Developing competence frameworks for working
with people with:
psychosis and bipolar disorder
personality disorder
Prof Tony Roth
(and Prof Stephen Pilling)
Some principles
Developing the frameworks :
Principles: Retaining the role of clinical judgment
• competence frameworks are intended to be
indicative, not prescriptive
– they spell-out how something is done
– they indicate what would be helpful
– but they don’t prescribe
• it is for therapists to choose how they implement
competences:
whether
when
how
Methodology: An ‘evidence-based’ approach
• we want to identify the competences most likely to
produce effective delivery of an intervention
• these competences:
– are those used by therapists in research trials which
demonstrate efficacy
– are described in the manuals used in these research
trials
yields information about “best practice”
Methodology
a) find the right trials
• identify ‘exemplar’ trials of interventions, based on:
– reviews of the literature (e.g. NICE and SIGN)
– oversight by an Expert Reference Group
b) find the manuals associated with these trials
• locate the manuals used in these trials (both published
and unpublished)
c) extract the competences
Organising competence lists
• “undifferentiated” competence lists are rarely helpful
• an ‘architecture’ is needed to help users navigate
through the lists
– reflected in ‘competence maps’
• maps reflect the way that therapist’s think about their
practice
Structure of competence maps
underpinning
generic skills
common to all
approaches
specific skills
needed to
apply the
therapy
‘packages’ of
interventions
with evidence
of efficacy
metacompetences
How frameworks guide a specific intervention
• sets out competences in a structured and logical order
• set out theory / basic principles/ therapeutic stance
• show how to put principles into action across each phase
of the intervention:
•
•
•
•
engagement and assessment
formulation and planning
carrying out the intervention
completing the intervention
Supervision and training: a critical element
• supervision framework developed as part of IAPT
– offers guidance on standards for supervision
– (as far as possible) evidence-based
• sets out:
– a generic model of supervision of all psychological
therapies
– also specifies modality-supervision skills:
CBT
systemic
psychodynamic
humanistic
Framework for people with
psychosis and bipolar disorder
Expert Reference Group
Katie Ashcroft
Alison Brabban
Frank Burbach
Prof Tom Craig
Grainne Faden
Prof Philippa Garety
Prof Andrew Gumley
Andrew Harrison
Elizabeth Holford
Ian Hulatt
Suzanne Jolley
Steve Jones
David Kingdon
Prof Elizabeth Kuipers
Thomas Meyer
Prof Anthony Morrison
Emmanuelle Peters
Prof Jan Scott
Craig Steele
Prof Graham Turpin
Core competences
knowledge of
presenting issues
ethical & legal issues
professional issues
(work with difference
working with and
within organisations)
working with
families/ carers
knowledge of
pharmacology
knowledge of
physical health
problems
Core competences
knowledge of
presenting issues
ethical & legal issues
professional issues
(work with difference
working with and
within organisations)
working with
families/ carers
knowledge of
pharmacology
knowledge of
physical health
problems
Therapist stance and values
Therapeutic stance, therapist values and therapist style
Therapist stance, e.g.:
• committed to collaboration and choice
• committed to drawing on client and carer strengths
• committed to understanding client’s experience from
a psychological perspective
Therapeutic stance, therapist values and therapist style
Therapist values, e.g.:
• able to work with the person in their family/ social and
cultural context
• able to reflect on own beliefs and assumptions about
factors that relate to recovery and relapse
Therapeutic stance, therapist values and therapist style
Therapist style, e.g.:
• open, responsive and transparent
• focused on maintaining mutual respect between
client and therapist
Core
competences
ethical & legal
issues
professional
issues (work with
difference
working with
and within
organisations)
Therapist stance and values
Generic
therapy
skills
basic
therapy skills
and
knowledge
engagement
working with
families/ carers
assessment
knowledge of
pharmacology
alliance
building
knowledge of
physical health
problems
managing
emotional
content
Core
competences
ethical & legal
issues
professional
issues (work with
difference
working with
and within
organisations)
Therapist stance and values
generic
therapy
skills
basic
therapy
skills and
knowledge
Assessment &
formulation
comprehensive
assessment
assessment
functioning within
multiple systems
engagement
working with
families/ carers
knowledge of
pharmacology
knowledge of
physical health
problems
assessment
alliance
building
managing
emotional
content
risk assessment
develop formulation
and intervention plan
f/back assessment
and agree plan
co-ordinate casework
Core
competences
ethical & legal
issues
professional
issues (work with
difference
working with
and within
organisations)
Therapist stance and values
generic
therapy
skills
c’prehensive
assessment
basic
therapy
skills and
knowledge
engagement
working with
families/ carers
knowledge of
pharmacology
knowledge of
physical health
problems
Assessment
& formulation
assessment
functioning in
multiple
systems
risk
assessment
Specific interventions
Bipolar disorder
CBTfor BD
Family Interventions
IPT/ Social Rhythm Therapy
Psychoed/ relapse prevention
assessment
alliance
building
develop
formulation &
intervention
plan
managing
emotional
content
f/back
