10.9 Counselor Competence

Competency is partially defined by an “appropriate standard of care,” which includes acting as most professionals would in a given situation (Ford-Sori, 2015, pg. 459).

Competence complaints and concerns remain the most prevalent complaint against counselors (Ford-Sori, 2015). Every professional code of ethics includes language prohibiting counselors from practicing outside their scope of practice or competence to protect client beneficence by receiving quality services (Koocher, 2003). The relevant ACA and NAADAC codes around competence utilized by dual diagnosis counselors are included below (ACA, 2014; NAADAC, 2021). Boundaries around the scope of competence can be particularly complex for counselors pursuing dual licensure, leading to even greater awareness of their services. This also applies to specialties and specific interventions, as discussed further in Chapter 8.

The ACA (2014) highlights boundaries of competence:

And also discusses specialty areas of practice:

NAADAC (2021) discusses this as scope of practice:

Clinical Competence Considerations in Working with Adolescent Clients

One should not assume that working with adults translates to adequately working with adolescents and vice versa (Ford-Sori, 2015). Working with adolescents represents a scope of practice issue, as many aspects of conceptualization, intervention, and legal needs differ for adults. Adolescent work also warrants a unique set of social skills and techniques compared to working with adults (Ford-Sori, 2015). Research shows that most adolescents are mandated by parents, legal services, or schools to receive treatment (Koocher, 2003). Therefore, counselors develop competence and experience working with mandated clients.

Family Systems

Competent counselors working with adolescents develop a sound knowledge of family systems and can apply this in their clinical work. Even if the young person’s family is not physically present in the counseling session, they are certainly metaphorically present. This is because the adolescent’s concerns must be understood in the context of their system(s) due to their legal status and limitations (Koocher, 2003). They must also be clear about their role as the child’s counselor and goals of protecting the child’s welfare, and not as a mediator, guardian ad litem, lawyer, expert, etc., as these roles likely require a different lens on the concerns at hand (Ford-Sori, 2015). Third parties will likely have different treatment goals than the adolescent client, and the counselor’s primary ethical duty is to the young person client (Koocher, 2003). Difficulty situations may arise when parents attempt to triangulate the counselor into “fixing” their child or working with them to behave in specific ways that would provide ease to the parent or family overall. However, this is not their job (Koocher, 2003). To reiterate, the counselor’s role is to show up for the client, not to make life easier for their adults. They work to include family in treatment as appropriate to foster system-wide change.

Developmental Lens

Adolescent counselors must also be knowledgeable in developmental psychology. Adolescents experience a “wide array of physical, cognitive, emotional, and social changes at a rapid pace” (Koocher, 2003, pg. 1247). These forces govern their world; counselors must know them to address their concerns and needs adequately. Because of the rapid pace of development, counselors are also aware of the range of social knowledge, executive functioning, and emotional intelligence they may encounter in this age group, and they utilize this developmental lens along with a person-centered approach to navigate the changes (Koocher, 2003). The primary developmental milestone for adolescents is building a sense of autonomy (Koocher, 2003). Autonomy is a foundational principle of counseling, and this can lead to tension with family, school, or legal personnel who do not view their autonomy similarly. Competent counselors conceptualize adolescent autonomy in relational terms and focus on planting the seeds for its growth by drawing on the therapeutic relationship (Ford-Sori, 2015). Counseling goals are made with the young person’s cognitive and emotional capacities in mind, which reinforces autonomy (Koocher, 2003). Counselors also recognize their legal limitations and remain sensitive to adolescents’ vulnerability due to their dependence on caregivers to meet their needs. They also hold space for tension that may arise from their lack of rights, abilities, economic resources, and life circumstances (Ford-Sori, 2015). In other words, foster autonomy with adolescents where you can.

Diagnostic Considerations for Adolescent Clients

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5TR) includes age ranges for specific diagnoses, meaning some are adolescent-specific. These include separation anxiety, reactive attachment disorder, oppositional defiant disorder, and enuresis (Ford-Sori, 2015). Counselors develop competency in diagnosing these with adolescents through training and supervision. They are also aware that symptom presentation typically looks different between adolescents and adults, and counselors must know what to look for in adolescents when they are trained in diagnostic practices from an adult lens (Ford-Sori, 2015). Diagnoses carry a weight of stigma, and competent counselors do not throw them around with clients, family, or others.

Working toward Competence in Working with Adolescent Clients

Due to the nuances of working with these populations, proper training, experience, consultation, and supervision are necessary for adolescents (Koocher, 2003). Counselors must pursue ongoing training to understand the above clinical competencies and ethics. They also participate in consultation groups and supervision with other professionals who have experience working with adolescents and can guide them toward best practices with this population. Counselors may seek out supervisors with experience or specialties in adolescent care and reach out for supervision as situations arise. It is also essential and mature to realize one’s limitations in working with this population and remain humble and open to feedback from other professionals (Koocher, 2003).

Additionally, counselors are tasked with understanding the relevant laws and ethical codes around working with adolescents and adhering to them (Koocher, 2003). Further, they know the nuances between child and parent rights as they apply to counsel and how to act accordingly (Ford-Sori, 2015). Working with this population requires a firm grasp and application of relevant legal statutes.