Literature Review
Preamble
The literature review was conducted by the Working Group in 2010 & 2011 with the aim of identifying the best available evidence related to the assessment of professional competencies in the psychological professions. Recommendations from this review and work done in similar circumstances by different organizations assisted us in forming the various principles and guidelines that supported us in the development of the generic or ‘core’ professional competencies of a European psychotherapist. Our main purpose was to concentrate on developing the Core Competencies – those that a common to all psychotherapists.
Languages
Given the difficulties and costs of translation, as well as a limited budget, at tis point in time only English-language documents could be consulted. Psychotherapists and people from universities (with psychotherapy training courses) in other European countries have been consulted, asked for their opinions, and also asked for any contributions to the Literature Review. The list of these contributions is still in the process of being developed. We hope to include relevant literature from non-English languages soon.
Core Competencies
We believe we have consulted widely enough to develop a reasonable set of Core Competencies. The documents in the current Literature Review can now be downloaded. To have a look at the extensive 'Literature Review' that we have been consulting (to date: July 2011), please click here (to download as a PDF file), or here (to see as an .htm file).
Specific Competencies
It should be noted that, above and beyond these Core Competencies, there are sets of professional competencies that are ‘specific’ to the various different mainstreams and modalities within psychotherapy, or that are ‘specific’ to the demands of a particular European country. These Specific Competencies will be developed differently – by direct input from the relevant European Wide Accrediting Organisations (EWAO) for the different mainstreams and modalities of psychotherapy, and from the different National Awarding Organisations or National Umbrella Organisations (NAO / NUO) for the different European countries; these form the basis of the European Association of Psychotherapy (EAP). In developing these Specific Competencies, they should perform their own literature review and build the Specific Competencies on the back of, and in the same format as, the Core Competencies.
Specialist Competencies
There is also a different additional set of ‘specialist’ competencies for working with ‘specialist’ client groups (like children & adolescents; refugees; people in prison; etc.) and also for ‘specialist’ functions (like psychotherapy training &/or supervision). Special sub-groups, comprising of people working in these specialist areas, would then develop these Specialist Competencies. In developing these Specialist Competencies, they should perform their own literature review and build the Specialist Competencies on the back of, and in the same format as, the Core Competencies.
Purpose
All these professional competencies are designed: (a) to inform the public, the politicians and the psychotherapeutic professions as to what constitutes the profession of a European psychotherapist; (b) to help establish an independent profession of psychotherapy in Europe; and (c) to lead – in due course – towards informing psychotherapy training curricula and establishing the basis of any final assessments of psychotherapy training within in all the EAP’s European Accredited Psychotherapy Training Institutes (EAPTI).
LITERATURE REVIEW
The whole review includes about 165 documents, papers and articles, published mostly since 2000. These come from a number of different sources, all seeming to have very different perspectives and also all seeming to purport to be up-to-date, definitive and quite authoritative. They have been divided into different categories, according to their declared functions. To have a look at these documents, please click here (to download as a PDF file), or here (to see as an .htm file).
European Union
Several papers came from the European Union (EU) and official bodies within the EU. These EU documents include the basic European Professional Qualifications Directives (89/48/EEC, 92/51/EEC) and the later Directive 2005/36/EC on the Recognition of Professional Qualifications. The various documents consulted are listed in the first section of the attached Appendix. Their purpose is essentially very broad, definitive and political.
One of the relevant political ‘bodies’ for European professions (like psychotherapy) is the European Council of the Liberal Professions (CEPLIS), within whose remit psychotherapy (as a profession) would be situated: "The services sector is the largest sector of the European economy. The main objective of the Commission proposal for a Directive on Services in the Internal Market is to remove legal barriers to the freedom of establishment for service providers and the free movement of services between Member States." (CEPLIS Position (COM(2004)2 final: p. 1)
As noted elsewhere, after the initial Sectoral Directives for certain key professions had been established, the General System of Recognition of Professional Qualifications was introduced. These EU & CEPLIS documents thus inform the general ‘political background’ for the free movement of professionals between countries within the EU and for the establishment of professional qualifications within a profession.
Books
Of great interest, were the 2 very well-written and -researched books by Len Sperry (Sperry, 2010a; 2010b) that cover the professional and academic background to this topic – though from a particularly American perspective. Kenkel & Peterson’s and Rodolfa’s books were also of interest as being more European, but they also dealt with “Professional Psychology” and whilst we recognize that professional (clinical) psychologists practice psychotherapy, sometimes – as is mentioned elsewhere – they don’t recognize that the independent professional psychotherapists should be able to do.
Journal Articles
There were about 30 English-language published journal articles (from peer-reviewed journals), mostly from the UK & USA, that presented a number of different perspectives about the use and formation of professional competencies in the various professions of psychology, psychiatry, psychotherapy and in some other related fields. Again, these formed a very useful background the application of professional competencies to this particular field and helped to legitimize the project within the wider profession.
UK & USA Professional Bodies
These were increasingly relevant and helpful, especially the two UKCP documents. The UKCP is one of the National Awarding Organisations within the EAP and is involved in high-level negotiations with the UK Ministry of Health and the Health Professions Council about the statutory registration of UK psychotherapists.
