Care Cluster 10 to 17

Communication, Relationships and Inter-Personal Skills

    These skills reflect being able to communicate effectively with both people in services, their families and professional colleagues, in whatever form that communication takes (verbal, non-verbal, spoken, written). This includes skills in understanding what others are communicating, skills in expressing oneself, and skills in establishing effective relationships that facilitate the building of trust and hope.

    Progression of this skill is characterised by developments in the complexity of the subject matter, situation/context, purpose, number of people being communicated with, diversity and difference, and potential impact (moving from individual person/clinician dyads to the organisation as a whole).

All Client-Facing, Clinical Staff


Psychological Awareness
Broad Definition of Skills

At the foundation level to be able to creatively engage and connect with people as equals, whatever their life stage or stage in their recovery journey, their families & colleagues.

Being able to understand what is being communicated, both verbally and non-verbally, and being able to express oneself appropriately (including in writing).

    Maintaining therapeutic boundaries

  • The ability to understand the need to establish and manage therapeutic “boundaries”:
    • Communicating in a consistent manner i.e. content and style from an individual and team approach
    • Ensuring that confidentiality is maintained, even when sessions are in the community or in public –
    • Being clear about how, when and where communication is permitted to take place (taking into account guidelines and ethics, e.g. around social media, personal phone numbers etc.)
    • Judging when to use personal disclosures; ensuring that are necessary, helpful, and in the person’s best interests, perhaps as a way of promoting engagement
    • To be able to appropriately share aspects of personal life experience to develop rapport and demonstrate understanding as a peer
    • Avoiding giving, receiving or exchanging gifts as per local policy
  • To actively seek to engage with families; families may be parents, spouses, partners or children (who may also be in the caring role)

    Building Trust and Respect

  • The ability to engage with, build and maintain trusting relationships with people and their families as equals

  • Through inspiring relationships, offer hope to those who are alienated or disenfranchised and feel powerless
  • During interactions focus on the person’s inner resources and existing strengths
  • The ability to communicate an understanding that people are more than problems or diagnoses
  • The ability to demonstrate courtesy and respect when communicating with others, treating people with dignity
  • Being reliable, dependable and trustworthy
  • The ability to communicate genuine concern for wellbeing.
  • Accepting and valuing the other person irrespective of behaviour, attitudes, beliefs, status or background
  • Use terms associated with ‘recovery’ and understand what that uniquely means to the person
  • To have a focus on building trust in the relationship with the person and their family/care system
  • Offer practical and flexible support to build rapport and trust
  • To genuinely learn from the person about their unique experience
  • Show a willingness ‘to go the extra mile’
  • To have an awareness of appropriate communication that can facilitate engagement e.g. modern media/social networking

    Responding to crises/Challenging situations

  • The ability to respond appropriately, calmly and consistently in a crisis; this relies on:
    • The ability to communicate sensitively when dealing with high levels of distress
    • The ability to apply basic de-escalation skills (with the aim of reducing a person's anger, aggression, agitation, hostility or distress, and preventing unsafe behaviour)
  • Encourage responsible risk taking, a positive outlook and expectations of the future

    Understanding verbal and non-verbal communication

  • A basic understanding of body language and nonverbal communication (one’s own, and other people’s) and the impact of diversity on these and the ability to adapt one’s communication style/form to take account of factors such as age, capacity, learning ability, diversity etc.
  • To be able to continue to collaborate with people who are challenging, for example, in terms of non-engagement with services due to beliefs about their experiences or suspicions of services
    Engaging and networking with others

  • The ability to engage and maintain contact with a number of different parties (e.g. the person you are working with; families and carers; external agencies)
  • The ability to contribute to discussions in various settings such as multidisciplinary team meetings; multi-agency meetings; skills groups

    Communicating Empathy

  • Be open and show empathy, care and acceptance in communication by affirming the person’s experience and their experience of services
  • The ability to communicate empathy, which depends on the ability to experience empathy, defined as follows:

    • being able to see things from others’ perspectives
    • understanding the person’s thoughts, feelings and worldview
    • having the ability to express your own understanding and how you feel appropriately
  • To empathise with distress and acknowledge that it is understandable in the circumstances and given the person’s belief system and experiences
  • The ability to use humour appropriately and with sensitivity
  • The ability to work with people from within their own frame of reference, acknowledging and appreciating their experiences
    Basic Listening skills

  • The ability to apply active listening skills and appropriate expressive communication (e.g. verbal and non-verbal attending; verbal and non-verbal encouragement

  • The ability to communicate using a kind, compassionate, caring, warm, understanding, encouraging and non-judgemental approach
  • Having a basic open questioning style, reflecting back and summarising what the person has said to clarify mutual understanding
  • The ability to listen and respond sensitively, validating (accepting and understanding) experiences and reactions when receiving highly sensitive/contentious information and when there is high distress (e.g. if a person discloses trauma or abuse)

Qualified
Mental Health Professionals

(Any graduate-level healthcare professional) Without further accredited training in delivering psychological interventions

Psychologically-Informed Healthcare
Broad Definition of Skills

More advanced communication skills with individuals pertaining to maintaining positive working relationships. Being able to communicate in circumstances that present particular difficulties.

    Negotiation skills

  • The ability to engage and maintain contact with a number of different parties (e.g. families and carers; external agencies), and respond to any challenges in this area (e.g. ruptures i.e. deterioration in the relationship seen through varying levels of confrontation or withdrawal - the need to acknowledge these and negotiate new ways of being and ways forward)

    Coaching and engaging communication style

  • Assuming the capacity for personal responsibility and ‘self-righting’ to get back on track
  • Focusing on living well with experiences or “symptoms” versus treating the illness
  • Focusing on enabling strengths to work towards personal goals and valued roles
  • Working with the person’s frame of reference, respecting different beliefs about experiences and not trying to force everyone to accept a particular way of thinking (i.e. not seeing personal explanations as signs of illness and the need to develop ‘insight’
  • To practically demonstrate care and support as a means of creatively engaging the person and their family
  • Finding the balance between creating dependence, engagement and supporting independence

    Modifying communication to meet specific needs

  • To respect and value diversity including; age, race, culture, disability, gender, spirituality and sexuality, and to flexibly modify communication accordingly to enable collaborative assessment and intervention
  • The ability to take account of any factors that might impact on communication, e.g. learning disability, culture, ethnicity, disrupted education, English as a second language, autism and reduced emotional literacy, and modify communication accordingly; this could involve:
    • Modifying the environment or context in which communication is taking place
    • Modifying the content or structure of communication e.g. simplifying the content; pacing
    • Finding alternative ways to communicate (written, diagrams, questionnaires etc.)
    • Using communication aids; involving an interpreter
    • Supporting self-discovery through creative means e.g. diaries, poetry, art-work

    Building trust and respect

  • The ability to communicate with compassion with people who are in an active psychotic/delusional state, (e.g. ‘suspension of disbelief’ - working within the person’s framework, responding to the emotion and the distress rather than the content)
  • The ability to help people find a ‘meaningful language’ to discuss experiences, feelings and articulate emotional states and thoughts
  • The ability to build and maintain trusting relationships in situations where there are significant challenges, e.g. on-going difficulties with trust, conflict, ruptures to the relationship

    Communicating complex information

  • The ability to communicate one’s own professional opinion or view (both formally and informally, in writing and verbally)
  • More advanced written communication skills – being able to write for different audiences (people who access the services/other professionals), treating material sensitively with an awareness of the potential impact on the intended audience, presenting it in an accessible way with an appreciation of the legal implications of their writing.
    • Feeding back the outcome of an assessment
  • Oral presentation skills – the ability to contribute or lead effectively in group settings, for example:
    • In meetings within the team or other services/agencies
    • In group settings such as psychoeducational groups or skills groups
    • Formal presentations
  • The ability to explain complex issues (for example risk assessment, care plans) in formal situations (such as Courts)

    More advanced interpersonal communication skills, including:

  • The ability to communicate accurate listening e.g. using paraphrasing -to express what has been heard and to clarify understanding and meaning
  • The ability to actively monitor the effectiveness of one’s own understanding using reflection and asking clarifying questions
  • The ability to articulate and handle differences of opinion sensitively in relationships with the people who come into services and colleagues
  • The ability to use self-disclosure in an appropriate manner for the benefit of the person accessing services, including sharing lived experiences and personal coping strategies
  • The ability to collaboratively agree with people and their care plan, focusing on the roles and goals valued by the person
  • The ability to hold uncertainty, and be genuinely open and curious about experiences and their explanations, having different hypotheses while maintaining an awareness of the influence of the person’s life stage e.g. adolescence and first episode psychosis

  • To take people’s account of their experiences seriously, to hold uncertainty - and demonstrate a genuine curiosity regarding possible hypotheses concerning the information described
    • The ability to adopt the person’s frame of reference, i.e. to see and appreciate the experience through the person’s own eyes
  • The ability to see and work with families as resources, experts and partners in care
  • To openly acknowledge and respect the caring role and the stresses and challenges that this can bring
  • To walk alongside and collaborate with the person and their family, to make sense of the experience and create some personal meaning, offering possible alternative explanations where appropriate
  • To be genuinely tentative in communicating professional perspectives and not just seeing this as a ‘therapeutic manoeuvre’
  • Focus on supporting people to identify, elaborate on and work towards personal values and goals

  • The ability to use person-centred questioning e.g. “What would make your life more enjoyable?” and then establishing steps “What would it take to make this happen?” without doing it for them what is therapist role?
  • To be able to not only establish, but also manage the expectations of others whilst holding hope, especially during repeated reoccurrence of distressing experiences
  • To demonstrate compassion, particularly around setbacks, to nurture a more positive view of the self and the future

Qualified (Uni-Model) Psychological Therapists

(Any graduate-level healthcare professional with further post-graduate accredited training in a recognised psychological therapy)

Delivery of
Evidence-Based Skills
Broad Definition of Skills

Ability to communicate effectively within the context of a specific psychological intervention relationship. Advanced communication skills.

