Knowing What You Don’t Know

Recently in one of my courses, I lectured on ethics in forensic psychological assessment. A case example was provided involving a psychologist who provided testimony citing non-existent risk and risk assessment literature in a death penalty case, which later resulted in the case being overturned. One of my students inquired about the repercussions of psychologists providing false expert testimony in forensic contexts—especially having read the American Psychological Association (APA) Ethical Principles of Psychologists and Code of Conduct (Code of Ethics; 2017) and articles on the implications of high-stakes testing at the beginning of the course (Sackett, Borneman, & Connelly, 2008; Sackett, Schmitt, Ellingson, & Kabin, 2001). Was there a state licensing board complaint? Follow-up intervention? Was the person’s license revoked? What happens to the prior cases in which this person provided testimony? Professional competence is a critical discussion topic in professional ethics in psychological practice.

Professional Competence

Competence has been defined as the knowledge and skills, and attitudes, values, and judgment needed to perform the work of a psychologist (Barnett, Doll, Younggren, & Rubin, 2007; Rodolfa et al., 2005). Epstein and Hundert (2002) further expand “[professional competence is] the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served” (p. 227).

Competence is considered both an aspirational and enforceable standard. The APA began requiring ethics in doctoral curricula in 1979 (Bashe, Anderson, Handelsman, & Klevansky, 2007). Education in psychology shifted to competency-based education and training (Kaslow et al., 2004). However, obtaining a graduate degree in psychology is presumed to be entry-level competence (Johnson, Barnett, Elman, Forrest, & Kaslow, 2012). Indeed, board certification exists for psychologists to demonstrate a higher level of competence in different specialties within psychology, although only 3% of psychologists have board certification (Johnson et al., 2012).

Boundaries of Competence

Psychologists are encouraged to practice within their areas of competence. Standard 2.01 (Boundaries of Competence) of the APA Code of Ethics (2017) states,

Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience. (p. 4)

For instance, if a psychologist in private practice has spent her early career working primarily with adults with severe and persistent mental illness, shifting to child custody cases could potentially be working outside her area of competence. Therefore, this person would need to receive training (i.e., further graduate courses, professional seminars) and supervision and consultation prior to engaging in such professional activities.

Practicing within boundaries of competence is particularly important in high stakes contexts where the implications and potential for harm is heightened (Sackett et al., 2001; 2008). High stake contexts could include educational assessments, civil and criminal forensic treatment and assessments (e.g., child custody, death penalty, sexual harassment litigation), and dangerous practice settings. Practicing outside areas of competence can lead to significant financial, personal, emotional, and physical consequences.

Problems in Professional Competence

Elman and Forrest (2004) coined the term problems of professional competence (PPC). Many factors can contribute to PPC, including deficits in current education, training, and experience, personal distress or illness, or cognitive decline (Johnson et al., 2012). Further, career-related stressors such as compassion fatigue and vicarious traumatization can further contribute to PPC (Johnson, Barnett, Elman, Forrest, & Kaslow, 2013). Practicing while impaired can result in harm to both psychologists and to their clients. Standard 3.04 (Avoiding Harm) of the APA Code of Ethics (2017) notes that psychologists should “take reasonable steps” to minimize foreseeable harm with their clients and others. Noticing PPC in oneself requires a great degree self-reflection. Bashe et al. (2007) note, “Students and practicing professionals need to reflect actively and decide how much of their own personal morality can be adapted to their growing knowledge and appreciation of the ethical culture of psychology” (p. 61).

Much of the literature regarding impaired professional practice focuses on students and trainees, and there is guidance on how to address PPC from graduate training to the post-doctoral level (Bamonti et al., 2014; Forrest, Shen-Miller, & Elman, 2008; Johnson et al., 2008; McCutcheon, 2008; Oliver, Bernstein, Anderson, Blashfield, & Roberts, 2004; Wester, Christianson, Fouad, & Santiago-Rivera, 2008). Interestingly, in a study assessing ethical violations, students endorsed PPC among their faculty (January et al., 2014). Students cited practice issues such as lack of skill-based competence and lack of cultural competency/multicultural sensitivity. Therefore, it is important for students, faculty, and supervisors to assess their professional competence across all areas of professional work—teaching, supervision, research, and clinical practice.

Psychology and the General Public

Problems in professional competence can have a broader impact. There are numerous myths about psychological science in the general public and media. It is the role of a psychologist to uphold a scientific and professional standard when interacting in public spaces. Here is a case example loosely based on recent testimony I witnessed:

A state is considering legislation that would prohibit LGBTQ parents from adopting children. A licensed psychologist testifies that allowing LGBTQ parents to adopt would be harmful to the child (stating “research says…”) and would limit adoption agencies in exercising their religious freedom.

