Clinical Assessment and Counselling Couples XX 10% Clinical Consultation Organisations and Individual Employees re workplace mental health

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1 CONTINUING COMPETENCY PROGRAMME Exemplar 4 Identify your areas of practice (Table 1) Major domains of practice Clinical, Sport/Exercise Clinical Professional Activities (e.g., intervention, formal assessment, diagnosis, research & evaluation, consultation, supervision, teaching, administration) Diagnosis, Treatment Planning, and Treatment of psychological/ psychiatric conditions and problems Client Characteristics (e.g., individual, couples, family, group, organisations) and/or (child/adolescent, adult, elderly) Individual adults with moderate to severe mental health issues Number of years you have practised in this domain % of current working hours (approx) (Total = 100%) XX 50% (35% severe, 15% moderate) Clinical Psychological Assessment and formal Report Writing (for courts, etc) Individual adults with legal difficulties XX 15% Clinical Assessment and Counselling Couples XX 10% Clinical Consultation Organisations and Individual Employees re workplace mental health XX 10% Clinical Supervision Intern Psychologist XX 5% Sport Teaching, Assessment & Intervention Groups (teams) Adult and Adolescent Clinical Treatment Individual Adolescents who have sexually offended XX 5% XX 5% Version: February 2012

2 Steps 1, 2 & 3: Record your self-reflective review 1 and the learning objectives arising (Table 2) Core Competency sets 2 Discipline, Knowledge, Scholarship and Research Self-reflective review I am aware that I am seeing a lot of cases where there is a PTSD diagnosis and sometimes I feel I need more interventions at my disposal to assist these clients. I often hear other clinicians refer to EMDR and have even had a client ask for it, but I do not have a deep understanding of it. I have heard that there is some evidence supporting its efficacy in treating PTSD. It would be good to know more about it to see if it is something I could bring into my practice. Strengths, weaknesses, and areas of interest for further development Having done a lot of research and refresher training following recent natural disasters I believe I am strong in the area of critical incident stress management, and the use of debriefing, psychological first aid and resilience training. However, I could benefit from more knowledge in the area of PTSD. I have not done a literature review in this area for a while and could do with a refresher on what I have learnt in the past. I rely on a certain targeted approach to treatment of PTSD but would benefit from broadening my options especially in relation to emotional processing. I will feel more informed and confident if I have better understanding of EMDR in particular. Learning Objectives To find out more about EMDR. To refresh myself on CBT and other treatment approaches for PTSD. Start by doing a literature review on recent studies on treatment of PTSD. I am also aware that I am increasingly working with couples and this is an area that I have not had much formal training in. I enjoy working with couples but it presents a number of challenges with two people to provide an intervention with and having to be a referee and mediator at times. I have been doing brief CBT solution I find working with couples stimulating and enjoyable and usually feel in control even where there is high conflict. As I do more work in this area I want to have more to offer couples in terms of tools to assist them with change. This is a priority area of development for me, Increase my knowledge and skills in couples therapy. Initial step is to identify appropriate training or workshops to attend or books to read. 1 The SRR can be guided by the optional prompting questions found on pages 9 & 10 of the Guide. 2 Remember that each set is composed of more narrowly defined competencies that should be reviewed as part of your SRR. The optional prompting questions may help you incorporate the sub-competencies.

3 work and also basic communication exercises. However, it would be useful to look at further couplescounselling specific models and approaches. Diversity, Culture and the Treaty of Waitangi I am working part time for a DHB where the medical model dominants, especially in relation to clients who are diagnosed with conditions involving psychosis. At times I find myself getting caught up in the language that is used around non-compliance with medication and conceptualisation of clients as having a brain disease. I need to remind myself to give sufficient consideration to the reasons for clients not wanting to use drugs and psychosocial causes of their difficulties. I also need to be more mindful of the psychological perspective on hearing voices and remind myself more often that delusions are on a continuum and that clients can get meaning from their hallucinations and learn to live with them, and aggressive drug treatment to eradicate symptoms is not always the best option. I am working frequently with clients who have a diagnosis of Borderline Personality Disorder, but have limited exposure to other personality disorders which I am interested in. Located where I am I work with a mix of five ethnic groups; European, I believe that I am able to influence colleagues in a MDT to look at cases beyond the medical model. However, often I don t have the right words or the specific evidence or experiences to back up the comments or suggestions I make. It would be useful to have exposure to current psychological teachings in the area and access to latest consumer perspectives. I have done intensive training in DBT; have regular supervision with an expert in this area, and the support of a DBT consult group. I find that treatment and management if BPD is an area of strength for me even if my motivation and interest can wane. I would like to know more about treating other personality disorders which interest me even more, so I can feel more informed in this area. I feel confident in my knowledge of Treaty of Waitangi and how that both Gain increase knowledge on working with psychosis from a psychological perspective. Likely would need to attend a seminar where experts as well as consumers have input. Increase my knowledge on treatment of personality disorders other than BPD. No specific learning objectives

