The current landscape of competences, standards, training and practice requirements within counselling and psychotherapy is a bit of a dog’s dinner. SCoPEd may or may not be the answer to that problem, but the question we’re more interested in is “Will it help me to become a better therapist?”  So far, the jury’s out

This feels a little shameful to admit, but I have a bad reaction to the term competences.

I know I shouldn’t, I know it’s wrong, but every time I hear or read the term when applied to counselling and psychotherapy, I feel the urge to lie down, take two paracetamol, and wait until it goes away. Every time I hear or read the term, I feel like a bit of my therapeutic soul dies. It’s as if the essence of what we do, the magic that occurs somewhere in the space between art and science, is being reduced to a set of competences.

This reaction has been responsible for me coming very late to the SCoPEd table. I even had to look at the BACP website to make sure I had the upper and lower cases in the right order. How off the pace am I?

Come to the table, however, I feel I must. But first, indulge me while I offer a little self-analysis, which you’re welcome to read, or otherwise skip over.

So, Barry, let’s explore this ambivalence a little further shall we?

Back in the first decade of this century I was part of the BACP’s Association for Counselling at Work Executive. I forget the precise detail, but my recollection was that BACP’s divisions were invited to map the competences that are specific to their specialist areas.

This was the first time that I recall my adverse reaction to competences. Needless to say, I didn’t put my name forward, and I’m grateful that other colleagues who were more enthusiastic did.

What exactly is my problem? At its heart, I think it’s my inability to get past the belief that a competence framework won’t make me a better therapist. Let me qualify that a little. I’ve never found a competence framework that feels remotely as if it might help me to become a better therapist. And that’s what I care about more than anything. Please note I speak for myself here. You are free to disagree, and also free to comment below.

What SCoPEd is, and what it isn’t

It isn’t my purpose here to diss the BACP, British Psychoanalytic Council (BPC) and the UK Council for Psychotherapy (UKCP). Neither is it my purpose to devalue the stated aims of SCoPEd, nor the Herculean effort that has so far gone into its development.

According the latest iteration of the SCoPEd framework:

The driving force behind this project is to find a shared way of representing the therapeutic work that counsellors and psychotherapists do – which we know profoundly changes peoples’ lives. The current landscape is rich in different traditions and associated titles, but it can also be confusing for employers, commissioners, clients, patients and trainees.

Confusing for employers, commissioners, clients, patients, and trainees. That is putting it mildly. I don’t think it would be unreasonable to describe the current landscape of competences, standards, training and practice requirements within counselling and psychotherapy as an absolute dog’s dinner.

It was bad enough when I was in the business of recruiting counsellors at the Royal College of Nursing in the mid-90’s. It’s surely got worse.

Now, I can pay £29 for an online counselling diploma course and call myself a psychotherapist.

Many have and many more surely will, until such time as counselling and psychotherapy are regulated professions. That’s a day, by the way, I hope never to see.

So, I have a lot of sympathy with the driving force behind SCoPEd. Maintaining the status quo is becoming increasingly untenable. To an external stakeholder, it must appear a bewildering picture.

I’m therefore open to an argument that a framework is needed that will put the professions, in the words of the framework’s latest iteration:

…..in a stronger position to talk to external stakeholders about opportunities for all our members.

The framework also states the confidence of the collaborating bodies in the “…potential for this framework…… to maximise paid employment opportunities for members.”

I’ve been around long enough to have seen the damage done to counselling and psychotherapy by the advent of IAPT. Our apparent fragmentation and lack of a credible evidence base have not served us well in that process. We’re still paying the price and I don’t want us ever to be in that position again.

Is SCoPEd the answer? I think it’s still too early to say. It is a work in progress, but what’s clear from social and professional media channels is that there are very many who remain to be persuaded. But, and for me it’s a big but, however well SCoPEd achieves its aims I can’t help feeling it’s never going to help me be a better therapist.

An opportunity missed?

The SCoPEd framework has been informed by a vast exercise of mapping the existing competence frameworks, professional standards, and practice standards across the partnership bodies, augmented by extensive consultation with members. One of my key concerns, however, is that I don’t seem to see this fully reflected in the structure of the framework.

What I see instead is this. Every item under the five themes of the framework: Professional Framework; Assessment; Relationship; Knowledge and Skills and Self-awareness and Reflection, appears to be framed as a competence.

I

Ability to provide and maintain a secure framework for clients or patients, in terms of meeting arrangements and the therapy setting

I

Ability to assess client or patient suitability for online therapy

I

Ability to critically reflect upon the client’s or patient’s process within the therapeutic relationship

I

Ability to understand the use of audit and evaluation tools to review own counselling work

I

Ability to monitor and evaluate fitness to practise, and maintain personal, psychological and physical health

A competence is not the same as a practice standard.  A competence states what we should be able to do. A practice standard, surely, states what we will do?  Compare the following:

  A: Ability to utilise audit and evaluation methodologies to contribute to improving the process and outcomes of therapy (Theme 4: Knowledge and Skills; Column C)

  B: Therapists will routinely assess with each client their level of engagement with therapy, as well as evaluate the degree of impact it has for the client

Having avoided competences successfully for most of my adult life I don’t profess to be an expert in these matters, but A above would seem to me to be a competence, and B a practice standard.

