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The competences required to deliver effectivehumanistic counselling for young peopleCounsellors’ GuideAndrew Hill, Anthony Roth, Mick Cooper

The competences required to deliver effectivehumanistic counselling for young peopleCounsellors’ GuideAndrew HillHead of Research, British Association for Counselling and PsychotherapyAnthony RothJoint Course Director, Doctorate in Clinical Psychology, Research Departmentof Clinical, Educational and Health Psychology, UCLMick CooperProfessor of Counselling Psychology, University of RoehamptonThe full listing of competences for humanistic counselling with youngpeople is available online at www.bacp.co.ukiThe competences required to deliver effective humanistic counselling for young people bacp 2014

ContentsExecutive summary1Acknowledgments1Background2Acknowledgement of source materialsA note on terminology: humanistic counsellingWho can apply the competence framework?How to use this report2222Developing the competences3Oversight and peer reviewIdentifying competencesEvidence from controlled trialsHumanistic counselling and the evidence baseSelection of source materials33334Future developments4Scope of the work5A focus on humanistic counsellingThe nature of humanistic counselling55Age rangeCreative practicesOrganisational context555The competence model for humanistic counselling for young people6Organising competence listsDomains of the competence listUnderpinning skillsBasic competences for counselling young peopleSpecific competences for counselling young peopleMetacompetences666666Integrating knowledge, skills and attitudes6 bacp 2014 Counsellors’ Guideii

The map of competences in humanistic counselling for young people8Using the mapLayout of the competence listsCore competencesKnowledge of development8888Knowledge of mental health problemsProfessional/legal issuesWorking within and across agenciesChild protectionWorking with differenceEngagement and communicationKnowledge of psychopharmacologyiii8101010101010Generic therapeutic competencesModels of interventionTherapeutic allianceWorking with emotionsManaging endings and service transitionsWorking with groupsUsing measuresUsing supervisionAssessment111111111111111212Basic competences for humanistic counselling with young peopleKnowledge of the basic assumptions and principles of humanistic counsellingAbility to initiate therapeutic relationshipsAbility to maintain and develop therapeutic relationshipsAbility to conclude counselling relationships1212131313Specific competences for humanistic counselling with young peopleApproaches to work with emotions and with emotional meaningsAbility to help young people make sense of experiences that are confusing and distressingAbility to use creative methods and resources13131414Metacompetences for humanistic counselling with young peopleWorking in the organisational contextAbility to work within a school contextEmotional health promotion in schoolsAbility to work within a voluntary and community sector context1414141415Use of additional therapeutic interventionsAbility to use self-help for a range of problemsAbility to use applied relaxation151515The competences required to deliver effective humanistic counselling for young people bacp 2014

Implementing the competence framework16Do clinicians need to do everything specified in a competence list?Are some competences more critical than others?The impact of treatment formats on clinical effectivenessThe contribution of training and supervision to clinical outcomes16161616Applying the competence rvice organisation – the management and development of psychological therapy servicesClinical governanceSupervisionSupervisor trainingAccreditation171717171717181818Concluding comments19References19Appendix A: Membership of the ERG20Appendix B: List of sources201.2.21Texts, manuals and sources of manualsBackground texts drawn on as helpful sources of information regarding humanisticcounselling with young people21Figure 1: Outline model for competences in humanistic counsellingfor young people7Figure 2: The map of humanistic competences for counselling young people8 bacp 2014 Counsellors’ Guideiv

