Framework for Minimum Professional Standards for Psychotherapists working with Children/Young People
An ad hoc Working Group here after referred to as the Working Group was set up by the Irish Council for Psychotherapy to draw up this Framework document in response to an increasing perception of the need to define more clearly the professional and training standards for those working with children/young people in psychotherapy in Ireland.
International Context for Psychotherapy with Children/Young People
In recent years there has been a movement within European countries to define more clearly the training required for psychotherapists who work with children and young people. In particular the UKCP has developed comprehensive professional training standards for those psychotherapists working with children and are now in the process of creating a separate register for child psychotherapists and for psychotherapists who are trained to work with children. Other countries, such as Austria, Italy, Germany and the EAP itself have developed or are working to develop such standards and in some countries these standards are enshrined in law.
In addition within the Irish context itself there have been growing concerns about how we as a society look after our children. This concern has been most intense around revelations of sexual, emotional and physical abuse and neglect of some children within families and of institutional abuse of children and young people in state care. Alongside this, some modalities of psychotherapy in Ireland already have specialist trainings for those who wish to work with children, while other Sections do not.
For the purposes of this paper the ICP Working Group are using the Irish legal definition of child which is:
“A child is defined as any person up to the age of 18 years; adolescence defines that period of childhood extending from puberty to adulthood” (In accordance with Irish law and the UNCRC).
This document has been developed by an ad hoc ICP working group (WG) convened in 2009 by the then chair of ICP Derval Ryan. The terms of reference include:-
to examine current professional and training standards for those who work with young people and children
to put forward a common template for such trainings for the future
this common template to be the basis for consultation to all Sections (modalities) with a view to getting all Sections of ICP to agree such a template as a way forward for training child psychotherapists and psychotherapists who work with children and young persons.
This document, prepared by the Working Group (WG) is deliberately broad based to allow modalities to have flexibility about how such training may happen for their trainees yet at the same time setting an agreed common standard for such trainings. It is important to acknowledge from the outset that the modalities within ICP have diverse ways of approaching psychotherapy with children/young people. These approaches range from in depth one to one work with children/young people to methods that work with the young person/child within the context of their family and their wider social milieu. There is therefore a range of existing practice be this as child psychotherapist or as a psychotherapist who works with children.
The Working Group framed this template within the Irish Council for Psychotherapy standards for training psychotherapists which is based on the European Certificate of Psychotherapy (ECP) of the European Association for Psychotherapy (EAP). The group consider it essential that those who are training in Child and Adolescent Psychotherapy exclusively as their core training complete a course that is fully compliant with EAP and ECP standards (see appendix 1 TAC/ECP standard). This standard also applies to any combined training to train those who wish to work with adults and/or children e.g. Family Therapy, Post-qualifying courses where a psychotherapist has already trained as a psychotherapist to work with adults could be shorter; as those training will have already reached the ECP standard and therefore will likely require fewer training hours to meet the standards set in this framework document.
In other words there are three ways to train to work with children either in a course designed specifically to train child psychotherapists; as part of a combined training where both criteria for working with adults and children will need to be met or as a post psychotherapy qualification top up training of those who are already qualified to work with adults.
The status of this document is an initial draft template for consultation with modalities (Sections of ICP).
The Working Group propose that Sections of the ICP would agree that the following core areas of training will be addressed for those psychotherapists who wish to train to work with children. In other words these training standards should apply regardless of the philosophical and theoretical orientation of the particular course. It is recognised that training courses of different theoretical orientations will offer different training contexts and opportunities to trainees to fulfil these requirements. The WG are conscious that there is much diversity in modality approaches and these core areas will need to be delivered in different ways to match the unique approach of each modality. At the same time these minimum training standards, laid down here will need to be included in the training process for psychotherapists who work with children and young people.
In particular there needs to be sufficient time allocated to allow for the integration of skills, theory, and personal development that facilitates the therapist in reaching a level of self-awareness and maturity in order to enable them to engage therapeutically with children, young people and their families and with the wider context of the child’s life. In particular such trainings need to foster both personal and professional development of the psychotherapist. Each training course should support their trainees in actively engaging with learning experiences, exploring their own intra-personal and inter-personal processes, thus developing an advanced capacity for reflective practice and insight.