    Developed collaborative engagement skills

  • To engage in ‘radical collaboration’; where the assumptions are based on:
    • The core of the person is positive
    • There is a shared responsibility in working towards wellbeing
    • Acceptance
    • Experiences are on a continuum
    • A focus on understanding the distress, not the source of the psychosis –
    • The therapist being themselves and modelling interpersonal behaviour

    Advanced Interpersonal skills

  • To be able to communicate in such a way as to motivate and support people to change (e.g. eliciting /evoking change talk i.e. looking forward questions and exploring extremes of change (or lack of), exploring importance and confidence regarding changes using scaling and looking at the decisional balance i.e. pros and cons of staying the same versus change; motivational interviewing skills)
  • The ability to use advanced questioning styles that aid intervention, e.g. Socratic questions, solution-focused questions
  • To be able to manage high expressed emotion and ‘higher-level’ interpersonal issues within the therapeutic relationship, e.g. poor engagement, boundary testing, the implications of power dynamics, managing interpersonal ruptures, endings and process issues e.g. transference

    Providing advice, supervision and consultation

  • The ability to adapt one’s communication style to provide support/supervision/ consultation/advice to staff of varying experience/knowledge/skill, working with one particular model
  • Oral presentation skills – able to deliver formal presentations within the area of knowledge, from the perspective of one model

    Communicating utilising a uni-model perspective

  • The ability to tentatively share uni-model psychological ideas (e.g. the nature and purpose of specific models/techniques) in an appropriate and flexible form and style (e.g. verbally/written/diagrammatically; collaboratively/didactically); in different contexts (therapeutic/professional; formal/informal settings)
  • The ability to engage in effective written communication of assessments and intervention reports/letters taking account of the unique needs of the intended audience
  • The ability to use single model formulations to assist multi-professional communication and understanding

Highly Trained Psychological Workers

(Any graduate-level healthcare professional with further post-graduate accredited training in a recognised psychological therapy)

Delivery of
Specialist Skills
Broad Definition of Skills

Ability to communicate in complex and difficult situations where a great deal of sensitivity and a high level of understanding is required.

Specialist advanced communication skills.

    Presentation skills

  • The ability to formally present scripted and non-scripted material about a range of highly complex issues from an integrative/multi-modal psychological perspective, whilst using strategies to maximise the learning of others (e.g. encouraging audience participation)

    Working effectively in complex networks

  • The ability to maintain the active and parallel involvement of multiple members of a group e.g. family members, team members, therapy group members, and to communicate with each of them in a way that is congruent with their different developmental stage or roles within the family/group/team/system

    Communicating and engaging effectively about complex issues

  • To flexibly engage with people in community settings, reflecting on professional boundaries and holding in mind the purpose, meaning, impact and context of the interventions to ensure the benefit to the person is of paramount focus
  • The ability to maintain positive and ‘hopeful’ therapeutic relationships and adapt interactions accordingly
  • Communicating (providing & receiving) highly complex, sensitive and contentious information regarding issues that require an integrative perspective
  • Being able to formulate particularly significant challenges (for example, with those who hold very fixed beliefs, or whose attachment style makes communication challenging, such as being hostile and antagonistic in highly emotive atmospheres or where co-existing conditions need to be taken account of e.g. learning disability/issues with substance misuse)

    Integrative/Multi-Model supervision, advice, consultation and leadership

  • The ability to communicate effectively (for example, a professional opinion or view) regarding highly complex issues, both verbally and in writing, within formal and informal settings, from a multi-model/integrative psychological framework
  • The ability to adopt and lead a team approach to delivering psychologically informed care
  • The ability to adapt communication style to provide integrative/multi-modal support/supervision/consultation/advice/leadership to staff of varying levels of experience/knowledge/skill
  • To be able to recognise, understand and work sensitively with systemic issues and power dynamics in relationships with people in services, colleagues and senior management

Principal Psychologists



Delivery of
Specialist and Complex Skills
Broad Definition of Skills

Ability to work with the most challenging of interpersonal situations and contexts with confidence

    Communicating and engaging effectively in complex and profoundly challenging situations

  • Highly specialised skills are required when communicating with those who present profound challenges to engagement

    Exercising leadership and negotiation in complex, challenging situations

  • The ability to develop strong working relationships with other professionals including service leads
  • The ability to communicate a professional opinion/view within a multi-modal psychological framework, and maintain it in challenging circumstances
  • Provide consultation and leadership, from a multi-model perspective, in the team regarding the provision of various psychological interventions
  • The ability to respond to/manage communication difficulties, e.g. those caused by clashes in communication styles or differences in systemic contexts (e.g. between colleagues/disciplines/teams/agencies) and to formulate and intervene sensitively in this network
  • Have a detailed understanding and management of interpersonal dynamics from a multimodal perspective in terms of dynamics within the team, and between the team and person accessing services

  • The ability to work with those people or systems where previous communication attempts have broken down
  • To have an awareness of the impact of negative labelling on people and their care and to challenge this at an individual and team level.
  • To challenge stigma and unhelpful aspects of traditional models, which can disempower and give rise to hopelessness.
  • The ability to lead, negotiate, and contribute to decision making according to a number of competing interests

    Encouraging reflective practice

  • The ability to encourage other professionals to reflect on current/innovative practice

Lead/Head Psychologists



Delivery of Organisational-Level and Competency Initiatives, Service Development, and Clinical Governance
Broad Definition of Skills

Ability to take position of ultimate responsibility regarding communication about psychological strategy, decisions, and governance.

    Communicating and building influence at a senior organisational/Network level

  • The ability to develop strong working relationships with directors and commissioners
  • The ability to explain (sometimes contentious) strategic and organisational decisions to everyone in an organisation

  • The ability to develop and implement policy, taking into account and balancing the needs of the organisation, high level professional guidance, and the overall research base
  • The ability to speak with confidence at formal events within and outside the NHS Trust/Organisation, being an ambassador for the profession and service

Assessment and Formulation

    Assessment is the process of discovering and gathering relevant information and data in order to make sense of what is going on and help to understand a problem. Formulation is the process of summarising core problems and suggesting how they may relate to one another by drawing on theory and principles, with the aim to explain the development and maintenance of issues and using this information to inform an intervention plan, whatever form that may take.

    Assessment and formulation are core aspects of psychological work, and are normally on-going hypotheses and processes rather than one-off events. As such, there are different levels of skill appropriate to different purposes and contexts. Increasing skill in this domain reflects greater ability to be able to collate and synthesise information from a range of sources.

All Clinical Staff Who Deal With People


Psychological Awareness
Broad Definition of Skills

To have a basic awareness of holistic assessment principles, including psychological issues, capacity, and risk.

To be aware of how assessment information informs a formulation, and an ability to contribute to this process.

    Understanding Capacity and Consent

  • Ability to assess person’s Capacity and Consent in relation to current activities engaged in with the worker

    Understanding risk assessment

  • An appreciation of the importance of risk assessment and the role that formulation (developed by others in the team) can play in understanding the function of risk behaviours and the development of subsequent healthy strategies to do what?
    Engagement in Assessment and formulation

  • To work with people to identify the WIIFM Principle (What’s in it for me) to understand and work with what is/will motivate behaviour change in line with their recovery goals

    Foundation level understanding of assessment and formulation

  • Ability to accurately collect information that feeds into a comprehensive, holistic, person centred assessment and/or strengths focused, needs-led formulation where the person is distinguishable from their experiences:
    • Via personal disclosure from the person or carer/other report of current and historical information. The expectation at this level is to ensure that relevant information is recognised, noted, and responded to appropriately
    • Via observation of the person’s behaviour – including knowing when to act immediately and when to seek further help
  • An understanding and appreciation of the function and importance of formulation to inform intervention
  • Basic understanding of commonly encountered psychosocial factors that frequently feature within psychological formulations, e.g. trauma as a trigger and have a willingness to ask questions about these areas, or respond appropriately if they are raised by the person themselves
  • To have an awareness of and ability to identify triggers and maintenance factors, and potential barriers to recovery e.g. social exclusion, poor engagement and ‘negative symptoms’ needs explanation or definition

Qualified
Mental Health Professionals

(Any graduate-level healthcare professional) Without further accredited training in delivering psychological interventions

Psychologically-Informed Healthcare
Broad Definition of Skills

To be able to carry out a basic holistic assessment, incorporating psychological factors alongside biomedical and social factors.

An ability to use assessment information to inform the development of basic formulations that can guide interventions or enhance understanding of problems.

    Assessing and formulating risk

  • Greater skill in assessing and formulating risk from a psychological perspective (e.g. regarding intended function, what response the behaviour gets etc.)
  • Being able to differentiate and balance reducing harmful risk with positive risk taking

    Recovery focused approach to engagement in assessment

  • Supporting the quest for meaning and offering tentative explanations, where diagnoses may be offered as a description not explanation
    • Supporting identity growth through redefining existing experiences and developing further elements of identity
  • Ability to distinguish between the person themselves (primary focus) and the illness (secondary focus)
  • Being open to different ways of understanding experiences and not insisting that people see their difficulties in terms of illness
  • Focusing on reducing distress and helping people live the life that they want, regardless of persistent experiences
  • Being able to differentiate and hold both person-centred recovery goals (strengths, value based, needs-led forward looking wants) and service led treatment goals (requirements and obligations to control behaviour and improve health)

    Bio-Psycho-Social formulation skills

  • Ability to assess factors at a general level in relation to a person’s reported psychological distress
    • Differentiating thoughts, feeling, behaviours, physiological distress and relevant environmental factors
    • Eliciting relevant problem factors (what, when, where, why, with whom, how)
    • Identifying triggers and moderating variables
    • Identifying strengths and resources (looking at values, coping strategies, dreams, goals and aspirations)
    • Eliciting relevant historical information, with an appreciation that the past influences how things in the present are experienced and interpreted
  • In particular, the ability to ask about sensitive areas (e.g. pertaining to abuse) as there is a recognition that both have a role to play in developing experiences diagnosed as psychotic in nature
  • Assessing person’s functioning within different/multiple systems
  • Ability to work in a way that acknowledges and values the personal, social, cultural and spiritual strengths and needs of each individual.
    Assessing Capacity and Consent
  • Ability to assess capacity and consent in relation to engaging in therapeutic assessment, formulation and subsequent intervention
    Accurate collection of information including observation and use of formal measures

  • Ability to accurately collect information that feeds into a person centred assessment and/or formulation, appreciating that this may take time over repeated sessions jargon, to allow for rapport building and trust before a person may share important relevant information:
    • Via semi-structured clinical interview
    • Via observation of the person’s behaviour and other information sources
    • Via structured self-report questionnaires including the ability to score these and use the data as a source of information. Selection of appropriate self-report measures would not necessarily be expected at this level, but may be administered under advice from those with higher levels of skill or relate to routine service measures clunky
  • Ability to utilise psychological assessment information in order to develop a basic psychological formulation (with some assistance from higher-skilled professionals where appropriate)
    • e.g. “5 P” formulation (clear description of the Problem; historical Predisposing factors; triggering Precipitating factors; Perpetuating or maintaining factors, including avoidance and Protective factors/resources)

    Knowing limits of expertise and when to see further advice/supervision

  • Ability to appropriately seek and utilise supervision, consultancy and advice in order to make sense of assessment information, including that pertaining to risk, and in particular to reflect on and make sense of a crisis, learning from the experience and incorporating it into revised formulations and intervention plans

    Assessing motivation and suitability for psychological intervention

  • Awareness of motivation and suitability factors in relation to psychological work (ability to differentiate psychological distress/need and ability to utilise psychological therapy)

    Ability to feedback assessment and agree intervention

  • Ability to feedback the results of assessment and agree an intervention plan with all relevant parties

Qualified (Uni-Model) Psychological Therapists

(Any graduate-level healthcare professional with further post-graduate accredited training in a recognised psychological therapy)

Delivery of
Evidence-Based Skills
Broad Definition of Skills

To be able to carry out comprehensive assessments that inform a psychological intervention plan. To be able to use assessment information to formulate from a psychological perspective that integrates theory with practice.

