Becoming a Competent Clinician:

Basic Competencies in Intervention

䊲

Jean Spruill
University of Alabama
䊲

Ronald H. Rozensky
University of Florida
䊲

Tommy T. Stigall
Independent Practice, Baton Rouge, Louisiana
䊲

Melba Vasquez
Independent Practice, Austin, Texas
䊲

Rosie Phillips Bingham

The University of Memphis
䊲

Cindy De Vaney Olvey

Argosy University

This article summarizes the results from the Intervention Work Group of
the Competencies Conference: Future Directions in Education and Creden-
tialing in Professional Psychology. The generic charge presented to the
Intervention Work Group was “to address issues related to interventions.”
The Intervention Work Group identified four competency components of
knowledge, skills, and abilities: (a) foundational competencies; (b) inter-
vention planning; (c) intervention implementation; and (d) intervention eval-
uation competencies. A fifth component that included “practice

Correspondence concerning this article should be addressed to: Jean Spruill, Box 870356, Tuscaloosa, AL
35487–0356; e-mail: jspruill@gp.as.ua.edu.

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 60(7), 741–754 (2004) © 2004 Wiley Periodicals, Inc.
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.20011
742 Journal of Clinical Psychology, July 2004

management” was labeled as “others.” Each component is discussed, includ-

ing competencies that were deemed an essential knowledge, skill, and/or
value. A discussion of training for intervention competence and assessing
that intervention competence is included. Future directions for the sci-
ence and practice of psychology in the intervention arena are summa-
rized. This is one of a series of articles published in this issue of the
Journal of Clinical Psychology. Several other articles that resulted from the
Competencies Conference will appear in Professional Psychology: Research
and Practice and The Counseling Psychologist. © 2004 Wiley Periodi-
cals, Inc. J Clin Psychol 60: 741–754, 2004.

Keywords: intervention; therapy; training

The Competencies Conference: Future Directions in Education and Credentialing in

Professional Psychology focused on the identification, training, and evaluation of pro-
fessional competencies for health and human service providers and educators in psychol-
ogy. This article summarizes the conference results from the Intervention Work Group 1
and should be viewed as a dynamic, continuously developing product. The generic charge
presented to the Intervention Work Group was “to address issues related to inter-
ventions.” Thus, for this purpose, “intervention” was defined broadly to include preven-
tive (primary, secondary, tertiary), developmental, and therapeutic interventions. Our
goal was to define the competencies in knowledge, skills, and values consistent with the
science and application of psychology to interventions in diversified settings and with
diverse populations.
Being a competent clinician involves having the knowledge, skills, abilities, and
attitudes necessary to perform a myriad of clinical tasks. How does one become a com-
petent clinician? As described in Brenner (2001), Stuart Dreyfus, a mathematician, and
Hubert Dreyfus, a philosopher, developed a generic model of skill acquisition based upon
the study of chess players and airline pilots. Brenner used the Dreyfus model to describe
the training of nurses. When applied to intervention, the Dreyfus model would be as
described as follows:

1. In the novice or beginner stage, the clinician has very limited knowledge and
understanding of how to analyze problems and/or how to intervene. Beginners
rely upon basic principles and techniques they have learned; they are rule bound
and are not experienced enough to be flexible in their use of these principles and
techniques.
2. Advanced beginners have acquired enough experience to recognize some trends
and patterns in behavior; however, their ability to generalize their skills to new
situations and clients/patients is limited. (Note: the terms client and patient will
be used interchangeably.) The rules and principles that they have learned now
become guidelines; nevertheless, the advanced beginner needs substantial sup-
port and supervision.

1
The members for the Intervention Work Group were Varda Shoham, group leader, Greg Keilin, recorder,
Melba Vasquez, steering committee representative, Laura Barbanel, Rosie Phillips Bingham, Sandra Brown,
Gladys Croom, Doug Epperson, Cindy Olvey, Ron Rozensky, Jean Spruill, and Tom Stigall.
 Becoming a Competent Clinician 743

3. Competence develops when the clinician is consciously aware of long-range goals

and plans for their clients and can adapt to the changes in the client with appro-
priate changes in the intervention plan. The competent clinician has a feeling of
mastery and is able to cope with and handle crises or other problems that may
arise. The competent clinician has an organization plan for sessions and guides
the clients toward meeting their goals for treatment. Competent clinicians are able
to integrate theory and research into every aspect of their practice applications.
4. The proficient clinician has a holistic understanding of cases, and performance is
guided by flexible, well-understood principles that reflect a clear understanding
of the nuances of therapeutic interventions and the impact of the intervention on
the client and others. Proficient and expert-level clinicians (described below) are
able to train others in intervention skills.
5. The expert-level clinician operates from an understanding of the total situation.
He/she has an intuitive grasp of each situation and can assess rapidly the prob-
lem(s) and design appropriate interventions; the expert quickly recognizes when
the intervention is not working and is able to make rapid changes in his/her
treatment approach.

