Responsibility for Management of Patients in Psychotherapy and Competence in Psychotherapy

Abstract

Competence in psychotherapy requires more than an understanding of dynamics and techniques of interpretation. The therapist needs confidence in applying therapeutic skills, particularly when handling patient management issues (type of therapy needed, suicidal and homicidal tendencies, psychotic episodes, psychophysiological symptoms, requests for tranquilizing medication, termination). Although the correct handling of these critical incidents is vital, they are more difficult than other issues. The best way to learn to manage critical incidents is to have them. But this depends upon the setting in which therapy takes place. Agency therapists have less opportunity to master the skills and anxieties of more responsibility and more intensive relationships with their patients as compared with therapists in private practice. Psychology's lack of its own inpatient facilities discourages psychologists from working with the full range of emotional problems, which in turn limits their opportunities to improve their competence in psychotherapy with severely disturbed people. Inpatient settings are currently more of a problem than outpatient settings. Psychology needs to establish its own residential psychological treatment centers, which would protect psychotherapy outpatients during crises, and permit psychotherapy to continue, rather than be disrupted by somatic therapies.