Some clinical psychology trainees don’t know how to do some things that every psychologist ought to know, including diagnosing correctly, administering a mental status exam, writing SOAP notes, and safety planning for people thinking about suicide. I agree that every trainee should know these things, but my concern is that an emphasis on knowing them will turn these sorts of administrivia skills into the definition of competence. I have the same concern about the psychology licensing exam and the ethical code and the regulations governing casework in child welfare practice. I think every psychologist should know the difference between criterion validity and construct validity, and I think they should obey the ethical code. I think every caseworker should follow every rule and regulation governing casework. But my concern is that once a host of easily measured rules are obeyed, our field will forget that these are not the same as competence.
One way to look at the problem is that we want to know who is competent and who is not, but we are always tempted to measure what is easily measured, like the old joke about the guy who looks for his keys under the street lamp where the light is good rather than on his darkened porch where he dropped them. In fact, when Aaron Beck started redefining brief psychoanalytic therapy as a whole new approach called cognitive therapy, he predicted his approach would gain favor not (only) because he thought it was more effective, but because the approach conceptualizes change in a way that is easily measured (self-report: psychoanalysts are suspicious of self-report). The danger is that clinical training will turn into a checklist, and the only things that the checklist will not have are the only things that matter: critical thinking about emotional material, mastery of analogy, probing curiosity, empathy, humility, courage, and a welcoming attitude toward what is marginalized.
My view is that most diagnoses (some actually matter because they imply a treatment plan), SOAP notes, and so on are like punctuation. You really ought to punctuate perfectly; it’s not that difficult. But don’t confuse punctuation with writing ability or with the quality of the ideas of the writer.
I confess I’ve never written a SOAP note, diagnosed more than two axes, given a mental status exam, or done a safety plan. But I’m pretty sure I could figure out how to do it if I needed to.
These skills also seem to me to be like the skill of looking in the mirror before giving a lecture to make sure there’s no spinach in your teeth or anomalous discharges around various orifices. Learning to write a SOAP note is like checking your fly before greeting a patient. It doesn’t mean you’re a good therapist if your fly is always up or a bad therapist if you left it down once or twice, but you really ought to check it.
Michael Karson, Ph.D. 
This post came at a great time for me. Makes me laugh about the pressure felt to do these specific procedures/techniques in order to be labelled as competent. Especially like the statement about you being able to figure it out if needed.
Some of the things you describe are basically plain old common sense. You don’t have to be a psychologist (or anything really) to complete a checklist, read a manual and follow instructions, or check yourself in the mirror. These are things your parents teach you, and you should know by when you are like 6, not things you have to spend $200k to learn in grad school.
Common sense is not competence (far from it), however is a prerequisite to competence. I like to define competence as adequate content knowledge plus professionalism. Basically the ability to know what you are doing at any given time and why you are doing it, to produce and respond accurately and timely based on the rules, ethics, and expectations of your respective field, to be on time for most things scheduled, to respect and treat others as the professional you strive to be, to not personalize things very much (conflict is ubiquitous), to be mindful of your and others boundaries. Things a 12 year old can do, minus the content knowledge of course.
In turn, just as common sense is a prerequisite to competence, the latter is to expertise. Now that’s a whole different ball of wax. I believe that’s what our licensing exams in psychology should be trying to capture but fail miserably. That’s worth the $200k you (or your lovely government to whom you are indebted for life) paid for. But licensing exams (and grad programs) are only as good as their makers, and most of these folks I classify as belonging to the first or second categories I described, at best. That’s my honest opinion based on personal experiences after 10 years in the field, not trying to be arrogant or conceited.
Expertise is doing all the things above with passion and creativity, the art of breaking the rules and conventions while staying within the margins. Reading through the lines, seeing the clandestine in the obscure, or maybe just the dull and the ordinary. One example I have is conducting what I call a “cold and dark” clinical interview of somebody that has found themselves in the chair across from me. Without any sort of testing and collateral at hand yet, I am perfectly synced in the moment, evaluating and weighing variables as I go, being invited to navigate through all the possible corridors, opening and closing doors behind me, then promptly finding myself inside the grand hall (or basement – depending on theoretical orientation), knowing how I got there and how to get back without getting lost, and also how to help best rearrange the furniture (in case we are going to do some therapy).
All this work is sort of like a Jackson Pollock painting. You can’t really capture it or measure it. Its too much to take in at first, but you just know its special somehow, and then you look closer and you see the pattern. You step back, then you step in again, and again. You “get it,” and like the expert therapist Jackson is, he knows you know he knows… Magical and deeply intimate and empathic. So yeah, I think examiners of psychology competence need to be more like established modern art critics, or film critics, or perhaps even better artists themselves. It’s hard to measure art, but one artists can tell the work of another.
Brief war story from the front. Yesterday Boulder PO (with several years of experience in the field) said its okay to get Valentine’s greetings from sex offender clients in her caseload. And then you worry about anomalous discharges from orifices (LOL)…
@ Ioannis Well said.
@ Lisa Thanks! I should have added sense of humor to my list of what really matters.
@ John Lovely, lovely, lovely.
This is one of those nice moments when I get to feel that what I think is competent practice actually is. Felt the same way when I read that heavy caffeine consumers exhibit lower incidences of heart disease.
As often happens with our profession the parenting paralles are many. As a competent parent I teach my kids to wash their hands after they go to the bathroom, memorize my phone number, stop at every crosswalk, saying please and thank you leaves a positive impression, and that work before play is a good habit to get into. When I see them following the rules and to appear happy, I pat myself on the back for doing a good job. Yet these check marks of competence are punctuation marks. My competence gets tested when my rail thin daughter declares she’s fat and disgusting. I pass the test when I resist the reflex to tell her that she could not be more wrong, and try to understand, “Why this? Why now?”
I’m off to bed just as soon as I google the difference between construct and criterion validity.