A conceptual and empirical review of the meaning, measurement, development, and teaching of intervention competence in clinical psychology

https://doi.org/10.1016/j.cpr.2008.09.008Get rights and content

Abstract

Through the course of this paper we discuss several fundamental issues related to the intervention competence of psychologists. Following definitional clarification and proposals for more strictly distinguishing competence from adherence, we interpret Dreyfus and Dreyfus's [Dreyfus, H.L., & Dreyfus, S.E. (1986). Mind over machine: The power of human intuition and expertise in the age of the computer. New York: Free Press.] five stage theory of competence development (from novice to expert) within a strictly clinical framework. Existing methods of competence assessment are then evaluated, and we argue for the use of new and multiple assessment modalities. Next, we utilize the previous sections as a foundation to propose methods for training and evaluating competent psychologists. Lastly, we discuss several potential impediments to large scale competence assessment and education, such as the heterogeneity of therapeutic orientations and what could be termed a lack of transparency in clinical training.

Section snippets

Why should we assess intervention competence?

We begin by asking two fundamental questions: should we assess intervention competence, and if so, why? The answers to these seemingly obvious questions are, in fact, quite complex. A simple-minded, yet nonetheless accurate response to these questions would be that the APA Ethics Guide (2002) says that we should. These guidelines clearly indicate that a therapist's competence is an ethical issue that we as psychologists are bound not only to consider and evaluate, but also to increase and

What is intervention competence, and what is not intervention competence?

Before we explore specific aspects of intervention competence, it is necessary to possess both positive and negative definitions of the term (viz., what it is, and what it is not). However, a plurality of definitions currently exists, and none is self-evident. Dictionary definitions provide some conceptual guidance, but lack specificity. For instance, competence can be defined as: (1) the state or quality of being adequately or well-qualified, (2) demonstrating ability, or (3) it can have a

How might intervention competence develop?

Another fundamental question about intervention competence concerns the nature of its development. Most would agree that it is a dimensional construct (although qualitative disjunctures in competence may exist) and that the development of competence “is an ongoing process within an individual that is, ideally, in a state of constant flux and renewal (Nagy, 2005, pg. 29).” Thus, development of competence is not an absolute and static notion possessing a fixed endpoint, but more a lifelong

Assessing patient outcome

Measuring intervention competence through assessment of patient outcome has been discussed in the literature. It makes intuitive sense that psychologists with high levels of competence should evidence better patient outcomes than less competent psychologists. Though not a prevalent approach, examples in the literature do exist (Brown et al., 2005, Okiishi et al., 2006) and a more widespread application could be easily accomplished through the use of pre- and post-therapy assessments conducted

Recommendations for engendering intervention competence in future psychologists

Providing suggestions for training future psychotherapists is a difficult venture, especially when data are lacking. There currently exists a plurality of program types and methods already slated with this task and, given the limited knowledge of how best to cultivate competence (if there is an objectively “best way”), this is probably a reasonable state of affairs. However, there may be pedagogical deductions from the reviews above that are applicable to future therapists. From a developmental

Conclusion

We have explored the concept of intervention competence, further differentiated it from adherence, and clinically elaborated upon an existing framework for its development. We hope that our psychotherapeutic adaptation of Dreyfus and Dreyfus's (1986) model and its progressive stages (namely the movement from a caricatured “adherence” to nuanced contextual judgment and increased levels of accountability and immersion) may prove useful in formulating competence benchmarks. Additionally, we

Acknowledgment

The authors would like to thank Shabad-Ratan Khalsa and Taylor DiGravina for their assistance in preparing this manuscript. This article was supported in part by NIMH R01-070664.

References (65)

  • WoehrD.J. et al.

    A construct-related validity of assessment center ratings: A review and meta-analysis of the role of methodological factors

    Journal of Management

    (2003)
  • American Psychological Association

    Ethical principles of psychologists and code of conduct

    American Psychologist

    (2002)
  • American Psychological Association

    Policy statement on evidence-based practice in psychology

    (2005, August)
  • A developmental model for defining and measuring competence in professional psychology

    (2007)
  • Aristotle (1984). Nichomachean ethics (W.D. Ross, Trans.). In J. Barnes' (Ed.) The complete works of Aristotle (in 2...
  • AtkinsP.W.B. et al.

