Learner
therapist (16)……What’s a good enough therapist
Torrey Orton
August 3, 2014
I
set myself the goal for my CPD tasks two years ago to design a generic
therapist competences framework. This is the first cut. It begins with the name
– the good enough therapist – which intentionally borrows from Donald Winnicott’s ‘good enough mother’. We could do with a
bit more good enough these days, and maybe I was thinking the same for
therapists. My objective is to use this framework as a template for
self-assessment, with elements of professional assessment added as possible –
that is, as I can succeed in finding colleagues who are prepared to judge.
I
have enquired around the formal psych fraternity – especially the APS and some of
its associated colleges – to find so far that no one has a generic, or a
context-specific, competence framework for therapists, even the CBT squad. So
there is no agreed framework for evaluating anyone’s performance, apart from
the “clinical psychologist” qualification standard of CBT masters and similar.
Anyone with a slight degree of program evaluation experience knows that quals
are only the starting place. It is therapeutic processes and outcomes that
count for patients.
Here
are some competences, knowledge and skills: no special order. I am seeking all
and any suggested additions to the following first. Then, I’ll entertain
alteration or deletion suggestions to the items listed.
1) Intercultural
communication, which includes knowledge of relevant cultural differences
affecting application of preferred treatment(s) and the capacity to negotiate
the treatment process. The key test of this competence is the capacity to
understand and accept that the suite of assumptions and practices which
constitutes Anglo psychotherapy will not be wholly shared by cultures
like Chinese, fundamentalist religious practitioners (Jewish, Christian,
Moslem, Hindu….), etc. In the end this competence would be exhibited by not
working with some cultures rather than assuming one can work with all which one
doesn’t know enough to know they are immutably different from one’s own.
2) In
vivo, person to person negotiation of the therapeutic process, including review
/ evaluate each session with patients, without shielding oneself by a
diagnostic stance presuming the therapist knows best. A test for this
competence might be the holding of a patient who experiences themselves as
sometimes ‘crazy’ or out of control and demonstrates that self-perception in
the room.
3) Knowledge
of a full range of therapeutic approaches, techniques and work styles,
including how these approaches integrate with each other at different times in
the therapeutic engagement. E.g. – CBT, IPT, dynamic therapies, behavioural
therapies, ACT, Mindfulness, etc.
4) Experience
being in therapy oneself, not just supervision, so the more permeable
boundaries of one’s self are in view and acknowledged as such – as being in
flux – and how affecting that flux is of one’s availability to patients under
various personal circumstances and conditions.
5) A
theory of the self which is holistic, embracing at least the
biopsychosociocultural paradigm’s domains, with awareness of the spiritual and
economic.
6) A
theory of life span learning stages and the processes through which they are
experienced by people, including micro learning processes and their integration
into life span learning.
7) A
human needs construct like:
Elements
of well-being (basic human needs)
*From:
The Treatment of Sex Offenders: Risk Management and Good Lives.
Tony Ward, University of Melbourne, Claire A
Stewart, Deakin University, 2005
Without specified needs
we cannot decide how we are doing and what trade-offs are required to improve
well-being. One approach to defining basic needs is this:
Needs
|
Wants specifications
of needs
|
|
1) Life (including healthy
living and functioning)
|
Adequate sleep, food,
exercise
|
|
2) Knowledge
|
Knowing that…Knowing
how to….knowing why…etc.
|
|
3) Excellence in play and work (including mastery
experiences)
|
Play an instrument, a sport; Practice a profession, trade, art,
hobby…
|
|
4) Excellence in agency (i.e., autonomy and
self-directedness)
|
Cooperative activities; enlisting others in our activities
|
|
5) Inner peace (i.e., freedom from emotional turmoil and
stress)
|
Meditation, martial arts,
|
|
6) Friendship (including intimate,
romantic and family relationships)
|
Appropriate care,
affection, connectedness….
|
|
7) Community
|
Authentic membership,
identification, …
|
|
8) Spirituality (in the
broad sense of finding meaning & purpose in life)
|
Relevant belief,
imagery, contemplation….
|
|
9) Happiness
|
In my view this is not a need; it is one outcome of well-being
|
|
10) Creativity
|
Opportunities to
invent at whatever level or domain of life activity (also a doubtful need)
|
8) Understanding
of social systems and the individual’s place in them, especially family
systems, workplace systems and social systems generally.
9) Capability
in leading patients through actual or virtual reconciliation cycles, including
creating and sustaining the power to be heard within those systems.
10) Ability to hold and contain intense feelings,
with a view to building patient authenticity and authority about those
feelings. Confronting high risk subjects: suicide, violence to others or self,
crime, abuse and how to contain an emotional outburst of any kind.
11) Ability to recognise and admit own mistakes appropriately
as they happen…..be a continuing learner with specific development aims and
goals.
12) Understand what makes research good enough and
what important emerging evidence-based research shows about good enough
psychological processes. Neuropsychology presents as a must appreciate emerging
field.
13) Capacity to make good enough judgments in the
room about:
Talking about possible
need for medication
Knowing where patients
are at, or up to
Managing exposure therapy
at the right pace / depth
How far to pursue a
patient who is loosely engaged in therapy
Appropriate
self-disclosure
Quantity of therapist
input required
Boundaries of contact:
in the room only?
14) Having
workable definitions of the main therapeutic entities: person, couple, family….
15) Knowing
at least one therapeutic paradigm in depth and a number of others to level of
workable confidence
16) Supervision
- peer and professional; one-to-one and group.
17) Knowing
when to refer and being free to do so
18) Having
a collegial support network
19) Having
had an ordeal to prove you’ve got the commitment to do therapy; mastery of
personal suffering and success
20) Wider
life experience: jobs, vocations, volunteer work, etc.
21) Having
a workable theory of contemporary life: it’s challenges, rewards, distortions
and distractions