Graduate training and internship training, although still at the beginner level, should
move the student from novice status to at least the initial level of development as a
competent clinician. Every skill, even the most basic skill such as empathic listening, has
a developmental trajectory. Throughout their training and professional career, it is expected
that clinicians will continue to grow in skills, eventually reaching the expert level.
In order to move from the novice to the expert level, the Intervention Work Group
identified four competency components of knowledge, skills, and abilities: (a) founda-
tional competencies; (b) intervention planning; (c) intervention implementation; and
(d) intervention evaluation competencies. A fifth component, practice management, is
deemed essential for the clinician seeking to apply his/her intervention skills, whether
working within an agency or independent practice. Space prevents more than a brief
description of each topic.

Foundational Competencies
The Intervention Work Group identified six basic foundational competencies that cut
across all intervention models. Each of these six competencies is considered of equal
importance, basic to the development of intervention skills from the beginner to expert
level, and overlapping rather than independent. The basic competencies are discussed
below.

Scientific Foundations

Scientific foundation includes knowledge of theoretical models and the knowledge of

evidence-based interventions within the problem area, followed by the ability to make an
informed choice of the best intervention plan. The Boulder model is the “framework for
the majority of training programs in clinical psychology” (Belar & Perry, 1992, p. 71).
There are three basic variations of the Boulder model with differing emphases on the
relationship between science and practice (Cherry, Messenger, & Jacoby, 2000). In all of
these models, the prevailing belief is that clinicians need to know theoretical models of
intervention, what works best for what types of problems, and, with the use of the sci-
entific literature, choose the best intervention plan for treating a particular individual.
744 Journal of Clinical Psychology, July 2004

Beutler, Williams, Wakefield, and Entwisle (1995) have shown that practicing clinicians
indicate they value research and consider their clinical practices to be augmented by
research findings. In spite of this, there continues to be a “disjunction between treatments
that are empirically supported and those used in practice settings” (Morgenstern, Mor-
gan, McCrady, Keller, & Carroll, 2001, p. 83). Perhaps the disjunction continues because
“our scientist-professional rhetoric outdistances our training and educational practices”
(Davison, 1998, p. 163). As a profession, we need to develop ways to facilitate the
translation of scientific findings into actual clinical practice.

Relationship Skills
The development of a therapeutic alliance or relationship is based on the interpersonal
and communication skills (discussed below) of the clinician, coupled with client vari-
ables. Conveyance of warmth, empathy, genuineness, and respect for the patient are
attributes that, to some extent, the clinician brings to the training situation. These per-
sonal characteristics can be enhanced—but it is unlikely that we can teach someone to be
genuine or respectful if these qualities are lacking in the person. Application of most
interventions requires that the clinician establish an effective relationship with the client.
Thus, the development of relationship skills is a foundational component of the acquisi-
tion of effective intervention skills. The beginning clinician must be educated about ways
to establish a therapeutic alliance. It is the strength of the therapeutic alliance that insures
positive change and growth for the client (Martin, Garske, & Davis, 2000); in order to
become a competent clinician, students must receive training in the further development
of their relationship skills. Most textbooks used in beginning psychotherapy classes have
a section devoted to building relationship skills (e.g., Brems, 2001).

Communication Skills
Establishing and maintaining an effective therapeutic relationship is dependent upon the
clinician’s ability to communicate effectively with the patient on many levels. Students
bring to the training experience basic personal skills, written and oral communication
skills, basic attitudes such as honesty, integrity, and respect for others’ cultures, beliefs,
and values, the desire to learn, personal organization, and personal hygiene. While many
of these personal characteristics cannot be taught, they nevertheless are important qual-
ities for psychologists. Essential attributes certainly can be encouraged, modeled, and
developed further through role modeling and psychotherapy, if necessary. Communica-
tion skills are one of the most important of the relationship-building skills, and one’s
social skills certainly facilitate or hamper the development of rapport. Communication
skills that can be taught or developed further may include ways to form a working alli-
ance with clients, as well as how to negotiate differences and conflicts while maintaining
appropriate boundaries. Communication also involves listening. Therapists need to learn
how to listen attentively, both to what is being said and what is not being said, sometimes
referred to as “listening with the third ear.” Listening with the third ear concerns the
understanding of communications and meanings, including body language that goes beyond
the denotation of spoken words (Macran, Stiles, & Smith, 1999). Most textbooks used in
beginning psychotherapy classes have a section devoted to communication and listening
skills (e.g., Heaton, 1998).

