You are here: Home > Reformulation > ACAT News Summer 1995 [Issue 101] > Can the Concept of Competencies Help Us to be Competent?

Can the Concept of Competencies Help Us to be Competent?

Welch, L., 1995. Can the Concept of Competencies Help Us to be Competent?. Reformulation, ACAT News Summer, p.x.

---

In this paper I want to focus on the language of competence, to think about the various ways in which the term competence is used. I will focus particularly on one view of competence which currently dominates thinking in this area, the view expressed by the National Council of Vocational Qualifications (NCVQ). I will give an example of how this approach might be used within CAT and then will go on to examine this approach critically. I will conclude by arguing that the theoretical framework of CAT, the Procedural Sequence Model, alongside the more recent exploration of Vygotsky's ideas from a CAT perspective, can provide us with the beginnings of an approach which can incorporate and move beyond the narrow definition of competencies offered by the NCVQ.

 

It is important at the outset to be clear why we are talking competencies. This is a complex area with many standpoints and it is easy to unwittingly adopt the dominant model of competence without realising the hidden agendas it enmeshes us in. I will highlight two areas of debate. The first area is about the relationship between our feelings of competence and the reality of what we can actually perform. Psychologists in America have been prominent in exploring this area. The second area is what I shall characterise as the NCVQ approach, although it extends beyond the NCVQ, where the predominant concern is to identify the particular skills or competencies that workers need in order to perform their work effectively.

 

I will begin by looking at the relationship between feelings of competence and actual competence. The desire to be competent is basic to our sense of self esteem and has roots in our early childhood experiences as we began to discover how our actions have an impact on the world. The relationship between our feeling of competence and the reality of what we are able to achieve is of course not a very close fit, and finding out how to test our feeling of competence against actual results is fundamental to learning.

 

Becoming competent is intimately tied up with our self esteem. Langer (in Sterner & Kolligian, 1990) makes a useful distinction between incompetence and precompetence, where precompetence "is incompetence on its way to competence" (p 149). This makes it clear that the student is confronted by a sense of not knowing, a sense of inadequacy. This is ameliorated by the accompanying sense that the feeling is appropriate to the phase of learning. By engaging in training, a trainee is acknowledging to him or herself that there is something to be learnt. It is important at this stage that the trainee is helped to accurately distinguish between the competence they have already established and the competence they are seeking to learn. Langer also identifies postcompetence as an important part of this analysis. Post competence exists where a level is reached where skill is assumed, taken for granted. For example, the ability of the trainee to write is assumed in CAT. The trainee will gain little comfort if, in criticising his/her reformulation, the supervisor tries to balance out negative comments with the praise that the grammar of the reformulation was sound.

 

Feelings of competence in psychotherapy take on a special meaning which is not found in areas of work outside the caring professions. Therapists are often invited by their clients to play the role of incompetent therapist. The therapist gets dogged by a sense of not quite getting it right. Dealing with these countertransferential feelings requires a focus on the subjective usually unnecessary in other areas of work.

 

The process of becoming competent in psychotherapy is made more difficult as it is hard to specify what makes a psychotherapist competent. Research findings have established the difficulty of clearly delineating what makes the difference in psychotherapy. In their overview of outcome research, Orlinsky et al (in Bergin and Garfield 1994) identify some 30 different therapist variables which have been studied in the search for psychotherapy's magic potion, including verbal activity, skilfulness, experiential confrontation, sureness vs unsureness. These studies underline the complexity of the task of identifying specific skills to be taught to psychotherapists.

 

The desire to be competent is of course not simply a product of the need for self esteem. The desire to be competent brings with it issues to do with gaining external recognition, and, most notably, employment.

 

Secure positive self esteem is not a product of the success of an individual in setting up their own positive thinking programme. It is tightly interwoven into relationships where recognition is quantified financially.

 

This takes us to a different view of competence. Perhaps the most widely quoted definition of competence is that of the Department of Employment White Paper "Employment for the 1990's" which sees competence as "the performance required of individuals to do their work successfully and satisfactorily." Here the debate about competence is shifted away from the feelings of the individual towards the definition of objectively definable skills necessary to perform a task.

