Self-assessment in clinical health psychology: a model for ethical expansion of practice

Introducing the QACP: development and preliminary validation of an instrument to measure psychotherapist's core competencies

The movement towards the conceptualization, description and evaluation of psychotherapists' competencies has been widely developed in the last years and has relevant implications for psychotherapy, training, and continuous education. In Italy, this movement has been supported by the Committee for Psychotherapists' Competencies established in 2010 by FIAP (Italian Federation of Psychotherapy's Associations) and CNSP (National Association of Psychotherapy's Training Institutes) and has involved more than 1000 psychotherapists from different approaches, by means of conferences, expert meetings, workshops, and focus groups. One of the outcomes of this process has been the development of a new self-assessment tool for core competencies (i.e., those that are shared by therapists from all modalities): the QACP (Questionario per l'Autovalutazione delle Competenze dello Psicoterapeuta). The present study aims to present the process of development and the preliminary proofs of the validity of this tool. Construct and knowngroup validity of the questionnaire were examined, and reliability was estimated by computing the internal consistency reliability coefficients for both the overall and the subscale scores. Overall, the instrument showed satisfactory psychometric characteristics. The limitations of the study and the results are discussed and directions for further research are proposed.

Recommendations for training in pediatric psychology: defining core competencies across training levels

OBJECTIVE

As a field, pediatric psychology has focused considerable efforts on the education and training of students and practitioners. Alongside a broader movement toward competency attainment in professional psychology and within the health professions, the Society of Pediatric Psychology commissioned a Task Force to establish core competencies in pediatric psychology and address the need for contemporary training recommendations. 

METHODS

 The Task Force adapted the framework proposed by the Competency Benchmarks Work Group on preparing psychologists for health service practice and defined competencies applicable across training levels ranging from initial practicum training to entry into the professional workforce in pediatric psychology. 

RESULTS

 Competencies within 6 cluster areas, including science, professionalism, interpersonal, application, education, and systems, and 1 crosscutting cluster, crosscutting knowledge competencies in pediatric psychology, are presented in this report. 

CONCLUSIONS

 Recommendations for the use of, and the further refinement of, these suggested competencies are discussed.

On Being a Psycho-Oncologist

This special issue of TCP focuses on the psychological and psychosocial components of coping with cancer and its aftermath. Psycho-oncology, a subspecialty within professional psychology, is a multidisciplinary field emphasizing the psychological and social aspects of cancer. In this introductory article, I show the congruence between counseling psychology and psycho-oncology, indicate how counseling psychologists can expand their parameters of practice to include cancer patients and families, and explain what evidence-based resources are needed to acquire relevant background knowledge. Health care reform changes—in general and oncology-specific—are explained as they currently open new opportunities for counseling psychologists in psycho-oncology. Finally, the five articles that make up this special issue are previewed. Psycho-oncology is a challenging yet rewarding subspecialty within counseling psychology, congruent with its values and parameters of practice, and now is an opportune time to expand one’s practice to include psycho-oncology and help those coping with cancer and its aftermath.

Developing the mental health workforce: review and application of training approaches from multiple disciplines

Strategies specifically designed to facilitate the training of mental health practitioners in evidence-based practices (EBPs) have lagged behind the development of the interventions themselves. The current paper draws from an interdisciplinary literature (including medical training, adult education, and teacher training) to identify useful training and support approaches as well as important conceptual frameworks that may be applied to training in mental health. Theory and research findings are reviewed, which highlight the importance of continued consultation/support following training workshops, congruence between the training content and practitioner experience, and focus on motivational issues. In addition, six individual approaches are presented with careful attention to their empirical foundations and potential applications. Common techniques are highlighted and applications and future directions for mental health workforce training and research are discussed.

Medical and psychology students' self-assessed communication skills: A pilot study

OBJECTIVE

The purpose of this study was to describe how psychology and medical students assess their own competency and skills before and after training, in which role-play was used to teach interpersonal and communication skills.

METHOD

Interpersonal and communication skills were assessed with a semi-structured questionnaire before and after the training.

RESULTS

The students of both medicine and psychology estimated their skill levels to be higher after the course. The psychology students estimated their skills for communication, motivating interviewing, empathy and reflection, and change orientation to be better at the end of the course. Medical students estimated their communication skills, motivating interviewing skills, and change orientation skills to be better at the end of the course.

CONCLUSION

Even a short period of training in interpersonal and communication skills can positively affect the self-assessed skills of the medical students.

PRACTICE IMPLICATIONS

In the future, it would be worthwhile to pay attention to reflective teaching practices in the training of both medical and psychology students. The cognitive and emotional components of these practices help students to develop their own communication skills.

