Competence and Self-Care in Counselling and Psychotherapy

Gerrie Hughes

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780415828062
• eBook ISBN: 9781317804383
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

What is it that makes a counsellor or psychotherapist competent?

In Competence and Self-Care in Counselling and Psychotherapy, Gerrie Hughes offers a framework for understanding what being competent means for individual practitioners, both generally and in moment-by-moment work with clients. Divided into two sections, Part One, The Competent Self, and Part Two, Care of the Self, the book explores care and replenishment of the self as an essential requirement for maintaining competence.

The Competence Framework presented here suggests that the three elements of Practitioner, Client and Context are essential factors for making good therapeutic choices, as well as offering a structure for reflection, either individually or in supervision. The eight principles that elaborate on these elements provide a route to explore competence that is relevant for any theoretical orientation and appropriate for practitioners at any stage. The reader is encouraged to make their own exploration of a number of factors that influence competence and to identify development of the self as both a necessary preparation for therapeutic work and as a continuing outcome of being a therapist. In addition, Hughes emphasises the importance of having a sound ethical framework and utilising professional structures as well as examining the contribution of supervision to the development and maintenance of competence.

This book is an ideal choice for counsellors, psychotherapists, supervisors and trainers who wish to maintain a robust standard of practice, and for those employing them.

Part I

The competent self

---

Chapter 1

What do we mean when we talk about competence?

---

Chapter outline

The concepts of competence and effectiveness are introduced and the differences between them in the context of counselling and psychotherapy are discussed. The significance of self-care for maintaining competence is outlined, emphasizing how therapeutic work can make specific demands on practitioners. A foundation is laid for an ongoing exploration of the impact of issues of diversity. The essential role of supervision in the maintenance of competence is acknowledged, together with a recognition of the significance of codes of ethics.

Can competence be defined?

Competence is contextual: a practitioner may be competent with a particular client in a particular situation and not competent in another. It can change from moment to moment as we negotiate the demands of client work. Because counsellors and psychotherapists are human beings, we are subject to limitations. This brings vulnerability, but it is also our great strength. We could not meet our clients in their vulnerability if we were not acquainted with our own.

A sense of being competent, or not, can often be subjective: I feel that I am working competently as I sit with a client. Another time I might feel that I have definitely strayed out of my area of competence and be wondering desperately what to do about it! I am certain that there also many times I step outside my competence levels and remain unaware that I have done so.

Many different elements contribute to defining competence. Tim Bond’s definition states:

Professional competence requires having adequate skills, being properly qualified and trained, effective and working ethically.

(2010: 120)

While this does not appear contentious, it leaves open to question what ‘adequate’ skills might look like. This would depend on what a practitioner has been trained in, and is qualified to do, and how effectiveness is recognized and measured within that approach. Each practitioner would need to arrive at the answers to these questions individually based on: their background and training; the client group with whom they work and the context in which it takes place. These elements will be explored in more detail in subsequent chapters.

Competence and effectiveness

Sometimes the terms competence and effectiveness can be used interchangeably. It is helpful to define how they are different, because doing so can allow the meaning of each of them to be more clearly understood. Here are some commonly held definitions:

Competence:

Ability

The state of being legally qualified

Language knowledge

Effectiveness:

Producing results

Producing a favourable impression

Ready for action

For the purposes of this book I will use the word competence to mean that a practitioner:

• has had, or is in the process of pursuing, an appropriate training;

• meets any criteria that may be required;

• understands and uses ‘the language’: knows the technical terms and styles of communicating;

• is embedded in structures that accredit, support, set ethical boundaries and censure when necessary.

Effectiveness is about producing a successful outcome. In a therapy context a successful outcome might be:

• the maintenance of a solid working relationship (Clarkson, 1995);

• changes to a client’s sense of themselves and/or the way they engage with the world (and/or the therapist) (Rogers, 1967).

Therapy is concerned with the nature of the relationship between individuals, so any person may be effective in providing many of the conditions that define a therapeutic encounter, without having done specific training (Berman and Norton (1985) in Rowan (2005)). This being the case, it is important to recognize that what makes counselling and psychotherapy into a profession, and distinguishes it from the helpful listening and confidences exchanged between friends, is the structure provided by the existence of:

• a well-tested theoretical base;

• properly evaluated training courses;

• respected accrediting organizations;

• sound ethical principles;

• the application of sanctions.

Competence is established by the evaluation procedures of training organizations, and in adhering to the requirements of professional associations such as BACP and UKCP. Effectiveness is measured by growth and change in our clients, underpinned by the findings of an increasing number of research projects and the growing acceptance of psychological therapies by other professions and the public in general.

The nature of therapeutic work means that it may be possible for a practitioner to be competent, and still not effective in a particular situation. This is because of the myriad of factors that influence an encounter between individuals. Yalom writes:

Though the public may believe that therapists guide patients systematically and sure-handedly through predictable stages of therapy to a foreknown goal this is rarely the case: instead … therapists wobble, improvise and grope for direction.