    Accurate collection of information including observation and use of formal measures

  • Ability to select, administer, and interpret relevant measures that contribute to assessment and formulation, including the monitoring of outcomes

    Ability to feedback assessment and agree intervention

  • Competence in sharing the outcome of assessment with the person and developing collaborative formulations as a feature of most (but not all) therapeutic approaches

    Assessing motivation and suitability for specific model approach

  • Assessing motivation & suitability for psychological work (including timeliness, appropriateness of intervention and safety/risk factors in relation to the person/system) with reference to a specific psychological model

    Theory based formulation

  • Integrate assessment information with theoretical knowledge to develop descriptive, maintenance and developmental formulations, that are idiosyncratic (personalised in relation to the person’s unique context and experience) or drawn from standard formulation models for specific disorders, based upon a specific psychological model
    • Identifying personalised maintenance cycles of unusual experiences and intrusive thoughts, in particular the role of hyper-vigilance
    • Ability to identify and differentiate co-occurring issues such as depression alongside experiences diagnosed as being psychotic

    Contributing to multidisciplinary formulation from specific model approach

  • Ability to contribute to the process of multidisciplinary formulation with particular contribution from a specific model

    Assessing and formulating risk from the specific model approach

  • An ability to assess and formulate risk issues from the perspective of the psychological model being used (which may involve consultation, supervision, or advice from a more skilled psychological practitioner who is able to draw on multiple models and theories)

    Assessing from a specific therapy/ model perspective

  • Ability to carry out a thorough, problem specific, semi-structured assessment of psychological factors (in the person’s/families own words), from a single model perspective (to include what might have led up to them starting, context, patterns in occurrence/triggers and analysis of recent event/experience), exploring function(s) of behaviour(s) and maintenance cycles (considering what meaning or impact they have had on the person, and also what strengths the person has to inform treatment from a specific theoretical perspective, while promoting the establishment of and enhancement of existing coping strategies
  • To be able to undertake assessment activities creatively and flexibly in community settings and using other colleagues in the team to support the information gathering process
  • Ability to assess capacity and consent in relation to engaging in therapeutic assessment, formulation and subsequent intervention

Highly Trained Psychological Workers

Who are able to draw on multiple models and theories (e.g. clinical or counselling psychologists).

Delivery of
Specialist Skills
Broad Definition of Skills

Ability to assess a person’s psychological needs and functioning in a comprehensive and high individualised way.

To be able to use this information to derive idiosyncratic formulations and decide which, if any, psychological approaches are most relevant

    Integrating multiple information sources and factors

  • Ability to utilise a wide range of sources of information and modify formulations in light of this information (e.g. knowledge of comorbidity, developmental disorders, brain injury, systemic factors)

    Multi-Model, integrative and individualised assessment

  • Ability to assess psychological functioning in a sophisticated, comprehensive, and highly individualised, person centred way, drawing on and integrating perspectives from more than one theoretical position, current research findings and explanatory models, whilst accounting for a wide range of interpersonal, biological, social and cultural factors, to develop a formulation with personal meaning, not just a ‘list of factors’
  • The ability to apply specialist skills in assessment and formulation of the person as well as their family and the ability to interpret the person-family situation to design appropriate person centred interventions

    Assessing motivation and suitability for psychological work

  • Assessing motivation & suitability for psychological work (including timeliness, appropriateness and safety) from a multi-model perspective, including prioritising and determining who should deliver what, when and in what context

    Developing highly individualised, tailored formulations

  • Use of multi-model, highly individualised and tailored formulations
  • To be able to analyse and interpret complex facts or situations and hold alternative/competing explanations in mind
  • Ability to apply assessment and formulation skills to broader relationship dynamics between the person, their family, their care team and the organisation as a whole e.g. regarding tensions over legal rights

    Contributing to multidisciplinary team formulation from multiple psychological models

  • Using multiple model to contribute to the process of MDT formulation
  • Ensuring that psychological formulation work is appropriately shared, understood, and used

    Selection and interpretation of specialist psychological assessment and formulation measures

  • Ability to select, administer, interpret and critically evaluate relevant formal assessment procedures, systematic interviewing and measures that contribute to assessment and formulation, including those measures that require specific training or skills (e.g. specialist personality assessment; cognitive assessments; formal functional analysis)

    Multi-Model approach to risk assessment

  • Ability to apply a multi-model psychological understanding to the area of functional risk assessment and management, including being able to guide the work of others and contribute to team-level risk management plans - including positive risk taking plans and personal safety/staying well plans

Principal Psychologists



Delivery of
Specialist and Complex Skills
Broad Definition of Skills

Ability to assess and formulate in situations where there is considerable complexity or difficulty.

    Synthesising information from many sources and developing formulations at individual and team/Network level

  • Ability to synthesise information from a wide range of sources and contexts, and use this information to develop flexible formulations for a variety of different functions and purposes (e.g. to guide the person, to help the team respond consistently and appropriately, to help plan coordinated interventions etc.)

    Leadership on psychological formulation

  • Ability to lead on psychological formulation within the team; supporting colleagues at all levels to understand and embed formulation in their practice
  • Ability to assess and formulate difficulties that arise within the multi-disciplinary team or between agencies (e.g. where there are differences of opinion or conflicting accounts), and develop subsequent strategies to improve functioning, i.e. using formulation as a clinical leadership tool to shape the team’s interventions
  • Ability to formulate issues and resistance within systems and organisations, and offer (rather than impose) these to facilitate team/organisation functioning.
  • To have an overview of service outcomes in this area that can be communicated to NHS Trust/Organisation management and that can be used to develop services based on clinical need

    Assessment and formulation in highly complex situations

  • An ability to assess and formulate in complex situations that require analysis, interpretation, and expert judgment, and where there may be a range of opinions (with the person, their family, the wider team, and other services as part of a shared formulation)
  • An ability to work with people with greater levels of complexity and hold’ more contentious or issue based cases (e.g. where there is dissatisfaction with the service)
  • An ability to make an assessment of psychological needs to inform broader assessment (e.g. of capacity and Deprivation of Liberty (DOLs) etc.)
  • Offering more detailed consideration when formulating the causal role of trauma and the potential traumatising effects of psychiatric interventions
  • Skills in assessing both the person and their family, interpreting person-family situations, and developing subsequent formulations and interventions plans
  • Takes a lead role in planning for complex situations where risk has been assessed as a significant issue and multi-disciplinary or multi-agency coordination is required
  • Ability to offer second-opinion assessments or reassessments where difficulties have been encountered

Lead/Head Psychologists



Delivery of Organisational-Level and Competency Initiatives, Service Development, and Clinical Governance
Broad Definition of Skills

Ability to take an organisational overview and systems-level approach to assessment and formulation, taking responsibility for designing and implementing effective assessment processes.

    Knowledge and application of organisation/management theory

  • Able to draw on organisational and managerial theory in addition to psychological theory

    Providing specialist, individualised complex assessments

  • An expert ability to assess and formulate complex situations, with individuals, families and the wider team, where analysis, interpretation, and expert judgment, and a range of opinions need to be considered
  • Ability to offer or arrange specialist assessments in situations where there are no clear commissioning guidelines

    Leading evidence-based psychological assessment and formulation processes and governance across the organisation

  • An expert ability to oversee the equitable and transparent delivery of psychological assessment across the organisation
  • Putting in place coordinated processes within, across and between systems to ensure that needs are fully assessed and managed in a timely and effective way
  • An expert ability to provide governance regarding psychological assessment across the organisation
  • An expert ability to ensure standardised evidence based best practice across the organisation in diagnostic pathways for early intervention and to develop these in line with national and professional guidance

    Applying formulation at systems/organisation level

  • Ability to formulate a system/service/organisation, and/or understand the dynamics of the service as a whole, and in particular, understand resistance to the application of psychological models, the evidence base and be able to match and promote the full range of psychological skills available to organisations to meet their needs
  • An expert ability to work with service partners (e.g. GPs, commissioners, voluntary agencies etc.) to plan and develop evidence based best practice care pathways and integrate and implement these within the organisation

Intervention

    Intervention can take many forms, but should always be underpinned by a level of assessment and formulation. However, it is possible that the person who assessed and formulated may not be the person delivering the actual intervention, which allows for flexibility in skill mix within teams. Intervention is commonly undertaken with individuals and families, although this may also be in a group context. Intervention may not always be in the context of a formal therapy relationship, but may take place in more informal or implicit ways, especially at lower levels. .

    At every level (except level 1), there is an implicit assumption and expectation that the professional will be able to advise, guide, and supervise the work of those working at a lower skill level.

All Clinical Staff Who Deal With People


Psychological Awareness
Broad Definition of Skills

Delivering specific psychosocial interventions under instruction/guidance, or supporting people with self-help. Focus especially on social inclusion and recovery.