Standard 2.04 (Bases for Scientific and Professional Judgements) of the APA Code of Ethics (2017) notes work should be based upon “established scientific and professional knowledge of the discipline” (p. 5). In this case example, this standard is not being met. In 2004, the APA adopted a policy resolution providing a summary of research supporting adoption for gay and lesbian parents and citing literature noting no adverse impact of their parenting on their children when compared to children with opposite-sex parents (Paige, 2005; Patterson, 2005). Therefore, personal biases may be impeding on scientific knowledge, which is detrimental when providing testimony regarding public policy. This example also elucidates the importance of remaining current on professional practice standards and literature.

Psychologists should be cautious about how they disseminate psychological knowledge and research to the general public. Accuracy and completeness of language and information, avoidance of being overly confident, highlighting limitations to research and outcomes, and avoidance of pseudoscience should all be noted (Cederberg, 2017). Again, Standard 3.04 (Avoiding Harm), as well as Principle B (Fidelity and Responsibility) of the APA Code of Ethics (2017) discusses avoiding harm and being aware of the “professional and scientific responsibilities to society and to the specific communities in which they work” (p. 3). Cederberg (2017) notes it is impossible for a psychologist to be an expert in all facets of the profession. Professional judgement, self-awareness, and humility are important in maintaining professional competence and ethical practice.

How do you address a colleague? According to Johnson et al. (2013), the APA Code of Ethics does not require psychologists to assist when another psychologist in the community suffers from PPC. Further, the authors indicated that many psychologists reported being reluctant to intervene when they notice an impaired colleague. Some jurisdictions have Colleague Assistance Programs; however, some have been discontinued due to mandatory reporting concerns and psychologists not seeking help in fear of being labeled impaired or incompetent (Barnett & Hillard, 2001). Some may want to be more direct but need more guidance on how to do so sensitively, respectfully, and professionally. Brodsky and McKinzey (2002) offer sample letters to address an unethical colleague when such a scenario arises. These samples facilitate a dialogue with the person that is polite, respectful, and devoid of shame. However, the authors ultimately note that complaints may often best be handled by the state licensing board in order to be effective.

Continuing Education and Competence

Self-assessment of competence should begin early in training and continue through the lifespan. Roberts, Borden, Christiansen, and Lopez (2005) outline a model for the assessment of competence which can be used at different stages throughout one’s trainee and career. Standard 2.03 (Maintaining Competence) notes psychologists “undertake ongoing efforts to develop and maintain their competence” (APA, 2017, p. 5). Both maintaining and enhancing one’s competence is essential (Barnett et al., 2007).

How do you know what you don’t know? Barnett et al. (2007) note that self-assessment requires a personal awareness that one has a deficit in education, training, and self-directed learning. This is particularly challenging, as it is often difficult for individuals to identify their blind spots. The reason why issues of professional competence are often discussed during graduate-level training is students are under the watchful eye of their supervisors, professors, and mentors. However, psychologists often do not have that luxury of oversight and support. Peer consultation may be an arena in which this work can continue. Continuing professional education is also essential. Continuing professional education has been defined as a “loosely federated assortment of professional activities, roles, and responsibilities that provide opportunities for psychologists to engage in new learning and to keep pace with the increasingly rapid changes in their fields” (Neimeyer, Taylor, & Cox, 2012, p. 476). At the time of their writing, Neimeyer and colleagues noted 44 jurisdictions in the United States have mandated some continuing education requirement for licensure renewal. In addition, some have proposed further education and credentialing as a potential solution to ensuring professional competence (Kaslow et al., 2004; Nelson, 2007), which could be in the form of certifications and board certification. However, as previously stated, only a small percentage of psychologists have board certification (Johnson et al., 2012).

Personal stressors can also impact professional competence. Trainees and psychologists are not immune to the stressors of life and illness. Bamonti and colleagues (2014) suggest self-care should be an aspect of professional competency, citing Standard 2.05 (Personal Problems and Conflicts) and Principle A (Beneficence and Nonmaleficience) of the APA Code of Ethics (2017) as rationale.

Conclusion

Psychologists are held to a high standard of professional competence given the sensitive nature of their work and the potential for high-stakes impact. Problems in professional competence not only impact direct service to clients but can impact the public’s perceptions of the field of psychology. Professional competence requires regular self-assessment and self-reflection on acquisition and maintenance of the skills, abilities, and training needed to perform effectively as a psychologist throughout one’s training and career.