FORBIDDEN TERRITORY? COMPETENCE BASED PCE THERAPY(CFD) - HELEN COLES AND ROS SEWELL KEELE CONFERENCE 2012

Forbidden Territory?
          Competence Based PCE
              Therapy(CfD)
                  Helen Coles and Ros Sewell
                    Keele Conference 2012

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What is CfD?
•   CfD is a NICE recommended form of psychological therapy for the
    treatment of depression specifically devised for counsellors working
    in the IAPT programme.(Level 3 Intervention - Stepped Care)
•   Appropriate for persistent sub-threshold depressive symptoms or mild
    to moderate depression where 6 – 10 sessions are recommended over
    a period of 8 – 12 weeks. (up to 20 sessions)
•   CfD targets the emotional problems underlying depression along with
    the intrapersonal processes, such as low self-esteem and excessive
    self-criticism, which often maintain depressed mood.
•   The therapy aims to help patients contact underlying feelings, make
    sense of them and reflect on the new meanings which emerge.
•   This, in turn, provides a basis for psychological and behavioural
    change

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Where has CfD come from?

• Skills for Health NOS
• Roth and Pilling Competence Framework
• NICE recommended treatment for
  depression

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Why develop CfD?
  IAPT initially focussed on CBT    Parity in NHS with other NICE
  4 further modalities introduced   Recommended Therapies

                                    Frameworks need to:
                                    • Link practice with
       • DIT                          research
       • IPT                        • Be expressed in clear
       • Humanistic/PCE               and accessible
         (CfD)                        language
       • Couples                    • Be valid - recognisable
                                      as representing the
                                      approach

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Structure of the framework

      CfD Competences
                        Generic competences

                         Basic competences

                        Specific competences

                         Meta-competences

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Examples of generic competences

• Knowledge and understanding of mental
  health problems
• Knowledge of, and ability to operate within,
  professional and ethical guidelines
• Ability to undertake generic assessment
  (relevant history and identifying suitability
  for intervention)
• Ability to manage endings

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Examples of Basic competences

• Ability to work with the client to establish a
  therapeutic aim
• Ability to experience and communicate
  empathy
• Ability to experience and to communicate a
  fundamentally accepting attitude to clients
• Ability to maintain authenticity in the
  therapeutic relationship

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Examples of specific competences
• Ability to help clients to access and
  express emotions
• Ability to help clients articulate emotions
• Ability to help clients reflect on and
  develop emotional meanings
• Ability to help clients make sense of
  experiences that are confusing and
  distressing

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Examples of metacompetences
• An ability, when working with clients, to
  maintain a holistic perspective
  (recognising the integral nature of
  intrapersonal, interpersonal, contextual,
  and spiritual aspects of the person)
• An ability to maintain a balance between
  directive and non-directive dimensions
      of the therapeutic process
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Group Exercise

• In small groups discuss your reaction to
  adherence to competences in the delivery
  of PC therapy?
• 5 minutes
• Large Group Plenary

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Controversies
• Directivity? “It isn’t PC to direct a client to emotion!”
• Manualisation? “ I work intuitively and you are turning me
   into an automaton!”

• Resistance to change? “I didn’t think there was
   anything CfD could teach me about being a PC therapist!

• Examining our practice? “I feel like I’ve gone back to
   being a student!”

• Invading the sacred space? “This isn’t how I usually
     practice….my client and I were conscious of the recorder in the
     room!”
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Challenges of Delivery of CfD
• Developing the training from the
  competence framework
• Trainer Training
• Commissioning
• Recruitment of trainees
• Supervision
• Practicum
• Assessment
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Small Groups Exercise

• What future do you foresee for CfD?

• Plenary

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Future Plans for CfD

•   CfD Evaluation Project
•   CYP Competences
•   Developing the evidence base for CfD
•   Commissioning or 2012/2013
•   RELY Trial
•   Schools based project
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CfD Trainee Comments
•   I have a first class degree in de-skilling myself but I felt comfortable here.
•   Before I came on the course, I didn’t really want to be here and I nick-
    named it ‘The Depressing Course’ but I very quickly changed my mind it’s
    been wonderful and fun and engaging I’ve learned so much.
•   When I started out on this course I was anxious and had a cloud above my
    head. I had two left feet and was trampling into triads. Then I felt like I was
    really getting in touch with Person Centred therapy. I am still clunking about
    with two left feet, but maybe I will be able to dance again.
•   It’s good for me to be with Person Centred people – it feels good to be able
    to say ‘it’s OK to be Person Centred’.
•   I’ve learned about really listening to the client rather than teaching the client.
•   I’ve been getting in touch with what it means to be Person Centred and
    really staying with the clients. It meant something to me to be chosen for
    this

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Thank you for participating

Helen Coles and Ros Sewell
British Association for Counselling & Psychotherapy

Helen.Coles@bacp.co.uk
Ros.Sewell@bacp.co.uk

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