Clinical Competency

I recently had a conversation with a colleague about the notion of an 8-10 year “sweet spot” at which time mental health therapists may find themselves experiencing a sense of mastery in their ability to provide quality and informed care. My colleague’s clinical trajectory has been different from mine but the similarities are evident. We had both worked in challenging residential settings. We had both spent several years working in acute care followed by community mental health. And we had both gone through the licensing process. For us, among other things, these experiences ultimately led to clinical competency. Most competent mental health therapists I’ve known have had similar career trajectories.


Clinical supervision and peer consultation are integral aspects of becoming a competent therapist. Supervision is required as part of the licensure process and includes hundreds of hours of clinical oversight. It is an invaluable learning opportunity where hands-on clinical skills are developed. Bi-annual Continuing Education Credits necessary to maintain licensure and ongoing consultation with colleagues similarly enhance clinical skills. With a diverse work history and robust supervision, therapists refine their practice. Through this process, they can become well-rounded, ethically principled and competent providers.


Even after having experienced different work environments and practiced with a variety of clientele, many mental health therapists don’t hit their clinical “stride” until the heretofore mentioned 8-10-year mark. The final facet of the clinical trajectory leading to competency is this: time spent practicing in the trenches. Nothing replaces the experience gained from thousands of hours of providing psychotherapy for real people with real problems. The learning curve is sharp during the first several years. Indeed, post-licensure followed by several years of practice, a therapist continues to learn, make mistakes and strive toward competency. It is not an automatic process. Rather, it requires diligence, commitment and a willingness to continue to learn from clients, colleagues and supervisors.

I earned licensure at the earliest possible date after completing graduate school. Among other requirements, The Alaska Board of Professional Counselors requires two years of supervised practice. They also require passage of the national examination before licensure eligibility. Was I competent as soon as I had fulfilled these benchmarks and earned my license? Truthfully, no. In retrospect, I didn’t achieve clinical competency until about year 9 of practice. I have always adhered to ethical standards and made every effort to provide best possible care, but I had not achieved competency as I know it now until years later and thousands of hours of face-to-face therapy. Competency developed for me not just after licensure and a few years of practice, but after an extended period working with extremely challenging and sometimes resistant clients. It meant becoming intimately familiar with evidence-based treatment modalities. I would submit that for most mental health therapists this is the rule rather than the exception.


What does it mean for a therapist to be clinically competent? I think of it as treatment fidelity, or treatment integrity. To further define these terms, I like to think about competency as the extent to which a therapist has the knowledge and skill required to deliver a treatment to the standard needed for it to achieve its expected effects. Psychotherapists must possess a range of abilities including more global psychotherapeutic skills, the ability to assess clients well and the ability to select and implement treatments appropriately.

In my practice, competency is measured by both the ratio of clients who consistently attend and demonstrate motivation as well as the increasing number of clients who “graduate” from services, who tell me they are feeling improvement such that they no longer feel the need for regular therapy or that they wish to down-titrate the frequency of sessions. While neither of these stand up to the rigors of a multi-year longitudinal study, they remain the clearest evidence that therapy works when practiced with competency.

As a caveat, there will always be some clients who present with symptoms outside a therapist’s expertise. In that case, their needs would be better met by referral to another provider. This is another important indicator of clinical competency: no matter how long a clinician has been practicing they must always be willing to refer out, with the readiness to acknowledge that a client’s needs might be better met if referred to another counselor or specialist.


Some clinicians achieve competency by way of different trajectories than discussed here, and I consider many of them to be competent and qualified practitioners. However, my belief remains that achieving clinical competency by way of experience in a variety of clinical settings, participation in robust supervision, going through the licensure process and many years of dedicated work in the field are fundamental components to achieving clinical competency. These are all things to look for when choosing a counselor.

I have been honored to be part of your process of change and success. Having a positive impact and observing you make meaningful strides is why I chose this field. Thank you for entrusting me with your care.

Speak Your Mind


1638 Eagle View Drive
Homer, AK 99603
(907) 602-2578

Got Questions?
Send a Message!

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.