Saturday, November 08, 2008

HPCE Expert Reference Group – Part 6

Entry for 7 November 2008:

In the continuing saga of the Humanistic-Person-Centred-Experiential (HPCE) therapy competences expert reference group (ERG), we have now reached our sixth meeting. The framework is now being worked on primarily by Andy Hill and Tony Roth, with input from various of the rest of us on the ERG, plus a working group at UKCP (UK Council for Psychotherapy). We have worked and reworked the “Generic Therapeutic Competences”. These run across different theoretical orientations with relatively minor variations in language and nuance, such that parallel versions exist for CBT, psychodynamic and family-systemic therapies. These are these are now in fairly good shape, so they got very little of our time today.

Basic Therapeutic Competences. Today’s main agenda item was to review the work that Andy and Tony had done on the next domain in the framework: “Basic Therapeutic Competences”, defined as foundational competences shared and constitutive of HPCE practice. These are really the heart of the HPCE framework. We had done quite a bit of work on these last time, and now had to review and try to finalize them, plus deal with various version control issues stemming from folks having worked off of different evolving version.

At this point, the Basic HPCE Competences are divided into the following outline (this is still not the final version, but should give the flavour):

A. Knowledge of the rationale for HPCE therapy
A1. Knowledge of humanistic principles that inform the therapeutic approach
A2. Knowledge of HPCE theories of human growth and development and the origins of psychological distress
A3. Knowledge of the HPCE conditions for and goals of therapeutic change
B. Ability to initiate therapeutic relationships
B1. Ability to explain and demonstrate the rationale for HPCE to the client
B2. Ability to work with the client to establish a therapeutic aim
C. Ability to maintain and develop therapeutic relationships
C1. Ability to experience and communicate empathy
C2. Ability to experience and to communicate unconditional positive regard for clients
C3. Ability to maintain congruence in the therapeutic relationship
D. Ability to conclude the therapeutic relationship

Under each of these headings are 5 to 20 subheadings, extending up to 3 outline levels deeper, presented in indented boxes, for example, under empathy, Box C1c, currently reads, “An ability to sense and understand those feelings and perceptions of which the client is aware, as well as those which [sic] have not yet entered the client’s awareness.”

A working group of the Humanistic and Integrative Psychotherapies (HIPS) section of UKCP had put a considerable effort into doing up a revision of the Basic Competences; the nature and extent of these proposals was such that several of us had gone into the meeting today worried about the potential for this to derail the whole process. Our fears proved unfounded, however, as Steve, Tony, Janet Tolan (the representative from the British Association for the Person-Centred Approach), and others were able to make creative use of many of these suggestions to improve the emerging product, while remaining true to the evidence base and training manual corpus. Thus, we were able to work efficiently (for us) through the latest version of this domain, and at the end were quite pleased for the progress on this part of the framework.

Metacompetences. One of the thing that came out strongly from the day was the importance of what Tony and Steve are calling “Meta-competences,” that is, competences about how to apply the competences. This is where things like clinical judgment, responsiveness, critical self-reflection, effective use of therapist own experiences, and issues of directivity and nondirectivity all come into play. Many of the really tricky bits fall under this rubric. For example, the key overarching principle in PE-EFT is actually a meta-competence: Balancing relational and task processes, a general issue that appeared in several forms over the course of the day. In fact, much of the input from UKCP about critical reflection and personal integration really speaks to issues that can be nicely handled as metacompetences. Furthermore, it has become clear that there are specific metacompetences distinctive of HPCE, which will be important defining criteria. So this turns out to be a very useful conceptual tool indeed, in a way analogous to regulatory DNA in the genetic code, which is turning out to be at least as important as the traditional kind of DNA, in that it turns the latter on and off.

Onward to the Specific HPCE Methods Domain. Before finishing up, we turned briefly to the next domain, Specific HPCE Methods, more to scope out the next steps than anything else. After some discussion, we clarified that this domain should address therapeutic methods common to many but not all (or even most) HPCE therapists. This means that there can be things here that various folks never use and might not even approve of, which allows the framework the capture important variations in practice, without their being imposed on those who don't want them.

Much of this section as it currently stands is derived from the two PE-EFT texts we’re using, Learning emotion-focused therapy (Elliott et al., 2004) and Emotion-focused therapy for depression (Greenberg & Watson, 2006). What isn’t clear yet is whether this will be the realm of the experiential branch of HPCE family only, or whether we will be able to find something useful in it for therapists from the classical/relational person-centred branch.

This section is also particularly important for the HIPS folks from UKCP, many but not all of whom belong to the experiential branch of the HPCE family. This is where their use of enactments (chairwork), re-experiencing, and focusing/awareness methods will be able to find a place. Fortunately, PE-EFF is an instance of an integrative humanistic therapy that has a systematic theoretical and practice framework, but also has the RCT evidence and detailed therapy manuals needed for the competence development process. This allows much of HIPS a road into the HPCE competence framework.

The issue of how to bring into this the classical-relational branch of HPCE is a more difficult question. After some discussion, we decided to see if we could broaden the entries in this domain, to make at least some of it more relevant to a wider range HPCE therapists of classical and nonclassical persuasions.

Translating PE-EFT into Classical PCT. This is actually something close to my heart at the moment, as I have recently been trying find ways to talk about PE-EFT concepts to more traditional students and colleagues. For example, I want to talk with classical-relational person-centred therapists about how they understand and work with conflict splits in a more traditional way, using empathic exploration rather than chair enactments. This is because for me working on the right task (for this client at this moment) more important than the particular methods used to work on that task. If you’re working on the wrong task (that doesn’t fit where the client is at the moment), then it doesn’t matter what you do; you’re still going to be at cross purposes with the client. But if you are at least going in the same direction as the client, it means that you are less likely to get in their way!

The result of our discussion today was that we appointed me to work with Andy and Tony to put in some further effort on the working with emotion section of the Specific Methods domain. This should be an interesting challenge…

Dialectical constructivist reflections. As the meeting broke up, it was 4pm on a Friday afternoon in London, darkening already in the early November dusk, but also I felt darkened by the deepening economic recession (I wondered if that was why the train to London was surprisingly empty). Mick and I stayed and chatted with Tony and Steve for a few minutes before heading off. I think it’s been a good journey so far, and the dialogue with them and with Vanja representing something of the humanistic-integrative position was been both educational and useful for all of us. I think we’ve all learned from each other, and over the months I think I’ve detected a rising respect for all this humanistic therapy stuff from Steve and Tony, or at least less bemusement and scepticism. At the same time, I’ve come to respect what they’re about on this project of developing all these different competence frameworks. What looked like it might turn out to be a cookie cutter process has turned into something much more subtle. In piagetian terms, there has been both accommodation and assimilation: We have changed and so have they, their views and even the general competence framework itself evolving out of the process. I was reminded of my friend Bill Stiles’ theory-developing case study research on the Assimilation Model, morphing and adapting as it encounters new data and new problems. In PE-EFT and Gestalt therapy terms, we’d say it has been a dialectically constructive process in which different processes were differentiated or separated, then brought back into contact, something that we believe is fundamental to the process of change, producing newness that is never predictable in advance, but which makes logical sense afterwards.

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