CHAPTER 8<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

PROFESSIONAL   COMPETENCE and TRAINING

Introduction

-                     focus on the ethical and legal aspects of professional competence and the education and training available for mental health professionals.

-                     Issues related to professional  licensing and certification as well as approaches to  continuing education..

-                     Controversy : generalist versus a specialty approach o professional counseling.

-                     Ability is not an easy matter for practitioners to assess. Maintain their competence, practitioners must keep up to date on new developments in their  specialties.

-                     Need to sharpen their skill and ways to meet needs of new populations.

-                     Areas such as eating disorders, sexual abuse, substance abuse, gerontological counseling, AIDS all present challenges that demand that practitioners do more than boast.

-                     What than  they learned in their training programs.

-                     Continuing  education is particularly important in emerging areas of practice.

-                     Training is given special attention because of the unique ethical issues involved in counselor training.

-                     One key issues is the role of training program in safeguarding the public when it becomes clear that a trainee has problems that are likely to interfere with professional functioning.

Therapist Competence : Ethical and Legal Aspects

-                     what therapist competence,

-                     How can assess it,  some of its ethical and legal dimensions.

-                     What ethical standards do the various mental-health profession have  regarding competence?

-                     What ethical issues are involved in training therapists?

-                     To what degree  is professional licensing an accurate and valid measure of  competence ?

-                     What  are the ethical responsibilities of therapists to continue to upgrade their knowledge and skill?

Perspectives on Competence

-                     overview of specific guidelines from various professional associations.

-                     The guidelines leave several questions unanswered.

-                     What are the boundaries of one’s competence,

-                     How  do professionals know ?

-                     When they have exceeded them?

-                     How can practitioners determine whether they should  accept a client if  they lack the experience or training they would like to have?

-                     What should  be the minimal degree required for entry level for professional  counseling?

-                     To be competent to practice with a variety of client populations, does a counselor have to be generalist and a specialist?

-                     These questions become more complex when we consider the criteria  used in evaluating competence.

-                     Many people who complete a doctoral program lack the skills or knowledge needs to carry out certain therapeutic tasks.

-                     Obviously, a degree alone not guarantee competence for any and all psychological services.

-                     Practitioners must also assess how  far they can safely go  with clients and when to refer them to other specialists.

-                     Similarly, it’s important to learn when consult another professional if the counselor hasn’t had extensive experience working with a particular problem.

-                     If you were to refer all the clients with whom you encountered difficulties, you’d  probably have few clients.

-                     Keep in mind that many beginning counselors have doubts about their general level of competence; in fact, it’s at all unusual for highly experienced therapists to wonder seriously at times whether  they have the personal and professional abilities needed to work with some of their clients.

-                     Thus, difficulty working with some clients doesn’t by itself imply incompetence.

-                     One way to develop or upgrade your skills is to work with colleagues or professionals who have more experience than you do.

-                     You  can also learn new  skills by going to conferences and conventions, by taking additional  courses in areas you don’t  know well, and by participating in workshops that combine didactic work with supervised  practice.

-                     The feedback you receive can give you an additional resource  for evaluating your readiness to undertake certain therapeutic tasks.

-                     In addition to having a basic preparation as a generalist, you might also want to acquire advanced training in a specialty area, a topic we deal with later in this chapter.

Making Referrals

-                     it is crucial for professionals to know the boundaries of  their own competence and to refer clients to other professionals when  working with them is beyond their professional training or when personal factors would interfere with a productive working relationships.

-                     After counseling with a  client for a few sessions for example you  may determine that he or she needs more intensive therapy than you‘re qualified to offer.

-                     Even if you have the skills to undertake long-term psychotherapy, the agency you work for may, as a matter of  policy, permit only short-term counseling.

-                     Or you and a client may decide that because of conflict or for some other reason your relationships isn’t productive.

-                     The client may want  to continue working with another person rather than discontinue counseling.

-                     For these and other reasons you will need to develop a framework for evaluating when to refer a client, and you’ll need to learn how to make this referral in such a manner that your client will be open to accepting your suggestion.

