Professional Incompetence

There are many reasons why mental health professionals receive complaints against them in regard to professional competence. The table below lists the complaints made against psychologists – some of which are relevant to counsellors and psychotherapists and some are not.

Complaint	Number	%
Professional—incompetency	41	16.5
Wrong/inappropriate diagnosis	10	4.0
Inadequate/inappropriate assessment	9	3.6
Inadequate treatment	8	3.2
Failure to notify government authority	4	1.6
Poor record keeping	3	1.2
Inadequate supervision	2	0.8
Miscellaneous (e.g., not following guidelines)	5	2.0
Professional—poor reports	35	14.1
General report	14	5.6
Workers compensation report	11	4.4
Family court report	7	2.8
Apprehended violence order report	2	0.8
Victim of crime report	1	0.4

Assessment and Diagnosis

Just to be crystal clear – as a counsellor or psychotherapist, you are not adequately trained or qualified to provide a diagnosis. No assessment or diagnosis should be done by anyone other than a psychologist or psychiatrist. If you are trained in doing assessments such as the K10 or DASS that can be useful information to pass back to the GP or to refer on to others, but they should never be used as a diagnostic tool.

Inadequate treatment

When treating clients, it is imperative that you have informed consent and agreed-upon goals with them so that there is a collaborative approach to therapy. This supports the client to feel empowered and to have a say in their treatment plan and see themselves as a contributor and not just a passive participant in it all. This reduces the likelihood that the client will feel that the treatment is not working as they will have an opportunity and be encouraged to speak up when they feel that the treatment is not working. This gives you both an opportunity to adjust the treatment plan or recommend a referral pathway to the client to support their autonomy.

Failure to notify government authority

As therapists (depending on what state you and your client are located in) there are mandatory reporting guidelines surrounding particular circumstances. These situations include childhood abuse, elder abuse, disability abuse, domestic violence, homicidal thoughts, suicidal thoughts, possession of guns and many other situations. It is important that you take the time to develop a policy and procedure for your practice on how you will navigate these particular situations so that when they occur, you know what you are required to do. I strongly encourage you to have procedures for your practice in the following areas, if you work for a company, they may already have some of these in place. It is recommended that you work collaboratively with your supervisor, your registration body and relevant laws and acts to write these procedures:

Domestic violence
Suicidal thoughts
Homicidal thoughts
Child abuse
Self-harm
Possession of guns when dealing with someone who is mentally unstable

Having these procedures in place supports you to feel more confident and capable of dealing with these challenging situations. As always, you must work within your scope of practice and only see clients that you are qualified to see. The ACA has Suicidal Client Guidelines that recommend that only level 3 and 4 accredited counsellors can see this demographic and never in isolation. Speak to your supervisor about your scope of practice and what clients fall in and outside of that scope.

Poor Reports

Some therapists have a blanket rule that they do not write reports for clients to avoid these particular situations. Some have rules that they will need to see the client at least 6 times before writing a report, and others will happily write reports (court or otherwise) in any given situation. It is important that no matter the path that you choose, you receive adequate training in report writing and clearly state your qualifications and the boundaries of your role in the report. This article on report writing for psychologists can be applied to counsellors as well, it outlines what to do and not to do in treatment reports.

Additionally, you must also consider the confidentiality of the client and gain the client’s consent before agreeing to write any given report. This does not mean that the client gets to have a say as to what is written in the report, as they can not bully you into writing what they want. If you do choose to write reports, be sure that you maintain your professional integrity and stay within your professional competency. You must justify everything you put into a report and have the evidence to back it up. Not only are you putting yourself at risk, but also the client if the information is of a subjective nature rather than a professional objective opinion.

Going outside your scope of practice

Staying within your scope of practice as a therapist is crucial for several reasons. First and foremost, it ensures the safety and well-being of your clients. Operating within your established expertise helps maintain a high standard of care and minimises the risk of harm. Additionally, it upholds ethical standards and legal regulations, promoting trust in the therapeutic relationship.

PACFA defines scope of practice for PACFA-registered counsellors as follows:

Scope of practice is the area of the profession in which a counsellor has the knowledge, skills and experience to practise competently, safely, and lawfully, in a way that meets standards and does not pose any danger to the public or to themselves. PACFA recognises that a counsellor’s scope of practice will change over time and that the practice of experienced counsellors often becomes more focused and specialised than that of newly qualified counsellors. This might be because of specialisation in a certain area or with a particular client group, or movement into roles in management, education, or research.

If a therapist wishes to treat a different demographic or address issues outside their expertise, seeking additional training and guidance is essential. Without proper training, a therapist may lack the necessary skills to navigate certain situations, potentially causing harm to the client. Recognising personal limitations and pursuing appropriate education is vital to expand one’s competence.

Warning signs that you are starting to head outside your scope could be:

feelings of inadequacy
uncertainty about treatment approaches
lack of confidence in managing specific client issues
feeling out of your depth with a client or case
the client’s symptoms are getting worse or they are not progressing
you do not have training or experience in that particular area
you find yourself overly justifying your actions
being defensive about how you managed the case
constantly thinking about a client or case
your supervisor tells you that you are outside your scope

If a therapist ignores these signs and proceeds without seeking supervision or additional training, they risk re-traumatising the client or exacerbating their condition. The ACA has guidelines around the scope of practice for each registration level in the document scope of practice for registered counsellors. It is recommended that you have read of the level pertaining to yourself and assess your competence against the recommended scope.

In general, if you do not have training in that particular area – you are outside of your scope. You need to be able to back up your treatment plan with evidence that you know what you are talking about. The best way to do that is with ongoing professional development. Go and take a short course on that particular demographic and learn the best practice guidelines for that area. It only takes a couple of hours and it is well worth the investment.

Being able to niche down into a particular demographic allows you to become an expert in that specific area, which helps with marketing and referrals. You don’t need to be everything for everyone and knowing the areas that you feel confident and capable in not only supports you, but your clients as well.