    Support and delivery psychological intervention under supervision

  • An ability to support and flexibly deliver low intensity psychological interventions that are delegated and specified by colleagues with a higher level of psychological knowledge (most likely from a cognitive behavioural/solution focused approach) in non-stigmatised settings where possible, especially with those in EIT define or hard to reach groups
    • Problem solving
    • Basic psycho-education, including links between psychological health and sleep, exercise etc.
    • Supporting people through the use of worksheets and guided self-help, including activity recording and scheduling
    • Relapse management and staying well plans (timelines, triggers, early signs and appropriate coping strategies), including the use of card sort exercises and self-monitoring
    • Simple formulation driven and supervised in-vivo interventions e.g. graded exposure activities and behavioural activation, where the focus is on the person’s own interests and goals

  • Flexibly deliver practical and supportive interventions based around social inclusion and personally meaningful social roles and values based recovery to build positive identity, self-confidence and self-esteem, and support in times of crisis
    • Helping people who are being supported to maintain positive relationships and family contact, peer support, active community involvement
    • Enabling carer involvement
    • Promote creative, culturally appropriate and recreational activities that are meaningful to the individual and take account of issues regarding equality and diversity to enable the best possible quality of life and fulfilment
    • Tackling social isolation
    • Enhancing social networks and sources of social support
    • Promoting increased physical activity
    • Providing/enabling access to specialist support re return to unpaid/paid work
    • Facilitating and encouraging the use of personal problem solving skills
    • Facilitating and developing the use of personal coping strategies for unusual experiences e.g. strategies for voice hearing and also to manage potential triggers identified in the formulation such as anxiety

  • Recognising when planned work ought to be modified and adapted to suit the needs of the person and seeking support and supervision to do this (e.g. when response is not as expected, when there is a crisis, substance misuse complicates the primary intervention etc.)
  • Having an awareness of when more specialist psychological skills may be of value and being able to refer to others within/outside the team as appropriate
  • Goal setting and reviewing progress (including the use of formal measures – interpreting and amending practice with support from supervision to address any issues that arise)
  • Contributing to a team approach to delivering psychological interventions (e.g. being able to focus on one part of an intervention in the context of a bigger picture that might involve other approaches and people)
  • Able to form and run non-psychological groups based on social inclusion and recovery (e.g. reading for wellbeing group; sports groups)
  • Able to co-facilitate group psycho-education or basic skills-based interventions in conjunction with a more skilled colleague

    Intervening in crisis/risk situations

  • Identify relevant information that may contribute to a crisis plan
  • Basic understanding of best practice in a crisis situation
  • The importance of containment validating the person’s experience, non-confrontational, de-escalation, and sensitive verbal and non-verbal responses
  • Awareness and ability to follow documented management plans that have been developed through formulation
  • Suicide intervention skills
  • Ability to recognise signs of distress, including suicidal thoughts and intentions
  • Ability to provide an appropriate response to support a person at risk of suicide, in order for them to remain safe
  • Ability to recognise the need to seek further advice/support as required

    Addressing stigma and promoting rights and recovery

  • Approach people and their situation with understanding and hope (an intervention in itself)
  • Listening (can be an intervention in itself) and taking on board the persons frame of reference for their experiences and validating usual experiences or experiences of trauma and abuse
  • De-stigmatising and normalising experiences/thoughts, including issues regarding loss and adjustment for both people and their families
  • Building and maintaining hope, motivation and resilience
  • Supporting the development of a sense of agency; so that the person comes to believe that they can have some control over their life. This can be achieved with subsequent development of self-advocacy, through supporting the adoption of personal responsibility and self-management
  • Sharing lived experience (especially for Peer Support Specialists define?) to model recovery, foster engagement and promote hope
  • Being an advocate for the persons views and rights
  • Offering flexible practical support to build rapport and trust

Qualified
Mental Health Professionals

(Any graduate-level healthcare professional) Without further accredited training in delivering psychological interventions

Psychologically-Informed Healthcare
Broad Definition of Skills

Delivering psychologically-informed interventions, protocol-based interventions, helping people with skills acquisition.

    Ability to understand and respond to emotional content and distress in sessions

  • Ability to understand and respond to the emotional content of sessions – including management of strong emotions such as anger and related aggressive behaviour, and where there is avoidance of strong emotions.
  • Ability to work with high levels of distress – allowing appropriate venting of emotions, de-escalating emotional reactions, containing emotions, without unnecessary use of personal disclosure or unnecessary boundary violations.

    Recovery focused intervention skills

  • Awareness and skills in applying the Personal Recovery Framework (Leamy, Bird, LeBoutillier, Williams & Slade 2011) – incorporating hope, self-identity, meaning and personal responsibility
  • The ability to work with the person to ‘frame’ their experiences in terms of developing positive personal meaning to make sense of, and frame the experience, not the person and then integrate this into their overall identity (may or may not be formulation driven)
  • Ability to understand the psychological need, but also barriers to social inclusion and be able to support people in overcoming internal barriers to enable them to develop more personally meaningful values based roles
  • Respectfully challenge beliefs, behaviours and practices within the logic of the cultural system
  • Adapting approaches to work with people from different ethnic and cultural backgrounds

    Application of sound psychological principles in general interventions

  • Able to adhere to sound therapeutic principles even when not engaging the person in formal therapy
    • Agree goals - A person’s goals need to be of a kind that can be put into practice, adhering to SMART principles (Specific, Measurable, Agreed, Realistic, Timed) but also need to be balanced and held alongside more aspirational goals
    • Managing a person’s non-engagement
    • Managing between-session contacts by the person
    • Understanding and managing ruptures (i.e. difficulties in the relationship with the person that could lead to disengagement and the absence of improvement)
    • Managing therapeutic endings
    • Help to maintain a balanced and optimal level of contact with emotions – enough, but not overwhelming.
    • Promote change through tasks between sessions where possible
    • Match the structure and pace of the work to the needs of the person
    • Session planning and management, working to timescales within and across appointments
    • Appropriate redirecting of the conversation
    • Maintaining adherence to tasks without unnecessary switching when minor difficulties arise
    • Using appropriate measures to monitor change
  • Supporting personal responsibility during times of crisis by working with people to develop skills in self-management of distressing aspects of their experiences e.g. hearing voices, suicidal urges and to create advance directives for use at times when they may be assessed as having lost mental capacity
  • Life story work including genograms, timelines (to put context to experience) and in EIT services Duration of Untreated Psychosis (DUP) define

    Delivery of specific standardised psychological interventions

  • The ability to devise and deliver flexible packages of recovery focused support based on assessment information and subsequent formulation
  • Be able to provide basic information whilst considering a range of different approaches that might be helpful (including those not able to be offered by the professional themselves
  • Competence in the use of brief or generic therapy skills such as motivational interviewing (e.g. focusing on what the person might want to change, undershooting/overshooting, focusing on potential positive outcomes), brief solution focused approaches (e.g. identifying strengths within the person and their families to help meet their goals), basic principles of CBT (cognitive behavioural approaches, e.g. behavioural activation and activity scheduling), and psychosocial interventions such as coping strategy enhancement and relapse prevention, to support people to stay well including recognising the importance of basic sleep hygiene and alternatives to the use of alcohol and recreational drugs

  • Delivering specific interventions for specific problem areas – under guidance, or using standard formulations
  • The ability to use recovery stories from different cultures and age groups
  • Using standard packages and written protocols for individuals or groups
    • Technical interventions rather than formal psychotherapy (as formulation is not required in order to deliver the treatment), e.g. hearing voices groups
  • More advanced psycho-education and problem solving with both people and their families – demonstrating an ability to adapt and integrate information rather than simply presenting information that is pre-prepared in a standardised way
  • Co-facilitate or lead group based psychoeducation or skills-based interventions that are within the clinician’s area of knowledge/specialism
  • Able to engage group members and contribute to managing group processes that arise
  • Ability to engage in facilitated team formulations and to follow subsequently devised intervention plans

    Flexible management of co-Existing issues

  • Being flexible when managing co-existing issues (e.g. depression, anxiety, substance misuse, trauma, eating disorders, learning disabilities, personality disorders etc.)

    Working with risk and managing crises

  • Working positively and in partnership with people at risk of, or who do engage in self-harm, using a harm-reduction problem solving approach and jointly agreed goals
    • Able to promote safety as well as positive risk taking examples
    • Empowering the person to decide the level of risk they are prepared to take with their own personal health and safety
    • Able to promote harm minimisation in the context of self-harm and substance misuse

  • Ability to respond to and manage crises
    • Work with the person (and others) to develop a crisis plan, identifying recurrent patterns and strategies that can be implemented to help deal with any emerging crises.
    • Specify the role the person, family and friends and services will play in the plan
    • Reviewing these plans (and identifying any ways in which they need to be revised)
  • Being aware of and able to work with personal and service risk aversion due to fear of criticism and potential to over focus on restrictive/medication as primary interventions

    Managing and reviewing endings and transitions

  • Ability to manage endings and service transitions positively - both planned and premature or unplanned endings where the person terminates contact with the service
    • Being outcome-focused, collaborative – reviewing, monitoring, and seeking feedback
    • Being aware of over engagement/dependency as much as non-engagement and managing both dynamics with sensitivity
    • Link with communication dimensions, especially written communication about care planning, reviews, ruptures, and endings

    Assessment and formulation with carers network

  • Having an awareness of the impact of caring on the family and core skills in offering and delivering family focused interventions, including elements such as: family meetings to all people in services where a shared understanding of what is going on for everyone is developed (formulation), separating the person and their family from the problem, exploring maintenance cycles, recognising strengths, psycho-education and skills training around communication, problem solving and crisis management, including negotiating levels of involvement and roles for family and friends. Also giving sensitive consideration to supporting families to re-evaluate and rebuild their own lives in a meaningful way, coming to terms with their family member’s experiences and making appropriate adjustments
  • Ability to co-ordinate casework or intervention across different agencies and/or individuals

Qualified (Uni-Model) Psychological Therapists

(Any graduate-level healthcare professional with further post-graduate accredited training in a recognised psychological therapy)

Delivery of
Evidence-Based Skills
Broad Definition of Skills

Delivering evidence based or recommended psychological interventions in a more formalised or structured way.