assessment
psychosis
CBT for psychosis
Family Interventions
co-ordinate
casework
Core
competences
ethical & legal
issues
professional
issues (work with
difference
working with
and within
organisations)
Therapist stance and values
generic
therapy
skills
knowledge of
pharmacology
knowledge of
physical health
problems
Specific
interventions
c’prehensive
assessment
basic
therapy
skills and
knowledge
engagement
working with
families/ carers
Assessment
& formulation
assessment
functioning in
multiple
systems
Bipolar
Disorder
risk
assessment
assessment
alliance
building
develop
formulation &
intervention
plan
managing
emotional
content
f/back
assessment
co-ordinate
casework
psychosis
Co-existing issues
(depression,
anxiety, substance
misuse,
personality
disorder, trauma,
learning disability,
autistic spectrum
disorder)
Core
competences
ethical & legal
issues
professional
issues (work with
difference
working with
and within
organisations)
Therapist stance and values
generic
therapy
skills
knowledge of
pharmacology
knowledge of
physical health
problems
Specific
interventions
c’prehensive
assessment
basic
therapy
skills and
knowledge
engagement
working with
families/ carers
Assessment
& formulation
assessment
functioning in
multiple
systems
risk
assessment
assessment
alliance
building
develop
formulation &
intervention
plan
managing
emotional
content
f/back
assessment
co-ordinate
casework
Bipolar
Disorder
psychosis
Metacompetences
coexisting
issues
Framework for individuals with personality disorder
Expert Reference Group
Carole Allen
Prof Anthony Bateman
Wyn Bolton
Marco Chiesa
Prof Susan Clarke
Prof Kate Davidson
Christine Dunkley
Ian Kerr
Prof Tom Lynch
Mary McMurran
Susan Mizen
Tom Mullen
Prof Glenys Parry
Steve Pearce
Alex Stirzaker
Michaela Swales
Heather Wood
Core
competences
ethical & legal
issues
professional
issues (work with
difference
working with
and within
organisations)
Therapist stance and values
generic
therapy
skills
c’prehensive
assessment
basic
therapy
skills and
knowledge
engagement
working with
families/ carers
knowledge of
pharmacology
knowledge of
physical health
problems
Assessment
& formulation
assessment
functioning in
multiple
systems
risk
assessment
assessment
alliance
building
develop
formulation &
intervention
plan
managing
emotional
content
f/back
assessment
co-ordinate
casework
General clinical care
Generic structured
clinical care
Psychoeducation and
problem solving
(PEPS and STEPPS)
Consulting to
individuals and teams
regarding individuals
with PD
Core
competences
ethical & legal
issues
professional
issues (work with
difference
working with
and within
organisations)
working with
families/ carers
knowledge of
pharmacology
knowledge of
physical health
problems
Therapist stance and values
generic
therapy
skills
basic
therapy
skills and
knowledg
e
Assessment
& formulation
c’prehensive
assessment
Generic
Clinical Care
Specific Psychological
therapies
CBT for PD
assessment
functioning in
multiple
systems
Schema-focused CBT
for PD
engagem
ent
risk
assessment
Mentalisation-Based
Therapy
assessm
ent
develop
formulation &
intervention
plan
Transference–Focused
Psychotherapy
alliance
building
managing
emotional
content
f/back
assessment
co-ordinate
casework
Interpersonal Group
Psychotherapy
Cognitive Analytic
Therapy
Core
competences
ethical & legal
issues
professional
issues (work with
difference
working with
and within
organisations)
working with
families/ carers
knowledge of
pharmacology
knowledge of
physical health
problems
Therapist stance and values
generic
therapy
skills
basic
therapy
skills and
knowledg
e
Assessment
& formulation
CBT for PD
assessment
functioning in
multiple
systems
Schemafocused CBT
for PD
risk
assessment
assessm
ent
develop
formulation &
intervention
plan
managing
emotional
content
Specific
Psychological
therapies
c’prehensive
assessment
engagem
ent
alliance
building
Generic
Clinical
Care
f/back
assessment
co-ordinate
casework
MentalisationBased Therapy
Transference–
Focused
Psychotherapy
Interpersonal
Group
Psychotherapy
Cognitive
Analytic
Therapy
co-existing issues
(depression,
anxiety, substance
misuse,
personality
disorder, trauma,
learning disability,
psychosis, other
personality
disorders
Core
competences
ethical & legal
issues
professional
issues (work with
difference
working with
and within
organisations)
working with
families/ carers
knowledge of
pharmacology
knowledge of
physical health
problems
Therapist stance and values
generic
therapy
skills
basic
therapy
skills and
knowledg
e
Assessment
& formulation
CBT for PD
assessment
functioning in
multiple
systems
Schemafocused CBT
for PD
risk
assessment
assessm
ent
develop
formulation &
intervention
plan
managing
emotional
content
Specific
Psychological
therapies
c’prehensive
assessment
engagem
ent
alliance
building
Generic
Clinical
Care
f/back
assessment
co-ordinate
casework
MentalisationBased Therapy
Transference–
Focused
Psychotherapy
Interpersonal
Group
Psychotherapy
Cognitive
Analytic
Therapy
Metacompetences
co-existing
issues
Using the framework
map of competences represents:
• a curriculum for developing training programmes
• a benchmark for current trainings
• a procedure for identifying competent practice
• an agenda for supervision
Using the framework
• a way of linking the evidence-base to practice
– identifying interventions with current evidence for
efficacy
– setting standards for competence
– setting standards for training
•
a resource for planning psychological intervention
services
all materials can be
downloaded from
www.ucl.ac.uk/CORE/