4 Maori, Pacific, Asian, and Indian. I am mindful of checking with individuals from the last four groups (which I am not a member of) that I am working with them in a way that is appropriate to their culture. I seek to learn from them in sessions and supplement that with readings I undertake. I am constantly mindful of seeking out cultural guidance and input wherever I experience some uncertainty about case conceptualisation and treatment planning. I am aware that it can be hard to source out appropriate cultural consultation at times. I recall a situation I had where a Maori client believed they were possessed and wanted to go through a cleansing ceremony. I received different (contradictory) advice from two Maori cultural consultants which appeared due to one being a Christian minister and the other not. influences the worldview of some Maori and the obligations I have to provided service in line with the treaty principles. I feel less confident that I can access good quality cultural supervision and continue to explore this through discussion in supervision. I have undertaken training on cultural competencies in Pacifica Health. I am fortunate to have working with me in the DHB a number of colleagues with Indian ethnicity who are freely available for consultation. I have made use of supervision sessions to discuss issues that come up that relate to client diversity and culture. For instance, in the last year I have had case discussions on working with young Christian Korean women, and immigrant Indian women with BPD, as I have had a number of clients with this cultural profile. I have a particular interest in Asian Mental Health due to personal circumstances. I have undertaken particular readings in this area, and completed last year an online course on Asian Mental Health competencies. for this year at this stage. Professional, Legal and Ethical Practice I believe I am sensitive to ethical issues and want to adhere to high

5 personal standards in this area, as well as act where I see possible breaches with colleagues. I considerably value personal integrity and consider professionalism and ethical practice essential for my identity as a person and psychologist. I am clear where I stand on issues important to me such as conflict between money and a person s needs. I seek to be transparent and fair in my dealings with clients. I am aware of keeping appropriate boundaries with clients, and the influence of transference and counter-transference in therapeutic relationships. I am proactive in bringing my own professional and ethical issues to supervision for discussion. Framing, Measuring and Planning In the last year an ethical/ legal challenge I have faced more than once is pressure to write favourable reports for clients who are at risk of problem behaviour. I kept clear by being mindful of the code for Expert Witnesses and Psychologists code of ethics. I have recently had cases of a psychologist colleague who I believed had an inappropriate relationship with a client, and a psychiatrist who I believed was mentally unwell. I reported both cases as I felt obliged to do so reflecting on Code of Ethics. This led to other colleagues coming forward. I make a point of never relying on just one source of data for my I have been thinking about obtaining further specialist supervision in relation to formal court and other legal reports I am increasingly undertaking. I feel confident in the process for addressing with colleagues concerns and if necessary reporting to authorities such as registration boards. I see myself as somebody with initiative and leadership in this area, though perhaps sometimes I may be too outspoken on these issues. Obtain some specialist supervision and consultation re risk assessments and for review of formal reports.

6 assessments. I am mindful of using combined information from clinical interview, third party sources, and psychometric testing to inform case formulation. I have been aware that I have been continuing to use pencil and paper psychometric tests and have not updated to electronic administration and scoring. I always make sure I use the latest version of a test, eg WMS- IV, but prefer to use the hardcopy materials. In some cases now I am not able to get materials that are not in electronic form. In the past I have not been impressed with test interpretative reports produced by a computer program, but there may be updates in this area including more useful reports generated. I have no concerns about computer scoring of tests, it s just that I have been slow to uptake this technology due to costs involved. I evaluate my intervention with clients in different ways. As a standard in psychotherapy sessions I use a working alliance inventory as well as pre and post measures depending on the presenting issue. I also have client feedbacks forms I use, including ones provided by organisations I contract to. I believe I am informed in my use of psychometric tests. I always read manuals thoroughly, try myself, and never use a test I am not comfortable with or without a clinical rationale. I also communicate limitations in test use. It would be useful for me to look into options now available in terms of technology for administration, scoring, and perhaps even interpretation of reports. I do get sent updates from test providers but do not always read them. Explore what electronic materials are available for psychometric tests that I regularly use. Also explore what new tests there are on the market that cover the constructs and areas I assess such as personality dysfunction. Start by going through the information I have been sent by test providers. Intervention and Service Implementation I seek to balance change and validation in my work with clients. If I believe I am well networked and

