Scope of Competence — Without Shame
This is where scope of competence becomes critical.
Working with high-functioning clients who want growth, direction, and performance-level change often pulls therapists beyond the training most of us received. That’s not a personal failure — it’s a reality of how the profession has evolved.
Ethical drift doesn’t usually happen because therapists are careless. It happens because we keep doing what we were trained to do, even when the client’s goals require a different approach. We learn to conduct treatment (which is perfect when treatment is required). OR we learn how to support people in developing insight, self awareness, and finding their own answers through insight oriented talk therapy.
There is definitely a time and place for this as well, especially when people have lived through hard things, or do simply need support in making contact with their truth.
But there are other clients who don’t need or want either of those things. And that’s where we therapists can come up short.
I’ve written extensively about this in scope of competence for therapists, because ethical care requires clarity about what we are — and are not — providing.
When Therapy Feels Inefficient, Clients Don’t Stay
High-functioning clients are especially sensitive to inefficiency.
If therapy doesn’t offer:
- Clear goals
- Forward momentum
- Practical application
They don’t become dependent. They disengage.
This is why therapists so often ask what to do when therapy isn’t working for a client, and why conversations about structure, outcomes, and ethical termination matter so much.
Resources like when to let therapy clients go and therapeutic boundaries for therapists can be especially helpful here — because sometimes the most respectful choice is to acknowledge that therapy is not the right container for the client’s current goals.
Medical Treatment vs. Developmental Change
One of the biggest sources of confusion — for both therapists and clients — is the blurring of medical treatment and developmental change.
They are not the same thing.
High-functioning clients who are not seeking treatment for mental illness are often looking for learning, growth, and performance-level change. When we apply a medical model to a developmental goal, therapy can start to feel misaligned and unsatisfying, even when everyone has good intentions.
I explore this distinction more deeply in rethinking the medical model in therapy, because this is where many therapists begin to feel discouraged, burned out, or quietly ineffective.
A Different Lens: Coaching Psychology
To be very clear: coaching is not appropriate for clients who need clinical mental health treatment. Therapy is essential, ethical, and often life-saving work.
But for high-functioning clients who want to learn, grow, experiment, and operate differently in their lives, coaching psychology offers a complementary framework — one that emphasizes goal clarity, action, accountability, skills transfer, and measurable outcomes.
Understanding coaching psychology can help therapists better align their work with what these clients are actually seeking, without abandoning ethics or clinical integrity. If this intersection is new territory for you, I recommend starting with what therapists should know about coaching.
If you’d like to explore this path more deeply, you can learn more about our coaching certification for therapists, which is designed specifically to help clinicians expand their skill sets responsibly and ethically — especially when working with high-functioning clients who want change, not treatment.
Clients are telling us what they want — clearly and consistently.
Our ethical responsibility isn’t to pathologize that.
It’s to listen, adapt, and grow.
Thanks for taking the time to read this. If it resonates with you, pass it on to a colleague who also needs to hear this message.
All the best,
Dr. Lisa Marie Bobby
PS: I’d love to hear what you think about this. Connect with me on Linkedin, and let’s continue the conversation!
References
Wang, P. S., Sampson, N. A., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2007).
Understanding mental health treatment in persons without diagnosable mental disorders: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 64(10), 1196–1203.
https://doi.org/10.1001/archpsyc.64.10.1196
Swift, J. K., & Greenberg, R. P. (2012).
Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547–559.
https://doi.org/10.1037/a0028226
Wierzbicki, M., & Pekarik, G. (1993).
A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24(2), 190–195.
https://doi.org/10.1037/0735-7028.24.2.190
Lambert, M. J., & Shimokawa, K. (2011).
Collecting client feedback. Psychotherapy, 48(1), 72–79.
https://doi.org/10.1037/a0022186
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011).
Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.
Norcross, J. C., & Wampold, B. E. (2011).
Evidence-based therapy relationships. Psychotherapy, 48(1), 98–102.
https://doi.org/10.1037/a0022161
American Psychological Association. (2017).
Ethical principles of psychologists and code of conduct.
https://www.apa.org/ethics/code
