Competence & Licensure Flashcards
What ethical principles does “Competence in Practice” fulfill?
Rests on principles of Nonmaleficence and Beneficience—avoiding harm and doing good
What are the three components of competence?
Most agree Competence has three components
- Knowledge
- Skill
- Diligence
What is competence? How is it monitored for licensure?
Competence = a minimum threshold for adequate care
Practitioner monitors their competence, report to state
Updating their list of competences whenever they want/have time/have a new competence to add.
Knowledge
Familiar with history, theory, and research of field
Offers ability, judgment, capacity to make informed decisions
Maintain knowledge via continuing education, good, interesting CE
How is knowledge acquired?
- Completing graduate program/formal study
- Dubin (1972) and Jensen (1979) suggest ~50%++ of what is learned in graduate school is obsolete in a decade
- Licenses have continuing education requirements
Skill
Practicing therapeutic procedures, approaches, interventions
What are the two forms of skill?
Two forms of skill
- Clinical: learn in basic counseling skillls class; soft skills, building rapport, reflecting, empathy
- Technical: administer IQ test and interpret, e.g., systematic desensitization, DBT, EMDR, etc.
How is skill honed?
Practicum—lengthy and heavily supervised
Post-degree supervision toward licensure
Diligence
Deliberate care from intake to termination
Diligence is the consistent attentiveness to putting client needs above other concerns; taking care with all aspects of relationship (not really monitored by state or included in licensure).
How is diligence developed?
Diligence is grounded in self-knowledge
Must understand strengths and weaknesses to be diligent
Taught/practiced reflection and self-awareness in classes
Explain the concept, “Performance is Key to Competence”
Competence refers to professional performance not abilities or capacity
May have ability to perform competently but competence is judged by performance of task
Performance varies from client to client, hour to hour—uniform performance is impossible
What factors might interfere with performance?
Performance varies from client to client, hour to hour—uniform performance is impossible
Environmental—impossible work load
Unpredictable events—illness
Mental health of counselor—depression, burnout
Client variables—client behavior, personality
**Critical to recognize recurring factors that interfere with performance and address them
Name 3 Limits to Competence
New Techniques
- Try to master new intervention
- Must provide informed consent with new techniques
New Populations
Rural Environments/Small Communities
-Greater comfort practicing on the edge of your comfort zone: more need than available, fully appropriate practitioner
Name 3 codes that discuss that include issue of Competence. What are the commonalities among the 3?
ACA Code of Ethics § C: Professional Responsibility (Welfel, 2010, p. 86)
APA Ethical Principles § 2.01-2.04 (Welfel, 2010, p. 87)
AAMFT Code of Ethics, Principle III: Professional Competence & Integrity
Commonalities among all three:
- Work within bounds of training and experience; knowledge, skill
- Responsible for monitoring own competence and improving it; diligence
- Competence = formal education, supervised practice, and CE
What does licensure have to do with competency?
Licensure is a way to protect public; help ensure competence
Board of Psychology, Behavioral Health and Therapy, and BMFT only truly review knowledge component
Evaluate skills indirectly by requiring supervised practice prior to being fully licensed
Diligence is not measured at all—more or less assumed when other thresholds are met
Requires completion of accredited graduate school, supervision, EPPP ethics exam
Expensive licenses
What are the psychological & counseling licenses available in Minnesota (5)?
Licensed Psychologist (LP) required Ph.D. or Psy.D.
Licensed Psychological Practitioner (LPP)
Licensed Professional Counselor (LPC)
Licensed Professional Clinical Counselor (LPCC)
Licensed Marriage and Family Therapists (LMFT)
LP
Licensed Psychologist (LP) required Ph.D. or Psy.D.
- Managed by Board of Psychology (est. 1971)
- M.A., LP until 1991
- Practitioners were grandfathered into system
LPP
Licensed Psychological Practitioner (LPP)
- Weak license—no independent practice
- Not on par with other M.A. licenses nationwide
- LPP discontinued; practitioners grandfathered into as M.A., LP
LPC
Licensed Professional Counselor (LPC)
- MA level
- Introduced 2003 to provide M.A. license in line other states
- Allows independent practice; reimbursed by insurance providers
48 Credit M.A. & 700 hour practicum
National Counseling Exam Or NCMHCE**
2000 hours supervision & 12 credits within 4 years
40 hours CE every 2 years
LPCC
Licensed Professional Clinical Counselor (LPCC)
- MA level
- Created 2007 to meet “Mental Health Professional” definition
- Practice independently; credentialed by insurance companies
- Can work with Medical Assistance (MA) clients
48 Credit M.A./51 cred & 700 hour practicum
Nat’l Clinical Mental Health Counseling Exam–CBT
4000 hours supervision, 1800 CC; balance of adult & children clients
12 credits within 4 years & 40 hours CE every 2 years
LMFT
Licensed Marriage and Family Therapists (LMFT)
- MA level
- Managed by Board of Marriage and Family Therapy (1987)
- Practice independently; accept insurance and MA
M.A. with 18 credits of add’l Marriage and Family Courses
Practicum with 300 client contact hours (not more than 150 hours with individual clients)
Marriage and Family Therapy National Exam State oral exam
1000 hours client contact (half with couples or families) and 200 hours supervision over at least 24 months
30 hours CE every 2 years
Name 3 causes of stress & burnout.
Emotional exhaustion
Business management
Institutional barriers
- Government
- Managed care (case management & working with Social workers & care team)
What are symptoms of Burnout? Who may be predisposed?
Symptoms of Burnout
- Emotional exhaustion
- Loss of sense of accomplishment in work (imposter syndrome)
- Depersonalization of client
Characteristics of good counselors makes them susceptible to burnout
Counselors often develop blind spot to own problems
What is vicarious trauma? What are the symptoms?
- Working with certain populations may lead to vicarious trauma or secondary PTSD
- ?emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured. It is important not to confuse vicarious trauma with ‘burnout’ “
Symptoms
- Withdrawal from others
- Inappropriate emotionality
- Loss of pleasure
- Loss of boundaries with clients
- Feeling overwhelmed or pressured