Individual and Cultural Differences

Recent literature has focused on the “culturally competent psychologist.” The first Na-
tional Multicultural Conference and Summit, held in January of 1999 (Sue, Bingham,
 Becoming a Competent Clinician 745

Porché-Burke, & Vasquez, 1999), unanimously reaffirmed the goal of implementing cul-
tural competence in all psychological endeavors. Sue and Sue (1999) have underscored
the importance of understanding culture in establishing a therapeutic alliance. In August
2002, the American Psychological Association Council of Representatives endorsed the
Guidelines on Multicultural Education, Training, Research, Practice, and Organiza-
tional Change for Psychologists (American Psychological Association, 2003). These guide-
lines reflect knowledge and skills needed for the profession in the midst of dramatic
historic sociopolitical changes in U.S. society, as well as needs from new constituencies,
markets, and clients. The first two Guidelines are designed to apply to all psychologists
from two primary perspectives: (a) knowledge of self with a cultural heritage and varying
social identities; and (b) knowledge of other cultures. The remaining four Guidelines
address the application of multiculturalism in education, training, research, practice, and
organizational change. It is our belief that all interventions should take into consideration
the total individual within the context of their age, gender, gender identity, race, ethnicity,
culture, national origin, religion, sexual orientation, disability, language, and socioeco-
nomic status. Because cultural incompatibilities often interfere with successful treatment
outcomes, it is crucial that clinicians receive training in working with individuals from
culturally and linguistically diverse backgrounds. Clinicians must be able to identify
those issues in the therapeutic setting that are a result of the patient’s cultural practices
and beliefs, the acculturation process, and/or individual psychopathology. Clinicians must
be aware of their own biases and the effect these biases may have on the client.

Ethical and Legal Guidelines

The competent therapist should be knowledgeable about the ethical and legal guidelines
that pertain to the profession, including knowledge of state and federal laws relating to
practice. For example, issues such as age to consent to treatment, treatment of a minor,
informed consent, confidentiality, privileged communication, involuntary hospitaliza-
tion, reporting of abuse, etc., are issues that are governed by both the ethical guidelines of
the profession and the laws of the states. Because psychology is a continually evolving
discipline, the ethical guidelines under which we practice also must evolve continually.
When making decisions regarding their ethical behavior, psychologists must consider the
APA Ethical Principles of Psychologists and Code of Conduct (American Psychological
Association, 2002), the applicable laws, and psychology board regulations of their state,
and may consider other guidelines that have been adopted or endorsed by scientific and
professional psychological organizations.

Critical Thinking
Critical thinking or analysis—defined as the “deliberate use of skills and strategies that
increase the probability of a desirable outcome” (Halpern, 1998, p. 449)—requires the
ability to listen and evaluate objectively all aspects of a situation, problem, or event. The
use of the word critical in this context is to “evaluate or judge” rather than “find fault.”
The competent clinician must convey warmth, understanding, and genuineness even as
he/she listens critically to the message being delivered by the client. Critical analysis
helps the clinician begin the intervention planning process and continues throughout the
entire intervention. The competent psychologist critically evaluates his/her practice and
intervention skills throughout the intervention process. It is the structure of thinking,
based upon the training as a scientist, that ensures this critical thinking approach to
intervention. Critical thinking is a skill that can be taught; Halpern (1998) offers an
excellent four-part empirically based model for the teaching of critical-thinking skills.
746 Journal of Clinical Psychology, July 2004

Intervention Planning Competencies

Three of the components necessary to become competent in intervention planning will be
discussed in this section include (a) assessment, (b) case formulation, and (c) selection of
the best strategy for intervention. Effective integration of theory, research, and practice
especially is important in developing competence in intervention planning. The first com-
ponent is the use of assessment. Without an adequate assessment of the client, a success-
ful intervention is unlikely. According to Harkness and Lilienfeld (1997), the science
of individual differences (assessment) aids treatment planning in four important ways:
“(a) knowing where to focus change efforts, (b) realistic expectations, (c) matching treat-
ment to personality, and (d) development of the self” (p. 349). Thus, assessment is an
essential part of the intervention process. The clinician needs to develop a systematic
approach to gathering data to inform his/her clinical decision making. Assessment pre-
supposes knowledge of psychometric bases of assessment methods, knowledge of issues
related to the integration of data from diverse sources, and the ability to use the informa-
tion gathered for diagnostic purposes.
Once a thorough assessment of the client has been completed, the next step is case
formulation. Based on the assessment data from the individual—which may include for-
mal testing, data from other sources, as well as a thorough history taking and diagnostic
interview—the clinician develops a conceptual model of the case. The conceptual model
should include a theory of the problem and a theory of behavior change. At the beginning
stages of training, the clinician is likely to rely heavily on his/her supervisor for the
development of the case theory.
The final stage is the selection of the most appropriate and effective intervention
strategy for a given client with the identified problem or diagnosis, that is, matching the
client’s problems and personality to the intervention. Thus, the competent clinician should
have knowledge of the major theoretical models, their underlying assumptions, change
mechanisms, and when the model is or is not appropriate. In assessing appropriate treat-
ment approaches tailored to meet the needs of the individual client, it is important that
clinicians be aware that therapist variables may influence the outcome of the therapeutic
process (Wierzbicki & Pekarik, 1993). Examples of therapist variables may include gen-
der, race, experience, or type of degree.
Intervention or treatment plans have taken on new importance in the era of managed
care. Goals and objectives need to be spelled out, and outcomes should be measurable
and measured by the clinician (Lambert, Okiishi, Finch & Johnson, 1998). Additionally,
the clinician must be flexible, must be able to carry out critical analyses of his/her work,
and know when and how to change the approach as necessary, as well as know the limits
of his/her expertise and when to refer the client. As therapy progresses, the clinician’s
initial assessment of the problem may change; as the assessment changes, so should the
intervention (Harkness & Lilienfeld, 1997). Competence in charting client progress as
part of the clinical record and as part of the ongoing diagnostic or assessment process is
necessary. The clinician must be able to communicate explanations/theory to the client in
a manner that is understandable and plausible to the client. After developing a treatment
plan, the next step is implementation.