 

Before looking in more detail at how this is done I would like to address the social context in which this view of competence has developed. This view of competence can be traced back to the 1920's in the US (p10 Tuxworth, In Burke) although it only really took root in the 1960's in America, particularly in teacher education. It is worth noting that the strong governmental backing for this form of training in the US in the late 60's did not lead to immediate results or improvements (p12). In the 80's a series of White Papers have focussed attention on competence-led training in the UK. The National Council for Vocational Qualifications (NCVQ) was established in 1987, giving this trend institutional expression. The NCVQ has set up Lead Bodies in different industries who are responsible for building up hierarchical maps of the competencies needed in each sector and setting the standards that need to be reached. The relevant body for psychotherapy is "Advice, Guidance, Counselling and Psychotherapy."

 

The question that is in my mind is why is government and industry so keen on this direction? The White Paper orchestrating this development seeks to build up the role of industry and the employers in the delivery of training and education. It is no coincidence that the same White Paper extols the virtues of the Tories' viciously anti-union legislation which seriously undermines the capacity of the workforce to defend itself in the workplace, introducing so-called flexible work practices where the flexibility is all in the employers' favour. The vision of competencies within the Tories camp is one in which the employers' needs to be able to control and direct the activities of the workplace override the human needs of the workers. At times an equal opportunities gloss is placed on this trend to make it more palatable, but essentially the move to make workers' skills easily transferable needs to be seen in the context of undermining the ability of workers to organise. I draw this idea to your attention not simply because I welcome any opportunity to give vent to my abhorrence for the direction the Tories are taking the country, but also because I think a key problem with this narrow definition of competence is that it focusses on performance and behaviour to the exclusion of purpose, thought and feeling. In raising this issue I am not wanting to use it as an argument to reject the notion of competence out of hand, but rather to look beyond this narrow definition.

 

After this brief polemic, I will turn to looking at this concept of competency in more detail.

 

The hallmark of the NVQ approach is the production of explicit, written statements listing the tasks that need to be performed in order to achieve competence. These lists provide the basis on which performance is assessed - in order to give a patient a bed bath, a nurse has to perform in the region of one hundred different tasks, each of which can be assessed. The British Association of Counselling has started moving down this road and in their draft statement of competence have identified five units of competence, all to do with the therapeutic relationship, broken down into 17 elements of competence and demonstrable by 134 performance criteria.

 

This gives you a clue as to the terminology involved. The key terms are: Competence; unit of competence; element of competence; performance criteria; standards; range statements; assessment.

 

As I have already stated, competence here means competence to perform satisfactorily in employment. The focus is on observable competence, on what can be demonstrated. The standards for this competence will be set by the employing body. The concern is not how the competence is achieved but rather that it is demonstrated in employment. It is a competence which is specifiable and available for all to see in a consistent format. (Jessup, in Burke 1989, p 68). This is known as a statement of competence.

 

Competence is made up of units of competence. These "represent a relatively discrete area of competence having independent value in employment (and) can be separately assessed and accredited to an individual - the units stand free from each other." (Jessup) Individuals acquire a number of units of competence in order to gain a qualification. Units are in turn made up of elements of competence which are the smallest sub-divisions of competence.

 

A key feature of this approach is to ensure that the competence can be observed and for this performance indicators are enumerated for each element of competence. These performance indicators define performance rather than making statements about the person. They define the characteristics of competent performance. They are in turn subject to range statements which highlight the variety of situations in which performance takes place.

 

This performance is then assessed. Assessments do not test someone's knowledge but rather make a judgement as to whether the individual's performance meets the required standard.

 

An illustration in terms of CAT may help to make this jargon a little more accessible. One way of delineating the core competencies of CAT is to identify four areas: Containment, Active Methods, Reformulation, Therapeutic Relationship. (CART) These four areas can be seen as the four units of competence. It would be possible to conceive of these areas as being relatively distinct, 'stand alone' competencies, though even a cursory analysis would identify areas of considerable overlap. For example, the reformulation shapes and affects the quality of the therapeutic relationship formed, it guides the active methods used to help effect therapeutic change, and it defines a focus for work within a time limit. Leaving aside the justification for the independence of these units, if we concentrate on one unit, the reformulation, then this can be subdivided into different elements. These elements, in turn, could be the written reformulation, the SDR, Rating sheets, and the goodbye letter. For each element, performance criteria have to be set.

 

Taking one element, the written reformulation, this must achieve certain performance criteria, such as:

1. State Target problems.

2. Identify pain inducing procedures.

3. Demonstrate empathy.

4. Demonstrate accuracy.

5. Demonstrate collaborativity.

6. Give an historical account of what circumstances promoted the chosen response of the client.

7. Give a tentative account of how the procedures have been enacted in the therapy so far and/or a prediction of how they might be enacted.