UK Department of Health (DoH)
There were 32 documents considered from the UK Department of Health covering the 4 main types of psychotherapy: 6 documents (totaling 172 pages) for Cognitive Behavioural Therapy; 7 documents (totaling 71 pages) for Humanistic Psychotherapy; 6 documents (totaling 79 pages) for Psychodynamic Psychotherapy; 7 documents (totaling 107 pages) for Systemic Psychotherapy; and 6 documents (totaling 78 pages) on Supervision. These are all available on-line. These documents were more useful as they begin to address the concept of specific competencies within the field of psychotherapy. However, the documents from the various branches of psychotherapy are not very consistent with each other, and the language used is also not very specific. So, whilst they helped to define the field, they were not of great help to the project, especially as it related more to the whole of Europe and also to all methods of psychotherapy, rather than just the 4 widely-accepted mainstreams.
UK 'Skills for Health' Psychological Therapies: National Occupational Standards (NOS)
Of greater interest, was the mass of detailed documentation – 50 documents in total – that set the ‘National Occupational Standards’ (NOS), again for the 4 main psychotherapies: Psychodynamic Therapies (14 documents & 65 pages); Cognitive Behavioural Therapy (11 documents & 51 pages); Humanistic Therapies (13 documents & 61 pages); and Systemic Therapies (14 documents & 108 pages); but going into much greater detail. There is a 19-page digest (or introduction). These NOS are supposedly setting the minimum acceptable standards for these professions: National Occupational Standards, known as NOS, describe what is expected of someone working in their occupation. They divide work into functions that are distinct enough to be talked about, reviewed or appraised separately. Each NOS has:
1. A title, defining the function the NOS covers
2. An overview, summarising the NOS and showing to whom it is relevant
3. Knowledge and understanding, that the individual needs to know and/or understand to enable them to meet the performance criteria for this function
4. Performance criteria, distinguishing performance that is good enough from that which is not.
It usually takes a number of NOS to set out the demands of a role or a profession. NOS are ‘national’ when there has been sufficient involvement and agreement among practitioners and other stakeholders across the four countries of the UK to establish credibility and validity. (Digest: p. 4) Whilst these were very informative, it was clear that they had largely been written independently of each other, but according to an imposed format. There was therefore no real attempt to define the ‘Core Competencies’, which would have meant much greater collaboration between the representatives of the various (psycho)therapies. There is also the rather confusing substitution of the word ‘Therapies’ instead of ‘Psychotherapies’. There is also a 225-page set of NOS competencies for Mental Health therapists (a euphemism for counsellors).
British Psychological Society: Functional Competencies of Clinical Psychology
We also consulted the Functional (Professional) Competencies of the British Psychological Society (BPS) for Clinical Psychologists – who also do psychotherapy – mainly within the UK National Health Service, and often mainly based on CBT. There were 7 documents (totaling 304 pages). These can be downloaded from the BPS website. Again, because of the closeness of the practice of Clinical Psychology and Psychotherapy, they were certainly useful, but again they were written from a fairly closed perspective within the profession and there was an unconscious CBT-focus.
UK National Health Service
Within the inter-departmental UK National Health Service material, there was an interesting 15-page document that compares the Job Profiles of Counsellors, Psychologists and Psychotherapists (even though – interestingly – a Psychotherapist is assumed to be the equivalent of a Clinical Psychologist). The different job descriptions, described using different levels of competencies, identify the different grades, which determine the different salary scales. There was also a 71-page Handbook that explains the process of Job Evaluation.
Counselling Competencies
The British Association of Counselling and Psychotherapy (BACP) commissioned a 116-page competency survey from ENTO, which was developed into the National Occupational Standards for Counselling. The European Association for Counselling (EAC) has just 18 Core (or general) Competencies (here).
Coaching Competencies
The International Coaching Federation (ICF) developed some professional coaching core competencies, which were also consulted.
Miscellaneous
In addition, there were 8 other documents considered: one concerning the AP(E)L Accreditation of Prior (Experiential) Learning; one Dictionary about Competencies; 2 from the European Association of Transactional Analysis (EATA), giving the Functional Competencies of Transactional Analysis; an article from Martin Seligman on the Effectiveness of Psychotherapy; one from another profession, listing the core competencies from the International Federation of Biomedical Laboratory Science; and a 21-page document about ‘Developing pan-European competency based professional standards and accreditation framework for health professionals.
Summary
Whilst a range of competence indicators and assessment tools were identified from a variety of these documents, only a few of the Journal articles included in the current review described approaches that ensure validity and reliability of competence assessment tools with any degree of rigour, mirroring findings reported elsewhere.
The majority of studies – especially the NOS documents – were informative, and some parts were exceptionally useful. But, given the initial separation into the 4 mainstreams, there was an absence of a really solid set of 'Core Competencies' on which to build a set of professional competencies.
The other studies were more descriptive in nature, reporting predominantly qualitative findings or subjective opinions, from the point of view of the particular branch of the mental health profession.
Other limitations included small sample sizes, single centres or time-points and voluntary participation. Regardless of these limitations, the actual competencies provided some useful insights into approaches for competence assessment. The recommendations listed in this report represent the views and experience of the authors in the working party, informed by this literature review.
The findings informed by the literature review should also be considered in the context of ongoing debates about the definition of competence and competency standards within the mental health professions. In broad terms, competency standards recommend expected levels of knowledge, attitudes, skills and behaviours. Competencies for professional psychotherapy should reflect the multi-faceted nature of the professional practice, the broad range of practice settings, and the cultural differences within Europe.