The core areas of training process addressed in this document should apply regardless of whether the course is offered as:
A core training to work with children/young people.
A combined training to work with all age groups both child and adult such as training in family therapy.
A Post Qualifying Course for psychotherapists who work with adults to train in order to be able to work with children
The training requirements for these trainings will reflect the theoretical and clinical approaches to the child’s needs in the therapy. For example Child and adolescent psychotherapy aims to provide long term intra-psychic work with the individual child. The minimum of four years training devoted to child psychotherapy is required to acquire the competency and skills for this approach.
GENERAL OVERVIEW OF TRAINING
Relationship with the Child/Young Person
The Working Group wish to emphasise at the outset the centrality of the therapeutic relationship when working with children/young people and their families and the importance of the availability of the therapist for a genuine congruent relationship. This ability to form a therapeutic working relationship with children is a key skill and needs to be complemented by therapist competence in the areas of training outlined below.
The trainee psychotherapist needs to develop the competence to take into account the developmental stage of the child or young person they are working with. They should also take cognisance of the young person’s level of dependence and their need for appropriate care. All of these aspects are important considerations to be taken into account in order to develop a comprehensive and collaborative understanding of the child’s therapeutic needs. The child’s or young person’s voice is central to the therapeutic process and in order for their voice to be heard it is important that the psychotherapist can deploy a variety of therapeutic approaches including verbal and nonverbal methods along with appropriate materials to facilitate the child or young person’s engagement in the therapy process. An important element, therefore in therapy with children is skilful use of developmentally appropriate approaches and materials in order to assist the young person in being heard. All of the above address the requirement for psychotherapy with young people and children to be inclusive and respectful and to privilege children’s ways of expressing themselves. Alongside working therapeutically with children/young people the therapist must work in partnership with parents/carers and guardians of the young person. Each modality will approach the necessary training to work with parents differently. Some may view the primary client as the child/young person while others will consider child focussed therapy as happening within the family system where the family is the client rather than the individual child. Some modalities will attend more to the intra psychic world of the child while others will attend more to the relational aspects of children’s lives and experiences. All of the above aspects need to be taken into account at each stage of the therapeutic process all the way from assessment to the end of therapy.
In addition the psychotherapist needs to develop competence in managing the diverse roles of different members of any multi-disciplinary team and/or other systems of professionals that may be involved in the child’s or young person’s life. The therapist should be able to take cognisance of and work with the multiple perspectives and approaches of other professionals in order to work collaboratively with children/young people, their family and any involved health or social care systems.
SPECIFIC CORE AREAS OF TRAINING PSYCHOTHERAPISTS TO WORK WITH CHILDREN AND YOUNG PEOPLE
1. Theory of methods, relevant theorists, and theories of human development
2. Methodology and Clinical Skills
3. Professional Context
4. Settings and Populations
5. Clinical Practice under Supervision
6. Post Training
To be ECP compliant any core training whether for child psychotherapists or a combined adult and child training will need to be of 4 years duration. All courses will provide tutor student contact hours wholly devoted to child psychotherapy to cover the specified theory and methodology studies detailed in areas 1 – 4 above, as well as the specific clinical components of any such training, as appropriate to the modality.
In addition it is envisaged that any post qualification course will require an additional two years of training in order to adequately cover areas 1 – 4 above as well as the specific clinical components of any such training. These post qualification courses must include 250 tutor student contact hours wholly devoted to child psychotherapy to cover the specified theory and methodology studies detailed in areas 1 – 4 above. In addition such a post qualification course the supervised practice component needs to include 250 hours of clinical practice with children/young people and their carers. The ratio of practice to supervision will be in keeping with the modality and the need to give consideration to the vulnerable population being worked with. In post qualification training some of these hours of clinical practice may be attained during a specified post-course practicum period in keeping with modality practices.