Executive summaryAcknowledgementsThis document identifies the competences requiredfor the delivery of effective humanistic counselling foryoung people within the 11–18 age range. It describesa framework for the competences; how practitionersshould apply this; its advantages for clinicians, trainers andcommissioners; and the uses to which it can be put.This project was commissioned by the British Associationfor Counselling and Psychotherapy (BACP). The projectteam was headed by Professor Mick Cooper and AndyHill, and the Expert Reference Group (ERG)1 was chairedby Nancy Rowland. Professor Tony Roth acted as advisorto the project team. The ERG comprised: Edith Bell, AlisonBrettle, Mick Cooper, Karen Cromarty, Helen Coles, AndyHill, Peter Pearce, Jo Pybis, Nancy Rowland, Tony Roth,Ros Sewell and Dave Stewart. Alison Brettle contributed tothe identification of source materials.This framework organises the competences intoseven ‘domains’:1. Core competences for all professionals workingwith young people.2. Generic therapeutic competences for professionalsworking in a therapeutic capacity.We are also grateful to colleagues who commented on theframework and to those who peer reviewed it including theBACP CYP Executive Committee.3. Basic competences for humanistic counsellingwith young people: skills that are fundamental tohumanistic counselling.4. Specific competences for humanistic counsellingwith young people: skills that are practised in some,but not necessarily all, cases, depending on howand what the young person presents in therapy.5. Metacompetences: overarching, higher-ordercompetences which humanistic practitionersneed to guide the implementation of anytherapeutic work.6. Competences relevant to working in the variousorganisational contexts associated with counsellingfor young people.7. Additional therapeutic interventions that are not partof the humanistic tradition, but that may be relevantto work with young people, and are indicative of thekinds of competences that humanistic counsellorsmight integrate into their practice when workingwith their clients.The report then describes and comments on the typeof competences found in each domain, and organisesthese into a ‘map’ that shows how all the competencesfit together and inter-relate. Finally it addresses issues thatare relevant to the implementation of the competenceframework, and considers key organisational issues.101Appendix A shows the professional affiliations of members ofthe ERGThe competences required to deliver effective humanistic counselling for young people bacp 2014

BackgroundAcknowledgement of source materialsThe development of the competences in this frameworkrested on two previously published frameworks:1. The competence framework for child andadolescent mental health services (Roth, Calderand Pilling 2011), commissioned by NHS Educationfor Scotland2. The competence framework for humanisticpsychological therapies (Roth, Hill and Pilling,2009), commissioned by the English Department ofHealth and by Skills for Health.The content and structure of these frameworks was aprimary source of material for the present work, withadaptations made to reflect the specific context ofcounselling young people. In places these revisions areextensive; in other areas there is close overlap between thisframework and the previous ones. To flag each instancewhere text has been transposed would distract from thecontent of this report, but in order to acknowledge theprovenance of material this note should be read as aglobal citation.The issue of competence and of relevant training is thecritical factor rather than the title of the person offeringthe therapy. Although most practitioners will use theprofessional title of ‘counsellor’ some may be denoted as‘psychotherapists’. The distinction in title reflects a mix offactors, such as the theoretical orientation being taught,the length of training and the training institution offering thetraining. It needs to be emphasised that both counsellorsand psychotherapists could offer the competencesembodied in this framework, so long as they have had anappropriate level of training.How to use this reportThis Counsellors’ Guide does not include the detaileddescriptions of the competences associated with eachof these activities: these can be downloaded from www.bacp.co.uk. They are available as PDF files, accesseddirectly or by navigating the map of competences (asrepresented by Figure 2 in this report).A note on terminology: humanisticcounsellingThe term humanistic counselling is used to denote anapproach to counselling that encompasses the humanisticand humanistic-integrative traditions. As discussed inmore detail on pages 25–27 of this Counsellors’ Guide,the framework is intended to be inclusive of a breadth ofapproaches whose affiliations are broadly ‘humanistic’including, for example, the person-centred approach;and integrative practices that are based around a personcentred, relational ‘core’.Who can apply the competenceframework?All the modality competence frameworks describewhat a counsellor might do; they do not identifywho can implement them. The standards set by theframework can be met by counsellors with a range ofprofessional backgrounds, on the basis that they havereceived a training that equips them to carry out thecounselling competently. bacp 2014 Counsellors’ Guide02