Intervention Implementation Competencies

Competent intervention implementation requires that psychologists be skilled in the imple-
mentation of a treatment plan, management of special situations, termination skills, work-
ing with and within various care systems, and general case management when necessary.
 Becoming a Competent Clinician 747

Implementation of Treatment Plan

Effective implementation of treatment plans depends on the communication and
relationship-building skills of the clinician, among other things (Stein & Lambert, 1995),
the development of a therapeutic alliance (Kivlighan, & Shaughnessy, 2000), the match
between the intervention plan and the personality of the client (Harkness & Lilienfeld,
1997), and the application of intervention strategies at the appropriate time (Holloway &
Neufeldt, 1995). Good supervision can be very effective in helping the novice clinician
learn techniques that facilitate implementation of the intervention plan, as well as assess
how well the intervention is progressing (Holloway & Neufeldt, 1995).

Management of Special Situations

The clinician must have the ability to manage effectively common clinical problems, as
well as “behavioral emergencies” or crises such as suicidal or homicidal clients (Kleespies,
Deleppo, Gallagher, & Niles, 1999). They must be equipped to deal with issues such as
reporting abuse, preferably in a way that will keep the client engaged in treatment. Again,
good supervision is essential in teaching the beginning clinician to handle a variety of
common, and not so common, clinical problems and the appropriate documentation in the
client’s file of the steps taken by the therapist. Perhaps the best skill that can be taught is
the use of consultation and how to recognize when consultation is needed.

Termination Skills
Often overlooked in training, termination skills are important to conclude successfully a
treatment program (Goldfried, 2002). Ideally, treatment starts with a treatment plan, which
is modified as needed, and when the treatment goals are reached, the therapist and client
say good-bye. Termination should be discussed throughout treatment, and termination
hopefully occurs when the client and clinician agree that the treatment goals have been
met. However, sometimes clients simply stop attending sessions—either because they
believe they have reached their goals, they are not making progress, or because therapy is
too painful a process (Goldfried, 2002). Other reasons for the client abruptly terminating
therapy may be financial or just a bad fit between the therapist and client. Reasons for the
clinician terminating therapy include terminating when it becomes reasonably clear that
the client no longer needs the service, is not likely to benefit, or is being harmed by
continued service, or when the psychologist is threatened or otherwise endangered by the
client or another person with whom the client has a relationship (American Psychological
Association, 2002). On the one hand, trainees need to learn how to recognize the cues that
signal that a client is about to terminate prematurely; conversely, trainees need to recog-
nize those patients who are content to attend sessions without any progress. Developing
competency in the termination process is an important skill that can be learned through
the educational process and practiced as the trainee gains experience. However termina-
tion is achieved, the competent clinician reflects this in a progress note that illustrates the
circumstances of termination, the treatment goals attained, and any referral or re-contact
information.

Working with Other Systems of Care

Dramatic changes in health-care services have affected both practitioners and the insti-
tutions in which they are trained. The skills needed to practice in the current marketplace
748 Journal of Clinical Psychology, July 2004

are different from those needed in the past (American Psychological Association, 1997).
As the delivery of health-care services continues to evolve, it is incumbent upon training
programs and competent clinicians to stay abreast of the current health-care marketplace
and skills necessary to practice competently. Psychologists must be knowledgeable about
the multifaceted needs of many clients and be able to work with other agencies to provide
the best care for a client. Treatment plans need to be focused and goal oriented and often
must include other agencies; therefore, an individual who is depressed and an alcoholic
may need to be involved in individual or group therapy and Alcoholics Anonymous. Brief
treatment modalities that are time limited, active, and directive are interventions that are
most likely to be effective when dealing with focused, specific problems (Hoyt, 1995).
Learning to schedule one’s caseload is an important skill whether one practices within an
agency or independently. The competent psychologist understands the realities of third-
party reimbursement, including the level of benefits available to that patient, and is pre-
pared to advocate for the client when additional or other types of services are needed.