Travelling in hope

The SCoPEd process has a long way yet to go. Finalised, it may yet succeed in its aim of putting the partnership in a stronger position to advocate for its members and maximise paid employment opportunities. If it does I hope that it can achieve that without too much collateral damage.

I live in the hope, though not necessarily the expectation, that the next iteration of the framework might go beyond competences into the realm of solid practice standards. Ones that will help me to be a better therapist. Ones that require me to draw upon the evidence of what works. Ones that require me to benchmark my impact with clients. I’ve offered an example of one above, but there are plenty more where that came from.

We know what works in therapy. Isn’t it time we started to incorporate that knowledge not only into competences, but also standards for the way we practice?

Until that happy day, I’ll keep on lying down and taking the tablets……

 

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Posted by:Barry McInnes

4 replies on “Will SCopEd make me a better therapist?

  1. I’m waiting for the day when, under a state-funded system, clients can authentically choose their helper, whether or not the helper is on some sort of state-sanctioned list, or is or is not part of some voluntary-to-join professional association.

    If a client is being presented with a pre-determined list of who the State deem as “qualified” people being helpful, then its not a true free will choice as to who a client may like to enlist as their helper, is it?

    I have no trouble offending our local professional associations, having publically labelled our biggest professional association in New Zealand (The NZ Association of Counsellors), a “corporate cult”.

    I have built a private practice from scratch, without any state funding or referrals, relying on 100% word of mouth referral, and I publish my Practice summary outcome results in the public domain, including my failure percentage.

    I have been formally measuring my client outcome results since 2010 (FIT Outcomes Programme), and have been in private practice since 2002.

    I simply don’t care about who or what defines “best practice”, “competencies”, “ethics” – it’s all arbitrary self-important hubris, most often (in my experience) exercised by people who weren’t very successful themselves in attracting and retaining clients, and who couldn’t secure meaningful outcomes for these clients, which then leads to positive word of mouth referral, resulting in positive referral critical mass.

    My stock standard reply to these people when they wax lyrical about “competency” is “let’s compare our respective client practice outcomes”.

    Not one of them has ever taken me up on this offer, and I have been putting it out there for over 10 years now.

    1. Thanks for your comments Stephen. The prospect of making outcome data visible is pretty terrifying for some of us, I think. There’s nowhere to really hide, is there? I wonder if that’s part of the reason that attacks on outcome measurement can be so vociferous. I wonder if you or others have any thoughts about the inclusion of measure data for people who aren’t necessarily looking for something that we might describe as reduction of distress or symptoms. People who maybe aren’t going to fall into the usual category of ‘clinical’?
      Cheers! Barry

  2. Hi Barry,

    Yes, if you look at the RML Practice website, you will see that the Practice also offers Career Counselling and a service I have created called Employer Workplace Assistance (EWA). EWA, as opposed to EAP, focuses on the needs of the employer, as opposed to the employee, and I do a lot of work in this space with SME owner-operator businesses. These are services that I would nominate as being outside what we may interpret as “classical” clinical stressors that may present in a more formal counselling setting.

    I capture the same outcome data with these client groups.

    Yes, I have observed the vociferous attacks on ROM, but again, I have found these attacks to be easily deflated by my now-stock-standard request i.e. “let’s compare our respective client outcomes”. The answer I invariably get in reply is “we don’t keep any”, or “they are commercially sensitive”, or “”it’s a privacy issue”.

    I call “bullshit” on all of these cowering responses.

    If a ROM outcome critic doesn’t keep any outcome data,. then they shouldn’t bring a knife to a gunfight by having a go at me for keeping outcome data, and having this data inform my ability to become a better therapist;

    Commercially sensitive to who? More like “If our funders saw how poorly we were performing in terms of client outcomes, they would stop funding us”, which, to my mind, would be a very good thing indeed. Give the money to those who can secure good outcomes – we must be one of the few industries in the world that flee from the prospect of being commercially competitive.

    Privacy is not breached if agency clients authorise collapsed and anonymised data to be collected, analyzed and shared in the public domain – it’s called a blanket consent.

    1. Steve, I love your unapologetic stance on this.
      I used to work for CORE IMS, which is the support organisation for the CORE System (similarish to FIT). I spent five years schlepping around the country gentling practitioners into measurement. I’m so glad I can work with a coalition of the more willing these days!
      Why not come over and join our TMN facebook group? Would love to have you there! https://www.facebook.com/groups/therapymeetsnumbersgroup

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