Developing the competencesOversight and peer reviewThe work described in this project was overseen by anExpert Reference Group (ERG). Members of the groupwere identified on the basis of their expertise in humanisticand humanistic-integrative counselling with children andyoung people: for example, through the extensive deliveryof training and supervision in this field, or through theevaluation of humanistic counselling in research trials.Although nearly all were members of BACP, membershipof professional organisations was considered a secondaryconcern, since the framework aims to set out clinicalpractice rather than to describe professional affiliations.The composition of the ERG ensured representationfrom all four nations of the United Kingdom. TonyRoth acted as an external consultant to the ERG inorder to provide consistency with previously publishedcompetence frameworks.The ERG helped to identify the research studies, manuals(see below), and basic texts most relevant to thiscounselling work; and aimed to ensure that the processof extracting competences was appropriate, systematicand established competences that were meaningful forcounsellors working in this field.Identifying competencesThe competences were developed from four sources:manuals of controlled trials of humanistic counselling withyoung people, key textbooks in the field, pre-existingcompetences frameworks, and professional consensuswithin the ERG.mechanistic or highly structured ways. For instance, amanual might ask therapists to relate to their clients inways that are deeply empathic, prizing and non-directive.Once the decision is taken to focus on the evidencebase of clinical trials and their associated manuals, theprocedure for identifying competences falls out logically.The first step is to review the outcome literature, whichidentifies effective therapeutic approaches. Secondly, themanuals associated with these successful approachesare identified. Finally the manuals are examined in orderto extract and to collate therapist competences5. A majoradvantage of using the manuals to extract competences isthat by using the evidence base to narrow the focus it setsclear limits on debates about what competences should orshould not be included.Humanistic counselling and the evidence baseWhile the foregoing sets out the basic methodologicaltemplate we have tried to follow, it is worth making someobservations relevant to work in this modality. The methodwe have adopted presupposes that the nature of evidenceis something over which there is wide agreement. However,some practitioners have expressed fundamental concernsabout the quantitative empirical methods conventionallyused to assess the efficacy of psychological therapies.Although these concerns take many forms, there maybe at least two significant objections to the approach wehave taken:1. The evidence base places an inappropriate focuson specific techniques of therapy, to the neglectof ‘relationship’ factors (such as the interpersonalcontribution made by the therapist and the client)and the importance of the therapeutic alliance.Evidence from controlled trials2. The standard of evidence we have adopted isalmost invariably the randomised controlled trial,or (more rarely) a controlled trial, consonant withcurrent NICE or SIGN standards of evidence. Theconcern is that this inappropriately narrows theevidence on which we can draw, partly becausetrials such as this may be hard to conduct(for example, research funding may not beforthcoming). More fundamentally however, thereis a view that such trials need to be supplementedby qualitative approaches, or trials which are moreprocess oriented, and that both these methods canvalidate the efficacy of an approach as conclusivelyas the RCT.The approach taken across the suite of competenceframeworks developed by UCL is to start by identifyingtherapeutic approaches with the strongest claims forevidence of efficacy2, based on outcomes in clinicalcontrolled trials3. Almost invariably the therapy deliveredin these trials is based on a manual, which describesthe therapeutic approach and associated methods.Therapeutic manuals are developed by research teams totry to improve the internal validity4 of research studies; andrepresent best practice for the fully competent therapist:the things that a therapist should be doing in order todemonstrate adherence to the model and to achievethe best outcomes for the client. Because research trialsmonitor therapist performance (usually by inspecting audioor video recordings) we know that therapists adheredto the manual. It is worth noting that although manualspresent detailed and systematic accounts of practice,they do not require therapists to practice in formulaic,032The ability to bring about a desired effect.3An experimental study in which the outcomes of anintervention are compared against those from no interventionor from an alternative intervention, to assess its efficacy.4The extent to which the study is actually testing what it ismeant to.5A detailed account of the methodology and proceduresused in this project can be found in Roth and Pilling (2008).Although this paper focuses on the development of the CBTframework the methodological issues it raises are relevant tothe present framework.The competences required to deliver effective humanistic counselling for young people bacp 2014

