Adherence and competence
Adherence refers simply to the extent to which a therapist conducts a therapy as it is described and defined in a manual.
The manual has usually been drawn up in a research context and so will describe those features that differentiate one therapy from another, and can be rated reliably by a trained independent rater using a scale. These elements are crucial in defining and differentiating an intervention in a research study but may be less well suited to developing clinical skills in practice.
The adherence scale for PI therapy was originally developed in a research context (Startup and Shapiro, 1993). It covers elements that differentiate this model from others, but also includes some “facilitating conditions” that are relevant to all therapists. The scale has been modified so that the elements reflect closely the skills we have discussed within the manual . Therapists can identify what level of skill development they have reached when listening to audio-recordings.
The PIT adherence scale is available to use to develop recognition of key components of PIT.
In contrast, competence is “the extent to which the therapists conducting the interventions took the relevant aspects of the therapeutic context into account and responded to those contextual variables appropriately” . Competence, therefore, involves skills like
- timing of interventions;
- how to choose which possible intervention;
- when to hold back; and also
- subtler skills related to the precise form of language used in a conversation.
These aspects are much more difficult to rate reliably but are often the focus of clinical training as discussed later.
The idea of core competencies across a range of therapies has been developed by the UCL research group.
Psychodynamic-Interpersonal (PI) Therapy
This section describes the knowledge and skills required to carry out Psychodynamic-Interpersonal Therapy.
It is not a ‘stand-alone’ description of technique, and should be read as part of the psychoanalytic/ psychodynamic competence framework. See here for this framework.
Effective delivery of this approach depends on the integration of this competence list with the knowledge and skills set out in the other domains of the psychoanalytic/ psychodynamic competence framework
For a printable version of the UCL framework follow the link Psychodynamic-Interpersonal Therapy (ucl.ac.uk)
You can read the UCL framework on psychotherapy competences