_______________________________________________________________________ Ethics for Psychologists
examining outcomes and “best practices” were developed. In addition, organizations started asking clients about their needs, expectations, and ideas. This led to the concept of partnerships or collaboration between psychologists and patients in creat- ing a treatment plan. It also led to surveys from patients and appraisals for teachers, employers, supervisors, and healthcare providers regarding whether or not expectations were being met. The concept of competency started to have, as a basis for evaluation, objective data on outcome and self-assessment, expected developmental progressions, and benchmarks for achievement of foundational skills and abilities at various points in time along a continuum of professional develop- ment. In addition to foundational skills (the knowledge basis one needs to be competent), functional skills (the abilities one must demonstrate to be considered competent) were proposed. Finally, the idea of outcome assessment (how does one know if what they are doing is working) was built into the model as a feedback loop for refinement of competency assessment. In an educational setting, these concepts were superimposed on a developmental perspective applicable to teachers, mentors, and supervisors. Eventually, the concepts were incorporated into psychology professional schools and APA accreditation processes for education in psychology. In 2007, the Assessment of Competency Benchmarks Work- group published their document for the APA entitled The Assessment of Competency Benchmarks Workgroup: A Develop- mental Model for the Defining and Measuring of Competence in Professional Psychology [12]. They created a three-dimensional “Cube Model,” with foundational competencies and functional competencies forming the 12 core competencies for clinical practice. These were placed in a developmental model to guide supervisors from practicum training through advanced practice to lifelong learning. Within the Cube Model, the foundational competencies consist of reflective practice self-assessment, scientific knowl- edge and methods, relationships, ethical and legal standards policy, individual and cultural diversity, and interdisciplinary systems. The functional competencies consist of assessment/ diagnosis/case conceptualization, intervention, consultation, research/evaluation, supervision/teaching, and management/ administration [12; 34]. The healthcare field in general began to look at models to assess value, the idea of the consumer of services being important to evaluate the services and outcomes of the services, and benchmarking quality for provision of health care. In the United States and Canada, psychology moved from a practice of completing hours and coursework and moved toward a focus on competency for accreditation standards as a benchmark
for quality education. Competency-based education, training, and credentialing efforts in professional psychology included graduate, practicum, internship, and postdoctoral levels; licensure; post-licensure certifications; and board certification. General and specialty credentialing efforts in North America and internationally followed suit. Cultural Competency In addition, psychology became increasingly aware of cultural and community reactions to diverse groups feeling excluded, stigmatized, and alienated. Over a period of about 40 years, psychology evolved from a profession in which “even the rats were white” and a focus on pathology of differences, to a field in which diversity in all forms (cultural and ethnic differ- ences; gender, racial, and sexual orientation; knowledge about different communities; sensitivity to disabilities, heritage, and individual strengths and weaknesses; and the value of diversity itself) became expectations of competence. Explore how cultural competence affects psychologists’ practice in the following examples: • A White psychologist is working with a group of predominantly African American and Hispanic clients on “anger issues” in a group practice. In talking with colleagues in the group practice, he discovers that his group on “anger management” consists of 75% African American men while the population of clients of the group practice is 85% White. In questioning the col- leagues about their criteria for referring clients to the group, they feel that the expression of anger by their African American patients was “more of a problem” than the expression of anger by their White patients. A retrospective review of charts showed that the group on “anger” is capturing only about 15% of eligible clients. White clients are not being referred regardless of whether anger was a presenting problem. • A psychologist seeks consultation regarding treatment of a gay male couple in family therapy. He indicates to the consultant that he is uncomfortable treating the couple now that they are legally married and are plan- ning to adopt a child. • A psychologist uses an interpreter to assist with the evaluation of a Spanish-speaking client. The psycholo- gist asks the client, “Are you suicidal?” The interpreter translates, “You aren’t suicidal, are you?” • A psychologist is asked to provide interven-tion strate- gies to help a group home for developmentally disabled adults keep a male client and a female client from having a sexual relationship because it makes the staff uncomfortable.
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