-                     Most codes of ethics have a standard pertaining to conditions for making referral, for example:

(social workers should refer clients to other  professionals when other professionals specialized knowledge or expertise is needed to serve clients fully,or when social workers believe they are not being effective  or making reasonable progress with  clients and additional service is required. NASW,1996)

-                     to make the art referral more concrete,  consider the following exchange between a client and her counselor.

-                     Helen is 45 year old and has seen a counselor at a community mental-health center for six sessions.

-                     She  suffers from periods of deep depression and frequently talks about how hard it is to wake up to new day.

-                     In other respects it is very difficult for Helen to express what she feels.

-                     Most of the time she sits silently during the session.

-                     The counselor, decides that Helen’s problems warrant long-term therapy that he doesn’t feel competent  to provide.

-                     In addition, the center has a policy of referring clients treatment to therapists in private practice.

-                     The counselor therefore approaches Helen With the suggestion of  a referral:

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-                     This exchange reflect a common problem. What do you think of the way  Helen’s counselor approached his client?

-                     Would you have done anything differently?

-                     If you were Helen’s counselor , would you agree to continue seeing her if she refused to be referred to someone alse?

-                     Why, or why not?

-                     If  you didn’t want Helen to discontinue counseling, a number of alternatives would be open to you.

-                     You could agree to see to see her for another six sessions, provided that your director or supervisor approved.

-                     You could let her know that you would feel a need for consultation and close supervision if you  were seeing her.

-                     Also, you could say  that although this might not be the appropriate  time for a referral, you would want to work toward a referral eventually. Perhaps you could obtain Helen’s consent to have another therapist sit in on of your sessions so that you could consult with him or her.

-                     There may be a  change that Helen would eventually agree to begin therapy with this person.

-                     What other possibilities can you envision?

-                     What would be the consequences if you refused to see Helen or  could not obtain approval to see her?

Ethical Issues in Training Therapists

-                     training is a basic component of  practitioner competence.

-                     Our discussion of  the central  ethical and professional issues in training is organized  around questions pertaining to selection  of trainees, diversity, content of training program,  best  approaches to training, evaluating  students, and accreditation.

Selection of  Trainees

A core ethical and professional issue involves formulating policies and procedures  for selecting appropriate candidates for a training program.  Here are some issues to consider:

-                     what criteria  should be used for admission to training programs?

-                     should the selection of trainees be based solely on traditional academic standard, or should it take into account the latest finding on the personal characteristics of effective therapists?

-                     To what degree is a candidate for training open  to learning and to considering new perspectives?

-                     Does the candidate have problems that are likely to interfere with training and with the practice of  psychotherapy?

-                     What are some ways to increase applications to programs by underrepresented groups?

-                     How open are we to diversity? How open are we to including people who will challenge us as trainers?

-                     Which populations do you desire to work with , and  which do you want as clients? Why?

-                     What  is the importance of  a thorough orientation to a program?

Training programs have  an ethical responsibility to establish clear selection criteria, and candidates have a right to know the nature of  these criteria when they apply. Although grade-point averages, scores on the Graduate Record Examination, and letters of recommendation are often considered in  the selection process, relying on these measure alone does not provide a comprehensive picture of a candidate. Many program ask candidates to write a detailed essay that includes their reasons for wanting to be in the program, their professional goals, an assessment of their personal assets and liabilities, and life experiences that might be useful in their work as counselors. We recommend conducting group interviews with candidates. A number of programs have both faculty members and graduate students on the reviewing committee.  If  many sources are considered and if more than one person makes the decision about whom to select for training, there is less likelihood that people will be screened out on the basic of some personal whim.

As part of the screening process, ethical practice implies that candidates are given information about what will be expected of them if them if they enroll in the program. Just  as potential therapy clients have a right to informed consent, expected to learn and the manner in which education and training will take place. With this kind of knowledge, students are better equipped to decide if  they want to make a commitment to program.

Screening is a two-way process. As faculty screen candidates and make decisions on whom to admit, candidates may also be screening the program to decide if this right for them. ACA’s (1995) guideline on orientation is:

“prior to admission, counselor orient prospective students to the counselor education  or  training program’s expectations, including but not limited to the following:

1.                  the type and level of skill acquisition required but successful completion of the training.