Having agreed to maintain the broadly quantitativeempirical standards described above, the ERG recognisedthe need to ensure that all available evidence wastaken into account. To achieve this Alison Brettle wascommissioned to undertake a systematic review ofevidence for humanistic counselling with young people.In relation to the criteria we applied, the evidence base wasnot found to be extensive (though there are indications thatthe volume of research is increasing). On this basis, theframework does not include a column identifying specificmodels of humanistic counselling with young people (asit does in other frameworks) but instead focuses on thegeneric humanistic techniques for which there is broadevidence for efficacy.Selection of source materialsAs was the case with the humanistic psychologicaltherapies framework, there were some therapy manuals todraw on, but more frequently descriptions of humanistictherapy are available in textbooks that combine statementsof theory with indications of specific practice. Wherepossible the ERG identified a series of core texts that wereconsidered to be representative of humanistic counselling(for example those used by courses in the field (listed inAppendix B); and competences were extracted.A further and significant source of competences was twopre-existing (and highly pertinent) competence frameworks:the Humanistic Psychological Therapies Framework, andthe Competence Framework for Child and AdolescentMental Health Services. Both of these frameworks utiliseda range of manuals and source materials, and these aredetailed in the associated background documentation (atwww.ucl.ac.uk/CORE/).In addition, competences were developed on the basis ofstrong professional consensus within the ERG regardingtheir importance and value.Future developmentsThis report is a ‘living document’, in the sense that it isbased on the evidence available at time of development,but may be revised and updated as new data and areasof practice emerge. For instance, in future, competencesmay be developed to cover online counselling; andfurther controlled trials may augment – or challenge – thecompetences detailed in this document. bacp 2014 Counsellors’ Guide04

Scope of the workA focus on humanistic counsellingAge rangeCounsellors working with young people in schools,and in other settings, identify with a number ofdifferent therapeutic orientations, including humanistic,psychodynamic and cognitive-behavioural approaches.However, the majority of counsellors for young peopleadopt an approach that fits broadly within the remit ofthe ‘humanistic’ therapies: from a classical client-centredapproach to an integrative practice that is groundedprimarily in humanistic principles and ways of working.For this reason, and to ensure that the frameworkarticulated a coherent approach to therapy, a decisionwas made early on in the ERG to focus the framework onhumanistic counselling. This term is used in a relativelybroad sense, and included an openness to drawing onmethods and ideas from ‘non-humanistic’ schools that areof recognisable value to young people. For this reason,the framework includes a small number of interventionsfrom other orientations that are evidenced as effective foryoung people, and which could, potentially, be integratedinto humanistic counselling. However, these additionaltherapeutic interventions are exemplars only, and it ishoped that, in future years, it may be possible to specifyfurther ‘non-humanistic’ methods that could be drawn intoa flexible and personalised humanistic counselling practice.The framework is intended for counselling work withyoung people aged from 11 to 18 years. The ERG madea decision, early on in its work, to focus specifically on thisage range – and not to attempt to cover children up to 11years old as well – as it was felt that this scope allowedfor the development of a more coherent and focusedset of competences. In addition, extending the scope tochildren as well as young people would have required alevel of literature reviewing that was beyond the resourcesavailable for the project. However, it is our hope that thecompetences detailed in this framework will be relevant formany aspects of humanistic counselling work with childrenin the five to 11 year-old age range. It is also our hope thata set of competences specifically for counselling work withchildren will be developed in the near future.The nature of humanistic counsellingAll modalities of therapy contain within them specificmodels of practice. Though these can differ in mattersof theory and emphasis, most can be contained fairlycomfortably under a single modality title becausepractitioners are able to agree on a common ‘core’ ofphilosophy and practice. In the case of the humanisticcounselling framework locating this common ‘core’ may bemore challenging, since there are significant variations inthe basic assumptions of the different schools.However, a central theme of all humanistic approachesis that they emphasise a relational way

Basic competences for humanistic counselling with young people: skills that are fundamental to humanistic counselling. 4. Specific competences for humanistic counselling with young people: skills that are practised in some, but not necessarily all, cases, depending on how and what the young person presents in therapy. 5.