Operating In One’s Domain of Training and Competence
There is one final ethical matter that must be addressed by someone doing psychotherapy—and more generally by anyone in the United States who is engaged in professional psychology. They must operate only in areas where they have acquired expertise. Having completed a doctoral program does not allow one to offer services in all areas of psychology. This ethical issue has become more salient as the field of professional psychology has become more finely differentiated in the United States and as new areas of specialization have emerged.
For instance, those trained as clinical psychologists might be inclined to expand their practice by offering services as a life coach or health coach alongside their clinical services. This expansion is not looked upon favorably by those who are monitoring either the clinical or coaching professions. This is especially the case if the clinician has received no training specifically as a life or health coach. Even if they have received this training and are “certified” as a life coach by an organization such as the International Coaching Federation (ICF), the therapist is expected to separate their clinical and coaching practices. Each is to be independently promoted and even run out of a separate business entity.
Many schools of psychotherapy (especially those with psychodynamic orientation) require extensive training and supervision before being able to use a title designating their practice in this specific area. Not everyone can call themselves a “psychoanalyst,” and specific schools of psychoanalysis usually require that those in their school designate their orientation when “hanging out their sign” (e.g., “Jungian psychoanalyst)). Historically, there has been an ongoing debate in psychoanalysis regarding whether the analyst should also have been awarded a medical degree. Those without a medical doctorate are called “lay analysts” and often charge less and sit lower on the totem pole than those with a medical degree, even though their medical knowledge is rarely used in this psychoanalytic practice. The one area in which their medical degree is engaged concerns the prescription of medications (such as those which reduce anxiety). While psychoanalysts have traditionally discouraged the use of anxiety-reducing medications by their patients (“pure” treatment requiring the leveraging of insights via anxiety), an alliance is growing between psychoanalysis and psychopharmacology among many contemporary analysts.
Expectations of Expertise
We can now turn to the client/patient’s perspective on the services being rendered by a psychologist or other human service provider.
Initial Impressions
As I have already noted, this is where the title of “Doctor” can make a real difference in the United States (and elsewhere in the world). Typically, the person seeking psychotherapeutic services will look for the doctoral diploma on the wall when first entering a therapist’s office, as will the person requesting an assessment or counselling with their troubled teenager. The request for organizational consultation by a corporate executive will usually come with a request that the consultant submit their resume (unless they are well known). The executive is often looking for both a degree and a record of previous consultations.