    Working with families and support networks

  • Being able to work with family members and other support networks

    Lead on psychoeducational, skills and basic therapeutic groups

  • Lead on psychoeducational, skills-based, or basic structured therapeutic groups
    • Able to plan the group structure and content and recruit appropriate people
    • Knowledge of and ability to manage the group process and group dynamics

    Advanced psychological intervention skills

  • More advanced psychological intervention skills
    • Ability to maintain adherence to an evidence based therapy whilst adapting methods to meet individual needs in response to treatment obstacles
    • Able to identify when resistance to therapy is a manifestation of the person’s difficulties and when the person is responding to an accurate perception of differences of opinion between themselves and the therapist e.g. regarding behavioural activation being able to formulate and understand why a person might not respond to efforts to increase activity levels etc.
    • Ability to be reflexive in noticing and attending to inter-personal dynamics and process in the moment (rather than only within supervision)
    • Able to engage the person in a discussion about the range of different approaches that might be helpful (rather than simply presenting information)
    • Able to adjust the pace and direction of therapy in response to feedback from the person and direct observations

  • Attune to feelings and engage in empathic challenge with the person using curiosity to explore issues which the person may not have been aware of before
  • Recognising when therapy has reached the limits of its usefulness, a process supported by routinely evaluating the effectiveness of interventions, making use of measures to evaluate treatment progress and support clinical decision making
  • Promote change between sessions by developing effective tasks in collaboration with the person and their current needs and level of understanding
  • Ability to be responsive and flexible in what is happening in the moment
  • Recognising and responding to subtle behaviours in the person (including shifts in affect)
  • Support people through practice, role play, rehearsal
  • Psychoeducation – drawing on specific theories and more advanced psychological knowledge
  • Ability to understand and respond to the emotional content of sessions - reflect on the meaning of the individual’s emotional expression/behaviour, and during interventions elicit emotions that facilitate change. Throughout both assessment and intervention, the practitioner has to manage any strong emotions such as excessive anger and related aggressive behaviour, and also avoidance of strong affect
  • Having the ability to manage complex, high risk clinical situations

    Delivering formal psychological interventions

  • Ability to offer and deliver formalised evidence –based psychotherapy in a structured way from a single specific theoretical model (e.g. NICE recommend at least 16 one-to-one sessions of CBTp define over a minimum of 6 months) N.B. the person needs to be ready, motivated and able to engage in therapy
    • Individualised collaborative formulation-driven psychotherapy, rather than relying on standard/generic formulation
    • Expert interventions from an appropriately trained and supervised psychotherapist, who has demonstrated skill through a formal accreditation process
    • Focusing interventions on reducing distress in relation to a person’s interpretation and making sense of things that they experience, focusing interventions on recovery goal achievement and getting on with lives in spite of experiences (more than symptoms reduction in terms of frequency or intensity)

  • Recommended model-specific interventions based on NICE guidelines and other professional guidelines and in line with specific model competencies e.g. for CBTp: sessional agenda setting, developing a shared conceptualisation in terms of understanding and relating to experiences, guided discovery, psycho-education, cognitive restructuring, exposure and testing out beliefs/looking for the evidence, behavioural activation, problem solving, self-monitoring, applied behavioural analysis and homework setting
  • Adapting interventions regarding difficult life circumstances and lifestyle choices e.g. regarding complex engagement issues
  • Offering more ‘opportunistic’ brief interventions focused around motivation for co-occurring issues such as issues with substance use

    Contribution to team-Based psychological interventions

  • Contributing to team based approaches to delivering psychological interventions with reference to a particular psychological model

Highly Trained Psychological Workers

Who are able to draw on multiple models and theories (e.g. clinical or counselling psychologists).

Delivery of
Specialist Skills
Broad Definition of Skills

Delivering specialist or complex psychological interventions that draw on more than one psychological model, and is underpinned by a good understanding of theory and evidence.

    Provision of advice, consultation, supervision and clinical leadership

  • Provide advice, consultation, and supervision in a specialist area
  • Understanding of adult education principles, coaching and mentoring
  • To work with teams to develop and deliver individualised psychologically informed interventions i.e. clinical leadership
  • Able to lead on designing evidence based protocols and running of complex group interventions

    Integrative approach and specialist to intervention in complex cases

  • Skill in delivering formulation driven evidence –based psychotherapy in complex cases
    • Deliver expert interventions from an appropriately trained and supervised psychotherapist, who is able to draw upon multiple theoretical orientations and has experience of integrating skills from different models
    • Demonstrate specialist or advanced skills in one or more areas of therapy, for example and as described by the BPS:
  • CBTp (as previously discussed)
  • Cognitive remediation – addressing issues with structuring thoughts, memory, problem solving and planning
  • Trauma focused therapy – adapted trauma focused skills for working with flashbacks and dissociation for someone experiencing symptoms of psychosis
  • Psychodynamic approaches – skills exploring how past events continue to affect us now in our relationships with others

  • Acceptance and Commitment Therapy (ACT) and Mindfulness – noticing what is happening in terms of thoughts and experiences, accepting them (not trying to control them) and focusing on what is important to us needs links
  • Narrative Therapy – skills to help people overcome the narrow and negative stories that the person/others have developed about their identity
  • Systemic therapy – skills to work with the person and their ideas and beliefs and stories in their relationships with their families and wider society
  • Voice dialoguing – skills for working with distressing voices where the facilitator/therapist asks questions of the different voices to enable the person to explore, understand and change their relationship with them
  • Family interventions (systemic, behavioural family therapy, open dialogue work as in Finland need a link/definition)

    Design of specialist, bespoke psychological interventions

  • Recommend and determine what approach might be helpful, when, and why
  • Able to work with complexity, where interventions need to be highly tailored and adapted to the person
    • Including chronicity; acute distress; multiple problem areas; uncertain diagnosis; comorbid problems; substance misuse; developmental and learning difficulties; physical health issues etc.
  • Ability to maintain overall focus without inappropriate switching between modalities when difficulties arise

    Provision of advice, consultation, supervision and clinical leadership

  • Provide advice, consultation, and supervision in a specialist area
  • Understanding of adult education principles, coaching and mentoring
  • To work with teams to develop and deliver individualised psychologically informed interventions i.e. clinical leadership
  • Able to lead on designing evidence based protocols and running of complex group interventions

Principal Psychologists



Delivery of
Specialist and Complex Skills
Broad Definition of Skills

Highly specialist or complex psychological interventions in situations where especially high levels of skill, knowledge and experience are required.

    Design of specialist, bespoke psychological interventions

  • Ability to work with highly complex presentations where the evidence base is lacking or absent, by drawing on sound psychological principles and theory to inform the bespoke work
  • Able to work with the team, or with the person directly, in cases where people may be regarded as unsuitable for therapy, but where a psychologically-informed intervention may nevertheless be helpful
  • An accomplished ability to provide the team/service with psychological oversight for the care of people with a diagnosis of psychosis and their families
  • Highly specialist psychological therapy (complex/multi-model interventions)
  • Able to work in highly specialised areas that require significant skill, knowledge and experience (e.g. dissociative identity; fixed delusional beliefs; chronic complex trauma)

    Provision of advice, consultation, supervision and leadership to team and organisation

  • To be able to provide advice in a specialist area
  • To be able to develop materials and group protocols to be implemented on a service wide/NHS Trust/Organisation scale
  • To flexibly respond to issues in service delivery/team needs e.g. providing consultation
  • Ability to work with i.e. intervene with the organisation as if it were the person accessing services, using knowledge and skills to promote psychological understanding, developing service models and systems

Lead/Head Psychologists



Delivery of Organisational-Level and Competency Initiatives, Service Development, and Clinical Governance
Broad Definition of Skills

Overseeing the psychological approach and clinical governance of the team, service, or organisation.

    Providing clinical leadership on development and governance of psychological interventions

  • An expert ability to provide clinical leadership and governance regarding the development and delivery of psychological interventions at a trust wide level
  • Able to intervene, inform and guide senior managers, directors/commissioners on clinical standards relevant to the specialist area/ skill mix/ safe evidence based clinical practice/ resources necessary to deliver safe and effective care
  • Work with organisations and commissioners regarding broadening access to psychological therapy and working to develop the use of innovate service designs e.g. IAPT for Severe Mental Illness (SMI)
  • Work with services to challenge the dominant paternalistic medical model and promote a more collaborative recovery focused approach to care
  • An expert ability to ensure people with a diagnosis of psychosis and their families have a voice in in the development of service provision
  • An expert ability to work at a national level developing professional guidance

  • An expert ability to collaborate with partners (e.g. GPs, commissioners etc.) to develop best possible innovative service provision
  • An expert ability to recognise gaps in service provision and make the best use of psychological resources across the NHS Trust/Organisation to meet the needs of the population

    Development, implementation and management of specialised psychological care and intervention

  • Able to develop tailored, specialised programme of care/care packages for delivery by others in line with the current evidence base
  • Work with services/clinicians to enable workers to flexibly tailor help based on needs rather than offering overly standardised packages of care with no personalisation
  • Ability to develop and implement psychological interventions in specialised areas or manage specialist services

Psychological Knowledge and Awareness

    This domain is about having the underlying knowledge and awareness of psychological theory, psychological processes, and psychological understanding of mental health to enable effective working.

    It is not just about having knowledge, but about being able to draw on this knowledge and understanding. All staff need training in the principles of a psychological approach to inform the culture of the services and ‘every conversation within them’ not just formal interventions.

    Although all of the dimensions of the model are closely inter-related, this dimension in particular underpins several of the other dimensions. For instance, the ability to communicate information rests on having an understanding of that information; the ability to assess, formulate and intervene depends on having sufficient knowledge in order to do so. Increasing skill in this domain is reflected by having higher levels of formal education, more in-depth training, accreditation in specific areas of psychological skill, and higher level critical thinking.

All Clinical Staff Who Deal With People


Psychological Awareness
Broad Definition of Skills

Basic knowledge, understanding and awareness of mental health issues and relevant psychological theory.

Able to act on knowledge that is provided, and know how to access further information.

    Understanding the impact of people’s life histories

  • Understanding that people’s histories and life experiences are crucial when making sense of their mental health
    • Basic understanding of the impact of trauma, abuse, neglect, loss
    • Basic understanding of attachment and how our relationships with early care givers influence our relationships with others as we grow older
    • Understanding that the impact of life events is individual, and cannot be generalised based on your or others’ experiences

    Addressing stigma and respecting diversity

  • Understanding of the stigma and discrimination faced by people with mental health problems and the need to advocate for and provide a non-stigmatising service
  • Ability to understand and respect diversity relating to: age; race; culture; disability; sex, gender and gender reassignment; spirituality, religion or belief; sexual orientation; pregnancy, maternity and parenthood; marriage, marital status, civil partnership and civil partnership status.

