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W. Brad Johnson, PhD

U.S. Naval Academy & Johns Hopkins University

“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 the community served" (Epstein & Hundert, 2002, p. 226).

For our Trainees = Overwhelming

� Establish & Preserve Professional Competence.

� Develop Knowledge, Skills & Values-Attitudes.

� Multicultural Competence

� Micro Competencies vs. Macro Competence

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� Competence IS:◦ Fluid

◦ Contextual

◦ Vulnerable

� Half-Life of Education

� Compassion Fatigue

� Vicarious Trauma

� Burnout

� Life’s Tribulations

� Illness

� Cognitive Decline

Frieda Fromm-Reichmann (1949)

� “We have to bear in mind that no amount of inner security and self-respect protects the [practitioner] from being as much a subject of and vulnerable to the inevitable vicissitudes of life as everyone else” (p. 378).

� Spending hour after hour in clinical work can leave our sense of self weak and apathetic, lacking in confidence and energy, thereby hindering our ability to be attentive and effective in helping our clients. (Jim Guy, 2000, p. 351)

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� Common therapist beliefs (Albert Ellis):◦ I have to be an

indubitably great and deeply loved therapist!

◦ Clients must follow my advice and they mustget better!

◦ Therapy must be easy and I should enjoy every minute of it!

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Self-Assessment and Credentialing

-Licensure is a single eventLicensure is a single eventLicensure is a single eventLicensure is a single event

-Entry-level Competence

-No requirement for No requirement for No requirement for No requirement for further demonstration of further demonstration of further demonstration of further demonstration of

competence or peer reviewcompetence or peer reviewcompetence or peer reviewcompetence or peer review

-Annual CE hours…

-Health Care professions Health Care professions Health Care professions Health Care professions rely on selfrely on selfrely on selfrely on self----directed directed directed directed

lifelong learninglifelong learninglifelong learninglifelong learning

-self-assessment only

Heidi Kraft: Rule Number Two

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� Vicarious traumatization (secondary traumatic stress, compassion fatigue, co-victimization) described by Figley(1995) and others.

� Burnout: What Baker (2003) describes as “the terminal phase of therapist of distress” (p. 21). Emotional exhaustion, depersonalization, and a decreased sense of accomplishment

� APA (2010) Standard 2.01◦ Psychologists provide services, teach, and conduct research…only

within the boundaries of their competence.

� APA (2010) Standard 2.06◦ Psychologists refrain from initiating an activity when they know or

should know that there is a substantial likelihood that their personal problems will prevent them from performing…in a competent manner.

� Grounded in Western assumptionsGrounded in Western assumptionsGrounded in Western assumptionsGrounded in Western assumptions◦ View of self as autonomous, self-contained

◦ Presumption of self-control and rationality

◦ Belief in accuracy of self-assessment

� Ignores communitarian valuesIgnores communitarian valuesIgnores communitarian valuesIgnores communitarian values◦ Acceptance of dependency on others

◦ Care for colleagues as collective moral duty

◦ Powerful sense of accountability to neighbor

� Ignores Ignores Ignores Ignores Evidence Regarding the Inefficiency and Inaccuracy of Evidence Regarding the Inefficiency and Inaccuracy of Evidence Regarding the Inefficiency and Inaccuracy of Evidence Regarding the Inefficiency and Inaccuracy of Human SelfHuman SelfHuman SelfHuman Self----AssessmentAssessmentAssessmentAssessment

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Why Self

Assessments of

Competence

are often Incompetent

� Human self-assessments of skill and character traits are flawed substantially and systematically. ◦ Dunning et al. (2004).

� Ethics

� Professional Competence

� Virtues

� Intelligence

� Tolerance

� Health

� Insight

� Attractiveness

� Driving…

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� “People tend to be blissfully unaware of their own incompetence”◦ Dunning et al. 2003

� Those who are least competent are least capable of self-assessing and correcting problems.

� Correlations between physician self-ratings of skill are unrelated (or weakly related) to external ratings

� Providers in lowest quartile of competence are least able to use exemplars to improve performance.

� SelfSelfSelfSelf----Serving BiasServing BiasServing BiasServing Bias: We

are prone to attribute poor performance to uncontrollable circumstances or bad luck.

� Illusory OptimismIllusory OptimismIllusory OptimismIllusory Optimism:

belief that we are immune to misfortune

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� Why don’t we easily intervene with colleagues?◦ We Overestimate

contribution of traits or attitudes

◦ We Underestimate the contribution of the situation

� A person is a person through other persons◦ Zulu Idiom

� We are bound up in a delicate network of Interdependence◦ Desmond Tutu

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� Emphasizes interdependence and communal relationships with emotional engagement

� Requires responsiveness to ‘neighbors in need’

� Assumes that individual ethical reasoning is insufficient and that relational virtues must be incorporated as well

“I’ll do this for you without expecting anything specific back from you, in the confident expectation that someone else will do something for me down the road.”

- Robert Putnam, Bowling Alone (2000)

“We are citizenscitizenscitizenscitizens. It’s a word that doesn’t just describe our nationality or legal status. It describes the way we’re made. It describes what we believe . . . This country only works when we accept certain obligations to one another and to future generations; that our rights are wrapped up in the rights of others.”

- Barack Obama, State of the Union address February 12, 2013

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“We are citizenscitizenscitizenscitizens. It’s a word that doesn’t just describe our nationality or legal status. It describes the way we’re trained. It describes what we believe . . . This profession only works when we accept certain obligations to one another and to future generations; that our competence is wrapped up in the competence of others.”

� Benificence/Nonmaleficence

� Fidelity

� Autonomy

� Justice

� Respect/Dignity

� What about Care?What about Care?What about Care?What about Care?◦ “Displaying kindness and concern for others”

Standard 2: Competence

Create an obligation of care for colleagues’ competence as well as for own competence.

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� Proposed Standard 2.03, Maintaining Competence: Psychologists undertake ongoing efforts to develop and maintain their competence. Psychologists maintain regular engagement with colleagues, consultation groups, and professional organizations and routinely solicit feedback from these sources regarding their competence in specific roles and with specific populations.

� Proposed Standard 2.06, Personal Problems and Conflicts: (c) When psychologists become aware of a psychologist colleague experiencing problems that may lead to interference with professional competence, they offer care and support, and collaborate with that colleague in assessing competence and determining the need to limit, suspend, or terminate their work-related duties.

What are competence constellations?

� Network or consortium of colleagues, consultation groups, supervisors, and professional associates who are instrumental to ongoing development, adaptive functioning, and professional competence

� Deliberately formed to encourage ongoing assessment of competence

� Cultural considerations may

Dictate ideal constellation size

(5-8)?

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Structure of a competence constellation

� Colleagues in regular contact with the practitioner, including (but not limited to):� Other psychologists

� Allied mental health professionals

� Personal psychotherapists

� Supervisors

� Consultation group members

� Close family members

� Clergy

� Other people with a commitment to the person

� Ask 1 colleague about his/her Constellation Inner Core

� Then share about your own

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�“We Teach Who We Are”

� Open & Transparent? (within boundaries)

� Discuss Competence Constellations?

� Have a visible network of colleagues?

� Visibly caring and concerned?

� Share personal examples of diminished competence and steps taken to address?

� Seek consultation from trainees?

� ADMIT imperfection (confess the contours of one’s own competence)

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