(1991: 13)

The scope of this book involves an exploration of both competence and effectiveness, and the relationship between them.

Self-care as essential element of maintaining competence

While the professional structures described in the previous section are crucial to establishing an individual’s competence, there is another factor that is equally significant. This is the psychological, emotional, physical and spiritual robustness of the practitioner. All of us have limitations, no matter how highly trained and extensively experienced we are. It is also the case that our flaws and imperfections are part of what make us effective in our work with others.

Research into therapists’ feelings of being incompetent carried out by Thierault and Gazzola identified that:

The practice of psychotherapy can be a hazardous undertaking (Brady, Healy, Norcross, & Guy, 1995) with almost three quarters of therapists reporting some level of role-related personal distress (Guy, Poelstra, & Stark, 1989). Among the elements that contribute to therapist distress, feelings of incompetence (FOI) figure markedly. Feelings of incompetence (FOI) refer to a therapist’s belief that his or her ability, judgment, and/or effectiveness as a therapist is absent, reduced, or challenged internally (Thierault & Gazzola, 2005). The literature that examines topics such as the therapist’s experience of therapy, therapist self-care, and the hazards of practicing as a psychotherapist is peppered with allusions to FOI (Daniels, 1974; Deutsch, 1984; Farber & Heifetz, 1982; Guy, 2000; Mahoney, 1991; Mearns, 1990).

(2008: 20)

As practitioners, each of us will decide whether our own subjective experience is similar or different to that described here. While it is beyond the scope of the research to identify the causes of these feelings of incompetence when they arise, or to validate whether they are objectively ‘true’ or not, we may be interested to explore this for ourselves, if we do experience similar feelings. For myself, I definitely experience feelings of incompetence on a regular basis. I believe there are a number of possible causes:

• The situation is actually one in which I cannot work competently or effectively, for whatever reason.

• I am experiencing a period of therapeutic ‘not knowing’. The heuristic nature of therapeutic work means that we (client and therapist) need to make powerful contact with feelings of not knowing what is going on, or how to progress, before something new can arise in the space.

• I am responding to something my client is communicating wordlessly, sometimes called counter-transference.

• I am overloaded, exhausted, ill or approaching burnout.

Because therapeutic work is rarely straightforward, often a mixture of these underlying causes may be present. Relying in part on our own vulnerability to be able to work effectively means that sometimes we think of ourselves as ‘wounded healers’. This term is often associated with Carl Jung, although it has connections back to Greek classical mythology. Jung’s understanding is that limitations are certainly natural and inevitable, and may even be desirable (Sedgwick, 2004). While identification with the wounded healer archetype may make sense for some practitioners, it will not fit for everybody. The assumption that we all have limitations and will eventually encounter situations in which we cannot work competently, is not meant to undermine practitioners, but to be supportive, especially because feelings of incompetence have been recognized as an issue for therapists.

Individuals naturally differ for many reasons, although personal histories and the choice of theoretical orientation (which probably inform one another) may be significant contributing factors. If it were to be generally recognized that many practitioners do feel that their sense of being competent is challenged from time to time, then structures could be put in place to deal with issues when they arise, which is likely to maintain and enhance the high standard of practice to which professionals aspire.

As therapists, we use the ‘self’ as the means of engaging with our clients in a meaningful way. Orientations might differ in their emphasis, but work with clients has, by its nature, a way of forcing practitioners to look at our selves and our own responses, encouraging us to develop and change as a consequence. For me, this is what keeps it being fascinating in the longer term.

It can be difficult to identify a distinct line between personal and professional development. Each is connected with both the topics of this book. Personal development, the maintenance of professional competence and the care of the self all have their roots in the needs of a person with a body, a mind, emotions, and a spiritual aspect that might look very individual, living and working within a particular context.

Diversity and competence

Each of us is unique. As human beings we have many similarities, and also many areas of difference. Some differences are accepted as having a particular significance. These are:

• ethnicity

• culture

• gender

• sexual orientation

• class

• religion and spirituality

• physical and mental ability or disability

• age.

This list is in random order and is probably not exhaustive.

In some circumstances, we cannot really know what it is like to be ‘other’. Several years ago I was one of a minor...

Table of contents

• Cover Page
• Halftitle Page
• Title Page
• Copyright Page
• Table Of Contents
• Acknowledgements
• Introduction
• Part I The competent self
• 1 What do we mean when we talk about competence?
• 2 How do we define competence?
• 3 The development of self
• 4 The diverse self
• 5 Becoming a practitioner
• 6 The competent practitioner
• 7 The influence of the client on competence
• 8 Context
• Part 2 Care of the self
• 9 Highlighting professional self-care
• 10 Highlighting supervision
• 11 Highlighting personal self-care
• Conclusion
• References
• Index