Competence is one of psychology’s core values. It is included in the General Principles of the APA Ethics Code (APA, 1992). It is, therefore, an aspirational goal; something we strive to achieve continually throughout our careers. One is never done with competence; it is an ongoing process. But what is competence? How do we achieve it and maintain it? What might adversely impact on it? How can we prevent it from eroding over time?

Competence refers to much more than just our knowledge and skills. As Welfel (1998) points out, it also includes diligence; the ability to effectively apply our knowledge and skills in a manner consistent with our patients’ best interests. Haas and Malouf (1995) add to this definition describing competence as possessing adequate knowledge to understand a clinical issue, the skills to apply this knowledge effectively, and the judgement necessary to use both of them effectively.

Competence is not a unitary concept. One is not either competent or incompetent. Rather, competence falls along a continuum ranging from the highest professional standards down to gross incompetence. Also, competence is situation and time specific. A psychologist may be competent to treat a patient from a particular population with a specific set of presenting problems, but not others, or the psychologist may be competent at present with this population, but may not be at a later date. Thus, competence is quite a dynamic process. As Overholser and Fine (1990) point out, competence may actually vary between and within various areas of clinical practice.

The development of competence is thought to entail four distinct elements: formal education, clinical training, supervised experience, and ongoing professional development. While some standards exist for each of these, specific guidance has proven somewhat elusive. But, to develop competence with any particular population or area of practice, one must begin with formal education, which is followed with clinical training and supervised experience. In each of these phases there should be some evaluative process to ensure we are learning and developing skills as needed. The supervision should be provided by one considered an expert in that area of practice. It is recommended that we not begin practicing a new service independently until the supervising expert recommends we do so. It is believed that this expert will likely be better able to judge when we are ready for independent practice than we are ourselves.

After competence is developed it must be maintained. This may include professional reading, continuing education workshops, and other types of advanced training. As was stated earlier, competence at one point in time does not ensure competence at a later date. The body of knowledge of our profession is constantly changing. New information, skills, and standards must be integrated into our repertoire over time. Interestingly, several authors (eg. Dubin, 1972; McNamara and Flanders, 1985) have applied the concept of "half-life" to professional competence. They estimate that 50% of a professional’s knowledge and skills will deteriorate or become obsolete within ten to twelve years of receiving the training. The body of knowledge of our profession changes, new diagnostic techniques are developed, and new skills are needed. Also, without ongoing practice and use, skills may deteriorate over time.

For example, consider the case of the clinician that had extensive and expert didactic and clinical training in hypnosis and biofeedback throughout graduate school, internship, and a post-doctoral fellowship. She used her knowledge and skills expertly for several years while simultaneously reading journal articles and attending relevant continuing education workshops. Then, due to a change in employment setting the demand for the use of these skills slowly decreased. Finally, she stopped using these skills and began shifting her professional development activities to new areas of practice. Presently, she has not used these skills in over seven years. Is she still competent?

The real question is competent to do what? While this dedicated and skilled clinician may be highly competent in many areas of practice, the scenario above indicates that she is no longer competent to utilize hypnosis or biofeedback. Should she want to utilize these skills again additional education, training, and supervised experience would be needed.

A wide range of possibilities exist for developing and maintaining competence and not all educational experiences are created equal. There is a great difference between reading an article or book, attending a weekend workshop, completing a one-week certification program, and graduating from a post-doctoral fellowship. The didactic training required will vary depending on the new skills to be mastered and on the psychologist’s experience and level of past training. A clinician skilled in the use of the WAIS-R will only need minimal training to become competent in the use of the WAIS-III. But the same clinician will likely need extensive training to learn to conduct neuropsychological evaluations. Similarly, a skilled diagnostician may be competent to conduct evaluations of adolescents and adults, but may need additional training before being considered competent to conduct similar evaluations of young children. For guidance on how to decide what training is needed, it will be helpful to consult with published standards. For example one might seek guidance from APA’s guidelines for child custody evaluations in divorce proceedings (1994) and the guidelines for doctoral training programs in clinical neuropsychology (1987). Consulting with recognized experts in the field is recommended as well before entering a new area of practice. The same is true for deciding on continuing education and professional development needs and requirements.

Once competence is developed it is always susceptible to decay and interference. Competence may become impaired if one is not cautious. This may occur if a patient’s treatment needs change and the new needs are beyond one’s scope of practice. To continue treatment then could possibly result in harm occurring. While one may be competent to treat a patient with one set of presenting problems, as new issues arise they may require expertise that one does not possess. Consultation with an experienced colleague and making appropriate referrals are then typically appropriate.

Competence may also become impaired as a result of forces directly impacting on the psychologist. Stress, distress, and burnout may all impact on our ability to effectively apply our knowledge and skills. As is stated in Standard 1.13 Personal Problems and Conflicts, of the APA Ethics Code (APA,1992), "Psychologists recognize that their personal problems and conflicts may interfere with their effectiveness" (p. 1601). We are all vulnerable to the stresses, pressures, and demands of our profession and of our own personal lives. Adequate attention to self-care will help ensure that our competence does not become impaired and that our patients receive the best care possible. The need for adequate self-care is addressed more fully in "No Time for Self-Care?" (Barnett & Sarnel, 2000) on this website.

Developing and maintaining competence are of vital importance to all psychologists. While professional competence may become impaired in a variety of ways, attention to the suggestions provided and issues raised in this brief article will help practitioners to remain competent with a broad variety of clinical skills throughout the span of our careers.

References

American Psychological Association. (1992). Ethical principles of psychologists and code of conduct. American Psychologist, 47, 1597-1611.

American Psychological Association. (1994). Guidelines for child custody evaluations in divorce proceedings. American Psychologist, 49, 677-680.

Barnett, J.E. & Sarnel, D. (2000). No time for self-care? 42 Online The online journal of Psychologists in Independent Practice, a division of the American Psychological Association.

Dubin, S.S. (1972). Obsolescence or lifelong education: A choice for the professional. American Psychologist, 27, 486-497.

Haas, L.J. & Malouf, J.L. (1995). Keeping Up The Good Work. 2nd ed. Sarasota, FL: Professional Resource Press.

McNamara, R. & Flanders, P. (1985). Continuing education for psychologists: A reexamination. The Clinical Psychologist, 24, 31-35.

Reports of the INS-Division 40 Task Force on Education, Accreditation, and Credentialing. (1987). The Clinical Neuropsychologist, 1, 29-34.

Overholser, J.C. & Fine, M.A. (1990). Defining boundaries of professional competence: Managing subtle cases of clinical incompetence. Professional Psychology: Research and Practice, 21, 462-469.

Welfel, E. (1998). Ethics in counseling and psychotherapy. Belmont, California: Brooks/Cole.