8. List the target problems and target problem procedures at the end.

 

We might set certain standards for the reformulation, for example that it should be written:

1. Written by the fourth session of therapy.

2. Written within two hours.

3. Not more than two sides of A4.

 

Superficial evidence of the accuracy and collaborativity in writing the reformulation could be shown by:

1. The client accepting it without requiring serious rewriting.

2. The client returning to therapy after the reformulation session.

3. The client completing the therapy.

 

This competence at writing reformulations could be demonstrated across a range of different clients from the relatively well functioning through to severely borderline.

 

This example of competence in CAT may have already raised your hackles as you begin to question why have I included a particular point or as a particular absence in my list leaps out at you. I would like you to leave aside these objections for the moment and consider, rather: What is the purpose of this listing?

 

In the NVQ approach to competence this listing provides apparently objective criteria for someone external to the task to judge whether or not the actor is performing competently. An assessor or rater can then tell the therapist whether the therapist is competent or not. A secondary gain is that the therapist has a somewhat clearer idea of what he or she is expected to be doing. We might reasonably hope that the therapist, armed with a clearer, explicit knowledge of what it is she or he should be doing, will be able to form more accurate, task centred judgements 'about themselves. The research into the use of manuals, as reported in Bergin and Garfield's Handbook of Psychotherapy and Behavioural Change, takes a rather more pessimistic view. One study showed that the use of manuals can make therapists less optimistic, more authoritative and defensive. (Binder, in Bergin and Garfeld, p 168).

 

A more important point is that while this listing may provide a way of judging performance, it is not necessarily the best way to learn. The danger of lists is that it can focus the actor's attention externally on grasping whether they have achieved external standards, rather than endeavouring to think about the meaning of their activity or relationship. This formal expression needs then to be restructured in the therapist's mind in order for it to begin to take on active meaning. When I try following a recipe I find myself rechecking the order of instructions, fearful I will have missed out a vital ingredient or misread a step. I have to reframe the instructions to my own rather chaotic, if occasionally successful, style of cooking.

 

Another problem with this approach, looking at it purely from the view of assessment, is the bureaucracy it generates. If we look at the experience of, for example, social work agencies in their use of this strategy of assessment, I think we would find the production of an enormous burden of paperwork. Moreover, the laudable aim of ensuring high standards in service can soon be subverted by a much less visible aim of covering the assessors' backs against criticism. The focus of attention gets narrowed down to an emphasis on show, on performance, not on meaning.

 

A more fundamental problem with the NVQ approach to competency is the reductionist method of analysis of competence into units, elements and performance criteria where the illusion is created that the truth somehow resides in the supposedly empirically verifiable performance criteria. Sixty years ago, Vygotsky made a powerful critique of this form of reductionism, comparing it to the chemical analysis of water into hydrogen and oxygen "neither of which possesses the properties of the whole and each of which possesses properties not present in the whole" (p 4). For Vygotsky, the key to understanding psychological phenomena lay in discovering the interrelatedness of different functions. This implies that competence is about the combination of capacities, knowledge, skill in such a way that the therapist can link his or her generalised experience with the specificity of the individual client. In contrast, the NVQ style approach is about dividing psychotherapy into tiny observable elements where the relationship between the units and the elements is either ignored or regarded as secondary. It is, if you like, an arithmetic view rather than an algebraic view. What is all important is the ability to specify tasks which can be observed, where the tasks have the same relation as potatoes in a sack have to each other. Because they can be grouped together they are all added up and it is assumed that once you have enough potatoes in your sack you are competent.

 

To return to the example of the reformulation. Reformulation is a high level task requiring the capacity to identify central aspects of the client's activity and generalise them in a way that is meaningful to the client and helps the client to see his or her life in a new light. Referring to target problems, to the client's history and the client's present, to the therapeutic relationship can be

identified as separate elements in the reformulation. The competent reformulation needs however to be able to weave these threads together into a new and coherent picture. It is not simply the presence or absence of elements that makes the reformulation powerful. It is the ability to identify common themes in the client's activity through all of these elements that is crucial. It requires the ability to create meaning where the client experiences brick walls.

 

In arguing against the NVCQ approach to competency in psychotherapy, I am not wishing to simply reject it outright. It does raise important issues for us, and, at the very least, we have to develop a coherent response to the social forces pushing us in that direction. I believe we need to develop a critique of this narrow approach which also offers a credible alternative. We need to identify more clearly how we can set about thinking about competency in terms which make use of our already existing theory.

