Therapist competencies necessary for the delivery of compassion-focused therapy: A Delphi study

Developing consensus-based clinical competencies to guide stroke clinicians in the implementation of psychological care in aphasia rehabilitation

Background People with aphasia experience depression and anxiety associated with negative outcomes across a range of time post-stroke. Stroke clinicians are well-positioned to facilitate low-intensity psychotherapeutic interventions after aphasia (e.g. mood screening, behavioural activation, problem-solving therapy, relaxation therapy); however, they self-report a lack of knowledge, skills and confidence to do so. The Theoretical Domains Framework (TDF) provides a lens through which to view and target clinician behaviours and training needs in this area of practice. The aim of this study was to develop and gain consensus on items for a rating scale of clinical competencies in facilitating individual-based, low-intensity psychotherapeutic interventions for people with aphasia. Methods An e-Delphi methodology using focus groups and survey rounds was used to gain consensus on clinical competencies considered important. Results Eight stroke clinicians (speech pathologists and psychologists), two people with aphasia and three family members participated in one of four focus groups. Four themes were derived from the data: (1) Communication support, (2) Assessment and therapy structure, (3) Interpersonal skills, and (4) Needs of the significant other (family or friend). Themes informed an initial list of 23 self-rated and observer-rated competency items. Following two rounds of e-Delphi surveys, 11 stroke clinicians (six speech pathologists and five psychologists) reached consensus (80-100%) for 19 competencies. Conclusions The Psychological Care in Aphasia Rehabilitation Competency scale offers a preliminary list of items to guide and train clinicians to implement low-intensity psychotherapeutic interventions for people with aphasia.

Defining compassion: A Delphi study of compassion therapists' experiences when introducing patients to the term 'compassion'

OBJECTIVES

Compassion-focused therapy (CFT) is shown to be an effective psychological intervention; however, patients can experience resistance to CFT due to preconceptions regarding the term 'compassion'. This study aims to obtain guidance from therapists in how to overcome these resistances DESIGN: This is the first study using the Delphi methodology to ask CFT therapists about how their patients understanding of the term compassion might act as a barrier to engaging with an otherwise beneficial therapy.

METHODS

Two rounds of interview questions were posed to 15 expert CFT therapists.

RESULTS

The results provide verification that there is resistance to CFT due to preconceptions around 'compassion', specifically its association with 'pity', 'weakness' and low-rank social positions. Further, this appears to be pronounced in patients who value competitiveness.

CONCLUSIONS

The results have practical implications such as the need for therapists to acknowledge the potential for resistance and the need for experiential strategies and illustrative examples of compassion to facilitate successful engagement with CFT.

Integrating top-down and bottom-up requirements in eHealth development: The case of a mobile self-compassion intervention for people with newly diagnosed cancer (Preprint)

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Stakeholder Engagement in Competency Framework Development in Health Professions: A Systematic Review

Competency framework development in health professions has downstream implications for all relevant stakeholders, from the professionals themselves, to organisations, and most importantly end users of services. However, there is little guidance related to what stakeholders might be involved in the competency development process, and when. This review aimed to systematically review literature related to competency framework development methodology in health, to identify the breadth and purpose of key stakeholders commonly involved in the process. Studies were identified using five electronic databases (MEDLINE, PubMed, CINAHL, EMBASE, and ERIC) and a search of websites of organisations involved in curriculum or regulation using keywords related to competency frameworks. The total yield from all databases was 10,625 results, with 73 articles included in the final review. Most articles were from Australia (30%) and were conducted in the nursing (34%) profession. Unsurprisingly, practitioners (86%) and academics (75%) were typically engaged as stakeholders in competency framework development. While many competency frameworks were described as patient-focused, only 14 (19%) studies elected to include service users as stakeholders. Similarly, despite the multi-disciplinary focus described in some frameworks, only nine (12%) studies involved practitioners from other professions. Limiting the conceptualisation of competence to that determined by members of the profession itself may not provide the depth of insight required to capture the complexity of healthcare and address the needs of important stakeholder groups. Future methodology should attempt to engage a variety of relevant stakeholders such as external health professions and the community to match professional education to health service demands. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=128350.

