Elizabeth S. Sburlati, Heidi J. Lyneham, and Carolyn A. Schniering
There are a number of cognitive behavioral empirically supported treatments (ESTs) available for treating child and adolescent anxiety and depressive disorders that therapists practicing in routine clinical practice (RCP) can use when delivering evidence-based practice (EBP). However, interventions for children and adolescents may not be as effective when implemented in real world RCP settings as they are when implemented in research settings (Weisz, Ugueto, Cheron, and Herren 2013). Research is now indicating that poor real-world implementation of ESTs could be partly due to inadequate training of the therapists who work in RCP (Beidas, Barmish, and Kendall 2009; Herschell, Kolko, Baumann, and Davis 2010). As a result, there has been a call to examine and improve the quality of therapist EST training (Rakovshik and McManus 2010). However, until recently, the specific competencies that are required for the effective implementation of ESTs that target anxious and depressed children and adolescents were unknown, which made the development of more effective EST training difficult.
The field of psychology is moving away from the traditional training approach, which focused on the trainee’s satisfying training activities (e.g., courses, client contact hours, supervision hours) to a competencies-based approach to training that aims to conceptualize, systematically train, and effectively assess the competence of trainees in performing as independent professionals (e.g., Hunsley and Barker 2011; Kaslow 2004; Kaslow et al. 2004; Knight 2011; Laidlaw and Gillanders 2011; Pachana, Sofronoff, Scott, and Helmes 2011; Roberts, Borden, Christiansen, and Lopez 2005). Competence is defined within the competencies-based approach as “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served” (Epstein and Hundert 2002, p. 227). The competencies-based approach suggests that competence is comprised of competencies, which are the important component parts of competence (Kaslow 2004; Kaslow et al. 2004). According to the competencies-based approach, these competencies include a therapist’s knowledge, attitudes, and skills that are related to his or her area of practice (Kaslow 2004; Kaslow et al. 2004).
As a part of a large-scale initiative in the United Kingdom, the dissemination project Improving Access to Psychological Therapies (IAPT), Roth and Pilling (2008) developed a model of therapist competencies for the evidence-based cognitive behavioral treatment of adult anxiety and depression. This model was designed to be used so as to develop a training curriculum aimed at teaching therapists in RCP to implement evidence-based practice in real-world settings. Drawing on the work of Roth and Pilling (2008) and acknowledging the vast array of different competencies required when treating children and adolescents (as opposed to adults), Sburlati, Schniering, Lyneham, and Rapee (2011) developed a therapist competence model targeting the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders. This model drew on all empirically supported treatment manuals that had been published prior to January 2010 and utilized the knowledge and feedback of experts from all around the world (for a complete description of the manuals, experts, and methods used in the model development, see Sburlati et al. 2011). The outcome was a model that provides a comprehensive listing of the individual competencies needed to conduct evidence-based practice with youth experiencing internalizing disorders in real-world clinical practice. The individual competencies in the model are grouped together by similarity, into competency categories, and these competency categories are placed under the three domains of competence (Sburlati et al. 2011). These three domains of competence are described below, in the part devoted to the subject. In the model, competencies were shaded gray if they were specific to the treatment of children and adolescents (but not adults) or require considerable adaptation when working with children and adolescents. (To view the model in its original format, see Sburlati et al. 2011, p. 94).
Generic therapeutic competencies, first identified by Roth and Pilling (2008), are those competencies that a therapist needs in order to interact with people within a therapeutic context, irrespective of therapeutic orientation. These competencies are not seen in cognitive behavioral therapy (CBT) only, but rather are used across all therapeutic models (Roth and Pilling 2008). The generic therapeutic competencies were reviewed, adapted, and expanded by Sburlati and colleagues (2011) to account for the needs of children and adolescents. The competency categories and individual competencies included in the generic therapeutic competencies domain can be seen in Table 1.1. These competencies are discussed across Chapters 3 to 7 of this book.
Table 1.1 Generic therapeutic competencies.