Self-Care

The American Psychological Association ethics code (American Psychological Associa-

tion, 2002) requires psychologists to take appropriate measures to ensure that personal
problems do not interfere with adequately performing work-related duties. It also is impor-
tant that psychologists engage in appropriate self-care to prevent problems. Norcross
(2000) emphasized the importance of recognizing the “hazards of psychological prac-
tice” (p.710). Psychotherapy can be demanding on the clinician, and competent clini-
cians develop specific strategies of self-care that enable them to maintain their intervention
competence.

Intervention Evaluation Competencies

Performance Appraisal/Self-Evaluation Skills

A competent psychologist knows how to evaluate the client’s progress and the success or
failure of the intervention(s). They also should know how to evaluate their own perfor-
mance, attitudes, behaviors, and work skills as objectively as possible. Clement (1996)
suggested that the competent clinicians who have a system to measure their effectiveness
are likely to have a competitive edge over those who do not. Belar and colleagues (Belar
et al., 2001) have proposed a template that the practicing clinician can use for self-
assessment; it is designed to help the clinician “gauge his or her readiness to provide
professional services in expanded areas of practice” (p. 135). Their model also is appli-
cable to self-assessment in general.
However, it is not enough that the competent clinician be able to assess his/her own
performance—their work must be open to the scrutiny of others. Psychological practice
is grounded in science. While it is expected that the researcher will subject his/her work
to scientific scrutiny of their colleagues, the idea of subjecting clinical practice to the
scrutiny of others is not well established. The Scientific Foundations and Research Com-
petences Work Group of the Competencies Conference identified the competencies nec-
essary for professional psychologists to practice scientifically; one such competency was
the importance of professional psychologist to subject their work to the “scientific scru-
tiny of colleagues, stakeholders, and the public” (Bieschke, Fouad, Collins, & Halonen,
2004). For further discussion of this topic, the reader is referred to the article from this
Work Group.
 Becoming a Competent Clinician 749

Utilization of Supervision and Consultation

The trainee’s experience in supervision is crucial to development of skills in assessment

and intervention (Holloway & Neufeldt, 1995). The beginning clinician typically is very
dependent upon his/her supervisor for guidance and assistance in most aspects of a case.
As they become more experienced and gain competence in intervention, trainees are
more autonomous, less dependent upon detailed guidance from the supervisor, but still
seek supervision when needed for a case (Kaslow & Deering, 1993). One of the primary
duties of the supervisor is to promote the supervisee’s self-awareness and ability to rec-
ognize personal issues as they arise in therapy. The role of the supervisor is both to
protect the client and to train the supervisee to recognize his/her limitations, blind spots,
and personal characteristics and/or mannerisms that may influence negatively the inter-
vention process (Holloway & Neufeldt, 1995). Perhaps the most important outcome of
the supervisory process is for the competent supervisee to learn to trust his/her instincts
and training. However, even the expert knows when to seek consultation and uses it
effectively.

Other Skills
One may be technically proficient to undertake psychological intervention and still not
be effective unless one also has acquired the knowledge, skills, abilities, and values that
will prepare him/her to become licensed for independent practice, provide services in an
area of specialization, and manage a practice. Other work groups from the Competencies
Conference have addressed some of these competencies in detail, but they are worth
noting in this context as well. Because of time limitations, the Intervention Work Group
could do little more than acknowledge the importance of a set of related competencies
that under gird effective therapeutic intervention. The comments that follow represent a
consensus of the authors, but not necessarily of the Work Group as a whole.

Licensure

Psychological intervention as an aspect of the practice of psychology is regulated by law

in the US and some other countries. Licensure as a psychologist is not a guarantee of
competence, but it does give some assurance to the public that common standards of the
profession have been met for purposes of entry-level practice. Applicants for licensure
should be acquainted with the laws and regulations of the state in which they intend to
practice. Knowledge of the law and its applications may be assessed during written
jurisprudence and/or oral examinations (Olvey, Hogg, & Counts, 2002). Doctoral train-
ing programs and internship supervisors should be able to provide valuable advice about
preparation for licensure, including possible opportunities for supervised postdoctoral
experience. Other useful sources of information include state psychological associations
and state licensing authorities.

