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Dr. Donald Moss on the Scope of Practice and Competence

Updated: Mar 24

Clinical practitioners always operate under practice standards developed by their home profession and under their state or provincial licensure acts. Two primary concepts governing what practitioners can and should do are the scope of practice and competence. Both of these concepts will be introduced here.

Scope graphic

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AAPB Book Recommendation

The text is partly adapted from Moss and Shaffer's (2022) A Primer of Biofeedback, which you

can purchase from AAPB in its member or non-member stores. The authors have donated their royalties to AAPB.

A Primer of Biofeedback

Scope of Practice and Competence

Listen to Dr. Donald Moss explain the scope of practice and competence © Association for Applied Psychophysiology and Biofeedback.

Scope of Practice

The scope of practice is defined by state and provincial licensure laws and the practice standards established by professional associations. Scope of practice defines which forms of assessment and treatment a clinical professional may deliver. Biofeedback is typically within the scope of practice for psychologists, social workers, physical and occupational therapists, counselors, nurses, dentists, and physicians, among others.

The scope of practice varies in some specifics from state to state and from one health discipline to another. The diagnosis of a mental health disorder is within the scope of practice of psychologists, but the diagnosis of a medical disorder is typically not. Most licensed health and mental health professionals are permitted in their scope of practice to provide treatment, including biofeedback, for patients with diagnosed medical and mental health disorders.

BCIA certifies technicians who must practice under a licensed and certified professional. Technicians may only treat diagnosed disorders under supervision. The technician’s scope of practice is defined by the supervisor’s license and scope of practice. Thus, a technician supervised by a dentist may provide biofeedback treatment for dental phobias but not for chronic back pain or panic disorder.

Scope of practice is often the “elephant in the room.” Until they face complaints, licensed practitioners rarely read the statutes that regulate their scope of practice and professional responsibilities (Hopkins, 2013). Unlicensed certificants may not understand how scope of practice applies to their activities and may not be informed of any limitations in their supervisor's scope of practice. Graphic © Aleksandr_Kuzmin/

Elephant in the room

Health and wellness coaches and sports trainers may utilize biofeedback training in their practice but typically cannot treat or advertise the treatment of diagnosed medical or mental health disorders. For example, coaches may provide relaxation training, stress management, or optimal performance training, even to patients with diagnosed disorders. Still, they cannot specifically treat a generalized anxiety disorder or major depression. Nor should they advertise treatment for diagnosed disorders.

Individual states vary greatly in how the scope of practice is defined and limited. In some states, for example, a psychologist may not provide any advice on dietary change or the use of nutritional supplements. Biofeedback practitioners are advised to read the licensing acts for their home professions in the states where they practice and to consult with the relevant licensing boards with any questions.

In some states, to give another example, a professional who is a licensed mental health professional and also a certified nutritional specialist may combine counseling, biofeedback, and nutritional advising in a single session; in others, the counseling or biofeedback practice must be delivered in a discrete and separate session from any nutritional services.