    Self versus others' ratings as predictors of assessment center ratings

    Personnel Psychology

    (2002)
  • BallantyneO. et al.

    Assessment and development centres

    (2004)
  • BarberJ.P. et al.

    Development of an adherence/competence scale for dynamic therapy: Preliminary findings

    Psychotherapy Research

    (1996)
  • BarberJ.P. et al.

    The role of the alliance and techniques in predicting outcome of supportive–expressive dynamic therapy for cocaine dependence

    Psychoanalytic Psychology

    (2008)
  • BarberJ.P. et al.

    Therapeutic alliance as a predictor of outcome in treatment of cocaine dependence

    Psychotherapy Research

    (1999)
  • BarberJ.P. et al.

    Assessing intervention competence and its relation to therapy outcome: A selected review derived from the empirical literature

    Professional Psychology: Research and Practice

    (2007)
  • BarghJ.A. et al.

    The automaticity of social life

    Current Directions in Psychological Science

    (2006)
  • BernsteinR.J.

    Beyond objectivism and relativism: Science, hermeneutics, and praxis

    (1983)
  • BrayD.W. et al.

    The assessment center in the measurement of potential for business management

    Psychological Monographs

    (1966)
  • BrownG.S. et al.

    Identifying highly effective therapists in a managed care environment

    American Journal of Managed Care

    (2005)
  • Crits-ChristophP. et al.

    Can therapists be trained to improve their alliances? A preliminary study of alliance-fostering psychotherapy

    Psychotherapy Research

    (2006)
  • Crosson, J. (2000, May 22). “Rebirthing” halted after a death. Philadelphia Inquirer, pp....
  • DreyfusH.L. et al.

    Mind over machine: The power of human intuition and expertise in the age of the computer

    (1986)
  • FeyerabendP.K.

    Against method

    (1975)
  • Flannery-SchroederE.

    Treatment integrity: Implications for training

    Clinical Psychology: Science and Practice

    (2005)
  • FoaE.B. et al.

    Treatment of post-traumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling

    Journal of Consulting and Clinical Psychology

    (1991)
  • FoucaultM.

    The order of things

    (1970)
  • Gadamer, H.G. (1975). Truth and method (J. Weinsheimer & D.G. Marshall, Trans.). New York: Continuum (Original work...
  • GallantP.J. et al.

    Using bug-in-the-ear feedback in clinical supervision: Preliminary evaluations

    Research on Social Work Practice

    (1991)
  • GuyJ.D. et al.

    Personal distress and therapeutic effectiveness: National survey of psychologists practicing psychotherapy

    Professional Psychology: Research and Practice

    (1989)
  • HatcherR.L. et al.

    Patients' view of the alliance of psychotherapy: Exploratory factor analysis of three alliance measures

    Journal of Consulting and Clinical Psychology

    (1996)
  • HatcherR.L. et al.

    Initial training in professional psychology: The practicum competencies outline

    Training and Education in Professional Psychology

    (2007)
  • HorvathH.O. et al.

    Development and validation of the Working Alliance Inventory

    Journal of Counseling Psychology

    (1989)
  • KaslowN.J.

    Competencies in professional psychology

    American Psychologist

    (2004)
  • KaslowN.J. et al.

    Guiding principles and recommendations for the assessment of competence

    Professional Psychology: Research and Practice

    (2007)
  • KazdinA.E.

    Research design in clinical psychology

    (1998)
  • KuhnT.S.

    The structure of scientific revolutions

    (1996)
  • Cited by (108)

    • Psychodynamic Psychotherapy

      2022, Comprehensive Clinical Psychology, Second Edition
    View all citing articles on Scopus
    1

    Tel.: +1 215 662 2306.

    View full text