E.1 Generic competences
Establishing a positive relationship with the service user
An ability to:
• Develop an empathetic, warm and genuine relationship
• Communicate effectively through appropriate use of empathic statements, reflection,
clarification, verbal and non-verbal behaviours.
Establishing good relationships with relevant professionals
An ability to communicate effectively with professionals about the nature of the service user’s difficulties, the intervention(s) offered and the resulting outcomes.
Gathering background information
An ability to:
• Gain an overview of the service user’s current life situation, any specific stressors and level social support
• Elicit information regarding diagnosis, past history and present life situation
• Gather information relating to the impact of emotional distress including work, home, social and private leisure and close personal relationships.
Establishing a context for the service and providing rationale for the service user of the self-help model
An ability to:
• Help the service user understand that the main purpose of the intervention is to facilitate the use of self-help material(s)
• Provide a rationale for guided self-help to service users in an encouraging and realistic manner • Establish a context for the intervention, through clear explanation of the practitioner role • Ensure that the service user understands the nature and the timing of sessions and the schedule of contacts
• Convey to the service user the service-user-led, collaborative nature of a self-help intervention.
Giving service users specific information relevant to the intervention
An ability to:
• Impart accurate information on the nature, course and frequency of the presenting problem • Give the service user information about alternative available evidence-based
psychological therapies treatment-choices, as set out in the agreed protocol for the delivery of guided self-help
• Give realistic information regarding outcomes and the prognosis for the service user’s condition relevant to the self-help interventions.
Assessing the service user’s main problems using a semi-structured interview
An ability to:
• Use open and closed question styles flexibly and responsively
• Phrase questions unambiguously
• Give the service user regular summaries during the interview
• Assess, using agreed protocols; risk to self, others and self neglect (distinguishing between thoughts, actions and plans) and establish preventative factors
• Gather information on current and past treatment (including relevant medical, psychological, social and pharmacological interventions)
• Gather relevant information on drug and alcohol use
• Identify the key problem(s) through appropriate information gathering relating to the impact of emotional distress including work, home, social and private leisure and close personal relationships.
Sources used in development:
Training and service manuals developed by Professor David Richards. University of York.
Gathering information using formal assessment methods
An ability to:
• Administer and interpret formal measures of mental health (e.g. PHQ-9, CORE-OM, the BDI, problem and goal statements)
• Support the service user in the completion of formal measures of mental health and to support the service user in using these to monitor their progress
• Support the service user in use of formal measures of mental health to determine the content and pace of the intervention.
Decision making regarding the appropriateness of the intervention
An ability to:
• Agree on the suitability of the self-help intervention for the service user
• Collaboratively negotiate and agree with a service user the next steps in contact including organisational and therapeutic arrangements • Where necessary in conjunction with a supervisor, identify service users whose problems lie outside the scope of low-intensity interventions and when alternative interventions are require
• Recognise, where necessary in conjunction with a supervisor, when referral to another part of the service is appropriate.
E.2 Basic CBT competences
Socialising the service user to a CBT model
An ability to:
• Communicate the essential components of a cognitive, and/or behaviourally based self-help programme
• Communicate the options available to a service user within a CBT based self-help programme.
Agreeing the aims of the intervention
An ability to:
• Summarise information gathered from the assessment into a concise problem summary which is shared and checked with the service user (which includes information on environmental and/or intrapersonal triggers, physiological, behavioural and cognitive components of the main problem and the broader impact of this problem on the service user’s functioning)
• Use the problem summary to agree intervention goals with the service user
• Negotiate and agree the specific components of a self-help CBT based intervention.
Facilitating service user self-monitoring
An ability to:
• Support self-monitoring through the use of service-user-completed diaries (including activity schedules, sleep and thought diaries)
• Review diary records with the service user, and to discuss any implications of these observations with the service user.
Facilitating service user led interventions
An ability to:
• Understand the use of appropriate self-help materials (including written materials) and self- monitoring materials, and support the service user in the use of relevant and effective materials • Help the service user problem solve difficulties encountered in the use of written materials, and self-monitoring materials
• Help the service user think through the rationale for performing homework and related tasks, and to identify and problem solve any anticipated difficulties in carrying out tasks • Communicate effectively about the delivery, implementation and monitoring of self-help interventions both in face-to-face contacts and in telephone contacts.
Ending the intervention
An ability to negotiate an appropriate ending to the intervention, including discussion of relapse prevention.
E.3 Metacompetences in CBT
An ability to:• Maintain a clear distinction between acting as a facilitator of self-help and taking on the more extensive role of a therapist
• With service users who are not making
progress or who show low motivation, to identify when to persist with the intervention and when to re-evaluate its appropriateness
• In the context of indicators of service user progress, maintain fidelity to the intervention model in the face of service user complexity • Use supervision to identify gaps in knowledge and understanding, and reflect on and to learn from experience.