    Promoting wellbeing and resilience

  • Understand the importance of good mental health and wellbeing and have good knowledge of how to promote these with people who need care and support.
  • Familiarity with factors that protect good mental health and wellbeing
  • Basic understanding of the concept of resilience

    Understanding of factors related to mental health crises and risk

  • Awareness of the concept and possibility of mental health crisis, and the potential impact on people's behaviour, feelings and perceptions when experiencing such a crisis
    • Understanding of concepts of risk, risk assessment and risk management
    • Basic understanding of why people self-harm and the different functions it can serve
    • Understanding the relationship between mental health crisis and other crises (e.g. physical health crisis, social crisis, financial crisis)
    • Understand that it is likely that different approaches may be needed at different points to support people with mental illnesses and problems.
    • Recognise that symptoms, wellbeing, and capacity can change, in different settings, in different contexts, and over time
    Knowledge of network support services

  • Signposting people with a range of mental health problems based on their knowledge of appropriate sources of help and support for people
    • Knowledge of local systems and frameworks, policies and procedures, to enable them to seek necessary help and support to ensure the immediate safety of someone experiencing a mental health crisis
    • Enable people who need care and support to get hold of up-to-date appropriate information and advice about looking after their mental health
    • Aware of information and local services that can assist in promoting good mental health such as access to leisure centres, welfare rights advice, opportunities for paid work or volunteering, information about healthy eating, etc.,
    Understanding recovery

  • Understanding of the concept of recovery and recovery-based approaches in mental health care (including specific models of service delivery as appropriate e.g. Early Intervention Teams/Assertive Outreach Teams focused on engagement and recovery via delivery of intensive, flexible, creative needs-led services), including an understanding that recovery is a process unique to each individual
    • Understanding the essential role of finding and maintaining hope
    • Understanding that the focus is not on eliminating symptoms but on reducing distress and building and living a personally meaningful life
    • Understanding the principle of establishing a positive identity, making sense of experiences and finding positive meaning in them
    • Understanding the need for and delivering flexible, needs led support
    • Understanding the need to promote the person taking responsibility and control
    • Understanding of the individual’s wider social and support networks and the contribution made by carers, family and friends to the recovery process and the subsequent associated need for social inclusion
    Foundation level knowledge and awareness of mental health problems

  • Basic knowledge and awareness of the range of psychosis related mental health problems
    • Basic knowledge and awareness of frequently-encountered co-existing problems, such as physical illness, cognitive impairment, developmental disorders, substance misuse
    • Awareness of the potential impact on people's sense of self; behaviour, feelings and perceptions of living with a long term mental health conditions and how this will differ depending on stage in the recovery journey and level of experience with services (and potential negative associations with this such as ‘revolving door’ or complex engagement)
    • Foundation level of understanding and knowledge of evidence based psychological models and interventions available e.g. CBTp, BFT and be able to describe these interventions to people to enable them to make an informed decision regarding whether they want to engage in these more formal psychological interventions

Qualified
Mental Health Professionals

(Any graduate-level healthcare professional) Without further accredited training in delivering psychological interventions

Psychologically-Informed Healthcare
Broad Definition of Skills

Good understanding of the field of mental health. Able to draw upon basic psychological theory and knowledge and apply this to their work.

    Diversity and links to mental health presentations

  • Awareness of key issues and differences in particular groups within the population, for example:
    • Differences in presentations between men and women
    • Issues for younger people
    • The effect of culture, spirituality and religion
    Knowledge of relevant legislation

  • To have a knowledge of current legislation and consideration of its impact on the therapeutic process e.g. Mental Health Act, Capacity, Informed Consent and the use of Community Treatment Orders, Knowledge and understanding of how to help carers
    • Knowledge and understanding of how best to help carers and relatives, resources and other local services that can support them
    • Understanding and recognising the impact of stigma, discrimination, social inequality and exclusion, working to overcome this with the person, their family, organisation and community

    Understanding evidence based practice

  • Understanding the concept of evidence-based and values-based best practice guidance from a range of bodies (e.g. NICE, Royal Colleges, mental health charities etc.)
    • Ability to understand and apply guidance relevant to their role and practice

    More advanced knowledge of mental health

  • To have a more advanced knowledge and understanding of the five aspects of recovery; Moratorium (withdrawal, loss and hopelessness), Awareness (realisation that all is not lost and a fulfilling life is possible), Preparation (identifying strengths, weaknesses and starting to work on developing recovery skills), Rebuilding (developing a positive identity, setting goals and taking control), Growth (living a meaningful life, autonomy and self-management, positive sense of self).
  • More advanced knowledge of the range of mental health problems and related areas, holding in mind at all times that distress experienced is in relation to the way a person interprets, makes sense of and responds to things that they experience
    • Knowledge of the range of presenting issues & commonly encountered problem areas
    • A full understanding of the bio-psycho-social model
    • An awareness of psychopharmacology and any side-effects, considering how both impact on receptiveness, engagement and outcome of psychological interventions
    • How understanding experiences and situations from a psychological perspective can offer different hypothesis about what is occurring and subsequent next steps in the recovery pathway
    • An understanding of the need to exclude physical causes for apparent mental health problems and an awareness of common physical health problems in people who have a diagnosis of psychosis e.g. type II diabetes
    • Awareness of dementia and other physical health conditions, and the relationship between physical and mental wellbeing

    Basic knowledge of psychological concepts and theories

  • Basic psychological knowledge and awareness of:
    • Attachment and transitions, and the relevance of this theory to a person’s interaction with services in relation to the impact of institutional and medically led care on the persons views and engagement
    • Learning theory and how it is relevant to psychological interventions (e.g. the role of reinforcement)
    • Models of interpersonal processes, and how this relates to therapeutic work (e.g. an understanding of the concepts of transference and counter-transference and the enactment unconscious material)
    • The main psychological models, how they are applied to selected interventions, and what models are likely to be most helpful in certain circumstances, being able to explain the pros and cons to support people to make informed choices about their engagement
  • Knowledge and understanding of why people may be engaging in behaviour experienced as challenging
    • Able to reflect on the function or effect, and the aim/intention of this behaviour
    • Understanding of harm reduction approaches
    • Understanding the concept of positive risk taking and why this is sometimes necessary
  • Understanding of the concept of a “therapeutic rupture” and why it is important to think critically about what has occurred and appropriate responses
    Meeting Continuing Professional Development requirements

  • Responsible for meeting the Continuing Professional Development requirements of their role, engaging in on-going learning using a variety of methods

    Knowledge of network and support services

  • Understanding of working arrangements and referral pathways with other related services (including NHS, Local Authority, and independent/third sector)
    • Learning Disability services, Child and Adolescent services, especially shared-care arrangements and transitions
    • Specialist services (where they exist, e.g. eating disorder, physical health)
    • Support services, including those in the third sector
    • Speech and language, physiotherapists, dieticians, epilepsy specialists, diabetic services etc.

Qualified (Uni-Model) Psychological Therapists

(Any graduate-level healthcare professional with further post-graduate accredited training in a recognised psychological therapy)

Delivery of
Evidence-Based Skills
Broad Definition of Skills

Specific knowledge and understanding of a particular psychological model. Ability to draw upon more advanced knowledge of psychological processes and complex issues in mental health.

    Supervision skills

  • Sufficient knowledge in an area of psychological practice to provide specialist supervision or teaching to others in that area (e.g. specific skills, techniques)
  • To be aware of and operate within accrediting organisations guidelines, particularly regarding limits of competence

    Enhanced knowledge of the recovery model

  • To have enhanced knowledge of the recovery model and be up to date with innovative developments in recovery orientated service delivery approaches e.g. recovery colleges

    Comprehensive understanding of theory and practice of one psychological model

  • A comprehensive understanding of the theory, scientific underpinning, efficacy and evidence base of at least one area of psychological therapy
    • Knowledge of the skills, techniques, methods, and approaches that form part of the model
    • Ability to think critically about the model, and critically appraise the literature (i.e. to judge whether the findings of a study in their area are reliable, valid, generalisable, etc.)
    • Ability to judge when the model is likely to be more helpful or less helpful to understanding or intervening with a particular person
    • Ability to explain the rationale behind interventions that form part of their model

    Continuing professional development

  • Responsible for meeting the CPD requirements of both the role and further on-going accreditation requirements
    • Understanding the evidence base for their work in a constantly evolving context

    General knowledge of psychological theory and links to practice

  • Knowledge and understanding of group processes in addition to individual work
  • Knowledge of the skills, techniques, methods, and approaches that form part of the model
  • Ability to reflect on and apply knowledge to clinical situations
  • Enhanced understanding of attachment theory, learning theory, therapeutic relationships, therapeutic boundaries, interpersonal processes
  • Enhanced knowledge and awareness of issues impacting on psychosis e.g. the association of migration with the development of psychosis and the subsequent development of specialist knowledge and skills required to work with immigrants and refugees
  • To have specialist knowledge of the legal frameworks relating to people with psychosis and how this applied to the person, the service and the environment where interventions take place

Highly Trained Psychological Workers

Who are able to draw on multiple models and theories (e.g. clinical or counselling psychologists).

Delivery of
Specialist Skills
Broad Definition of Skills

Specialist knowledge across the field of applied psychology. Ability to apply critical thinking skills to learning.

Ability to support other people’s learning at different levels.

    Grounded specialist knowledge of mental health

  • Highly developed specialist knowledge of the full range of mental health problems, underpinned by training in theory and practical experience obtained through degree, post-graduate doctoral degree and supplemented by short specialist continued professional development courses and regular clinical supervision

    Understanding and appraisal of research evidence base for psychological theory and practice

  • An ability to understand and critically appraise research, literature, and the broad evidence base for a range of approaches and theories, and be able to apply this to service evaluation and clinical research in the workplace
  • Ability to reflect on and apply knowledge in a creative way, in novel clinical situations
  • Understanding of research tools, methodology and statistics in relation to conducting outcome measures, service evaluations, and audits as part of clinical governance
  • Ability to be self-sufficient in researching and understanding applied psychology in areas that fall outside current expertise, seeking further education and training where appropriate

    Knowledge and experience of a range of client groups services

  • Knowledge and experience of working in different settings and with the development of psychological issues across the lifespan, including:
    • Child and adolescent services
    • Learning disability services
    • Services for older people and/or dementia

    Knowledge of psychological supervision and consultancy

  • Knowledge and understanding of models of psychological supervision and consultancy and the ability to act as both supervisor and consultant

    Knowledge and understanding of multiple psychological models/ theories

  • Knowledge and understanding of more than one model of applied psychology

    Knowledge of psychometric assessments, their selection and application

  • Knowledge of a range of psychometric tests and ability to apply these to the clinical area
    • For example; tests of intellectual functioning; personality traits; memory; concentration; diagnostic-based tests (e.g. ADHD, Autism)
    • Able to select appropriate tests, including specialist neuropsychological tests
    • Able to administer, or oversee the administration, of tests that require specialist training
    • Able to interpret and report critically on the outcome of tests
    • Able to determine when testing is not appropriate, or where findings cannot be interpreted

    Understanding of complex presentations

  • Specialist applied knowledge of complex areas of mental health and the ability to practice and exercise autonomous professional judgement in this area with people with complex presentations and multiple issues e.g. combined psychosis, cognitive impairment and substance misuse
  • Knowledge and understanding of psychological models and approaches for working with people and their families and care system within the organisation and the local community
  • Understanding of functional behaviour, maladaptive coping, and self-defeating patterns that can underpin assessment, formulation and intervention (especially relating to risk)

    Knowledge and understanding of multiple psychological models/theories

  • Knowledge and understanding of more than one model of applied psychology within the broader biological/neurological/ sociological and circumstantial environment

    Broad knowledge of psychology specialisms

  • Broad base of general psychological knowledge that helps underpin applied practice (knowledge that is typically acquired via an undergraduate psychology degree), e.g.:
    • developmental psychology
    • functional neuroanatomy
    • sensation and perception
    • memory and attention

Principal Psychologists



Delivery of
Specialist and Complex Skills
Broad Definition of Skills

Expert knowledge based on extensive learning and experience. Ability to apply psychological knowledge at the level of the team, ensuring that psychological knowledge is embedded throughout the service.