 

Vygotsky was not arguing against analysis as such but rather he was aiming to identify the correct level of analysis, a unit "that is further unanalyzable and yet retains the properties of the whole." The Procedural Sequence Model provides us with such a unit for analysing activity in a way which emphasises the connectedness of aims, appraisals, actions and evaluations. It provides us with a way of thinking about competence which can both acknowledge the importance of becoming able to describe what it is we are trying to do while at the same time holding onto the less tangible and definable aspects of therapy, of the human relationship. The understanding of competence requires a highly complex understanding of how our aims, appraisals, actions and evaluations interweave to produce human activity.

 

I would like briefly to touch on two of Vygotsky's ideas which I feel could be helpful in approaching the task of learning and teaching about competency. One central idea is that of the Zone of Proximal Development. Vygotsky developed this idea through exposing the limitations of 1Q tests which focus on the completed ability of children, on what they can currently achieve. This gives no clue as to what the child is capable of developing, or of how far they can progress. Instead Vygotsky experimented with methods of assessing what the child could achieve with the aid of an adult. The Zone of Proximal Development refers to the difference between the problems the child can solve on his or her own and the problems that can be solved with the help of an adult. For example, he found that where two children's mental age was eight, with an adult one was capable of solving problems designed for a twelve year old, while another was restricted to problems of a nine year old.

 

I believe we actually address this Zone of Proximal Development in the reality of our supervision work. We are, in effect, saying to our supervisees, we can help you solve therapeutic problems and through that help you will become able to solve those problems on your own. To do this we are constantly assessing our mutual ability to solve problems and discovering the level at which the problem that the client presents can be addressed in the collaborative activity of supervisor and therapist. This I believe is the true meaning of continuous assessment - it is the constant evaluation of the collaborative activity. External standards can help us refine this process and make it more accurate. The danger is that they will ossify the process and substitute certainty about what standards should be achieved in place of thinking about the meaning of the standards.

 

Vygotsky developed the idea of the ZPD in the context of his ideas about the nature of concepts and of the relationship between thinking and language. He distinguishes between concepts and words and argues that acquisition of a new word is only the beginning of a complex process of development. For example, a child learning the word "flower" will initially use it interchangeably with rose or daffodil. The child's conceptual understanding leaps forwards when he or she realises that flower is a higher level of generalisation. In this way a new system of thinking is formed. This is a process which continues throughout life, though it can easily get stuck at any stage. Our first encounter with the term "Borderline" patient gives us the word. This may degenerate into an unthinking form of abuse unless we expand and deepen our knowledge of the concept and discover its use for us in practice. At first it may simply be a more technical description of clients whom we find difficult. With development the term takes a new place in our system of thinking, helping to re-organise and deepen that thinking. A complex interaction takes place between the use of the word and the development of our understanding.

 

Vygotsky hypothesised a distinction between two forms of concepts: everyday, spontaneous concepts that children brought to school, and the academic or scientific concepts that they are taught at school. Scientific concepts are organised, systematised, and can be verbally defined. They are taught in a highly structured way, imposing a specific logical ordering on the child. The latter, however, does not come to them as a "tabula rasa". The child brings everyday concepts which enable her or him to grasp everyday reality.

 

These are concepts to do with, for example, family, like brother, sister, mother, father, or objects, animals, plants. Scientific concepts start with the abstract and move to the concrete, while everyday concepts are rooted in concrete everyday experience and gradually become more abstract. Vygotsky argues that these two sets of concepts have a powerful impact on each other and it is the interaction between the two which leads to intellectual development.

 

I believe this approach can help us to understand more clearly what we are aiming for in CAT training. Of course, trainees come with much skill and knowledge and it would be wrong to simplistically apply the term spontaneous concepts to their level of development. However, in order for CAT to be offering them something of value, they must have some sense that their current level of conceptual development might usefully be expanded. Their ability to reformulate will exist at a relatively spontaneous level. They will draw on their everyday capacity to communicate in writing but will generally not be able to weave together the threads of the client's activity into a coherent whole. The supervisor, hopefully, brings a more systematic, organised and practised approach to the reformulation. Through reading other reformulations, through working with the supervisor, through practice, the trainee acquires the ability to reformulate. However, the ability to reformulate is not simply a skill in communicating to the client in writing. The ability to reformulate requires the development of a number of other therapeutic capacities: evenly hovering attention, professional judgement, the ability to integrate, the capacity to understand reciprocal role relationships etc. These capacities do not develop in isolation from each other, but rather interact with each other'to..form a new system, a new way of reliably working with clients. It is at this stage that the trainee becomes and feels competent.

