A Question of Competence

Psychologists and psychiatrists must maintain a sense of professionalism within their scope of practice. The definition of scope of practice refers to the range of responsibilities that the specific individual has within their respective profession. In most contexts, the scope of practice is based on certain terminology that has been expressed by either a national and/or state licensing boards that explicitly define the extent of actions or processes that the licensed individual can carry out. Essentially, the crux of the definition is that individuals are bound legally by what they can do in their particular practice. 

Moreover, when discourse is conveyed on the matter the subject of competency also arises. As psychologists and psychiatrists perform a myriad of different functions, competency refers to their ability to appropriately execute these tasks. Competency is quite often debated within the area of ethics as it is an ethical issue (Roe, 2002). The rationale here is that psychologists and psychiatrists should not be taking on certain clientele without justification for doing so. For example, a psychiatrist who has no depth in the area of child psychology should not take on children with ADHD as clients. 

Roe (2002) stated that there are problems in the field of psychology in determining the specializations as "there is no single systematic basis for differenti[ation]. The major areas of specialization differ with respect to the role of the clients or subjects, the institutional setting in which they are placed, the type of problems addressed, client behavior, etc. The need to define the profession is amplified when considering individuals who [have been] educated and employed in different countries" (pg.193). Yet, even though the field of psychology is a vast and voluminous one, it would seem that a defining context of the word competency would not cause so many problems as far as specification. 

One aspect of competency has been the issue of informed consent that psychologists and psychiatrists have toward their clients. In defining the context of competency, discussion on informed consent is often had. Rosenfeld (2002) posited that informed consent has three specific elements that must be present in order for the psychologist area of expertise in recommending treatment to be validated. These three criteria are the knowledgeable element, which refers to competency. Specifically, the psychologist must have a reasonable quantity of information of the benefits and/or risks associated with said treatment. The volume of information pertaining to most disorders and diseases is immense, so the informed consent dynamic will depend solely on the nature of the individual that the psychologist is treating. Second, is the idea of voluntariness. Under this criterion, the patient must be free to make the decision regarding the suggestion of the psychologist. Thirdly, competence is identified as an element that must be present and is noted as being the most important to the role of informed consent. While the topic of competence has always been an interesting one in scholarly debates, the subject of competency has been an attractive ideal among psychological fields. This element states that adults are competence to make decisions and are able to handle the consequences associated with those decisions unless proven otherwise (pg.174-175).

The Standards in the American Psychological Association (APA) defines the process of informed consent within their physicians' ethics code. The Ethics Code "is intended to provide guidance for psychologists and standards of professional conduct that can be applied by the APA and by other bodies that choose to adopt them. In the process of making decisions regarding behavior, psychologists must consider this Ethics Code in addition to applicable laws and psychology board regulations" ("Ethical Principles of Psychologists and Code of Conduct," 2013). The Standards define competency more or less as something that psychologists are taught to do based on their "education, training, supervised experience, consultation, study or professional experience" ("Ethical Principles of Psychologists and Code of Conduct," 2013). The definition of informed consent then within the context of competency deals with psychologists understanding their role and in relaying what they are capable of handling to their patients.

Escobedo et al. (2007) approached the subject of informed consent from a more ethical construct by assessing the barriers that the field of psychology is often faced with. These barriers pertained to language differences as well as religion. When a psychologist or psychiatrist recommends a certain type of treatment for a particular issue or problem, expressed consent is required from the patient for that treatment. The authors stated that "it is assumed that an individual who [expresses] such consent does so with the understanding of the information given" (pg. 3). The problem lies when there are language barriers and/or religious protrusions that elicit misunderstandings. "According to the United States Department of Health and Human Services, federal regulation 45CFR46.116 states that informed consent has to be given in a language that is understood by the participant or their representative, but misunderstanding can still occur because of inadequate language translations. The quality [then of] the interpretation is almost as important as the informed consent itself' (pg.3). Therefore, informed consent can be concluded to be vital to not only the competency of the psychologist/psychiatrist, but gives weight and credibility to the field of psychology itself. 

In reference to religion, the informed consent process is designed to provide every individual the particular option of accepting or refusing treatment that is recommended (Escobedo et al., 2007). This refers back what Rosenfeld (2002) established in the three element discussion, specifically with the idea of voluntariness. Patients have the ability to judge appropriately whether or not the recommended treatment by a psychologist/psychiatrist is worthy of their time or not irrespective of whether that treatment will assist and/help them or not. It is simply then a matter of quid pro quo in that the psychologist informs the patient of the recommended treatment with the hopes of the individual being able to execute that treatment sufficiently and effectively.

Escobedo et al. (2007) stated that even though there are established guidelines under the concept of informed consent, there can be what is known as false expectations between the patient and the psychologist (pg. 5). In other words, clear cut communication of what is the noted outcome should be informed to the patient prior to any type of treatment execution. If this is not done prior, then the patient can state that the psychologist/psychiatrist violated the ethical standards that the APA has set up. While misunderstandings are probable in any discussion especially within the medical arena, the likelihood is less that any issue will come up regarding the relationship between the patient and medical professional as long as the established rules of informed consent are expressly followed. Essentially, the patient should not have any kind of false expectations of treatment if the psychologist is honest and upfront with them in reference to the treatment. The understanding that the psychology professional has then, must be exceptional in terms of competency. The individual stating that a certain treatment is needed has to know about the treatment, the potential side effects of the treatment and the likely outcome of the treatment with the particular individual that the treatment is being recommended to. 

It is odd that discussion on competency and informed consent have not been mentioned as significantly as they probably should be given the importance. The statement can be made that the field of psychology hinges on both concepts in terms of viability and specification. The respective field has an honor to uphold the scope of practice and ethical standards that they claim to have. Any potential issues or problems that come up within the concepts and overall understanding have the potential to undermine the field entirely if not properly addressed.

References

Escobedo, C., Guerrero, J., Lujan, G., Ramirez, A., & Serrano, D. (2007, Fall). Ethical issues with informed consent. Bio-Ethics, (1), 1-8.

Ethical principles of psychologists and code of conduct. (2013). Retrieved from http://www.apa.org/ethics/code/index.aspx

Roe, R. A. (2002, September). What makes a competent psychologist? European Psychologist, 7(3), 192-202.

Rosenfeld, B. (2002). The psychology of competence and informed consent: Understanding decision-making with regard to clinical research. Fordham Urban Law Journal, 30(1), 173-185.