    Knowledge of leadership and management theory

  • Knowledge and awareness of leadership and management theory, and basic organisational psychology

    Understanding organisational policies and impact on delivery

  • Understanding of NHS Trust/Organisation direction and local and national policies that impact on the delivery of psychological services

    Expert knowledge of multiple models of psychological theory and practice

  • Expert knowledge and practical experience in more than one model of applied psychology
  • An accomplished knowledge of current national and professional evidence base to enable the refinement of care pathways and the development of new interventions & groups

    Knowledge and experience of risk management

  • Knowledge and experience of managing the highest levels of risk

    Knowledge and skill in research and best practice

  • Knowledge and skill in designing and implementing audit, research, publication and dissemination of best practice in clinical settings

Lead/Head Psychologists



Delivery of Organisational-Level and Competency Initiatives, Service Development, and Clinical Governance
Broad Definition of Skills

Expert knowledge that includes the wider health context, national frameworks, future direction, and knowledge of commissioning processes in relation to mental health and psychology specifically.

    Knowledge of local and national policies, guidance service models and systems and best practice evidence

  • Up to date theoretical and practical knowledge of service model designs, their evidence base and efficacy
  • Knowledge of local NHS and other systems
  • Knowledge of national drivers, frameworks, guidance
  • Knowledge of local and national commissioning arrangements and opportunities
  • An expert ability to work at an organisational level to collaborate in identifying training needs for other professional groups

  • Knowledge of and the ability to link with partner agencies to support senior management in facilitating transitions and overcoming barriers such as different ethos and approaches between services e.g. CAMHS to EIT
  • Active awareness and contribution to developing the evidence base, promoting and educating senior managers on the importance of psychologists at all levels using research skills in the pursuit of clinical governance
  • An expert ability to engage in audit, research, publication and dissemination of best practice in clinical settings

Professional Development, Supervision and Training

    This domain covers three related areas. Professional development and training includes taking responsibility for one’s own continued skills and knowledge development needs in relation to psychological practice, which may not be already adequately specified by the minimum standards for different professional groups.

    At higher levels, there is the expectation that training will also include an ability to train others. Supervision is included here both from the perspective of being able to receive and utilise supervision, and also the ability to offer and deliver supervision to those at lower levels.

    These skills reflect being able to utilise and deliver clinical supervision effectively, recognise individual psychological training needs and deliver effective psychological training at a range of levels.it acknowledges the dual aspect of supervision skills; that people need to be skilled in the use of supervision but also as you move up the levels they need to be skilled in its provision.

    Progression of this skill is characterised by developments in the complexity of the subject matter, situation/context, purpose, and level at which training and supervision is being delivered in terms of the level of psychological skill of people being trained and supervised. People at Level 1 will not be expected to supervise.

All Clinical Staff Who Deal With People


Psychological Awareness
Broad Definition of Skills

To be aware of the purpose and importance of clinical supervision and how to utilise it effectively.

To be aware of individual CPD needs in relation to role, and how these align with agreed service delivery.

    Understanding the role clinical and management supervision

  • An understanding of the difference between clinical supervision (contained supportive space) and other forms of supervision e.g. managerial supervision, line management
  • An awareness of the purpose and benefits of various forms of supervision (professional development and reflective practice/caseload management etc.)
  • An ability to use supervision appropriately as follows:
    • To confidentially discuss and reflect on one’s work including one’s personal and professional responses to it
    • To discuss and form intervention plans and overcome problems that arise
    • To discuss and explore issues in the therapeutic relationship/system
    • To promote one’s own personal and professional development
  • The ability to recognise the strengths and limits of one’s own individual competence/gaps in one’s knowledge and being open to discussing, exploring and addressing these through seeking help through feedback, training and supervision.
  • Attending and engaging in appropriate training, being open to different ideas, new developments and being willing to implement these in clinical practice

Qualified
Mental Health Professionals

(Any graduate-level healthcare professional) Without further accredited training in delivering psychological interventions

Psychologically-Informed Healthcare
Broad Definition of Skills

Ability to use clinical supervision more effectively and collaboratively. More detailed understanding of individual CPD needs and how these align with agreed service delivery.

Able to deliver basic training to carers & staff, and able to supervise aspects of the work of those at Level 1.

    Continuing Professional Development

  • To have a more detailed understanding of individual Continuing Professional Development needs and of personal responsibility in meeting these, and to be able to engage in on-going learning using a variety of methods

    Delivery of safe and effective clinical supervision

  • To be able to deliver clinical supervision to less skilled or knowledgeable colleagues following appropriate training
  • The ability to give (and receive) balanced feedback to supervisees
  • An ability to support the supervisee’s capacity to manage risk, and to ensure the person’s and their own safety
  • Show modesty and awareness regarding the limits of professional knowledge
  • Ensuring that practice is safe with respect to limits of competence
    • To recognise limits of competence in other junior colleagues and support them in seeking help or signposting on
  • An ability to use professional judgment to take appropriate action when the supervisee’s clinical practice raises serious concerns
  • Being aware of the limitations of one’s own knowledge and being able to refer to more specialist colleagues and move to address training needs if appropriate for this level of delivery of psychologically informed care

  • An ability to recognise problematic interactions between supervisor and supervisee and to seek consultation in order to identify an appropriate way forward (including making alternative arrangements for supervision)
  • To be able to recognise when an issue might need to be managed outside of supervision and be able to signpost on appropriately (e.g. for individual therapy)
  • To have an understanding of the effective use of supervision for supervision
  • To have a more detailed understanding of the purpose of, commitment to, and appropriate use of reflective practice.
  • To be able to support others through mentoring and coaching (following appropriate training and under supervision)

    Skills Transfer Process knowledge and application of learning

  • To have an understanding of effective skills transfer processes.
  • Seek and apply learning in specialist areas relevant to the area of work (e.g. training in working with older people, young people, substance misuse, difference and diversity)

    More advanced understanding of effective clinical supervision

  • To have a more detailed understanding of the effective use of clinical supervision.
    • Awareness of different supervision methods, and ability to seek, establish, and utilise them as appropriate, e.g. peer supervision, group supervision, one-to-one supervision, specialist supervision
    • Having an openness to the development of self-knowledge about personal and professional values, and reflecting on the influence this has over interactions with others

    • Understanding that being an effective supervisee is an active process, requiring a capacity to be reflective and open to criticism, willing to learn (including from the people that we are working with) and willing to consider (and remedy) any gaps in competence which supervision reveals
    • Ability to prioritise material for discussion within supervision, selecting the most important and relevant material
    • An appreciation that supervision also reflects on the therapeutic relationship as well as technical intervention competencies
    • Understanding of the need to recognise, address, and overcome avoidance in relation to supervision
  • Awareness of the difference between consultation and supervision, and when each might be appropriate
    • Consultation usually focused on seeking advice, suggestions, or opinion
    • Supervision being broader in focus with more depth of detail, usually in the context of an on-going developmental relationship

Qualified (Uni-Model) Psychological Therapists

(Any graduate-level healthcare professional with further post-graduate accredited training in a recognised psychological therapy)

Delivery of
Evidence-Based Skills
Broad Definition of Skills

Be able to provide specialist clinical supervision to unqualified or qualified staff from the perspective of a specific psychological model.

To be able to deliver training in a specific psychological model to unqualified and qualified staff.

    Delivery of effective clinical supervision, mentorship and training

  • Basic training in models and techniques of supervision and given time to deliver this for level 1 and 2 clinicians in a specific therapeutic modality
  • Able to develop and work in accordance with terms of a specified supervision contract

  • Able to set up and structure an approach to supervision that is appropriate to the psychological therapy model they are delivering
    • Supervisors need to have direct knowledge of the models they are applying and personal expertise in the therapeutic approaches they are supervising
  • Work with the supervisee to establish learning needs, boundaries, concrete issues (such as timing, frequency) as well as appropriate content and work towards addressing issues raised
  • An ability to balance a focus on the supervisee’s educational development with an obligation to identify and prevent practice which could be harmful or unhelpful to the person
  • An ability to help the supervisee judge how to balance risk aversion against appropriate risk taking
  • Able to support other staff in achieving accreditation through close supervision, which would normally include an evaluative element
  • Able to offer consultation to others regarding issues relating to the specific therapy they are accredited in
  • To be able to deliver specialist training in a specific therapeutic modality to unqualified and qualified staff

    Enhanced ability to make effective use of supervision

  • Actively seek feedback from people about their experience of the clinician, interventions and services using a variety of methods including direct observation and/or video/audio recording and utilising tools such as the Revised Cognitive Therapy for Psychosis Adherence Scale (R-CTPAS) and INSPIRE (a service user rated tool of recovery support received from the clinician) to reflect on and take forward through supervision/service development channels
  • Engaging in supervision and CPD as specified by professional bodies and their accrediting criteria e.g. HCPC, BPS, BABCP
  • Skilled in engaging in reflective supervision as identified within the supervision contract; reflecting on values, competence and limitations, prioritising topics, succinctly presenting formulations and issues for discussion and receiving and giving feedback and working productively with clinical supervisor to manage difficulties within the supervisory relationship

Highly Trained Psychological Workers

Who are able to draw on multiple models and theories (e.g. clinical or counselling psychologists).

Delivery of
Specialist Skills
Broad Definition of Skills

Able to co-ordinate and provide clinical supervision to qualified staff, senior practitioners, other less experienced psychologists, trainees and assistants from a multi-model perspective. Able to offer consultation as well as clinical supervision.

Able to deliver training in specialist areas.

    Development and evaluation of training

  • Being able to develop, deliver and evaluate highly specialist training regarding intervention skills from a multi-model perspective to multidisciplinary colleagues
  • To contribute as required to clinical training courses e.g. selection/supervision

    Advanced supervision skills utilising multiple models

  • Engaging in further training in models and techniques of supervision and training to support the learning of others in the application and implementation of psychological knowledge and skilled interventions
  • Day to day coordination and delivery of supervision for MDT colleagues and assistant/trainee psychologists, flexibly adapting supervision based on individual need
  • Ability to offer supervision of the clinical supervision delivered by others
  • Being able to offer individual and team reflective practice/’case bust’ sessions focusing on developing clinical interventions and consultation sessions

Principal Psychologists



Delivery of
Specialist and Complex Skills
Broad Definition of Skills

Provide clinical supervision to those at lower levels and same level, & be able to develop and co-ordinate a service-wide clinical supervision strategy.

