The Professional Competencies of a European Psychotherapist

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  • Definitions
• The Domains
• Competencies
  • Overview
  • Core Competencies
  • Specific Competencies
  • Specialist Competencies
• Working Group
• Practice Analysis Survey
• Appendices
  • Appendix 1
  • Appendix 2
  • Appendix 3
  • Appendix 4
  • Appendix 5
  • Appendix 6
  • Appendix 7
  • Appendix 8
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  • Participants List
  • Participants Comments

 

 

 

The Core Competencies:

Domain 2: The Psychotherapeutic Relationship

A European Psychotherapist is competent to: -

• §2.1: Establish a Psychotherapeutic Relationship
• 2.1.1: Communicate clearly: which involves – using language that is accessible and appropriate for the patient/client; explaining any terms and issues that may not be familiar; discussing the ethos and intent of the psychotherapy, including any significant differences in cultural values; explaining the theoretical framework and any different or other methods and theories (as appropriate); encouraging the patient/client’s active participation and feedback; providing clear and transparent information about the service, including details of any forms of assessment and other conditions; ensuring that the patient/client’s first contact is positive, welcoming and professional; etc.
• 2.1.2: Define the psychotherapist’s role and the client's role: which involves – discussing the psychotherapist’s role in the psychotherapy [as a professional facilitator, supporter, provider, guide, etc.]; clarifying the differences between ‘patient’ and ‘client’ as 'recipient' or as being actively involved; identifying clearly the boundaries of the psychotherapeutic relationship; describing and explaining any limitations to confidentiality; covering the possibility of any potential issues or difficulties between the psychotherapist and patient/client, including any dual roles; describing possible issues of difference and diversity - class, cultural, race, religion, diversity, gender preferences, rank, status or power imbalances; informing the patient/client about ethics and complaints procedures (see also Domain 9); etc.
• 2.1.3: Identify and start working towards mutually agreed and achievable aims or goals: which involves – addressing the patient/client’s needs (as appropriate); assisting the patient/client towards self-empowerment, independence, autonomy and a relief of (negative) symptoms, where possible; defining the possibilities, limitations, contra-indications, and (any) risks or the parameters of the psychotherapy, including clarifying any issues around assumptions and/or expectations; recognising the autonomy of the patient/client; and – even where the psychotherapy is more of a ‘treatment’ – respecting the patient’s position and obtaining their informed consent; etc.
• 2.1.4: Agree responsibilities: which involves – discussing responsibilities with the patient/client, including session times, frequency, expected length of psychotherapy, methodology, any financial issues (adjusted – if possible – to the recipient’s resources), cancellation policies, contact arrangements, holiday arrangements, etc.; mentioning any legal requirements and duties; discussing other details of the psychotherapeutic ‘contract’ (see also Domain 4); obtaining (where possible) the patient/client’s informed consent in writing; etc.
• 2.1.5: Establish a relevant set of perspectives: which involves – understanding things from the patient/client’s perspective in a number of different ways; exploring the subjective world of the patient/client; being aware of significant aspects of their physical, social, and cultural environment; understanding something of the dynamics of their family of origin; and understanding something of their ideas or belief systems (religious & spiritual); etc.
• 2.1.6: Express empathy and understanding: which involves – understanding background of the symptoms, difficulties and behaviours; understanding internal frames of reference, or subjective position of the patient/client; being empathic about the patient/client’s issues; demonstrating a genuine concern for their welfare; identifying (emotional, as well as physical) safety and security issues; reinforcing the autonomy, self-esteem and independence of the other person; respecting their boundaries, preferences, cultural differences and sensitivities; respecting their present position, thoughts and feelings; etc.
• 2.1.7 Establish a psychotherapeutic presence: which includes – being present for the patient/client, in a coherent, non-judgmental, positive way; not feeling that (as a psychotherapist) one has to respond in any particular way to the various interjections of the patient/client; knowing that the essence of the psychotherapy is for the patient/client (somehow) to meet themselves, through their own processes, reflected by the un-intrusive presence of the therapist; enabling the patient/client to be able to internalise a positive therapeutic perspective of an accepting, enquiring attention to and understanding of their own internal processes; etc. (see also §5.2.2)