1. Theory, Theorists, and Human Development
Theory including a model of psychotherapy, relevant theorists and literature and overview of other modality approaches
Theories of human development such as personality theories e.g. attachment theory, object relations, family life cycle, Piagetian, constructivist, social constructivist, systemic developmental theories etc.
Knowledge of and a capacity to understand how and why children and young people struggle in their lives, this includes: international systems of classification of children’s social, emotional and behavioural psychopathology, such as DSM IV / V and ICD 10; strengths based, collaborative and non-expert led intervention; narrative; constructivist and solution-focused approaches.
Knowledge of creative approaches appropriate to working therapeutically with children and young people.
Ability to consider & critique diverse psychotherapeutic ideas & approaches
Knowledge of what can facilitate children’s or young person’s growth and development.
Awareness and integration of relevant psychotherapy research with children and young people
2. Methodology & Clinical Skills
All trainings should foster the therapist’s competence in the following areas:
Managing a clinical practice including referrals and consideration of the appropriateness of referrals, therapeutic contracting and complying with clinical governance
Ability to participate in pre-therapy assessment or consultation and develop a case formulation or hypothesis
Ability to respond to the client’s needs and to take account of the client’s age, gender, ethnicity, sexual orientation, culture, abilities, communicative style and socio-economic circumstances
Develop a confidential context for the child/young person and their family within the social and statutory context with particular reference to the newly revised “Children First” guidelines (published by DOHC 2011) and the UN Convention on the Rights of the Child ref http://www.unicef.org/crc/
Creating and maintaining a safe therapeutic space appropriate for the child / young person.
Develop and maintain the therapeutic relationship in developmentally appropriate ways and the creation of a collaborative alliance with the child/young person and the persons in their social context
Ability to deploy psychotherapy skills appropriate to young clients, including non- verbal approaches and to work creatively using child/adolescent friendly approaches such as play & art, and the use of a range of toys, therapeutic technology & other child friendly materials
Ability to work collaboratively with the parents/carers to assist them in their parental/carer role and to understand the child’s/young person’s presentation in order to support the emotional needs of the child / young person
Ability to explore problems within shared understandings and different perspectives
Ability to conceptualise and formulate the psychotherapy process and make appropriate clinical decisions
3. Professional Context:
All trainings should foster the therapist’s competence in order to address the following areas:
3.1 Understanding of and adherence to the Code of Ethics of the relevant accreditation bodies
3.2 Psychotherapists need to be fully informed of the legal and statutory requirements when working with children and young people.
3.3 Awareness of and keeping up to date with child protection issues
3.4 Ability to maintain confidentiality and understand its limits within the therapeutic setting given the statutory and legal framework in relation to children and young people
3.5 Consideration of the differing roles, practice and discourses of multi-disciplinary teams and/or other professional systems or contexts
3.6 Working in partnership with professionals and adult carers
3.7 Management of risk with appropriate responses including referral to other professionals as required.
3.8 Consideration of multiple factors and contexts in case formulation or hypothesis generation
4. Settings and Populations
Training needs to include experience of a broad range of clients and clinical contexts in order to foster development and demonstrate competence in the following areas:
4.1 Understanding of and ability to work with the familial and social context of the child/young person
4.2 Understanding of and ability to work within agency contexts, care systems and other professional systems where therapy takes place and with whom clients are involved – including child care, social work and psychiatric teams within the public sector/private sector
4.3 Understanding of and the ability to respond to the multiple perspectives of other professionals involved with the child/young person and their family
4.4 Understanding and consideration of the diverse impact of these contexts and systems on the child/young person
4.5 Understanding the diverse impact of life events e.g. parental separation on the developing child/young person and respond appropriately to the specific issues
4.6 Understanding of factors equality such as gender, age, ethnicity, social and cultural diversity which are relevant in each person worked with.
5. Clinical Practice under Supervision
5.1. 300-600 hours of clinical practice under supervision “either within a mental health or social health setting, or equivalent” are required in all core trainings; in keeping with Training and Accrediting Committee (TAC) standards and ECP requirements (appendix 1). Some of these hours may be attained during a specified post-course practicum period in keeping with modality practices.