To be able to develop and co-ordinate Service/Specialism-wide psychological training strategy.

    Wider clinical leadership for service improvement plans

  • Able to demonstrate clinical leadership skills within the service, including aspects such as:
    • understanding and rising to the challenges of service improvement
    • understanding the context in which services are to be improved – local politics, national policy imperatives, the local environment and the people in it
    • understanding the characteristics of the people involved and building on their diversity
  • Ability to attend to broader workforce issues which cannot be managed by training and development of current team members alone (e.g. high turnover, retention of staff with specialist accreditation, inability to attract people of the necessary calibre)
  • Taking responsibility for implementing agreed changes - increasing knowledge and skills in leading others, managing change and partnership working

    Development and implementation of supervision and consultation for teams and services

  • Day to day coordination and delivery of supervision for trainees and less experienced qualified psychological therapist colleagues from a multi-model perspective from a position of having an advanced knowledge and understanding of models of psychological supervision and consultancy
  • Developing and implementing supervision strategies within the specialism/service
  • Offering supervision to multidisciplinary teams, with a focus not just on clinical interventions but using formulation skills to identify dynamic processes with the team and the impact of those on clinical care, the individual and team in promoting staff resilience
  • Offering debriefs to teams after serious incidents e.g. deaths and being involved in the sensitive communication of findings and post-support after investigations
  • Being involved in the delivery of peer special interest groups
  • Offering shared formulation sessions to care teams where they can reflect on and develop their understanding of issues. Session can be used to reduce blame, develop less stressful and more therapeutic environments and relationships, though developing more creative and consistent care plans. Sessions can also improve confidence and job satisfaction
  • Identifying and supporting people and teams to challenge malignant alienation i.e. deterioration in relationships characterised by less sympathy and subsequent support from clinicians

    Developing, evaluating and implementing specialist training

  • Developing, implementing and auditing training strategies for multidisciplinary teams within the specialism/service (being up to date with current innovations)
  • Designing and delivering specialist training for colleagues within psychological therapies
  • Contributing as required to clinical training courses e.g. selection, teaching, supervision and assessment

    Engaging in multi-model CPD

  • Engaging in appropriate multi-model CPD as required by accrediting bodies and in line with service requirements
  • Engaging in training wider than specific service delivery areas to broaden and integrate knowledge in order to develop services

Lead/Head Psychologists



Delivery of Organisational-Level and Competency Initiatives, Service Development, and Clinical Governance
Broad Definition of Skills

Able to develop and co-ordinate NHS Trust/Organisation-wide clinical supervision strategy and NHS Trust/Organisation-wide psychological training strategy.

    Knowledge of leadership and management/organisational theory and practice

  • An expert theoretical and practical knowledge of models of leadership and management theory and basic organisational psychology.

  • To be able to guide and advise from a specialism perspective on psychological needs for different strategies (e.g. Organisation Development, Staff Well-being, Sickness and Absence)
    • Senior supervision and consultation

  • Being responsible for the governance of clinical supervision across the organisation
  • Offering consultation and advice to senior NHS Trust/Organisation management teams and boards
  • Supporting organisations to develop their inclusion of service users at all levels of service development and within staff training
  • To be able to advise on staff Competency and development in psychological practice skills

    Planning and implementation of psychological skills development and training strategy

  • Plan, develop, monitor and review the recruitment, deployment and management of psychological skills and strategy across the NHS Trust/Organisation
  • Organising placement, professional and clinical supervision of staff at all levels up to the most senior
  • Lecturing and teaching in a specific field of expertise at a NHS Trust/Organisation level, at professional networking groups, and conferences
  • Being informed by and helping organisations interpret and implement audit tools and good practice guidelines e.g. Pillars of Recovery Service Audit Tool (PoRSAT)
  • Developing and coordinating NHS Trust/Organisation wide supervision strategy and policy in line with national guidance and best practice
  • Developing and coordinating NHS Trust/Organisation wide training strategy and policy in line with national guidance and best practice
  • To be able to advise the organisation on change processes and effective skills transfer

Well-Being, Self-Awareness and Self-Care

    These skills reflect the importance of acknowledging and prioritising the well-being of staff working in caring and supportive roles. Promotion of psychological well-being, awareness and self-care is important at all levels and not only from an individual perspective, but also that of a Team and Organisation.

    This domain is about having the ability to reflect on one’s own strengths and needs, and the ability to seek out and utilise appropriate support to enable effective working. Increasing skill in this domain is reflected by having higher levels of personal awareness and a recognition of the impact of organisational stressors and skill in facilitating the development and self-care of others and the organisation as a whole through the use of psychological skills in terms of assessment, formulation and intervention.

All Clinical Staff Who Deal With People


Psychological Awareness
Broad Definition of Skills

A basic awareness of emotional intelligence, and knowledge of self in relation to common emotional triggers and reactions in this field of work.

For staff to have an awareness of stress levels and effective ways of managing these.

    Basic identification and self-management of emotional states

  • To be emotionally intelligent i.e. recognising and being able to respond and work with emotions in oneself and in others
  • To have an appreciation of how one can choose to respond to (as opposed to immediately react to) the triggering of strong emotions (e.g. tolerating and working with high levels of distress, sitting and working with difficult feelings, “not being able to make it better”)
  • Being aware of the impact of one’s own life experience, culture and values and how this will impact on therapeutic and working relationships
  • An appreciation of the relationship and how others’ behaviour and experiences might evoke strong feelings in oneself (particularly in relationship to own personal experiences and the potential to over identify)
  • Being able to recognise challenges of the role e.g. vicarious traumatisation (being traumatised by hearing accounts of trauma) and seeking appropriate support

  • Being able to reflect on the self; stopping and thinking critically in order to develop further
  • To be aware of the need to look after your own mental health and to be able to respond to your own needs kindly and in a timely fashion
  • To be able to recognise one’s own personal signs of stress
  • To be able to use effective coping skills for stress management (including accessing and using support/supervision)
  • To ensure fitness to practice and that health does not adversely impact on work performance or judgement (and to modify or stop practice if required)
  • Recognising and challenging discriminatory behaviour
  • Being open to and adapting to change
  • To have good problem solving skills (framing problems as goals, identifying possible solutions, considering pros/cons and selecting a response, reviewing and revising as appropriate)
  • To recognise sources of team and organisational stress and identify means of raising these appropriately

Qualified
Mental Health Professionals

(Any graduate-level healthcare professional) Without further accredited training in delivering psychological interventions

Psychologically-Informed Healthcare
Broad Definition of Skills

Staff have a more detailed understanding of emotional intelligence, and are able to utilise this information more effectively in relation to themselves.

Staff to have a more detailed and balanced knowledge of stress, resilience, and compassion, and are able to utilise this knowledge to manage themselves effectively.

    Developed understanding of and self-management of emotional reactions

  • Greater understanding of one’s own triggers for emotional reactions and sensitivities – as well as one’s own ways of dealing with difficult emotions
    • Greater skill at being able to choose an appropriate response based on one’s own emotional reactions (this may often be about recognising personal challenges and taking these to supervision)

    Supporting others

  • An understanding of how to support effective coping skills in others
  • A more detailed understanding of what resilience is and how to support a culture that fosters this within the organisation.
  • A more detailed understanding of what self-compassion is and what conditions individuals need to nurture compassion in themselves and in others.

    Developed understanding of relationship between intra- and interpersonal processes, their impact and management

  • A greater understanding of the relationship between intrapersonal and interpersonal processes (for example, a more advanced ability to recognise and distinguish personal issues from professional issues and deal with these appropriately, e.g. within clinical supervision, managerial supervision, or via external support
  • A more advanced understanding of how to recognise signs of stress in oneself and others, especially those for whom one has a supervisory or line management responsibility
  • A more advanced understanding of how to prevent and manage personal stress and respond to stress in others

Qualified (Uni-Model) Psychological Therapists

(Any graduate-level healthcare professional with further post-graduate accredited training in a recognised psychological therapy)

Delivery of
Evidence-Based Skills
Broad Definition of Skills

Sophisticated understanding of emotional intelligence, and an ability to apply this understanding effectively within formal psychological relationships.

Awareness of how the personal and professional interact in the delivery of psychological interventions.

    Supporting self-Reflection and self-Care for others

  • An ability to help support others in attending to emotional triggers and reactions through clinical supervision
  • To have the knowledge of and ability to deliver self-care initiatives to staff e.g. training in stress management skills

    Enhanced self-Reflection abilities

  • An ability to recognise and utilise one’s own emotional reactions within the moment, rather than only within the context of supervision
  • An ability to reflect upon and evaluate personal values, clinical competence and limitations as psychological therapist

    Debriefing skills

  • To have the ability to debrief after critical events (with appropriate training and supervision)

Highly Trained Psychological Workers

Who are able to draw on multiple models and theories (e.g. clinical or counselling psychologists).

Delivery of
Specialist Skills
Broad Definition of Skills

Ability to apply emotional intelligence in more challenging contexts.

Ability to apply knowledge and skills about stress and resilience to the Team context.

    Emotional self-awareness in challenging situations

  • An ability to recognise and utilise one’s own emotional reactions within the moment, in particularly challenging contexts
  • A sophisticated ability to attend to different levels of need within the supervisory relationship, both from the position of supervisee and supervisor

  • An ability to identify, assess, and formulate stress within the team
  • An understanding of systemic issues that influence staff stress and use models to inform understanding in teams.
  • An ability to advise on/develop team interventions/specialised programmes for the management of team stress/to enhance team resilience.

Principal Psychologists



Delivery of
Specialist and Complex Skills
Broad Definition of Skills

As in Level 4, but also to be able to consider the Service level of context.

    Identifying and addressing systemic sources of stress in services

  • To have the ability to identify, assess and formulate stress within the service/specialism.
  • To have an understanding of systemic issues that influence staff stress and use models to inform understanding within the service.
  • To advise and develop interventions for the development of self-care initiatives and management of stress within the service/specialism and to enhance resilience.

Lead/Head Psychologists



Delivery of Organisational-Level and Competency Initiatives, Service Development, and Clinical Governance
Broad Definition of Skills

As in Level 4 & 5, and also be able to consider stress from an organisational perspective across the NHS Trust/Organisation.

    To identify and address systemic sources of stress in the organisation

  • To have the ability to identify, assess and formulate stress within the Organisation
  • To have an understanding of systemic issues that influence staff stress and use models to inform understanding within the Organisation
  • To advise and develop interventions for the management of stress within the Organisation and to enhance resilience
  • To have overall skills in offering strategy, consultation and advising the board, senior management and the Organisation regarding practices for caring for its workforce specifically regarding reasonable demands on colleagues and compassionate responses to issues raised