• §2.2: Manage & Maintain A Psychotherapeutic Relationship
• 2.2.1: Maintain the psychotherapeutic relationship: which involves – using language that is familiar to the patient/client and explaining any concepts, interventions or dynamics, as appropriate; being consistent, listening, and supportive; being empathic and caring; maintaining an appropriate psychotherapeutic presence at all times; getting regular feedback from recipient and discussing the process and progress of the sessions; providing and receiving highly complex, sensitive and/or possibly contentious information; etc.
• 2.2.2: Respect and value the psychotherapeutic relationship: which involves – allowing the patient/client time and space to determine what is appropriate for them; following, rather than leading, the pace and direction of the patient/client’s process; being there for the patient/client as much as a support, a sounding board, a guide, a human resource, than as being a psychotherapist providing a treatment; learning from the patient/client, rather than teaching them; respecting their progress to date, rather than their lack of progress; appreciating their difficulties and discussing how these can be dealt with appropriately; etc.
• 2.2.3: Establish self-awareness in relationship: which involves – engaging in rigorous self-examination, monitoring thoughts, feelings sensations and behaviour; demonstrating a mature approach to the patient/client’s issues and choices; drawing on relevant life experiences; making appropriate use of the ‘Self’ in the psychotherapy, including relevant self-disclosure; in the event of personal difficulties with the patient/client, being resilient, non-retaliatory and responding appropriately and professionally; recognising unresolved emotional conflicts in one’s own life and guarding patient/clients from these; managing one’s own emotions appropriately; maintaining appropriate boundaries in the psychotherapeutic relationship; etc.
• 2.2.4: Communicate appropriately: which involves – communicating about the relationship and the patient/client’s progress, back to the them, and also to any other relevant persons (e.g. referrer, consultant, doctor, team, other professionals, members of family, where appropriate; etc.); communicating in a fashion and language that is appropriate for the patient/client and that can be clearly understood by them; using a translator, where appropriate; etc.
• 2.2.5: Evaluate the psychotherapeutic relationship: which involves – reviewing it regularly and appropriately; utilising suitable assessment criteria to monitor the quality and progress of the relationship; evaluating the communication, process and methodologies used with patient/client; where appropriate, engaging the patient/client in collaborative team work to explore their issues; utilising clinical supervision for on-going reflection of the patient/client’s process; keeping up to date with current professional opinions and research in any relevant ‘treatment’ methods or new approaches; reporting to and seeking others’ opinions, where appropriate (e.g. from line managers, referrers, specialists, team meetings, other professionals, etc.); etc.
• 2.2.6: Manage the process of change: which involves – reviewing and managing the psychotherapeutic process of change throughout the course of the psychotherapy; demonstrating competence in appropriate interventions; using inputs that are familiar and understood, informed by and coherent with in-depth theoretical perspectives; working consistently with guidelines, standards, ethics, and sensitivities; working in line with the desires and needs of the patient/client; encouraging and enabling disclosures of their concerns, expression of their deeper feelings, and working with their intellectual, emotional and behavioural expressions; acknowledging changes that have already happened, and anticipating probably future changes; (see also Core Competency §5.1.4) etc.
• 2.2.7: Manage out-of-session contact: which involves – discussing with the patient/client such contact, which might include e-mail, letters, texts, telephone, visits and casual or unexpected encounters; developing a pre-determined policy that has been communicated to the patient/client appropriately and integrated into the psychotherapeutic relationship; determining an appropriate policy for contact between sessions, or when the patient/client misses sessions, or terminates psychotherapy abruptly; being alert for possible danger signals, especially in repeated out-of-session or unwanted contact with the patient/client; considering the implications of any invitation or request to meet the patient/client outside of the normal psychotherapy situation and acting appropriately; etc.
• 2.2.8: Manage breaks and holidays appropriately: which involves – giving the patient/client substantial notice of forthcoming events; determining a policy and making a clear agreement with the patient/client; making appropriate arrangements for patient/clients to receive emergency support during any absences, if necessary; recognising ways in which breaks and holidays can interfere with the psychotherapeutic relationship and discussing these with the patient/client appropriately; planning for regular breaks and holidays to enhance one’s own well-being; etc.