Specialization

Specialization in professional practice is different from self-defined areas of interest in a

career of research and scholarship. Competencies specific to a particular specialty are
grounded in a specialized body of knowledge, techniques, and procedures germane to the
specialty, and are particular to populations served or problems addressed by practitioners
of the specialty. Students should inform themselves early about career pathways leading
750 Journal of Clinical Psychology, July 2004

to specialty practice and specialty credentials. The American Psychological Association

has established a formal mechanism for the recognition of specialties and proficiencies in
professional practice (Stigall, 1998).
Practitioners meeting specialized training and experience requirements may qualify
for specialty board certification or other credentials. In some instances, state laws pro-
vide for specialty credentials issued by state licensing or certification authorities. One of
the oldest and best known non-statutory credentialing organizations is the National Reg-
ister of Health Service
Providers in Psychology. For information about credentialing, contact the National
Register (http://www.nationalregister.org). The College of Professional Psychology, affil-
iated with the American Psychological Association, offers examination and certification
in the treatment of alcoholism and other psychoactive substance-use disorders. Certifi-
cation by the American Board of Professional Psychology (ABPP) signifies competence
in a number of recognized specialties based upon credentials review and examination.
Individuals may contact the American Board of Professional Practice (http://www.abpp.org)
for information on board certification in specialized areas of psychology.

Practice Management

Psychological intervention often takes place within a particular service delivery setting
such as an organized system of care, a hospital, clinic, or other public or private institu-
tion (e.g., school, correctional facility), or in a private practice setting. Whatever the
setting, it is necessary to manage available resources to achieve the desired intervention
outcome. Management skills are needed to recruit, train, and supervise other profession-
als, paraprofessionals, and support staff. Even solo practitioners may employ one or more
office staff, such as a clinical assistant or a receptionist. Office policies and procedures
should be written in a manner consistent with state and federal laws pertaining to privacy,
electronic transmission of protected health information, and record keeping. Knowledge
of Medicare, Medicaid, and other third-party reimbursement mechanisms is highly desir-
able and, in some settings, it is essential. Psychologists who anticipate contracting with
managed-care companies need to understand how to apply for provider panels, submit
their credentials for review, interpret contract provisions, interact with care managers,
prepare treatment plans for review, and explain benefits to their clients. Specific clinical
privileging may be required by managed-care panels, hospitals, and other forms of insti-
tutional practice. Effective psychological intervention depends upon learning and nego-
tiating the culture and requirements of diverse practice settings.

Training for Intervention Competence

The principles that underlie this section are threefold: (1) learning is a lifelong process,
(2) developmental aspects of training are important, and (3) training should include didac-
tic, experiential, and mentoring components. Examples of training approaches are given
for each of the competencies discussed above.

Foundational Competencies

The scientific foundations for intervention can be taught through courses, workshops,
and literature reviews. Experiential training may include single case-design clinical stud-
ies and intervention research projects, faculty research groups, theses, doctoral papers,
 Becoming a Competent Clinician 751

and dissertations. Mentoring can occur through collaborative intervention research with
mentors, research teams, and peers.
Communication and relationship skills can be taught through a mixture of courses on
the basic foundations of psychotherapy and workshops or labs in which the students
practice these skills with each other and/or volunteers. Experiential activities that focus
on development of oral and written communication skills, self-exploration activities,
empathy training role playing, and client/patient simulation can be used to train the
beginning student in communication and relationship skills. Role modeling and mentor-
ing by the supervisor, as well as fellow students, is important for the development of
communication and relationship skills that pertain to the therapeutic interaction. Clinical
supervision, with a portion including observation, peer group consultation, and observa-
tion of interventions by others are ways in which mentoring can facilitate the training of
students.
Individual and cultural differences can be taught through courses, workshops, and
literature reviews; however, this competency is learned best through experience. Self-
exploration of one’s attitudes, beliefs and culture, exposure to diverse populations, and
intervention with diverse clients or patients is essential. Mentors can assist by exposing
the student to diverse experiences and providing supervision with diverse clients.
Ethical and legal guidelines should be integrated throughout the curriculum in courses,
workshops, and required readings in professional ethics, risk management, and state laws.
Case discussions of ethical dilemmas, role playing, and discussion of ethical issues as
they arise in the student’s practicum caseload will allow for more experiential learning.
Clearly, mentors should serve as role models and be knowledgeable about (and willing to
discuss) potential ethical conflicts, dual relationships, and similar problems in their super-
vision of the student.
Didactic training in intervention planning, intervention implementation, and inter-
vention evaluation competencies can be accomplished through course work, seminars,
workshops, and literature reviews. Experiential training involves the supervised clinical
experience, observation of others, videotapes of one’s self in the intervention session,
which may occur through practicum, internship, postdoctoral training, clinical research
studies, client or patient feedback, and/or quality improvement measures. Most mentor-
ing occurs through clinical supervision and in relationships with other competent
psychologists.
Training for practice management skills is important at both the pre- and postdoc-
toral level. Didactic training could involve coursework, seminars, and workshops. Expe-
riential training could occur through exposure to professionals with diverse practice
approaches and diverse intervention activities as an aspect of socialization into the pro-
fessions. Again, mentoring most likely would occur through supervised experiences in
diverse settings.