Source: Sburlati, Schniering, Lyneham, and Rapee (2011, p. 94).
| Category | Individual competencies |
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CBT competencies are those competencies required to plan, administer, and flexibly tailor specific CBT techniques to the individual needs of the child or adolescent and his or her family (Sburlati et al. 2011). The CBT competencies domain in Sburlati and colleagues (2011) is not to be found in the Roth and Pilling (2008) model; it was derived from combining two separate Roth and Pilling (2008) competence domains – basic CBT competencies and metacompetencies. The competency categories and the individual competencies included in the CBT competencies domain can be seen in Table 1.2. These competencies are discussed across Chapters 8 to 11 of this book.
Table 1.2 CBT competencies.
Source: Sburlati, Schniering, Lyneham, and Rapee (2011, p. 94).
| Category | Individual competencies |
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Specific CBT techniques are techniques that target the theoretical factors that maintain anxiety and depression and that are included within empirically supported cognitive behavioral treatments for child and adolescent anxiety and depressive disorders (Roth and Pilling 2008; Sburlati et al. 2011). The competency categories and the individual techniques included in the specific CBT techniques domain can be seen in Table 1.3. These competencies are discussed across Chapters 12 to 19 of this book.
Table 1.3 Specific CBT techniques.
Source: Sburlati, Schniering, Lyneham, and Rapee (2011, p. 94).
| Category | Individual techniques |
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The present book calls on the expertise of many leaders in the field to explore in detail each of the competencies in Sburlati and colleagues’ (2011) model. This book is aimed at two main audiences. First, it is aimed at clinical supervisors who are mentoring therapists who will be (or are) treating children and adolescents with anxiety and depression, and at trainers who are developing and/or delivering training programs in university or college settings and continuing professional development programs. The book will assist this audience with the development of comprehensive and effective training curricula, will guide trainers and supervisors on relevant competencies that should be assessed throughout training, and can be used as a resource to support training or supervision programs leading to trainee therapists gaining a wide range of empirically based competencies. Second, given the current push for therapists to assess their own level of competence and to govern their own professional development (e.g., Bellande, Winicur, and Cox 2010), this book is aimed at therapists who wish to gain an understanding of the competencies they need to acquire in order to effectively work with the targeted population and to come to know what competent practice looks like for each individual competency; and the competency descriptions will provide a benchmark against which they can assess themselves. Third and finally, the aim of this book is to improve the quality of the treatment provided to children and adolescents as a result of the enhancement of individual therapists’ abilities.
This book is divided into three parts that reflect the three-domain structure of the competencies model described earlier. Further, chapters within these three parts broadly map onto the competency categories of each domain. For example, Part I covers the generic therapeutic competencies domain of the model and includes five chapters that focus on the four competency categories within this domain, namely “Practicing Professionally,” (which is covered over two chapters) “Understanding Relevant Child and Adolescent Characteristics,” “Building a Positive Relationship,” and “Conducting a Thorough Assessment.”
In order to ensure comprehensive coverage of each of the Sburlati and colleagues (2011) competencies as well as consistency throughout the volume, most chapters in this book contain a number of recurrent sections. The headings below give a general description of these sections; the exact wording may have been adapted within each chapter. Chapters 5, 8, and 9 do not follow this structure, as their content does not fit with this manner of organizing (e.g., the chapter is knowledge-based).
The first section of each chapter describes each competency in detail, highlighting the behavioral markers of each of the individual competencies. Illustrations or examples of the competent use of therapeutic techniques and processes are also included, so as to increase the clinical utility of the book.
Considerable differences exist among the different anxiety disorders (e.g., between panic disorder and social phobia) and also between anxiety disorders in general and depression. Therefore all chapters include a section focused on how the competencies covered in the chapter might be uniquely tailored when treating these different disorders.
Since this book spans competent practice across a large age range (from early childhood to late adolescence), the third section in each chapter highlights important developmental differences in treating children from different age groups. Specifically, unique competencies required for adapting evidence-based CBT for cognitive, emotional, and social maturation are considered.
Given that there are inevitably obstacles to the competent implementation of evidence-based CBT, the final section of each chapter covers typical obstacles to competent practice and provides strategies for overcoming them. These strategies come from the literature and clinical expertise.
It is the editors’ hope that this book will become the cornerstone of the development of a generation of therapists competent in treating children and adolescents with anxiety and depressive disorders. We believe that, by raising the standard of practice, the quality of the treatment provided to youth seeking a way out of these common and debilitating conditions in real-world RCP settings can be enhanced.