5.2. Trainees on post qualifying courses need to complete 250 hours of supervised clinical practice under supervision. Some of these hours may be attained during a specified post-course practicum period in keeping with modality practices.
5.3 The supervisory relationship is critical as it gives the trainee and qualified psychotherapist the opportunity to reflect on the ongoing work with the child or young person and therefore needs to be at a frequency appropriate to the experience of the psychotherapist or trainee and in keeping with modality requirements.
5.4 Supervisors who supervise trainee psychotherapists need to be appropriately qualified and experienced in working with children/young people.
5.5. Clinical practice and/or placements, should prepare psychotherapists to recognise severe psychosocial crisis/mental health problems and treat or refer appropriately. Psychotherapists who intend to work with children/young people experiencing severe adversity/ mental health problems will require more experience with such clients. Placements with Child and Adolescent Mental Health Services, community based services, or other agencies may be appropriate in these circumstance
5.6 Specialist training may be necessary for trainees to attain the necessary competence in dealing with significant adversity with specific age groups (e.g. toddlers, young children, adolescents etc.).
5.7 Each modality should consider if specialist internships are to be required. This will be influenced by the complexity of the work to be undertaken and the degree of mental health difficulty experienced by the psychotherapist’s client group as well as the specialist approach of the modality concerned. It is the responsibility of each modality to reflect on what training may be required given the principles elaborated above.
6. Post Training:
All child psychotherapists and psychotherapists trained to work with children will be required to:
6.1. Comply with all ethical and practice requirements in relation to clinical practice and supervision. Supervision both during and in the immediate years after training will need to be with a supervisor who has sufficient qualification/experience to work with young people . The ratio of supervision to practice should take account of the fact that the work is being undertaken with a potentially vulnerable population (Appendix 2 Vulnerable Populations to be provided by Aoife Twohig)
6.2. Maintain competence through Continuous Professional Development.
The Irish Council for Psychotherapy along with each modality will need to consider an arrangement for grandparenting and recognising psychotherapists who already work competently with children and young people.
The ICP Training standards committee should be given the remit to require all trainings of child psychotherapists/psychotherapists who work with children and young people to demonstrate how each of their trainings is compliant with these standards.
As many psychotherapists will encounter children/young people who may need psychotherapeutic input and appropriate referral then all adult psychotherapy trainings should provide a minimum of one full day of course time to outline the specialist nature of working with children and young people including covering the specific training outlined in this document and ethical considerations required to work safely with children.
All psychotherapy training courses should specify the client groups that their graduates will be qualified to work with and must include appropriate content to adequately equip their trainees for this named practice.
European Certification of Psychotherapy Requirements
The following is taken from the Training Accreditation Committee of the EAP and the ECP text.
9. Training programme
9.1 Total length: 3 200 hours, spread over a minimum of 7 years
9.2 First 3 years of general training in human sciences
(Medical, psychological, social, educational, or equivalent).
Estimated length = 1.800 hours
9.3 Minimum of 4 years of training in a specific modality = 1 400 hours for example, divided into:
9.3.1 250 hours of personal psychotherapeutic experience, or equivalent
in individual or group setting
9.3.2 500 – 800 hours of theory or methodology, including psychopathology,
in accordance with the usual standards of the modality
Theories of human development throughout the life-cycle
An understanding of other psychotherapeutic approaches
A theory of change
An understanding of social and cultural issues in relation to Psychotherapy
Theories of psychopathology
Theories of assessment and intervention
9.3.3 300 – 600 hours of clinical practice with clients/patients
– Either within a mental or social health setting, or equivalent
– Either with individual clients/patients, families or groups, under regular supervision
Even if this practice is not directly organized by the institute, it remains its responsibility.
9.3.4. 150 hours of supervision of an effective clinical practice of the trainee.
9.3.5. Practice does normally not take place in the first two years of the training.
Note: Exceptions of early practice must be justified by the training institution that the student has prior knowledge of practice or that the institute offers special condition for such practices.