Posttraumatic stress disorder caused by the misattribution of seizure-related experiential responses

Patients with temporal lobe seizures sometimes experience what John Hughlings Jackson described as "dreamy states" during seizure onset. These phenomena may be characterized by a re-experiencing of past events, feelings of familiarity (déjà vu), and hallucinations. In previous reports, patients have been aware of the illusory nature of their experiences. Here, however, the case of a patient with a documented 37-year history of temporal lobe epilepsy who is not aware is described. Fifteen years ago, the patient saw visions of traumatic autobiographical events that he had never previously recalled. He believed them to be veridical memories from his childhood, although evidence from his family suggests that they were not. The patient's psychological reaction to the "recovery" of these traumatic "memories" was severe enough to qualify as posttraumatic stress disorder (PTSD). To our knowledge, this is the first report of PTSD caused by the misattribution of mental states that accompany a seizure.

Identifying critical competencies for psychotherapeutic practice with eating disordered clients: a Delphi study

Mental health professionals lack systematic criteria against which to assess their competence to provide psychotherapy to eating disordered clients. In this Delphi study, a multidisciplinary panel of professionals with expertise in eating disorders treatment reached a consensus on essential eating disorders psychotherapy competencies, which included both literature-derived and participant-generated items. Competency domains included specialized knowledge and skills, professional responsibility, and therapist characteristics. An empirically derived, operational definition of minimum competence in psychotherapy for eating disorders was obtained. The essential competencies have utility for practitioners, novice and experienced, who wish to assess and enhance their ethical practice in psychotherapy for eating disorders.

Changing educational needs of psychologists: do we need more medical knowledge, basic science and more psychological science?

Psychologists of the 21st century must be highly skilled and versatile to function effectively in academic health centers (AHCs). Thus, the current paper focuses on the training psychologists receive to prepare them for their diverse roles in AHCs. The paper is framed around the question: Do we need more medical knowledge, basic science and more psychological science? posed to the author by the conference organizers of the 3rd National Association of Psychologists in Academic Health Centers (APAHC) Conference and is based on the perspective of the author.

Teaching evidence-based practice: implications for psychology

A movement advocating the use of evidence-based practice (EBP) is increasingly influencing health care and the practice of psychology. Thus, teaching evidence-based practice in psychology (EBPP) is critical to the preparation of future health service psychologists. In this article, the authors address common myths associated with EBP, propose core components involved in teaching EBPP, and describe an example of how such training can be incorporated into a professional psychology education and training curriculum.

Evidence-based practice in clinical psychology: What it is, why it matters; what you need to know

The history and meaning of evidence-based practice (EBP) in the health disciplines was described to the Council of University Directors of Clinical Psychology (CUDCP) training programs. Evidence-based practice designates a process of clinical decision-making that integrates research evidence, clinical expertise, and patient preferences and characteristics. Evidence-based practice is a transdisciplinary, idiographic approach that promotes lifelong learning. Empirically supported treatments (ESTs) are an important component of EBP, but EBP cannot be reduced to ESTs. Psychologists need additional skills to act as creators, synthesizers, and consumers of research evidence, who act within their scope of clinical expertise and engage patients in shared decision-making. Training needs are identified in the areas of clinical trial methodology and reporting, systematic reviews, search strategies, measuring patient preferences, and acquisition of clinical skills to perform ESTs.

Invitation to a dialogue between researchers and clinicians about evidence-based behavioral medicine

BACKGROUND

Evidence-based behavioral medicine (EBBM) aims to improve the process through which best scientific research evidence can be obtained and translated into best clinical decisions regarding behavioral treatments to improve health.

PURPOSE

The objective was to examine some legitimate concerns raised by both clinicians and researchers about the evidence-based movement.

METHODS

This article begins with a discussion of clinicians' fears that EBBM devalues clinical judgment and the therapist-patient relationship, will be used to restrict practice, is unnecessary, and is based on research that is irrelevant to clinical decision making. Next we consider researchers' worries that EBBM neglects evidence not based on randomized controlled trials and ignores causal mechanisms.

RESULTS

We find that these fears, although understandable, largely reflect misinterpretations of the evidence-based movement. Further, it is suggested that behavioral medicine is in a unique position to enhance the evidence-based movement by encouraging increased attention to treatment mechanisms and to knowledge translation.

CONCLUSIONS

Clinicians, researchers, and, importantly, the public will benefit from the evidence-based movement by having a health care system that is built on solid grounds of evidence in determining which treatments should constitute the standard of care. A full partnership between clinicians and researchers is called for to generate the practical, rigorous evidence base needed to take behavioral health treatments to the next level of scientific support and implementation.

Training in family psychology: a competencies-based approach

After providing an overview of the family psychology landscape and the competencies-based movement in professional psychology, attention is paid to eight family-specific competencies in the following areas: the application of scientific knowledge to practice, psychological assessment, psychological intervention, consultation and interprofessional collaboration, supervision, professional development, ethics and legal issues, and individual and cultural diversity. Effective strategies for providing family-focused education and training to psychology trainees at the doctoral, internship, and postdoctoral levels and to psychologists through continuing professional education in these core competency domains are provided.