• §2.3: Manage any Difficulties in the Psychotherapeutic Relationship
• 2.3.1: Manage the process of change: which involves – reviewing and managing the psychotherapeutic process of change throughout the course of the psychotherapy; demonstrating competence in appropriate interventions; using inputs that are familiar and understood, informed by and coherent with in-depth theoretical perspectives; working consistently with guidelines, standards, ethics, and sensitivities; working in line with the desires and needs of the patient/client; encouraging and enabling disclosures of their concerns, expression of their deeper feelings, and working with their intellectual, emotional and behavioural expressions; acknowledging changes that have already happened, and anticipating probably future changes; (see also § 5.1.4) etc.
• 2.3.2: Recognise difficulties: which involves – recognising difficulties as and when they occur; engaging with the patient/client to explore these (in as much as they may be relevant to the psychotherapy); having the competency, skills, awareness and ethical understanding to negotiate (explore and respond to) any difficulties appropriately for the patient/client; recognising any personal (psychological, emotional, behavioural and physical) responses within the psychotherapist towards the patient/client, or towards their issues; recognising any personal, professional or experiential limitations and seeking to overcome these; making suitable changes, or using a different approach or other relevant methodologies, if appropriate; or – perhaps - finding an appropriate way to end that (current) psychotherapeutic relationship and referring the patient/client on to a more suitable professional; etc.
• 2.3.3: Manage any difficulties: which involves – being able to manage sometimes significant barriers to acceptance; where the patient/client perceives themselves (or their situation) negatively, challenging or assisting them to re-evaluate these perceptions more realistically; working clearly within the framework of the psychotherapeutic alliance; identifying and analysing these difficulties, as they arise; managing any interventions that may cause confusion, embarrassment, anxiety or offense; managing situations where the patient/client feels distress or discomfort at values, beliefs or behaviours in others (including the psychotherapist); working with patients/clients that may be potentially hostile, antagonistic, manipulative or highly emotionally charged; having an awareness of any limitations of the patient/client due to possible personality problems or psychopathologies; recognising when only supportive interventions are appropriate; facilitating self-awareness, self-help, self-empowerment and problem-solving, where appropriate; acknowledging where the psychotherapy is challenged by the patient/client – sometimes by lack of cooperation, or by silence – and responding appropriately; assessing the situation with respect to any risks, to the patient/client, the psychotherapist, or others; being prepared to acknowledge and apologise for any deficiencies, or even mistakes; exploring any personal or theoretical limitations, especially with non-dominant cultures; monitoring and checking frequently with the patient/client as to their understanding of the process of the psychotherapy; being flexible with interventions, phrasing and timing (brief, medium or long-term psychotherapy and with different frequency of sessions, where needed); being aware of and assessing any ethical difficulties, as well as any appropriate policies, procedures or formalised responses in the event of difficulties; contacting other relevant health professionals (or supervisors) to help support, or give advice to the patient/client, or oneself and ensuring that appropriate support is in place, so that the patient/client remains committed and engaged; recognising when the patient/client moves out of difficulties into a crisis or emergency situation, and responding appropriately; reviewing and debriefing any others involved, once the immediate crisis situation is over (see also: Core Competency 5.1.5 and Domain 13); etc.
• 2.3.4: Manage out-of-session contact: which involves – discussing with the patient/client such out-of-session contact, which might include e-mail, letters, texts, telephone, visits and casual or unexpected encounters; developing or having a pre-determined policy for such contact that has been communicated to the patient/client appropriately and integrated into the psychotherapeutic relationship; determining an appropriate policy for any contact between sessions, or for when the patient/client misses sessions, or terminates psychotherapy abruptly; being alert for possible danger signals, especially like repeated out-of-session contact, or unwanted contact, or an abrupt cessation of contact with the patient/client; considering the implications of any invitation or request to meet the patient/client outside of the normal psychotherapy situation and acting appropriately; etc.
• 2.3.5: Manage breaks and holidays appropriately: which involves – giving the patient/client substantial notice of any forthcoming events, disruptions, or breaks in the pattern of continuity of sessions; determining a policy and making a clear agreement with the patient/client about breaks and holidays; making appropriate arrangements for patient/clients to receive emergency support during any absences, if necessary; recognising ways in which breaks and holidays can interfere with the psychotherapeutic relationship and discussing these with the patient/client appropriately; planning for regular breaks and holidays to enhance one’s own well-being and to encourage the patient/client’s ability to cope independently; etc.

• §2.4: Conclude a Psychotherapeutic Relationship
• 2.4.1: Recognise an approaching conclusion: which involves – in consultation with the patient/client, deciding when and how to conclude the psychotherapeutic relationship; negotiating an end-date, allowing sufficient time for the patient/client to process the ending in accordance with a consistent, coherent and in-depth theoretical perspective; being flexible with this end-date, if necessary or possible; in the case of a fixed number of sessions, ensuring the psychotherapy ends satisfactorily on the agreed date; recognising any ‘attachment’ style, considering how it makes an impact on the relationship, and taking this into account when ending; analysing and processing any aspects of the patient/client’s life history where an ending is significant; facilitating the patient/client in any mourning or grieving process about the ending of the psychotherapeutic relationship; etc.
• 2.4.2: Manage sudden endings: which involves – where the psychotherapeutic relationship ends at short notice, and especially if against the patient/client’s wishes, discussing the implications with the patient/client and recognising their feelings; discussing these issues with the psychotherapist’s line manager, or supervisor, following any existing policy / guidance; informing the patient/client of, and negotiating with them, any possible alternatives, or onward referrals; etc.
• 2.4.3: Conclude the Psychotherapeutic Relationship: which involves - negotiating an appropriate ending with the patient/client, when the therapy seems sufficient and the patient/client seems ready; using the ending phase to review the patient/client’s progress and achievements over the course of the psychotherapy; developing strategies to ‘cope’ with the end of therapy or for the change of being without the therapeutic relationship; discussing plans for action that take into account their current social situation and other relationships; exploring any options for referral, ongoing support and information, or any other therapeutic interventions should the need arise; examining thoughts, feelings and identifying other experiences, as well as otherwise unprocessed material about other ‘endings’, ‘leaving’ or ‘loss’, ‘abandonment’, ‘being alone’, etc. as relevant; considering also one’s own attachment to the therapy, the patient/client, and feelings about endings and discussing these with one’s supervisor; etc. (see also §7.1.2)
• 2.4.4: Record the outcome of the psychotherapy: which involves – recording an appropriate summary, attached to the case notes, including any assessments or tests, satisfaction / dissatisfaction surveys, onward referrals, and post-ending follow-ups; etc.

Footnote:
[1] All these Core Competencies should be read in conjunction with the relevant sections of the EAP Statement of Ethical Principles (see Appendix 6 (see here) or the EAP website (see here)

To go back to the Domains page, click here.

To view the Core Competencies in other Domains, click here.

Working Group on Professional Competencies: committee@psychotherapy-competency.eu

 

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Page last updated: October 28, 2014