Can we assess counselor competencies?

For 30 years I have been training clinical supervisors, preparing many for certification and presenting the Blended Model of Supervision. During my five-day class we discuss how to evaluate counselors. Honestly, that is my least favorite topic of the class. I secretly hope the class will end, we will run out of time and I will not get around to how to assess counselor competencies. Now I know why I’ve been reluctant to address this topic.

It may be heresy to say this, but although our counselor certification systems tout that they assess competencies for credentialing, trying to do so is like aiming at a moving target with an elusive criterion and a faulty instrument. Contrary to all we are taught, research has failed to show that certain skills determine client outcome. What is clear from the data is that non-specific factors (affective qualities and the therapeutic alliance) are key predictors of client outcome. Here’s more bad news:

• It is unclear from the research what educational experiences yield competent counselors.

• Academics and credentialing do not necessarily correlate with client outcome and success in treatment.

• Credentialed counselors change over time, sometimes for the better, sometimes not; some counselors fossilize the   longer they are in the field; some counselors have one good year of growth and then they keep repeating that year, again and again.

• There is a lack of performance measurements that can distinguish competent from incompetent counselors.

• What most “competency exams” measure is knowledge of theoretical models, policies, codes of ethics, procedures in counseling, etc., which may or may not have anything to do with client success in treatment.

• Our psychometric procedures are typically flawed, according to Dr. Norman Hoffmann, a key researcher in the field.

Yet, we believe specific competencies are critical. The absence of evidence may not be evidence of absence. Besides, we have a legal and ethical responsibility to train, supervise, and assess counselor competencies. And, there is good research that indicates that personal characteristics of counselors are highly predictive of client outcome.

What does the research say?

Meta-analysis research from Lambert and Ogles (2004) Hubble, Duncan and Miller (1999), and Wampold (2001) indicate some very important factors that are predictors for success and competency:

1. Allegiance to a treatment model and the quality of the therapeutic alliance
highly correlate to outcome and treatment effects.

2. The dodo effect is true in the treatment of childhood and adult disorders: the superiority of any therapeutic approach over another has little support.

3. What makes the difference is the therapist himself/herself. The differences between therapist effectiveness account for five to 10 times more of outcome than the approach used. In other words, it’s about the relationship!

4. Instead of seeking empirically-supported therapies we should seek empirically-supported therapists, for it seems to be the individual therapist that makes the differences in patient outcome.

5. The longer people are in substance abuse treatment, the better the outcome. By contrast, general mental health patient samples typically show little outcome gain after the first few visits, with the incremental success becoming barely noticeable after approximately the twentieth outpatient visit.

6. There is a growing body of research that indicates that therapists may need to exercise greater skill in gauging the level and intensity of treatment in order to keep clients engaged.

7. Feedback to counselors regarding their skills and competencies, using a valid, reliable outcome tool, is an essential first step in measuring effectiveness.

8. Quoting Norm Hoffmann, “When assessing counselor competency we need to understand there is so much art to the science of behavioral change.” We can assess for knowledge and the ability to apply that knowledge appropriately in practice. However, that requires direct observation and judgment, rather than relying on a handy tool to yield desired information.

What should we do?

What is clear from the data is defining counselor competencies in terms of either knowledge about or fidelity to a particular model or methods of treatment (including those deemed “evidence-based”) contributes little to nothing to outcome. Any definition that ties competencies to a therapeutic model is misguided. Instead, what we need to do is identify counselors within a setting with superior outcomes and then try to understand why they were more effective than others.

Competency seems to be contextual. We need to turn the competency question on its head and ask the client how therapy is going. Here are some questions supervisors should routinely ask clients. (For additional information on these questions, visit www.talkingcure.com):

• What do you, the consumer, care about, and want to see in a counselor?
• How would you describe a competent counselor?
• Did you feel heard, understood and respected by the counselor?
• Did you work and talk about in therapy what you wanted to work on and talk about?
• Was the counselor’s approach a good fit for you?
• Overall, was today’s counseling session right for you?

My guess is that clients would define a competent counselor as someone who knows when and if they are helping and who ensures continuity of care when they are not helping. My guess is clients would define a competent counselor as a good listener, who tracked well and understood what the client was feeling. A competent counselor would be someone who demonstrates caring and compassion to the client. That’s my guess.
 
In the end, to assess counselor competency, we ought to determine does the client get better. Does the client establish a durable recovery over time? We ought to assess the ability of the counselor to facilitate client engagement. This takes time and money to do so — precious commodities in today’s treatment world. Too often the economic tail wags the clinical dog. However, if we are to assess competency, we ought to be observing counselors in action and asking the client about the effectiveness of the counseling.

References
N. Hoffmann, private communication.
Hubble, Duncan & Miller (1999). The Heart and Soul of Change.
B. Wampold (2001). The Great Psychotherapy Debate.

This article is published in Counselor,The Magazine for Addiction Professionals, October 2006, v.7, n.5, pp.18-19.

One person has commented on this article.

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Sky, Unregistered

I believe in training,academies, creditation and licensure, however, the character of a counselor and their client relationship, (I believe) will yeild a better outcome.

 Posted 2007-10-23 21:11:54

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