2.                  subject matter to be covered,

3.                  basic for evaluation

4.                  training components that encourage self growth or self disclosure as part of the training process.

5.                  the type of supervision  setting and requirements of the sites for required clinical field experiences.

6.                  students and supervisee evaluation and dismissal  policies and procedures.

7.                  up to date employment prospects for graduates

Africa Americans and Hispanics are severely underrepresented in graduate program in the mental-health professions. Data on the ethical distribution of counseling doctorates show that most students in the program are Caucasians. Thus, it appears that effort to redress racial and ethical imbalances in training program have not been effective (Zimpfer & DeTrude, 1990). Diversity in program is endorsed by ACA’s Code of Ethics (1995). “Counselor are responsive to their institution’s and program’s recruitment and retention needs for training administrators, faculty;  and  students with diverse backgrounds.”  If  the faculty is made up of diverse individuals, the chances are increased that the program will emphasize of  attracting a diverse student population – and a wider range of potential students will likely feel encouraged to enroll in the program.

Content of a Program

-                     what is content of a training program and how is it decided?

-                     Is the curriculum determined by the preferences of the faculty, or is it based on the needs of the people being served, or both?

-                     Lazarus (1990) writes that “most graduate programs socialize their students into delimited schools  of  thought.”

-                     In his lectures to professional audiences, he often warns of limitations of  rigidly following a particular theory and then stretching clients to fit its preconceptions rather than adapting the techniques that flow from a theory to fit the unique needs of each client.

-                     He argues that a multimodal, systematic, teach nically eclectic model can point the way to a genuinely scientific approach to the training of the therapists.

-                     Thus, training program would do well to offer students a variety of therapeutic techniques and strategies that can be applied  to a  wide range of problem  with a diverse clientele.

-                     Some program are structured around a specific theoretical orientation.

-                     Other program have a broader content base and are aimed at training generalists who will be  able to step into future positions that  present evolving challenges.

-                     Some think that all specialty training should be abolished.

-                     They an concerned about training practitioners in only one therapeutic orientation.

-                     There is merit in  an analytically trained therapist’s learning about alternative approaches such as behavior therapy or a systemic model.

-                     By the  same token, a behavior therapist and systemic therapist should be able to recognize the role of transference and countertransference in the therapeutic process.

-                     Therapists should learn when a particular approach is contraindicated,  especially if is their own specialty.

-                     From an ethical perspective, counselor educators and trainers are expected to present varied theoretical positions:

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-           we recommend that students  be exposed to the major contemporary counseling theories and that they be taught to formulate a rationale for  the therapeutic techniques the employ.

-                     it is a good idea to teach students the strengths and limitations of these contemporary counseling theories.

-                     Some writers point out the limitations of basing  training mainly on these standard  counseling  models and call for training in alternative theoretical positions that apply to diverse client populations.

-                     For an overview of the contemporary counseling theories see.

-                     In deciding what to teach, certain questions are worth considering:

-                     Is the curriculum based on a  monocultural or a multicultural set of   assumptions?

-                     Is there a universal definition of mental health, or is mental health culturally defined?

-                     Should therapy help clients adjust to their culture? Or might it health  encourage them to find ways of constructively changing within their culture?

-                     Does the curriculum give central attention to the ethics of professional practice?

-                     Is it ethical to leave out training in  ethics?  Is  it enough to hope that ethical issues will be addressed through the supervision process alone?

-                     What is the proper balance between academic course work and supervised clinical experience?

-                     What core knowledge should be taught in counselor education programs?

-                     What is the appropriate balance between basic preparation and advanced specialization?

In training program for various mental-health professions,  general content areas are part of core curriculum. For example, in counseling programs the following areas are typically required for all students: professional orientation, human growth and development, social and cultural foundations, counseling theory and practice, group counseling, lifestyle  and career development,  appraisal of individuals, and research and evaluation.

