Prof Tony Roth (and Prof Stephen Pilling)

1. Developing competence frameworks for working with people with: psychosis and bipolar disorder personality disorder Prof Tony Roth (and Prof Stephen Pilling)

2. Some principles

3. 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

4. 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”

5. 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NICE and SIGN) • oversight by an Expert Reference Group • locate the manuals used in these trials (both published and unpublished)

6. 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

7. Structure of competence maps underpinning generic skills common to all approaches ‘packages’ of interventions with evidence of efficacy meta-competences specific skills needed to apply the therapy

8. How frameworks guide a specific intervention • engagement and assessment • formulation and planning • carrying out the intervention • completing the 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:

9. Supervision and training: a critical element • CBT psychodynamic • systemic humanistic • 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:

10. Framework for people with psychosis and bipolar disorder

11. Expert Reference Group Katie Ashcroft Alison Brabban Frank Burbach Prof Tom Craig Grainne Faden Prof Philippa Garety Prof Andrew Gumley Andrew Harrison Elizabeth Holford Ian Hulatt Suzanne Jolley Steve Jones David Kingdon Prof Elizabeth Kuipers Thomas Meyer Prof Anthony Morrison Emmanuelle Peters Prof Jan Scott Craig Steele Prof Graham Turpin

12. Core competences knowledge of presenting issues ethical & legal issues professional issues (work with difference working with and within organisations) working with families/ carers knowledge of pharmacology knowledge of physical health problems

13. Core competences Therapist stance and values knowledge of presenting issues ethical & legal issues professional issues (work with difference working with and within organisations) working with families/ carers knowledge of pharmacology knowledge of physical health problems

14. Therapeutic stance, therapist values and therapist style • committed to collaboration and choice • committed to drawing on client and carer strengths • committed to understanding client’s experience from a psychological perspective Therapist stance, e.g.:

15. Therapeutic stance, therapist values and therapist style • 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 Therapist values, e.g.:

16. Therapeutic stance, therapist values and therapist style • open, responsive and transparent • focused on maintaining mutual respect between client and therapist Therapist style, e.g.:

17. Therapist stance and values Core competences Generic therapy skills ethical & legal issues basic therapy skills and knowledge professional issues (work with difference working with and within organisations) engagement assessment alliance building managing emotional content working with families/ carers knowledge of pharmacology knowledge of physical health problems

18. Therapist stance and values Core competences generic therapy skills Assessment & formulation ethical & legal issues comprehensive assessment basic therapy skills and knowledge professional issues (work with difference working with and within organisations) assessment functioning within multiple systems engagement assessment alliance building managing emotional content risk assessment working with families/ carers develop formulation and intervention plan knowledge of pharmacology f/back assessment and agree plan knowledge of physical health problems co-ordinate casework

19. Therapist stance and values Core competences generic therapy skills Assessment & formulation Specific interventions ethical & legal issues c’prehensive assessment Bipolar disorder basic therapy skills and knowledge professional issues (work with difference working with and within organisations) assessment functioning in multiple systems CBTfor BD Family Interventions IPT/ Social Rhythm Therapy risk assessment engagement assessment alliance building managing emotional content Psychoed/ relapse prevention working with families/ carers develop formulation & intervention plan psychosis knowledge of pharmacology CBT for psychosis f/back assessment knowledge of physical health problems Family Interventions co-ordinate casework

20. Therapist stance and values Core competences generic therapy skills Assessment & formulation Specific interventions ethical & legal issues c’prehensive assessment basic therapy skills and knowledge professional issues (work with difference working with and within organisations) Co-existing issues (depression, anxiety, substance misuse, personality disorder, trauma, learning disability, autistic spectrum disorder) assessment functioning in multiple systems Bipolar Disorder risk assessment engagement assessment alliance building managing emotional content working with families/ carers develop formulation & intervention plan psychosis knowledge of pharmacology f/back assessment knowledge of physical health problems co-ordinate casework

21. Therapist stance and values Core competences generic therapy skills Assessment & formulation Specific interventions Meta-competences ethical & legal issues c’prehensive assessment basic therapy skills and knowledge professional issues (work with difference working with and within organisations) assessment functioning in multiple systems Bipolar Disorder co-existing issues psychosis risk assessment engagement assessment alliance building managing emotional content working with families/ carers develop formulation & intervention plan knowledge of pharmacology f/back assessment knowledge of physical health problems co-ordinate casework

22. Framework for individuals with personality disorder

23. 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

24. Therapist stance and values Core competences generic therapy skills Assessment & formulation General clinical care ethical & legal issues c’prehensive assessment Generic structured clinical care basic therapy skills and knowledge professional issues (work with difference working with and within organisations) assessment functioning in multiple systems Psychoeducation and problem solving (PEPS and STEPPS) risk assessment engagement assessment alliance building managing emotional content working with families/ carers develop formulation & intervention plan Consulting to individuals and teams regarding individuals with PD knowledge of pharmacology f/back assessment knowledge of physical health problems co-ordinate casework

25. Therapist stance and values Core competences generic therapy skills Assessment & formulation Generic Clinical Care Specific Psychological therapies ethical & legal issues c’prehensive assessment CBT for PD basic therapy skills and knowledge professional issues (work with difference working with and within organisations) assessment functioning in multiple systems Schema-focused CBT for PD Mentalisation-Based Therapy risk assessment engagement assessment alliance building managing emotional content working with families/ carers develop formulation & intervention plan Transference–Focused Psychotherapy knowledge of pharmacology f/back assessment Interpersonal Group Psychotherapy knowledge of physical health problems co-ordinate casework Cognitive Analytic Therapy

26. Therapist stance and values Core competences generic therapy skills Assessment & formulation Generic Clinical Care Specific Psychological therapies ethical & legal issues c’prehensive assessment co-existing issues (depression, anxiety, substance misuse, personality disorder, trauma, learning disability, psychosis, other personality disorders CBT for PD basic therapy skills and knowledge professional issues (work with difference working with and within organisations) assessment functioning in multiple systems Schema-focused CBT for PD Mentalisation-Based Therapy risk assessment engagement assessment alliance building managing emotional content Transference–Focused Psychotherapy working with families/ carers develop formulation & intervention plan knowledge of pharmacology Interpersonal Group Psychotherapy f/back assessment knowledge of physical health problems Cognitive Analytic Therapy co-ordinate casework

27. Therapist stance and values Core competences generic therapy skills Assessment & formulation Generic Clinical Care Specific Psychological therapies Meta-competences ethical & legal issues c’prehensive assessment CBT for PD basic therapy skills and knowledge professional issues (work with difference working with and within organisations) assessment functioning in multiple systems Schema-focused CBT for PD Mentalisation-Based Therapy co-existing issues risk assessment engagement assessment alliance building managing emotional content Transference–Focused Psychotherapy working with families/ carers develop formulation & intervention plan knowledge of pharmacology Interpersonal Group Psychotherapy f/back assessment knowledge of physical health problems Cognitive Analytic Therapy co-ordinate casework

28. Using the framework map of competences represents: • a curriculum for developing training programmes • a benchmark for current trainings • a procedure for identifying competent practice • an agenda for supervision

29. 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

30. all materials can be downloaded fromwww.ucl.ac.uk/CORE/