may serve while making a reasonable effort to gain the competence.

Sohee2.02, emergencies: with no other services available, you may help, and you stop as soon as the emergency ends or appropriate services are available.

Ryan2.06: if personal problems may interfere, get consultation or assistance and decide whether to limit, suspend, or end duties.

SoheeAnd 2.03: competence is ongoing. Continuing education, consultation, honest self-assessment, and self-care all keep it current.

RyanThat last point is for you, too. Studying for this exam is professional development. You're doing exactly what the Code asks: ongoing effort.

SoheeAnd be as kind to yourself as you'd be to a colleague doing hard work. Rest is part of competence. Thanks for listening to EPPP Prep.

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