Assessing Intervention Competence

How do we assess whether or not a trainee has acquired the entry-level knowledge, skills,
and abilities outlined above? The conference had a Work Group specifically focusing on
assessment of competencies across domains; therefore, the discussion and information in
this section is limited. The following principles form the basis for evaluation of competence:

1. Some portion of evaluation should include direct observation.

2. Assessment should be developmentally appropriate to the individual.
3. Assessment should be a lifelong process.
752 Journal of Clinical Psychology, July 2004

4. Measures used for assessment of competence should be valid.

5. Assessment should be flexible (to allow for model-specific competency assessment).
6. Assessment should include multiple measures (including observation).
7. Assessment should include repeated measures over time.
8. The assessment modality should be appropriate to the training modality and content.

Assessments of intervention competencies can be didactic through examinations in

courses, written and/or oral case presentations, client-satisfaction surveys, and critical
literature reviews. At later stages of professional development, licensure and specialty
examinations measure some aspects of intervention competency. Experiential assess-
ments could include ratings of competence in various aspects of intervention by the
individual, by peers, supervisors, and client-satisfaction questionnaires or critical litera-
ture reviews. Changes in client status as measured by outcome measures throughout the
course of therapy, retention of clients, and evaluations of work samples are among some
of the experiential measures of intervention competency. A type of examination used by
the American Board of Professional Psychology (ABPP), a widely recognized psychol-
ogy specialty certification body, toward the end of the student’s didactic training, and
again towards the end of the internship, would mirror the board certification exam includ-
ing ethics, professional issues, and specific skills such as assessment and intervention. It
would help to prepare the trainee for eventual board certification and is an accepted
method of assessment of competency.

Future Directions
The profession as a whole should work on developing and promoting innovative training
for specific competencies in all areas of professional psychology and the assessment of
these competencies. With the advent of telehealth, telemedicine, and computer-based
assessments, specific practice competencies should be developed that assure that trainees
who wish to engage in those activities have some direction towards expected knowledge
and skills in these developing areas. In general, the field of professional psychology
should:

1. Work towards developing and promoting innovative technologically based inter-

ventions. Media may include, but should not be limited to, use of the internet,
email, point-to-point video conferencing, as well as telephone-based interactions
between client and clinician or between clinician and other stakeholders (Gleuck-
auf, Pickett, Ketterson, Lomis, & Rozensky, 2003). Gleuckauf and his colleagues
reported that nearly every aspect of face-to-face health-care service is being deliv-
ered by these methods in a variety of settings. Competent psychologists must
prepare for and “envision their role in the future contexts that science and tech-
nology will most certainly bring about (Jerome et al., 2000, p. 420).
2. Promote life-long professional development through an individualized competency-
based developmental training plan.
3. Reaffirm the need for integration of science and practice and develop a compen-
dium of validated procedures for interventions, balancing the use of empirically
validated treatments and our scientific foundations with the day-to-day applica-
tion of that science in practice.
 Becoming a Competent Clinician 753

4. Reaffirm the necessity for critical thinking and the science-based interventions.
5. Develop taxonomy of specific competencies in each of the stages of professional
development described and within each of the skills of intervention suggested.