            It is our opinion that training program need to be designed so that students can learn a good deal more deal about themselves as well as acquire theoretical knowledge.  Ideally, students will be introduced to various content areas, will acquire a range of they can utilize in working  with diverse clients,  will learn how to apply theory to practice through supervised fieldwork experience, and will learn a great deal about themselves personally. A good program does more than impart knowledge and skills essential to the helping process. In a supportive and challenging environment, the program encourages students to build on their life experiences and personal strengths and  provides opportunities for expanding their awareness of  self   and other.

            Ethics deserves prominent attention in any program geared to educating and training mental-health practitioners. We are aware of an APA accredited doctoral program in clinical psychology in which a separate ethics course is not required! Although the content of ethics is supposedly incorporated in a number of required course , seminars, and practicum and  internship experiences, we believe that the lack of systematic coverage of ethical issues  will hinder these students, both as trainees and  later as professionals. ACA’s (1995) standard on teaching ethics is. “Counselor make students and supervisees aware  of the ethical responsibilities and standards of  the profession and student’s  and supervisees’ ethical responsibilities to the profession.  We think the topics we address in this book deserve a  separate course as well as infusion throughout all courses and supervised fieldwork experiences.

How Can We Best Train?           

Program  geared to educating and training counselors should be built on the foundation of the natural talents and abilities of the students. Ideally as we have said, programs teach people the knowledge and skills they need to work effectively with diverse populations. In addition, students need a core set of  attitudes and values that are congruent with carrying out their  role  as helping  professionals. In his provocative article “Can  Psychotherapists Transcend the Shackles of Their  Training and Superstitions?” Lazarus (1990) contends that formal education  and training in psychological diagnosis and treatment often undermine the natural talents and skills  of trainees. In illustrating his point, he describes a friend who was “an absolute natural  when it came to understanding people and showing genuine warmth, wisdom, and empathy” when Lazarus brought his own problems to his friend, he found the experience to be “amazingly therapeutic .” After his friend obtained a Ph.D. in psychology however, Lazarus was able to receive only “a string of platitudes and labels.” He maintains that  as his  friend  took courses in assessment, diagnosis, and treatment, his natural talents were destroyed. Of course, Lazarus does not believe that training necessarily erodes natural talent, but he  does warn that “one of the main shackles under which many therapists labor comes from the almost endless list of proscriptions that they are handed”

            In our view, one of  the best ways to teach students how to effectively relate to a wide range of  clients, many of  whom will differ from themselves, is for faculty to model healthy interpersonal behavior.  Teachers and supervisors should display cohesive relationship among themselves and treat students in a collegial manner with respect. This is not always the case, however. In some program the faculty functions some what like a dysfunctional family with behavioral characteristics of  power plays, unaddressed interpersonal  conflict, and even hostile behavior. Conflict among faculty members may  be obvious, and students are sometimes drawn into these rivalries, being expected to side with a particular faculty member. In an effective program, differences are discussed openly  and there is an atmosphere of genuine respect and acceptance of diversity of perspectives. If faculty practice  the principle they teach, they are demonstrating powerful lessons about interpersonal relating that students can apply to their personal and professional lives.

-                     what problems would you encounter  if you found yourself in a program characterized by dysfunctional behavior? How would  you deal with the problems you might face?

-                     How would you react to a student who said, “ I  don’t care what they do; I just want to get my degree and get out of here”?

-                     If you were concerned about the ethics of this  program as a student, what actions would be open to you besides quitting?

Effective programs combine academic and personal learning, weave together didactic and experiential approaches, and integrate study and practice. A program structured exclusively  around teaching academics does not provide important feedback to students on how they function with clients. In experiential learning and  fieldwork, problem behaviors of trainees will eventually surface and can be ameliorated. Evaluation is an important component of this process. The policies and procedures pertaining to how students will be evaluated and how decisions will be made about their advancement or dismissal from a program  should be known by all students. Evaluation criteria is the topic we turn to next.

Evaluation Criteria

Every training institution has an ethical responsibility to screen candidates so that the public will be protected from incompetent practitioners. Programs clearly have a dual responsibility : to honor their commitment to the students they admit and also to protect future consumers who will be served by those who graduate. Just as the criteria for selecting applicants to a program should be clear, the  criteria for successful completion and the nature of  the evaluation process  need to be spelled out as objectively as possible.

