importance of that social contract was emphasized by The European Association of Clinical Psychology and Psychological Treatment (EACLIPT) Task Force on Competences of Clinical Psychologists (2019): “Politicians, societies, stakeholders, health care systems, patients, their relatives, their employers, and the general population need to know what they can expect from clinical psychologists” (p. 1).
Some patients may expect magic. For them, competence means that we can guarantee results, act flawlessly, and meet all needs. While this superhero, shero, or theyro role can be tempting, and some of us find it difficult to turn down potential worshippers, it is not realistic. We don’t have a magic wand that can disappear our clients’ distress, pain, and difficulties. Unfortunately some therapists indulge their ego and take up residence in this delusional state.
This chapter is a reminder that as therapists, we are all human and imperfect. We all have weaknesses, blind spots, and biases, as well as strengths, abilities, and insights. Hence, it is important for us to keep a healthy dose of humility.
Failures of competence often spring from our human vulnerabilities. We face temptations, pressures, distractions, demands, and countless other forces. These forces can weaken our ability to know the limits of our competence and can sometimes block our ability to act effectively altogether. Consider, for example, the ways in which we have been socialized to respond to members of various groups. Unless challenged, this socialization affects our attitudes, beliefs, biases, and prejudices which may impact our competence to provide therapy or counseling to members of diverse groups. In addition, each of us has our own personal history, individual experiences, and an array of group-based reactions which can also impact our competence. See if the following self-assessment turns up any challenges to competence for you. Imagine you are in your office and a new patient walks in. Set aside for the moment whether you have training to work with a member of the group. Focus only on whether the patient’s membership in a specific group evokes any reactions in you that might weaken your competence to welcome, become interested in, listen openly to, empathize with, and create a positive working relationship with them. Also, consider how you may respond if you are a member of a social group that has a history of being harmed by the new client’s social group (Chapters 7 and 23 provide more discussion). The array of patients you meet may include:
A rich, young White man dressed in designer clothing and speaking in a condescending tone of voice.
An extremely aggressive malpractice attorney who rarely loses a case, specializes in suing clinicians, and wins large judgments.
A heavily tattooed teenager gang member with an accent, dressed in baggy pants that fall underneath his buttocks.
A Black woman who is richer, more professionally successful, and personally happier that you ever hoped you could be and whose minor problem, which brought her to seek therapy, is one you’ve had for a long time and have been unable to overcome no matter what you tried.
A member of US Immigration and Customs Enforcement (ICE) who comes dressed in uniform.
A leader of the anti-choice movement who is deeply religious.
A man who owns a string of “massage” parlors, which are occasionally raided by the police, resulting in the arrest of the young women who work there (but not their customers).
A very successful political operative who opposes your most cherished values in the areas of social justice, human rights, and human well-being.
Someone who uses racial slurs in therapy and sees that as freedom of speech and authenticity of self-expression.
A gay-rights activist.
A migrant worker who speaks English with an accent that is difficult for you to understand.
A famous movie star.
A man who has not bathed in a while because he lost his job and his water was cut off for nonpayment. He has an extremely strong body odor.
A man under court order to seek therapy because he beats his wife.
An animal-rights activist who breaks into research labs to free the animals.
A physician whose specialty is performing abortions.
A gun rights activist who carries a gun where open-carry laws allow but who also has a permit to carry a concealed weapon—He’s coming to you because others keep telling him he has an anger problem and poor impulse control.
A therapist who specializes in conversion or reparative therapy,
An orthodox Jew
A wealthy White woman who has had several plastic surgery procedures on her face who wants you to change all of your other appointments to accommodate her busy schedule.
A Catholic priest.
A devout Muslim woman who wears a full burka.
A medical researcher whose experiments on dogs involve inducing disabling pathologies, painful surgeries, and death within a matter of months.
Someone who believes in the intellectual, cultural, and moral superiority of their race.
A Black academician who is seeking mental health services to address the racism he experiences at work.
A gender expansive Filipino who uses they pronouns.
How did you do? Turn up any potential challenges to competence? Achieving awareness of these challenges puts us in a better position to handle them carefully, knowledgeably, and ethically, and to approach each situation with humility.
Our own values and experiences as members of different groups contribute to our biases, blind spots, and other limitations. Our ethical awareness depends on us becoming aware of these limitations. Despite our best efforts to spot problem areas, some of these challenges may stay hidden from our awareness for quite a while yet manifenst themselves in our moment to moment interactions with our patients, supervisees, mentees, and colleagues. We may pride ourselves on our lack of biases toward certain groups and yet our behaviors may seem somehow “off.” Others may view what we say or do in regard to members of that group as avoidant, passive-aggressive, subtly hostile (words and behaviors sometimes termed “microaggressions”), or more openly biased—all of which may escape our attention. In addition, we may be well aware of the biases and prejudices that we have toward particular groups, but we may excuse them or view them as valid.
One tipoff that we may need to examine our competence to work with a particular group is if we talk about members of that group differently when they are present than when they are not within earshot. This difference in behavior, depending on whether members of a group are present, can be much more subtle than simply telling certain jokes, imitating accents, making generalizations about the group, and the like.
The theme of blind spots and biases affecting our competence on the individual level runs throughout this book and is a focus of Chapters 7 and 23—but a parallel theme is the way they affect the competence of organizations. For example, think of the different clinics,
