The Competency-based Framework

In the USA, frameworks of competencies in terms of knowledge, skills and values have become endorsed by the APA as a way to achieve a national training standard for psychologists (Sperry, 2010; Spruill, Rozensky, Stigall, Vasquez, Bingham, & De Vaney Olvey, 2004; Thomas & Hersen, 2009). Kaslow, Celano, and Stanton (2005) advocate a competency-based approach to training psychotherapists where an explicit framework has been formulated to “initiate, develop, implement, and evaluate the processes and outcomes of training” (p. 338). Trainers focus upon trainees’ ability to apply their acquired theoretical orientation and knowledge to real clinical contexts. Assessment of trainees is implemented using performance criteria that are linked to practice outcomes as an evaluation tool for trainees.

For psychologists, Overholser (1993) outlines a schema of five main competencies of factual knowledge, generic clinical skills, orientation specific technical skill, clinical judgment, and interpersonal attributes. Brems (2001) proposes that generally psychotherapeutic competence encompasses three interrelated core components. Firstly, self-awareness constitutes trainees committing to introspection and allowing their personhood to be developed to enhance

conveying presence and authenticity to their clients within the therapeutic relationship. This self- awareness needs to be both observational and philosophical in that psychotherapists must be able to see what they are doing during psychotherapy as well as the personal ideas, beliefs and values that influence how they personally view the patient (Ellis, 1966). Secondly, acquiring knowledge and theories of psychotherapy is essential to provide psychotherapists with a sound rationale for what they do, when and how with clients. Lastly, the attainment of applied skills involves translation of knowledge and awareness into action. This process can include learning techniques, intervention strategies and formulating treatment plans.

Subsequently, from a behavioural and cognitive psychotherapy stance, Bennet-Levy (2006) has conceptualised the Declarative Procedural Reflective (DPR) model which involves trainees developing both declarative and procedural knowledge (Anderson, 1993). Declarative knowledge is metalinguistic knowledge of facts and concepts expressed as propositions, for example, knowing that Paris, is the capital of France or in psychotherapy understanding the

29 purpose of transference. Conceptual information is stored in long-term memory and organised into schemas that form networks or webs. These webs are utilised to show relationships to shape comprehension and inform interpretations. In contrast, procedural knowledge involves

knowledge that is utilised in the performance of tasks. Such implicit knowledge involves action sequences and knowing how something happens in a particular way, for example, knowing how to ride a bicycle (Hiebert & Lefevre, 1986) or in psychotherapy conveying empathy towards clients. In addition, Bennet-Levy (2006) emphasises reflection skills as the third component of this model. He argues that reflection is essential as it is a metacognitive skill which involves an intellectual and emotional exploration of one’s experiences to arrive at new understandings.

Lemma, Roth, and Pilling (2008) have drawn up guidelines for the British government National Health Services (NHS) briefly outlining generic therapeutic competencies across theoretical orientations as well as specifically detailing psychoanalytic/psychodynamic competencies for clinical psychologists who work within the NHS. Generic competencies included: an ability to build trusting relationships and to relate to others in a warm, encouraging and accepting manner, as well as knowledge and understanding of mental health problems, knowledge of a model of psychotherapy, and the ability to understand and employ the model in practice. Specifically, psychoanalytic/psychodynamic competencies involved: the capacity to demonstrate understanding the client’s unconscious experience which will then involve the ability to utilise the transferences of the client within the therapeutic relationship as well as knowledge of the basic principles and rationale of psychoanalytic/psychodynamic approaches. In essence, psychoanalytic/psychodynamicpsychotherapists focus on the client’s unconscious experience of the relationship. Importantly, Lemma et al. emphasise that fostering a good therapeutic relationship is central across all theoretical orientations.

Tuckett (2008) proposed three frameworks or lenses within which the psychoanalytically competent psychotherapist operates. Firstly, a participant-observational frame is defined as the manner in which the psychoanalyst interacts with and listens to the patient and the capacity of the psychoanalyst to explore, elaborate and reflect on the patient’s material. Secondly, the conceptual frame involves the psychoanalyst being able to identify the transference and countertransference, to identify and conceptualise the development of the analytic process that resonates with the patient. These conceptual tasks draw from the psychoanalyst’s capacity to think about the latent meaning of the material that the patient brings to sessions and to in a sense,

30 slot the clinical material into a theoretical model that enhances the analytic work. Here, the analyst’s conceptual ability involves the ability to create meaningful links between

psychoanalytic ideas and clinical material to bring about greater understanding of the therapeutic process of patients to bring about transformation. Thirdly, the interventional frame outlines the technical interventions that the psychoanalyst formulates and employs within psychotherapy and also the psychoanalyst’s ability to apply interventions taking into account the patient’s needs and doing so with appropriate timing. Sarnat (2010) highlights therapeutic relationship skills, self- reflection, assessment and diagnosis, and intervention as central competencies of psychodynamic psychotherapists.

Newman (2013) outlines core competencies that CBT psychotherapists need to demonstrate within the broader generic cube model of competency (Sperry, 2010). Firstly, conceptual foundations of CBT need to be taken hold of by the psychotherapist to be utilised as a road map to understand client functioning and dysfunction (e.g., negative automatic thoughts) and to direct the process of CBT. Secondly, relationship building and maintenance is prioritised by the CBT psychotherapist by establishing a positive and collaborative alliance as well as paying attention to ruptures in the working alliance with clients. Westbrook, Kennerley, and Kirk (2007) emphasise that the CBT psychotherapist walks alongside the client as a guide, educator and practical scientist in providing the client with a model to address problems. Thirdly, intervention planning involves initially assessment procedures of current problems and then constructing a case conceptualisation or formulation that explains a client’s problems, how the problems may have developed and possible maintaining processes of the problems (Westbrook et al., 2007). Fourthly, intervention implementation, involves utilising the Socratic method of questioning, identifying cognitive biases, participating in role play and modifying core beliefs and schemata, as well as participating in behavioural or physical experiments, for example breathing exercises with clients (Westbrook et al., 2007). Fifthly, intervention evaluation and termination involves ongoing measurement of progress in psychotherapy, for example, frequency counts, self-ratings, diaries, questionnaires. Relapse management is also a key task of the CBT psychotherapist (Westbrook et al., 2007). Lastly, CBT psychotherapists prioritise practicising with a culturally and ethically sensitive lens (Newman, 2013).

Another example of competencies being explicated comes from the perspective of training family psychotherapists in the USA. Kaslow et al. (2005) have identified core

31 competencies that need to be harnessed in family psychotherapy trainees. In relation to

psychotherapy competencies, firstly, family psychotherapist trainees need to become well-versed in systemic epistemology to effectively apply knowledge to practice. Secondly, trainees are taught intervention strategies that address “functional and dysfunctional relationships and processes within couples and families; how these processes impact the adjustment of constituent members; and the complex interplay between interventions, psychological disorders, and health problems” (Kaslow et al., 2005, p. 340). Competencies in family psychotherapy is a central aim of South African psychologists who are trained in a systemic theoretical orientation in relation to psychotherapy.