of effectiveness and for whom do such techiques work. If clinical methods are to avoid charlatanism, hucksterism, and well-meaning ineffectiveness, they must work (at least some of the time). The practitioner’s supposed competence means little if their methods lack competence. In his provocative article The Scientific Basis of Psychotherapeutic Practice: A Question of Values and Ethics, Jerry Singer (1980) emphasized the ethical responsibilities of clinicians keeping up with the emerging research basis of the methods they use.
Intellectual competence also means learning what approaches have been shown to be invalid or perhaps even harmful. George Stricker (1992) wrote:
Although it may not be unethical to practice in the absence of knowledge, it is unethical to practice in the face of knowledge. We all must labor with the absence of affirmative data, but there is no excuse for ignoring contradictory data (p. 544).
Intellectual competence is not frozen in time. David Barlow showed how quickly well-designed research can change our views of which interventions are effective, worthless, or even detrimental. “Stunning developments in health care have occurred during the last several years. Widely accepted health-care strategies have been brought into question by research evidence as not only lacking benefit but also, perhaps, as inducing harm” (Barlow, 2004, p. 869; see also Sue, 2015).
Intellectual competence also means admitting what we do not know. We may know about depression in adults but not depression in kids. We may be familiar with the culture of one Asian population but not others. We may understand the degree to which the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) can assess malingering among criminal defendants but not whether it can identify leadership strengths among job candidates in the tech industry.
Intellectual competence also involves knowing how to do certain clinical tasks. We gain this kind of competence, the development of skills, through carefully supervised experience. We can’t learn how to do therapy just by reading a book or sitting in a classroom; therapy is a set of skills that is learned through practice. The APA Ethics Code Standard 2.01c (APA, 2017a) encourages properly trained psychologists planning to provide services new to them to achieve competence in those new services through relevant education, training, supervised experience, consultation, or study. Both the APA Ethics Code (Standard 2.03) and the CPA’s Ethics Code (Standards IV.3 and IV.4) recognize that knowledge becomes obsolete and that psychologists don’t stop developing and maintaining competence when they become licensed.
EMOTIONAL COMPETENCE FOR THERAPY: KNOWING YOURSELF
Emotional competence for therapy, as described by Pope and Brown (1996), reflects our awareness and respect for ourselves as unique, fallible human beings. It includes self-knowledge, self-acceptance, and self-monitoring. We must know our own emotional strengths and weaknesses, our needs and resources, our abilities and our limits for doing clinical work.
Therapy can stir strong emotions in both therapist and client. Some clinical work places great emotional demands on us. For example, working with people who survive torture can evoke intense reactions that can lead to secondary trauma, despair, helplessness, and burnout (Allden & Nancy Murakami, 2015; Comas‐Diaz & Padilla, 1990; Long, 2020; Pope, 2012; Pope & Garcia-Peltoniemi, 1991).To the degree that we are unprepared for the emotional stressors and strains of therapy, our attempts to help may be futile and perhaps even harmful.
Table 6.1 presents research findings about intense emotions experienced in therapy. The numbers indicate the percentage of therapists in each study who reported at least one instance of each behavior. Readers who have had experience as therapists or patients may wish to compare their own experience to these findings.
Table 6.1. Percentages of Intense Emotions and Other Reactions in Therapy.
| Behaviors | Study 1a | Study 2b | Study 3c |
|---|---|---|---|
| Crying in the presence of a client | 56.5 | ||
| Telling a client that you are angry at them | 89.7 | 77.9 | |
| Raising your voice at a client because you are angry at them | 57.2 | ||
| Having fantasies that reflect your anger at a client | 63.4 | ||
| Feeling hatred toward a client | 31.2 | ||
| Telling your clients of your disappointment in them | 51.9 | ||
| Feeling afraid that a client may commit suicide | 97.2 | ||
| Feeling afraid that a client may need clinical resources that are unavailable | 86.0 | ||
| Feeling afraid because a client’s condition gets suddenly or seriously worse | 90.9 | ||
| Feeling afraid that your colleagues may be critical of your work with a client | 88.1 | ||
| Feeling afraid that a client may file a formal complaint against you | 66.0 | ||
| Using self-disclosure as a technique | 93.3 | ||
| Lying on top of or underneath a client | 0.4 | ||
| Cradling or otherwise holding a client in your lap | 8.8 | ||
| Telling a sexual fantasy to a client | 6.0 | ||
| Engaging in sexual fantasy about a client | 71.8 | 28.0* | |
| Feeling sexually attracted to a client | 89.5 | 87.0 | 87.3 |
| A client tells you that they are sexually attracted to you |