Revised model for evaluating visiting health care services in rural and remote settings

OBJECTIVE

Visiting health care services were developed to improve access to essential health care in rural and remote areas. Evaluating these services requires a robust framework. The objective of this study was to assess the confirmability and credibility of a model of 7 principles for effective visiting health care services.

SETTING

Three iterative online survey rounds administered between July and December 2020.

PARTICIPANTS

A heterogeneous panel of 13 experts in rural and remote health care participated, including managers of health care services, senior clinical staff in rural and remote regions and research academics specialising in rural infrastructure.

DESIGN

The model was appraised using the Delphi method involving iterative online survey rounds to facilitate anonymous and structured discussion between panel members.

RESULTS

Findings indicate consensus between panel members and support for a revised model. The revised model includes 4 modifications: (a) proposal of a new principle titled Feasibility, (b) restructure of 2 existing principles, (c) refined shape of the model to more accurately reflect the nature of service delivery and (d) detailed definitions of each principle.

CONCLUSION

This study presents a credible, revised version of the model of 7 principles for effective visiting services. This will enhance the quality of the health workforce across geographically large countries, like Australia, enabling organisations to more effectively and consistently evaluate the impact of their service on rural and remote communities.

The development of the Compassion Focused Therapy Therapist Competence Rating Scale

OBJECTIVES

Compassion-focused therapy (CFT) has shown promise as a treatment for a number of clinical presentations; however, existing studies have not adequately addressed issues of treatment fidelity. The aims of the present study were to identify initial candidate items that may be included in a CFT therapist competence rating scale and to develop the behavioural indicators to anchor these items.

DESIGN

The Delphi method was used to develop and operationalize the competencies required for inclusion in a CFT therapist competence rating scale over five rounds.

METHODS

Face-to-face meetings with two CFT experts were conducted in rounds one, two, and five, and these were used to define and operationalize the competencies. Nine other CFT experts were invited to complete online surveys in rounds two and four. An 80% consensus level was applied to the online surveys.

RESULTS

The resulting Compassion Focused Therapy Therapist Competence Rating Scale (CFT-TCRS) consisted of 23 competencies which were separated into 14 'CFT unique competencies' and nine 'Microskills'. There was high agreement about the included 'CFT unique competencies' and 'Microskills'; however, there were some differences in opinion about the specific content of some items.

CONCLUSIONS

This is the first study that has attempted to reach consensus regarding the competencies and behavioural anchors for a CFT therapist competence rating scale. The next stage of development for the CFT-TCRS is to establish whether the scale can be reliably and validly used to evaluate CFT practice.

PRACTITIONER POINTS

The Compassion Focused Therapy Therapist Competence Rating Scale (CFT-TCRS) is the first scale to operationalize the unique and generic competencies required to deliver compassion-focused therapy (CFT). The CFT-TCRS can be used as a learning guide for delivering CFT training and with further development could be used to assess therapist competence for CFT training courses, clinical practice, and treatment fidelity in research trials.

A Mixed-Method Modified Delphi Study toward Identifying Key Elements of Psychotherapy in Iran

PURPOSE

In Iran, psychotherapy is regarded as an effective treatment for psychiatric disorders. However, no previous research has identified the key elements of psychotherapy that may be specific to Iranian society. The current study was conducted in an attempt to identify these elements.

METHODS

A mixed-method modified Delphi approach was used, taking place over several stages during 2017-2018. The first stage involved interviewing 12 experts in psychotherapy to identify key elements of psychotherapy in Iran by thematic analysis. Then, successive Delphi rounds were conducted to obtain consensus (75% agreement) from 70 psychotherapy experts on these key elements.

RESULTS

Key elements of psychotherapy were grouped into the following themes: (1) systematic education/training; (2) psychotherapist competency; (3) psychotherapy reflective of Iranian societal needs; and (4) the substrate (scientific/ethical principles) of psychotherapy. Consensus was reached during two Delphi rounds. In Delphi round 1, 52.8% of the statements reached consensus, and all remaining statements reached consensus in round 2.

CONCLUSIONS

The key elements of psychotherapy in Iran are a set of conditions for the education and training of competent psychotherapists who can perform psychiatric interventions appropriate to Iranian society under supervised rules. These should serve as a framework for improving the current delivery of psychotherapy in Iran.