 

In coming to the end of this talk I would like to summarise my main points: in order to understand the concept of competence, we need to be wary of the desire to reduce the concept to observable performance and to place the assessment of competence above our knowledge of the process of development. We should make use of the complex understanding of psychological phenomena offered us by the Procedural Sequence Model, linking together issues to do with self perception, activity and evaluation, and not pretend that because it is possible to analyse activity into observable components, people's subtle feelings about the latter will disappear. For us to become competent at competencies, we need to attain a high level of competence in both our theoretical understanding and also our understanding of the relationship between trainer and trainee, supervisor and supervisee.

REFERENCES

Bergin & Garfield, Handbook of Psychotherapies and Behavioural Change, John Wiley & Sons 1994.

Boan R & Sparrow P, Designing & Achieving Competency: A competency based approach to developing people and organisations The McGraw Hill Training Series, ed Roger Bennett McGraw-Hill 1992

Burke JW (ed), Competency Based Education and Training, Falmer 1989

Elizur A, Kretsch R, Spaizer N, Sorek Y, Self evaluation of psychotherapeutic competence, British Psychological Society 94 231-5

Field L & Drysdale D, Training for Competence, A handbook for trainers and FE teachers Kogan Page 1991

Stemberg RJ & Kolligian J, Competence considered Yale 1990

Main T, Knowledge, learning & freedom from thought, Psychoanalytic Psychotherapy (1990) Vol 5 No 159-78

Newman F & Holzman L, Lev Vygotsky: Revolutionary Scientist Routledge 1993

Remington M, Sutton L & Vetere A, Core competencies in clinical psychology: the Wessex model, Clinical Psychology Forum, N° 46, August 1992

Vygotsky L, Thought & Language (ed by Kozulin A), MIT 1986

Van der Veer R & Valsner J, The Vygotsky Reader, Blackwell 1994

Wertseh J, Vygotsky and The Social Formation of Mind. Harvard University 1985

Whyte C, Competencies, British Journal Of Psychotherapy ?94

Mental Health Foundation Psychotherapy Research Initiative Summary of Research Areas, Sept 1994

Society for Psychotherapy Research (UK) Task group on assessing therapists' psychodynamic competence consensus statement for discussion

Care Sector Consortium Voluntary Organisations Group Through the Maze Towards NVQs in Care "Deciding to Implement in Voluntary Organisations" 1991

London Open College Foundation leaflets

CCETSW (Central Council for Education and Training in Social Work) Code of Practice & Registration Scheme

This paper was delivered at the ACAT Conference, February 1995

Lawrence Welch

Petition to NHS England - The Case for Funding Training in the NHS 2021 Alert!
ACAT's online payment system has been updated - click for more information

Full Reference

Welch, L., 1995. Can the Concept of Competencies Help Us to be Competent?. Reformulation, ACAT News Summer, p.x.

Search the Bibliography

Type in your search terms. If you want to search for results that match ALL of your keywords you can list them with commas between them; e.g., "borderline,adolescent", which will bring back results that have BOTH keywords mentioned in the title or author data.

Related Articles

An Update on Microsupervision
Bennett, D., 1999. An Update on Microsupervision. Reformulation, ACAT News Summer, p.1.

CAT and its Relationships to Non-CAT - Preliminary Thoughts About Annalee's Diagram
Nehmad, A., 1993. CAT and its Relationships to Non-CAT - Preliminary Thoughts About Annalee's Diagram. Reformulation, ACAT News Winter, p.x.

How should we respond to Therapists offering CAT without valid training or qualifications?
Wilton, A., 2000. How should we respond to Therapists offering CAT without valid training or qualifications?. Reformulation, ACAT News Spring, p.x.

Meditation on the Phenomena of Anxiety in CAT Clinical Training
Dunn, M., 1993. Meditation on the Phenomena of Anxiety in CAT Clinical Training. Reformulation, ACAT News Autumn, p.x.

Supervision: Integrating Self and Skill
Welch, L., 1994. Supervision: Integrating Self and Skill. Reformulation, ACAT News Spring, p.x.

Other Articles in the Same Issue

Can the Concept of Competencies Help Us to be Competent?
Welch, L., 1995. Can the Concept of Competencies Help Us to be Competent?. Reformulation, ACAT News Summer, p.x.

Do We Allow CAT To Have A Heart - And If We Do, Does This Make It Soft And Wet?
McCormick, E., 1995. Do We Allow CAT To Have A Heart - And If We Do, Does This Make It Soft And Wet?. Reformulation, ACAT News Summer, p.x.