Therapists' competence – maintenance matters too

Davidson & Scott left us in no doubt that therapist competencies matter in the delivery of psychological therapies. ¹ As a concept there has always been a degree of ‘face validity’ to this assertion, but it is the attention they devote to maintaining competence that is perhaps of most significance – and most concern – within psychiatry. In 2005, the Psychiatric Bulletin published the results of a survey of psychiatrists who had received training to diploma level at one of Scotland's recognised cognitive–behavioural therapy (CBT) courses. ² The results clearly established that access to personal supervision and for some also opportunities in continuing professional development were poor. Nevertheless, there was optimism that with the advent of job planning, consultant psychiatrists could spell out and negotiate for the time needed to undertake this, so as to ensure that these specific skills are not wasted. Indeed, Whitfield concludes that ‘planners should think carefully about how to harness and hold on to psychiatrists with these (CBT) skills if future diversity in psychological skills training is to be assured’. ²

For CBT at least, the assessment of the competencies required to deliver effective therapy has been aided by the publication of a self-assessment tool by the British Association for Behavioural and Cognitive Psychotherapies (www.babcp.com/members-/a-self-assessment-tool-of-cbt-competences-/), in response to the 2007 Department of Health publication, ³ and the Royal College of Psychiatrists has outlined the competencies required for training in psychotherapy in general. Not knowing why, how or what to do is no longer an issue.

Unfortunately, in 2009 consultants face increasing pressure from employers to replace supporting professional activity time with direct clinical care time, the assumption being that this will bring better value for money for the National Health Service. Jobs with as few as one supporting professional activity are being advertised which in our view is inadequate to allow consultant psychiatrists to be involved in teaching and training as well as maintaining their own continuing professional development. This would be regarded as completely unacceptable by others involved in delivering psychological therapies, for example clinical psychologists.

It seems highly likely that increased direct clinical care time by consultants will come at the expense of robust supervision arrangements for them and for the supervision that they can supply. This makes it likely that improved access to psychological therapies, at least as delivered by psychiatrists, will not bring with it the desired outcomes for patients. Davidson & Scott are right to be anxious about the quality of what is offered. ¹