Group supervision in psychotherapy: The relationship between focus, group climate, and perceived attained skill

This study examined supervisees and supervisors' view on focus and group climate in group supervision and their relationship with supervisees' attained skill. After supervision, supervisees completed a revised version of Buckley's measure of psychotherapeutic skill. Supervisees and supervisors' experience of focus and climate in the supervision was measured with a questionnaire, Topics and Climate (TAC). The results showed that supervisors' ratings of the extent to which different foci were used in the supervision were significantly higher compared to supervisees' ratings. Hierarchical regression analysis showed that differences in supervisor style were related to supervisees' experience of attained skill. Supervisees' experience of the degree to which focus in supervision was on psychodynamic processes was positively related to perceived attained skill, whereas focus on Theoretical aspects was negatively related. These findings underline the importance of research work with topics and group processes in group supervision.

Competencies conference: future directions in education and credentialing in professional psychology

The Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology was organized around eight competency-focused work groups, as well as work groups on specialties and the assessment of competence. A diverse group of psychologists participated in this multisponsored conference. After describing the background and structure of the conference, this article reviews the common themes that surfaced across work groups, with attention paid to the identification, training, and assessment of competencies and competence. Recommendations to advance competency-based education, training, and credentialing in professional psychology are discussed. This is one of a series of articles published together in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.

Becoming a competent clinician: basic competencies in intervention

This article summarizes the results from the Intervention Work Group of the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology. The generic charge presented to the Intervention Work Group was "to address issues related to interventions." The Intervention Work Group identified four competency components of knowledge, skills, and abilities: (a). foundational competencies; (b). intervention planning; (c). intervention implementation; and (d). intervention evaluation competencies. A fifth component that included "practice management" was labeled as "others." Each component is discussed, including competencies that were deemed an essential knowledge, skill, and/or value. A discussion of training for intervention competence and assessing that intervention competence is included. Future directions for the science and practice of psychology in the intervention arena are summarized. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.

Health services and health care economics: the health psychology marketplace

In an effort toward cost containment, the health care system in the United States has undergone radical changes in the last decade. These changes have influenced the delivery of clinical health psychology services. This article reviews several economic and marketing factors salient to the clinical health psychology marketplace. For example, these economic changes have placed greater emphasis on the need for cost-effectiveness and accountability in the health psychology field. Implications for education and training, collaboration with other health care specialties, new practice initiatives, and public relations are reviewed. Future challenges and opportunities for clinical health psychology are discussed.

Defining competencies in psychology supervision: A consensus statement

Supervision is a domain of professional practice conducted by many psychologists but for which formal training and standards have been largely neglected. In this article, supervision is proposed as a core competency area in psychology for which a number of elements reflecting specific knowledge, skills, and values must be addressed to ensure adequate training and professional development of the trainee. Supra-ordinate factors of supervision viewed as permeating all aspects of professional development are proposed. These include the perspective that professional development is a lifelong, cumulative process requiring attention to diversity in all its forms, as well as legal and ethical issues, personal and professional factors, and self- and peer-assessment. A competencies framework is presented with particular elements representing knowledge (e.g., about psychotherapy, research, etc.), skills (including supervising modalities, relationship skills, etc.), values (e.g., responsibility for the clients and supervisee rests with supervisor, etc.), and meta-knowledge. Social contextual factors and issues of education and training, assessment, and future directions also are addressed, with specific elements listed. Suggestions for future work in this area are addressed, including the need to refine further and operationalize competences, develop clear expectations for accreditation and licensure regarding supervision competencies, and expand the description of developmental levels of supervisors from minimal to optimal competence. This is one of a series of articles published together in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.

Introduction to the Special Section on the Future of Health Psychology

Following 25 years of landmark progress, health psychology faces even greater change in the foreseeable future. Evolving patterns of health and illness and developments in medicine and related fields will shape the future of health psychology. The articles in this special section discuss these future issues in several areas: the biopsychosocial model, changes in demographics, prevention, clinical health psychology interventions, health care financing, and new technologies. In every case, the future holds a variety of important challenges and opportunities in research, practice, training, and policy.

General practice, primary care, and health service psychology: Concepts, competencies, and the Combined-Integrated model

The profession of psychology is being impacted profoundly by broader changes within the national system of health care, as mental and behavioral health services are being recognized as essential components of a comprehensive, preventive, and cost-efficient primary care system. To fully define and embrace this role, the discipline of professional psychology must develop a shared disciplinary identity of health service psychology and a generalized competency-based model for doctoral education and training. This very framework has been adopted by Combined-Integrated (C-I) doctoral programs in professional psychology, which train across the practice areas (clinical, counseling, and school psychology) to provide a general and integrative foundation for their students. Because C-I programs produce general practitioners who are competent to function within a variety of health service settings, this innovative training approach has great potential to educate and train psychologists for a changing health care marketplace.