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

b) find the manuals associated with these trials

c) extract the competences

• identify ‘exemplar’ trials of interventions, based on: – reviews of the literature (e.g. NICE and SIGN)– oversight by an Expert Reference Group

• locate the manuals used in these trials (both published and unpublished)

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

‘packages’ of interventions with evidence of efficacy

specific skills needed to apply the therapy

meta-competences

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 psychodynamic

systemic humanistic

Framework for people with psychosis and bipolar disorder

Expert Reference Group

Katie AshcroftAlison BrabbanFrank BurbachProf Tom CraigGrainne FadenProf Philippa GaretyProf Andrew GumleyAndrew HarrisonElizabeth HolfordIan Hulatt

Suzanne JolleySteve JonesDavid KingdonProf Elizabeth KuipersThomas MeyerProf Anthony MorrisonEmmanuelle PetersProf Jan ScottCraig SteeleProf Graham Turpin

Core competences

knowledge of presenting issues

working with families/ carers

ethical & legal issues

professional issues (work with differenceworking with and within organisations)

knowledge of pharmacology

knowledge of physical health problems

Core competences

knowledge of presenting issues

working with families/ carers

ethical & legal issues

professional issues (work with differenceworking with and within organisations)

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

working with families/ carers

ethical & legal issues

professional issues (work with differenceworking with and within organisations)

knowledge of pharmacology

knowledge of physical health problems

Therapist stance and values

Generic therapy skills

basic therapy skills and knowledge

engagement

assessment

alliance building

managing emotional content

Core competences

working with families/ carers

ethical & legal issues

professional issues (work with differenceworking with and within organisations)

knowledge of pharmacology

knowledge of physical health problems

Therapist stance and values

generic therapy skills

basic therapy skills and knowledge

engagement

assessment

alliance building

managing emotional content

Assessment & formulation

comprehensive assessment

assessment functioning within multiple systems

risk assessment

develop formulation and intervention plan

f/back assessment and agree plan

co-ordinate casework

Core competences

working with families/ carers

ethical & legal issues

professional issues (work with differenceworking with and within organisations)

knowledge of pharmacology

knowledge of physical health problems

Therapist stance and values

generic therapy skills

basic therapy skills and knowledge

engagement

assessment

alliance building

managing emotional content

Assessment & formulation

c’prehensive assessment

assessment functioning in multiple systems

risk assessment

develop formulation & intervention plan

f/back assessment

co-ordinate casework

Specific interventions

Bipolar disorder

CBTfor BD

Family Interventions

IPT/ Social Rhythm Therapy

Psychoed/ relapse prevention

psychosis

CBT for psychosis

Family Interventions

Core competences

working with families/ carers

ethical & legal issues

professional issues (work with differenceworking with and within organisations)

knowledge of pharmacology

knowledge of physical health problems

Therapist stance and values

generic therapy skills

basic therapy skills and knowledge

engagement

assessment

alliance building

managing emotional content

Assessment & formulation

c’prehensive assessment

assessment functioning in multiple systems

risk assessment

develop formulation & intervention plan

f/back assessment

co-ordinate casework

Specific interventions

Bipolar Disorder

psychosis

Co-existing issues (depression, anxiety, substance misuse, personality disorder, trauma, learning disability, autistic spectrum disorder)

Core competences

working with families/ carers

ethical & legal issues

professional issues (work with differenceworking with and within organisations)

knowledge of pharmacology

knowledge of physical health problems

Therapist stance and values

generic therapy skills

basic therapy skills and knowledge

engagement

assessment

alliance building

managing emotional content

Assessment & formulation

c’prehensive assessment

assessment functioning in multiple systems

risk assessment

develop formulation & intervention plan

f/back assessment

co-ordinate casework

Specific interventions

Bipolar Disorder

psychosis

co-existing issues

Meta-competences

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

working with families/ carers

ethical & legal issues

professional issues (work with differenceworking with and within organisations)

knowledge of pharmacology

knowledge of physical health problems

Therapist stance and values

generic therapy skills

basic therapy skills and knowledge

engagement

assessment

alliance building

managing emotional content

Assessment & formulation

c’prehensive assessment

assessment functioning in multiple systems

risk assessment

develop formulation & intervention plan

f/back assessment

co-ordinate casework

General clinical care

Psychoeducation and problem solving(PEPS and STEPPS)

Consulting to individuals and teams regarding individuals with PD

Generic structured clinical care

Core competences

working with families/ carers

ethical & legal issues

professional issues (work with differenceworking with and within organisations)

knowledge of pharmacology

knowledge of physical health problems

Therapist stance and values

generic therapy skills

basic therapy skills and knowledge

engagement

assessment

alliance building

managing emotional content

Assessment & formulation

c’prehensive assessment

assessment functioning in multiple systems

risk assessment

develop formulation & intervention plan

f/back assessment

co-ordinate casework

Specific Psychological therapies

CBT for PD

Schema-focused CBT for PD

Mentalisation-Based Therapy

Transference–Focused Psychotherapy

Interpersonal Group Psychotherapy

Cognitive Analytic Therapy

Generic Clinical Care

Core competences

working with families/ carers

ethical & legal issues

professional issues (work with differenceworking with and within organisations)

knowledge of pharmacology

knowledge of physical health problems

Therapist stance and values

generic therapy skills

basic therapy skills and knowledge

engagement

assessment

alliance building

managing emotional content

Assessment & formulation

c’prehensive assessment

assessment functioning in multiple systems

risk assessment

develop formulation & intervention plan

f/back assessment

co-ordinate casework

Specific Psychological therapies

CBT for PD

Schema-focused CBT for PD

Mentalisation-Based Therapy

Transference–Focused Psychotherapy

Interpersonal Group Psychotherapy

Cognitive Analytic Therapy

Generic Clinical Care

co-existing issues (depression, anxiety, substance misuse, personality disorder, trauma, learning disability, psychosis, other personality disorders

Core competences

working with families/ carers

ethical & legal issues

professional issues (work with differenceworking with and within organisations)

knowledge of pharmacology

knowledge of physical health problems

Therapist stance and values

generic therapy skills

basic therapy skills and knowledge

engagement

assessment

alliance building

managing emotional content

Assessment & formulation

c’prehensive assessment

assessment functioning in multiple systems

risk assessment

develop formulation & intervention plan

f/back assessment

co-ordinate casework

Specific Psychological therapies

CBT for PD

Schema-focused CBT for PD

Mentalisation-Based Therapy

Transference–Focused Psychotherapy

Interpersonal Group Psychotherapy

Cognitive Analytic Therapy

Generic Clinical Care

co-existing issues

Meta-competences

Using the framework

map of competences represents:

• a procedure for identifying competent practice

• an agenda for supervision

• a curriculum for developing training programmes

• a benchmark for current trainings

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/