The Core Competencies:
Domain 4: ‘Contracting’ (Developing Goals, Plans & Strategies)
A European Psychotherapist is competent to: -
- §4.1: ‘Contract’ with a Patient/Client
- 4.1.1: Formulate the main issues: which involves - reflecting on the assessment (and the sometimes contradictory information therein) and information from other sources; being able to integrate all these perspectives; articulating the patient/client’s core issues and the possible origins of these; and presenting (or reflecting back) these perspectives to the patient/client in a sufficiently appropriate and sensitive way that they can understand and accept; checking the accuracy of these formulations; and discussing the parameters behind these formulations; ensuring that this formulation is reasonably consistent with the modality’s main ethos and theoretical understanding; etc.
- 4.1.2: Identify appropriate and achievable goals, plans & strategies: which involves - including prior history, the patient/client’s economic, social, emotional, intellectual and psychological capacities; identifying any potential contra-indications or any risk assessments or factors; discussing the length, frequency, cost, environment and external parameters (including the patient/client’s external relationships) around any planned course of interventions; discussing any confidentiality issues; and distinguishing what is reasonably achievable and what may not be so within the patient/client’s process; etc.
- 4.1.3: Discuss the patient/client’s motivation: which involves - understanding their desire and motivation for change and the factors that might have brought them to this point; recognising the level of the patient/client’s awareness of themselves and others; acknowledging that there are (probably) several factors that might also hinder their capacity to engage fully in the psychotherapeutic process; recognising their ability to recognise and understand their level of psychological functioning; and their ability to take responsibility for their own individual process; etc.
- 4.1.4: Decide upon the amount or extent of the psychotherapy: which involves – having made a clear assessment about the nature of the patient/client’s core issue; having clearly explained any limits to the provision of sessions (by an agency or health insurance, etc., if relevant); having explained the process of regular review at various stages, if a more open-ended ‘contract’ seems appropriate; making an informed and mutually agreeable decision about whether brief psychotherapy is appropriate, or – if not, the expected number of sessions; etc.
- 4.1.5: Make a ‘contract’: which involves – taking into account the patient/client’s circumstances; negotiating mutually agreeable terms and conditions with the patient/client; identifying cancellation or ‘no show’ policies, holiday & illness policies, fees and cost implications of the course of psychotherapy, the cancellation of any sessions, frequency of sessions, and possibly even strategies or referral possibilities if the ‘contract’ fails; etc.
- 4.1.6: Moderate the ‘contract’: which involves – revising the ‘contract’ and re-assessing the goals at regular stated intervals; listening to the patient/client’s feelings and experiences; checking with supervisors and line managers (where appropriate); taking into account changing circumstances in the patient/client’s circumstances and in the psychotherapist’s practice; etc.
- 4.1.7: Give opportunities for referral on: which involves – checking with the patient/client that they are reasonably happy with you as their psychotherapist; being clear about the likelihood of the patient/client’s needs being successfully met; being open about offering them other choices and explaining these choices; facilitating any referral on to another psychotherapist or other mental health professional; discussing other alternatives; etc.
- §4.2: Plan the Psychotherapy
- 4.2.1: Make use of evidence of effective practice: which involves – becoming familiar with appropriate and effective treatments for the particular issues facing one’s patient/client; providing information to the patient/client about recommended strategies; ensuring that one’s particular methodology has a sufficient evidence-base for the patient/client’s particular issue; etc.
- 4.2.2: Draw on psychotherapeutic theory: which involves – utilising the theoretical perspectives of one’s modality that relate and may be helpful to the patient/client’s general situation, whilst also being aware of other theoretical perspectives; utilising theoretical perspectives that relate to the patient/client’s particular issues; explaining all these to the patient/client in easily understandable terms; outlining the implications of these as these pertain towards developing a strategy for the psychotherapy; etc.
- 4.2.3: Decide on the psychotherapeutic approach or strategy: which involves – discussing the various possibilities with the patient/client; explaining the pros and cons of the various strategies; using clinical experience and research to suggest possible strategies with reasonably successful outcomes; deciding mutually on what seems the most appropriate approach or strategy for the patient/client and their particular issues; building-in, or encouraging, an on-going self-reflective component, from both sides, that monitors and develops the strategy; etc.
- 4.2.4: Moderate the plan or strategy: which involves – utilising the experience of being a key component in the psychotherapeutic process itself to influence those aspects of theory and practice that become more relevant at any one moment; utilising the self-reflective aspects of clinical experience, professional practice, own therapy and supervision to guide and moderate one’s ‘affect’ and especially one’s choice of interventions as a psychotherapist [N.B. the extent to which this self-reflective component guides or manages the course of the psychotherapy depends largely on theory of the modality within which one practices as a psychotherapist]; being sensitive and flexible to the patient/client’s current situation and emotional state, and allowing this to influence one’s choice in the moment, without necessarily deviating from the overall plan; etc.