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Does therapists' competence matter in delivering psychological therapy?

  • Kate Davidson (a1) and Jan Scott (a2)
Summary

Therapists differ in their effectiveness in the delivery of psychological therapy. Can trainees who are exposed to similar training in psychological therapy achieve the same standard of competence regardless of professional background? This is a timely question given the planned expansion of psychological therapists to treat common mental disorders in England and Wales and the Scottish initiative to increase access to psychological therapies.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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American Psychiatric Association (1995) Task force on promotion and dissemination of empirically supported therapies. The Clinical Psychologist, 48, 323.
Angrist, J. D., Imbens, G.W. & Rubin, D. B. (1996) Identification of causal effects using 436 instrumental variables. Journal of the American Statistical Association, 91, 444472.
Beutler, L. (2007) The therapist as a neglected variable in psychotherapy: an illustration by reference to the role of therapist experience and training. Clinical Psychology: Science & Practice, 4, 4452.
Crits-Christoph, P., Baranackie, K., Kurcias, J. S., et al (1991) Meta-analysis of therapist effects in psychotherapy outcome studies. Psychotherapy Research, 1, 8191.
Davidson, K., Scott, J., Schmidt, U., et al (2004) Therapist competence and clinical outcome in the prevention of parasuicide by manual assisted cognitive behaviour therapy trial: the POPMACT study. Psychological Medicine, 34, 855863.
Department of Health (2008) Improving Access to Psychological Therapies Implementation Plan: National Guidelines for Regional Delivery. Department of Health.
Dunn, G. & Bentall, R. (2007) Modelling treatment-effect heterogeneity inrandomised controlled trials of complex interventions (psychological treatments). Statistics in Medicine, 26, 47194745.
Keisler, D. (1996) Some myths of psychotherapy research and the search for a paradigm. Psychological Bulletin, 65, 110136.
Lafferty, P., Beuder, L. & Crago, M. (1989) Differences betweenmore and less effective psychotherapists: a study of selected therapist variables. Journal of Consulting and Clinical Psychology, 57, 7680.
Mannix, K., Blackburn, I., Garland, A., et al (2006) Effectiveness of brief trainingin CBT techniques for palliative care practitioners. Journal of Palliative Medicine, 20, 579584.
Martin, D., Garske, J. & Davis, M. (2000) Relation of the therapeutic alliance to outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438450.
NHS Education Scotland (2007) Increasing the Availability of Evidence-Based Psychological Therapies in Scotland. NES.
Roth, A. D. & Pilling, S. (2008) Use of evidence based methodology to identify the competencies required to deliver effective cognitive and behavioural therapy for depression and anxiety disorders. Behavioural and Cognitive Psychotherapy, 36, 129147.
Scott, J. & Colom, F. (2008) Psychotherapy for bipolar disorders: gaps and limitations. Psychotherapy and Psychosomatics, 77, 411.
Scottish Executive (2006) Delivering for Mental Health. Scottish Executive (http://www.scotland.gov.uk/Resource/Doc/157157/0042281.pdf).
Stiles, W. & Shapiro, D. (1994) Disabuse of the drug metaphor: psychotherapy process-outcome correlations. Journal of Consulting and Clinical Psychology, 62, 942948.
Trepka, C., Rees, A., Shapiro, D., et al (2004) Therapist competence and outcome of cognitive therapy for depression. Cognitive Therapy and Research, 28, 143157.
Wampould, B., Lichtenberg, J. & Waehler, C. (2002) Principles of empirically supported interventions in counselling psychology. Counselling Psychologist, 30, 197217.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Does therapists' competence matter in delivering psychological therapy?

  • Kate Davidson (a1) and Jan Scott (a2)
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eLetters

Therapists Competence - maintenance matters too

Moira A Connolly, consultant psychiatrist
12 May 2009

Therapists Competence – maintenance matters too

Davidson and Scott (2009) left us in no doubt that therapist competencies matter in the delivery of psychological therapies. As a concept there has always been a degree of “face validity” to this assertion, but it is the attention they devote to maintaining competence that is perhaps of most significance – and most concern – within psychiatry. In 2005, the psychiatric bulletin published the results of a survey of psychiatrists who had received training to diploma level at one of Scotland’s recognised CBT courses (Whitfield et al, 2005). The resultsclearly established that access to personal supervision and for some, CPD opportunities, was poor. Nevertheless, there was optimism that with the advent of job planning, Consultant Psychiatrists could spell out and negotiate for the time needed to undertake this, so as to ensure that these specific skills are not wasted. Indeed Whitfield’s concluding sentence read “planners should think carefully about how to harness and hold on to Psychiatrists with these (CBT) skills if future diversity in psychological skills training is to be assured”.

For CBT at least the assessment of the competencies required to deliver effective therapy has been aided by the publication of a self assessment tool by the BABCP (http://www.babcp.com/members-/a-self-assessment-tool-of-cbt-competences-/), in response to the 2007 Department of Health publication, “The competencies required to deliver effective cognitive behavioural therapy for people with depression and anxiety” (DOH2007), and the Royal College of Psychiatrists have outlined the competencies required for training in psychotherapy in general. Not knowing why, how or what to do is no longer an issue.

Unfortunately in 2009 Consultants face increasing pressure from employers to replace supporting professional activity time (SPA) with direct clinical care time (DCC), the assumption being that this will bringbetter value for money for the NHS. Jobs with as few as one SPA are being advertised which in our view is inadequate to allow Consultant Psychiatrists to be involved in teaching and training as well as maintain their own CPD. This would be regarded as completely unacceptable by othersinvolved in delivering psychological therapies e.g. clinical psychologists.

It seems highly likely that increased DCC time by Consultants will come at the expense of robust supervision arrangements for them and for the supervision that they can supply. This makes it likely that improved access to psychological therapies, at least as delivered by psychiatrists,will not bring with it the desired outcomes for patients. Davidson and Scott (2009) are right to be anxious about the quality of what is offered.

Moira Connolly Consultant Psychiatrist and Clinical DirectorGartnavel Royal Hospital, Glasgowemail:moira.connolly@ggc.scot.nhs.uk

Tom Brown Consultant Liaison Psychiatrist, Western Infirmary, Glasgow

Davidson K, Scott J (2009) Does therapists competence matter in delivering psychological therapy?Psychiatric Bulletin (2009), 33, 121-123.

Whitfield G, Connolly M, Davidson A et al 2006. A survey into the use of cognitive behaviour therapy (CBT) skills amongst psychiatrists in Scotland formerly trained in CBT. Psychiatric Bulletin 30: 58-60

Wolfe AD and Pilling F, DOH (2007). The Competencies Required to Deliver Effective Cognitive and Behavioural Therapy for People with Depression and with Anxiety Disorders.

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_078537
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Conflict of interest: None Declared

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