A therapist’s competence covers all parts of their work with clients whether that’s how they work with clients towards a satisfactory ending of therapy, their scope of practice,  for example a specialist area, and many more. It’s certainly a subject that the Get help with counselling concerns service regularly talks to clients about. 

Firstly, I would say that all practitioners have an ethical responsibility to work within the scope of practice in which they have competence. It’s the practitioner’s responsibility to work to professional standards by working within their competence (Commitment 2a, Ethical Framework), as well as demonstrating accountability and candour by ‘monitoring how clients experience our work together and the effects of our work with them’ (Commitment 6d). If the practitioner, the client, or in some circumstances the practitioner’s supervisor, have concerns over whether the practitioner is competent to work with a particular client, then the therapist will need to see how best to address this.

It could be that with extra support, training, or supervision they can continue the work, but if these aren’t sufficient, it might mean that the practitioner will need to end with the client and refer them to another service or practitioner.

Careful discussion in supervision is essential, to ensure that the needs of the client are put first, and that their client is informed and supported through this process thereby ‘making clients their primary concern while working with them’ (Commitment 1).

For example, a practitioner may be competent to work with adults, but not with specialist groups such as children or young people, or couples. Or they may have received sufficient training for working face to face, but not for online work, meaning they are not competent to work in this way. Practitioners must have confidence in their own ability to practise competently and safely, which, in turn, can inspire client confidence.

Competence might also include whether a therapist is providing a medical diagnosis (or challenging a diagnosis) or giving an opinion without the appropriate medical training. Unless a therapist holds specific professional qualifications, counsellors and psychotherapists are not able to make medical or psychiatric diagnoses, such as autism, ADHD, or narcissism, or give medical opinions.

A therapist should avoid getting drawn into providing expertise in an area in which they’re not qualified, even if clients specifically ask for information or an opinion. Good practice would suggest a therapist explains to clients if a matter is beyond their competence and refers them on to an expert for a medical diagnosis or opinion.

Therapists should also be careful how they advertise or describe themselves, so potential clients are not misled. We have often spoken with clients who have been disappointed in the level of expertise in an area that a therapist has advertised. Therefore, therapists should provide clients with adequate and accurate information from the outset, so they can make an informed decision about whether they are likely to be suitable for their needs (Good Practice, points 43-45). Therapists should only offer specialisms if they have had relevant training and continuing professional development (CPD), and they should also ensure that their supervisor has ‘...adequate levels of expertise ...’ (Good Practice, point 62) to support any specialisms they offer.

Sometimes, therapists may take on work that seems to be within the areas and levels of their competence but that becomes more complex as sessions progress. However, the onus is on the therapist to assess whether to stay with the work, for example, increasing supervision, seeking specialist consultation, or engaging with CPD or refer the client to another practitioner with more experience in the field.