            The ACA (1995) addresses the evaluation process in counselor education and training programs in this way:

“counselors clearly state to students and supervisees,  in advance of training, the levels of competency expected, appraisal methods, and timing of evaluations for both didactic and experiential components. Counselors provide students and supervisees with periodic performance appraisal and evaluation feedback throughout the training”  

            We strongly support the ACA’s  position.  In addition to evaluating candidates when they apply to a program, we favor periodic student reviews to determine whether trainees should be retained.

            Students need feedback on their progress so they can build on their strengths or remediate problem areas. Ideally, trainees will also engage in self-evaluation to determine whether they are “right” for the program and the program is suitable for them. We are uncomfortable with a judgment such as “You’ll never be a counselor.” If shortcomings are sensitively pointed out to trainees, they can often correct them.

            Sometimes students have personal characteristics or problem that interfere with their ability to function effectively, yet when this is pointed out to them, they may deny the feedback they receive. A program has an ethical responsibility to take action and not simply pass on a student with serious academic or personal problems. ACA’s Code of Ethics (1995) addresses this issues:

“counselors, through ongoing evaluation and appraisal, are aware of the academic and personal limitations of  students and supervisees that might impede performance. Counselors assist  students and supervisees in securing remedial assistance when needed, and dismiss from the training program supervisees who are unable to provide competent service due to academic or personal limitations. Counselors seek professional consultation and document their decisions to dismiss or refer students or supervisees for assistance. Counselor assure that students and supervisees have recourse to address decisions made, to require them to seek assistance, or to dismiss them”      

It has become clear to us that many counselor educators are hesitant to dismiss students. This is especially true if the concerns are about personal characteristics or problematic behavior, even in cases where the faculty are in  agreement regarding the lack of  suitability of a given student.  Some counselor educators have expressed fears of becoming embroiled in a law suit, either personally or as a program, if as a program, if a student is not allowed to continue. Faculty who are in the business of training counselors should be credited with the ability to have accurate perceptions and observations pertaining to personality characteristic that are counterproductive for becoming effective counselors. If  a  student has good grades but has serious unresolved personal conflicts or demonstrates dysfunctional interpersonal behavior, action needs to be taken. Dismissal from a program is a measure of last resort. We would hope this option would not be employed unless all other attempts at remediation had failed.

Counseling programs can be held legally liable for turning out incompetent counselors(Custer, 1994). If the counselors who graduate from a program are  proven to be incompetent, the program can be sued. If  it can be demonstrated that a program failed to adequately train an individual, the university is responsible for the harm the graduate inflicts on the clients. Custer describes a lawsuit involving a master’s  level counselor who graduated from Louisiana Tech College of Education. A female therapy client named Louisiana Tech in a suit, claiming that program allowed an incompetent practitioner to graduate from the program.  The client claimed that her life had been destroyed by incompetent therapy. The claim was that her life had been destroyed by incompetent therapy.  The claim was that the program itself was inadequate in that it simply did not adequately prepare her counselor. The counselor was named in malpractice action along with her supervisor and the university. The initial lawsuit was settled in 1994 for $1.7 million. A case such  as this makes it clear that specific competency standards for retaining  and graduating counseling students are not only useful but  necessary.       

Donigian (1991) takes the provocative position that the consumer’s trust in the profession is  violated if counselors are not psychologically prepared  for the challenges they will confront as they undertake their work. He suggests that preparation programs should take responsibility for evaluating students’ emotional and psychological readiness to become practitioners.

If faculty group assume the role of examining and both the academic  and personal fitness of students to graduate, the question ought to be raised: Who evaluates and examines the examiners? Assume that several advanced students approach the dean of their graduate school to express their concern about the seeming discrepancies between what they   are experiencing in their internships and  supervised sessions and what they are being taught in their counseling classes. They complain that their professor live in an ivory tower, and they point out that not one of their professors is a counseling practitioner. Then dean replies that all of the faculty members are properly credentialed. Although they are not seeing clients, they have had practical experience in the past.

-                     is it important for counselor educators to have current hands-on experience with clients?

-                     Every program evaluates students and their suitability for the counseling profession. Is it equally important to evaluate the evaluators and their suitability to make such assessments?