References
American Psychological Association. (1997). Changes in the health care delivery system: Recom-
mendations for the education, training, and continuing professional education of psycholo-
gists. Washington, DC: Author.
American Psychological Association. (2002). Ethical practices of psychologists and code of con-
duct. American Psychologist, 57, 1060–1073.
American Psychological Association. (2003). Guidelines on multicultural education, training, research,
practice, and organizational change for psychologists. American Psychologist, 58, 377– 402.
Bieschke, K.J., Fouad, N.A., Collins, F.J., & Halonen, J.S. (2004). The scientifically-minded psy-
chologist: Science as a core competency. Journal of Clinical Psychology, 60, 713–723.
Belar, C.D., Brown, R.A., Hersch, L.E., Hornyak, L.M., Rozensky, R.H., Sheridan, E.P., Brown,
R.T., & Reed, G.W. (2001). Self-assessment in clinical health psychology: A model for ethical
expansion of practice. Professional Psychology: Research and Practice, 32, 135–141.
Belar, C.D., & Perry, N.W. (1992). The National Conference on Scientist-Practitioner Education
and Training for the Professional Practice of Psychology. American Psychologist, 47, 71–75.
Beutler, L.E., Williams, R.E., Wakefield, P.J., & Entwisle, S.R. (1995). Bridging scientist and prac-
titioner perspectives in clinical psychology. American Psychologist, 50, 984–994.
Brems, C. (2001). Basic skills in psychotherapy and counseling. Belmont, CA: Brooks/Cole.
Brenner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice. Upper
Saddle River, NJ: Prentice Hall.
Cherry, D.K., Messenger, L.C., & Jacoby, A.M. (2000). An examination of training model out-
comes in clinical psychology programs. Professional Psychology: Research and Practice, 31,
562–568.
Clement, P.W. (1996). Evaluation in private practice. Clinical Psychology: Science and Practice,
3, 146–159.
Davison, G.C. (1998). Being bolder with the Boulder model: The challenge of education and train-
ing in empirically supported treatments. Journal of Consulting and Clinical Psychology, 66,
163–167.
Gleuckauf, R.L., Pickett, T., Ketterson, T.U., Lomis, J.S., & Rozensky, R.H. (2003). Preparation for
the delivery of telehealth services: A self-study framework for expansion of practice. Profes-
sional Psychology: Research & Practice, 34, 159–163.
Goldfried, M.R. (2002). A cognitive–behavioral perspective on termination. Journal of Psycho-
therapy Integration, 12, 364–372.
Halpern, D. (1998). Teaching critical thinking for transfer across domains, dispositions, skills,
structure training, and metacognitive monitoring. American Psychologist, 53, 449– 455.
Harkness, A.R., & Lilienfeld, S.O. (1997). Individual differences science for treatment planning.
Psychological Assessment, 9, 349–360.
Heaton, J.A. (1998). Building basic therapeutic skills: A practical guide for current mental health
practice. San Francisco: Jossey-Bass.
Holloway, E.L., & Neufeldt, S.A. (1995). Supervision: Its contributions to treatment efficacy. Jour-
nal of Consulting and Clinical Psychology, 63, 207–213.
Hoyt, M. (1995). Brief therapy and managed care. San Francisco: Jossey-Bass Publishers.
Jerome, L.W., DeLeon, P.H., James, L.C., Folen, R., Earles, J., & Gedney, J.J. (2000). The coming
754 Journal of Clinical Psychology, July 2004

of age of telecommunications in psychological research and practice. American Psychologist,

55, 407– 421.
Kaslow, N.M., & Deering, C.G. (1993). A developmental approach to psychotherapy supervision of
interns and postdoctoral fellows. Psychotherapy Bulletin, 28, 20–23.
Kivlighan, D., & Shaughnessy, P. (2000). Patterns of working alliance development. A typology of
client’s working alliance ratings. Journal of Counseling Psychology, 47, 362–371.
Kleespies, P.M., Deleppo, J.D., Gallagher, P.L., & Niles, B.L. (1999). Managing suicidal emergen-
cies: Recommendations for the practitioner. Professional Psychology: Research and Practice,
30, 454– 463.
Lambert, M.J., Okiishi, J.C., Finch, A.E., & Johnson, L.D. (1998). Outcome assessment: From
conceptualization to implementation. Professional Psychology: Research and Practice, 29,
63–70.
Macran, S., Stiles, W.B., & Smith, J.A. (1999). How does personal therapy affect therapists’ prac-
tice? Journal of Counseling Psychology, 46, 419– 431.
Martin, D.J., Garske, J.P., & Davis, M.K. (2000). Relation of the therapeutic alliance with outcome
and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology,
68, 438– 450.
Morgenstern, J., Morgan, T.J., McCrady, B.S., Keller, D.S., & Carroll, K.M. (2001). Manual-guided
cognitive–behavioral therapy training: A promising method for disseminating empirically
supported substance abuse treatments to the practice community. Psychology of Addictive
Behaviors, 15, 83–88.
Norcross, J.C. (2000). Psychotherapist self-care: Practitioner-tested, research-informed strategies.
Professional Psychology: Research and Practice, 31, 710–713.
Olvey, C., Hogg, A., & Counts, W. (2002). Licensure requirements: Have we raised the bar too far?
Professional Psychology: Research and Practice, 33, 323–329.
Stein, D.M., & Lambert, M.J. (1995). Graduate training in psychotherapy: Are therapy outcomes
enhanced? Journal of Consulting and Clinical Psychology, 63, 82–196.
Stigall, T.T. (1998). Commission for the recognition of specialties and proficiencies in professional
Psychology. In A.S. Bellack & M. Hersen (Series Eds.) & A.N. Wiens (Vol. Ed.), Compre-
hensive clinical psychology: Vol. 2. Professional issues (pp. 221–230). New York: Pergamon.
Sue, D.W., Bingham, R.P., Porché-Burke, L., & Vasquez, M. (1999). The diversification of psy-
chology: A multicultural revolution. American Psychologist, 54, 1061–1069.
Sue, D.W., & Sue, D. (1999). Counseling the culturally different: Theory and practice. New York:
Wiley.
Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional
Psychology: Research and Practice, 24, 190–195.