Determining the boundaries of competency

[beginner2011]

I'm curious how others determine the limits of competency and the need for supervision vs consultation vs competent independent practice. I'll share a de-identified example that I'm curious to see others thoughts on.

Say I completed a postdoc in PCMHI where my training was focused primarily on preparation to take a VA staff position in the clinic or a similar clinic and gained a lot of experience providing CBT for insomnia and did a small 8-week rotation in the VA sleep clinic during which I received 1h/week supervision from a sleep psychologist. After completing the PCMHI postdoc and gaining independent licensure I took a research position that allowed for some minor portion of my time to be providing clinical care in a Sleep Clinic at the local university medical center.

Would it be within my competence to provide clinical services in a Sleep Clinic at the university as an independent clinical psychologist, or would it be more appropriate to have some amount of supervision from a sleep psychologist before practicing independently in this setting?

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[cara susanna]

I'd say that's enough for competence, personally.

 

[WisNeuro]

Depends on the complexity of the treatment and/or population. Sleep stuff and CBT-i is pretty straightforward. True DBT less so.

 

[Ollie123]

There are a lot of considerations beyond just diagnosis. Individual case, comorbidities, setting, heck even geographic region. There is a fair bit of discussion in the ethics literature that your boundaries around what you treat necessarily should differ if (to pick an extreme example) you are the only provider in 100 miles in a rural region versus working in a specialty clinic in NYC.

In this particular case, I would absolutely say yes with some caveats. Can you do CBT-I for primary insomnia in a college kid who constantly pulls all nighters, stays up late partying, than sleeps til 3PM and basically just needs a schedule reset. Without a doubt yes. The person working swing shifts with multiple medical comorbidities, sleep apnea and parasomnia? That one I might refer out. Or you can start to treat, but preface it with the caveat that you can cover the basics but may need to refer out quickly. Or - if you have access - you treat but do so while consulting heavily with colleagues there.

I'm a strong proponent of this sort of model in psychology/psychiatry and its something I think other healthcare fields are much, much better at doing. Work within your comfort zone, but be ready to refer to a specialist rather than letting folks linger indefinitely.

 

[thebalmofhurtminds]

This sounds like somewhere I know