Scope of Practice

In the field of Psychology it is natural for a therapist to try to help everybody. We often feel if we could help out one person, the same principles could help another. In an emergency situation this could be disasterous!! It is important to stay within your expertise - in clinical terms called Scope of Practice

In the Mental Health Urgent Care, we see a vast spectrum of adults who suffer from mental illness. The degree of impairment is from catatonic to high functioning. Can deep interpersonal work be managed with those barely functioning? I am afraid not. It takes a working relationship, trust, and little "ah ha" moments of insight to solidify a good therapuetic relationship with clients. Can this be established with everybody? We are hopeful but this isn't practical.

Don't get me wrong. I have seen clinicians make tremendous connections with paranoid Schizophrenics in a homicidal fit. Can I do that? At times I have but that is the exception to the rule. Working with people at this level of distress on a daily basis would burn out the best clinician in a few weeks!

My training is on people that have good insight to themselves, can be a bit introspective, and are motivated on changing themselves for the better. When somebody doesn't fit that criteria they are now outside of my scope of practice.

A person came in for help today who had a lifelong impairment. Off her medication for a few weeks she was unstable, fighting with others and needed to stablize on medication. This person had a mild developmental delay (formerly referred to as mental retardation), had delusions in which she lived in a fantasy world, and a history of psychiatric hospitalizations. Can I as a therapist work my magic and bring the subconscious to the conscious? Since she had no real insight to herself this would be an impossiblity. Plus, her subconscious was already at the surface. Digging more into her mind may create more problems anyway. Therefore I knew to assess her for dangerousness, refer her to the staff Psychiatrist (who I will be talking more in depth about in the future), and make sure she had a support group that would monitor her compliance to taking her medication.