6.C.3
Keeping competence current
Énoncé de compétence 6.C.3 d’ASPPB : Engage in ongoing appraisal of areas of professional growth and update knowledge and skills to maintain one’s competence
Competence is not earned once. Knowledge, tests, laws and recommended treatments change, and skills fade without use. APA Standard 2.03 calls for ongoing efforts to develop and maintain competence, and the CPA Code places competence and self-knowledge under Responsible Caring. Because experience alone does not guarantee improvement and clinicians' impressions miss many clients who are getting worse, appraisal works best when it draws on outcome data, feedback and current evidence.
Notions clés
- Maintaining competence
- APA Standard 2.03 requires ongoing efforts to develop and maintain competence, and Standard 2.04 requires that professional work rest on the established scientific and professional knowledge of the discipline.
- Outdated tools
- Standard 9.08 bars basing assessment decisions or recommendations on tests and measures that are obsolete and not useful for the current purpose, or on test results that are outdated for that purpose.
- Experience is not improvement
- Following 170 therapists for an average of almost five years, one study found that client outcomes on average declined very slightly as experience grew, though some therapists improved and early dropout fell (Goldberg and colleagues, 2016).
- Judgment misses deterioration
- Clinicians rarely predicted which clients would not benefit from therapy, while a questionnaire with decision rules identified every client whose condition had deteriorated by the end of treatment (Hannan and colleagues, 2005).
- Feedback helps
- A meta-analysis of 24 studies found routine outcome monitoring with feedback superior to usual care in two thirds of studies; it reduced deterioration and nearly doubled reliable or clinically significant change for clients predicted to do poorly (Lambert and colleagues, 2018).
Exemple commenté
A psychologist's clinic adds a brief outcome questionnaire that flags clients who are off track. In the first month, four of her clients are flagged, although she had felt that all four were progressing.
- Treat the flags as information, not an insult: clinicians' own impressions often miss clients who are not improving (Hannan and colleagues, 2005).
- Discuss the results with each client and revisit goals, the working relationship and the treatment plan, the use of feedback that helped clients at risk of poor outcomes (Lambert and colleagues, 2018).
- Look across the flagged cases for a pattern, such as a shared problem or population, that points to a skill to update.
- Turn the pattern into a plan under Standard 2.03: targeted reading of current evidence, training, and consultation on those cases.
Let outcome data, not confidence, show where you need to grow.
Vérifiez vos acquis
What did Goldberg and colleagues (2016) find when they followed therapists' outcomes over several years?
Sources
- American Psychological Association (2017), Ethical Principles of Psychologists and Code of Conduct, Standards 2.03, 2.04 and 9.08
- Canadian Psychological Association (2017), Canadian Code of Ethics for Psychologists, Fourth Edition, Principle II, Responsible Caring, value Competence and Self-Knowledge
- Goldberg, Rousmaniere, Miller, Whipple, Nielsen, Hoyt and Wampold (2016), Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting, Journal of Counseling Psychology 63(1), 1-11 (PMID 26751152), Abstract: methods (6,591 patients, 170 therapists, mean 4.73 years) and results
- Hannan, Lambert, Harmon, Nielsen, Smart, Shimokawa and Sutton (2005), A lab test and algorithms for identifying clients at risk for treatment failure, Journal of Clinical Psychology 61(2), 155-163 (PMID 15609357), Abstract: clinicians rarely predicted treatment failure; formal monitoring identified 100% of deteriorated clients at termination
- Lambert, Whipple and Kleinstäuber (2018), Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring, Psychotherapy 55(4), 520-537 (PMID 30335463), Abstract: 24 studies; superior in two thirds; reduced deterioration; nearly doubled change in clients predicted to do poorly