What is a Therapists Scope?


By David Joel Miller.

Therapists and Counselors need to remember what is in and what is out of their “scope.”

In school, every beginning counselor is taught to pay attention to scope issues. It is not something that we talk to clients about very often. Somehow, a while out of school, a lot of professionals forget about this issue. One reason it is so hard to keep clear is that there are in fact two different “scopes.” Recently a reader commented about their therapist mentioning something as being out of their scope. That comment suggested this post.

Counselors need to remember both their scope of practice and their scope of competency.

1. Scope of practice.

Scope of practice is defined by the law in your jurisdiction. If you get an MFT license you are allowed to do some things, a Licensed Professional Counselor does certain things, an LCSW has their set of allowable things and so on.

This gets confusing sometimes. We professionals know for example who can do certain kinds of testing and who cannot. The clients do not usually know this and may come to a professional for something that their license does not allow.

In cases like that, we should always refer clients to someone who can help.

A social work license does not allow you to cut hair, or do tax returns, for example. The Therapist or social worker may have been trained as a beautician before becoming a social worker and they may have done tax returns to help pay the cost of going to school, still that Behavioral Science license does not allow them to do those things with their therapy clients.

If a person has two different licenses, say they are lawyers and they are therapists, there are all sorts of rules about what they have to do to keep those two professions separate so as not to confuse clients as to what they are allowed to do and not do.

Every group has a code of ethics and that may influence what a professional does or does not do, but scope of practice is largely a legal issue defined by the law that permitted the licensing of that profession in the first place.

In a future post, I want to tell you about codes of ethics, who has to follow them and why.

In many places, coaches are not licensed. That means that those who call themselves life coaches do not need to have had any training to do coaching. What the life coach should not do is treat a recognized illness like Major Depressive Disorder. They can help you with say “motivation.” But is you have low motivation because of your depression that is outside their “scope of practice.” They would need to have a license as a counselor, therapist or social worker to treat a mental illness.

2. Scope of Competency.

To become a licensed counselor, social worker or therapist there are certain classes everyone needs to take. The typical program at the master’s level would include about 60-semester college units. Some programs might go up to 65 units, some programs include only 45 units. Most classes are 3 units so that means about 20 classes. If they take a few 1 or 2 unit classes they might get up to say, 25 classes.

The beginning mental health professional would get a class in how to diagnose and a couple of classes in how to treat mental and emotional problems but with over 400 recognized mental, emotional and behavioral issues in the DSM-4 no one ever gets much training in working with specific issues in their program.

For example, a substance abuse counselor in a two-year (A.S,) program would take 36 college units in drug abuse counseling. Most licensed people LMFT’s, LPCC’s and LCSW’s will get one to three units in Substance abuse.

So if you only had a one unit class in counseling the drug dependent, say that was a one unit class one weekend, that person would not feel very competent in working with someone with a drug problem.

Many of us had at most a few minutes discussion of eating disorders and Dissociative Identity Disorder and Body Dysmorphic Disorder probably was not talked about at all in a therapist’s formal training.

So while a person may be licensed as a particular mental health professional they may realize that they just do not know enough about the disorder that the client has to be able to work effectively with that client.

We call this lack of skill in a particular disorder or technique something outside the therapists “Scope of competency.”

Most mental health professionals will find they do more studying, read more books and attend more trainings after graduation than they have done in their master’s level training programs. If you do not continue to study and learn, more and more things will turn up that are outside your scope of competency.

There are ways to expand your scope of competency. Get more education and training in a particular disorder or technique, work with a supervisor or consultant who is knowledgeable in the area and do more supervised experience in that area. Some professionals do all that and over time grow their scope of competency. Others may decide that they will restrict their practice to the problems they feel competent in working on.

So if you have a relatively common problem, say depression or excess anxiety, most professional counselors can help you. But is you have a more difficult problem, substance use disorder, eating disorders or many of the trauma-related disorders you may need to seek out someone who understands and knows more about your issue.

Hope that explains the very basics of scope of practice and scope of competency.

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2 thoughts on “What is a Therapists Scope?

  1. Hi. I stumbled across your blog while conducting some informal research today, and truly enjoy your almost impossibly non-biased and accurate posts. At least thus far (maybe 50+ and counting), I have not seen discussion regarding the BCBA title/role (and aba as mental illness treatment). If you have any knowledge or opinion, I would really appreciate the perspective! Due to multiple factors including but not limited to: the ASD “diagnosis fad”, educational policies regarding state funded additional supports, insurance denial for unlicensed service providers, changes in healthcare coverage, certification v licensure debate, scope of practice/ability, and seemingly philosophical differences regarding dx, therapeutic options, ethical obligations, and meaning of treatment generalization, many of us practicing therapists and professionals in Illinois are seeing big changes this past year in both private and public sectors including Lengthy acute hospitalizations, diminished client-focused care and obligations, and discrepancies in the least-restrictive care model and significant surge/flooding of state funded residential treatment care prior to attempting other treatment models. Are these changes occurring nation wide? Do you have any insight regarding their long term implications for any/all parties involved? Are there currently any substantially agreed upon pros and cons? Are the differences in codes of ethics problems elsewhere for social workers, clinical psychologists, professional counsellors, therapists, etc when working with BCBAs or this specific Subfield? We have definitely seen benefits in the expanding skill and therapeutic repertoires of the licensed professionals, learning applicable ABA techniques and utilizing common behavior plan components. It has allowed for an increase in the number of skilled and educated providers willing to work with clients diagnosed with ID, Asd, and adults functioning at different levels, but with intense backlash and criticism for integrating emotional, cognitive, and systems-related interventions rather than strict ABA. Any knowledge and insight you have is greatly appreciated!
    Thank you,
    Sincerely Biased Sarah (..hoping for a reduction, hence the multitude of fact seeking questions!)

    Like

    • Thanks for the comment. Yes I have heard about Behavioral analysis and behavior modification. Last year there was an effort, here in California, to create a license for people who do some kind of behavioral modification. Yes I believe this part of a nationwide trend to create several new specialized licensees.
      This raises a lot of questions. This topic needs a full post or maybe several. There are a number of issues that need consideration. As time permits I will write about this. I appreciate your comment that the posts are unbiased. I try to think them through and check the research on the topic so sometimes it takes a while to get this done. Some points in your comment that need thought and discussion are below.
      1. ABA (applied behavioral analysis) or Behavior modification can help some people, sometimes. Who and when?
      2. Who should do ABA and how much training do they need? Who will supervise them?
      3. How many separate mental health licenses need to be created?
      4. People with ASD etc., can also become depressed, anxious or suffer trauma. How can we be sure that they also get standard mental health treatment?
      5. Will creating an ABA specialty prevent other mental health practitioners, even doctors from doing this type of treatment?
      6. Is there reason to be concerned that with the new “spectrum” disorders everyone falls somewhere on the spectrum and will require treatment? Is anyone still normal or do we all need meds and behavior modification? (Behavioral control?)
      Let me see what I can do on answering these questions in the near future. Most of the posts for the rest of the year are written and scheduled but let’s see if I can get another one done and slipped in.

      Like

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