7 Communication change is not occurring with a client then I look at other ways to work with them to be more effective. I am open to new evidence-based interventions and seek to keep abreast of latest research generally. For example, in the last years I have heard a lot about the effectiveness of EMDR and would like to learn more about this intervention. If I come across a presentation I have not worked with before, ie, gender identity disturbance, I will undertake an extensive literature review, textbook readings, and also consult with my supervisor(s). If in doubt about my knowledge I will refer on. It seems to be that I am able to build rapport and obtain information from a range of persons due to my communication style and personality type. Sometimes I have to adjust my style to engage with certain types of individuals. I also believe I communicate well with family members of clients. As I am increasingly undertaking formal reports to be used in Court I am aware that it is imperative that my written communication is at the highest level. take opportunities to attend professional developments events. I follow an evidence-based approach by reviewing research through online psychological databases which I have access to. I frequently buy specialist textbooks. I block off time for research and reading even if I am busy seeing clients and writing reports as I think it is critical. I believe that a strength of mine is that I am able to consult with organisations and sports teams about mental health issues, and how they can change the behaviour of employees/ athletes. I am proactive in bringing concerns to supervision and in consulting with colleagues. I believe report writing is a strength of mine but I can miss things and think it is good practice to have all reports reviewed. My current supervisors do not have experience in this area or are not always available for this. To find out more about EMDR Obtain specialist supervision for review of formal reports. Professional and Community Relations, Consultation, On a daily basis I contribute to a MDT I believe I am passionate and No specific learning objectives

8 Collaboration at the DHB where I work. I have input into case discussions at meetings and also consult one to one with colleagues from other disciplines. proactive in MDTs. I could be more patient at times. for this year at this stage. I am reflective on what I say to the media when I am contacted for comment. I believe I have been thoughtful in how I have responded to media enquires but there has been one occasion when I could have been more cautious. Reflective Practice I believe I understand the limits of my competence. I have been thinking in recent times that I need to have more knowledge and skills to work with adolescents as I am being referred treatment cases of youth sexual offending due to my skills in knowledge in the area of risk assessment and treatment of sexual offending. Most of my work in the past has been with adults. I believe I am proactive in using supervision to consider my limits in competence. I believe I am competent to work with adult sexual offenders, but would benefit from further knowledge and possibly supervision before working with adolescents. Increase my knowledge and confidence to work with adolescents, particularly in relation to sexual offending. I refer on any work with children. I have turned down requests to apply for specialist report writing for the Family Court. Supervision I am very mindful of living a balanced life. While sometimes I work long or irregular hours I make up for it by taking regular time off (an hour or a day, etc, here and there) rather than waiting for a dedicated holiday period. I am been thinking that as a supervisee I am at the point in my I believe I use supervision well. I am always looking to maximise the value I Obtain specialist supervision for report review, and for working

9 career where I need some specialist consultation and also can have a mix of individual and peer supervision given my years of experience. get out of supervision, especially when I am paying for it. I think it would be useful to start a peer supervision group with senior colleagues I know or others working independently in private practice. with adolescents. as detailed elsewhere. Explore peer supervision options with a view to take a leadership role in setting up a group. This year I am supervising an Intern. I have done this in the past and also supervised registered psychologists. I have undertaken supervision courses in Australia and New Zealand. As a supervisor I believe I am appropriately trained and informed. As a supervisee and supervisor I always work with a supervision contract and keep notes. These practices have been refined over the years. I have been reflecting on my supervision of others and no notable areas requiring attention come to mind. I have reviewed feedback forms from past supervisees who describe me as supportive. I am aware that sometimes I feel that I do not give enough attention to my supervisees due to being busy with my own practice as a psychologist. However, they have not reported such a concern to me (though they may not say that given the power relationship I have with them). Version: February 2012

10 Steps 4, 5, & 6: Document your learning plan for each objective, the learning activities you actually complete, and your end-of-year review of progress against each objective (Table 3) Learning Objectives (transfer from Table 1) To find out more about EMDR. Learning Plan Consider the option of doing a training course if one becomes available due to trainers coming to New Zealand. If I don t undertake a course, find appropriate readings and consult with colleagues who have done endorsed EDMR training. Actual Professional Development Activities Completed Level 1 training on EMDR XX through EMDR International organisation and trainer XX. End of year review of progress on objectives Doing the training made me realise it was not an intervention I wanted to specialise in and I have decided to not go on to do level 2 training. I am more informed about EMDR and believe that I have learnt more skills to help me work with clients who are suffering from PTSD. To refresh myself on CBT and other treatment approaches for PTSD. Do a literature review on recent studies on treatment of PTSD. Undertook literature review August to October I believe I am more knowledgeable about working with clients who are suffering from PTSD. I am keen to work with these clients and apply my new knowledge but have not received any recent referrals for clients with this diagnosis so have not yet had a chance to do so. Increase my knowledge and skills in couples therapy. Identify appropriate training or workshops to attend or books to read in the area of couples therapy. Purchased a number of books about couples therapy and I am continuing to read them. Attended two Workshops of wellknown couple therapists/ experts. 1. Search for the Mythical Mate Bader and Pearson 2. Bridging the couple chasm: a research based approach John and Julie Gottman I have increased confidence and more tools at my disposal in working with couples. In particular I am using more assessment instruments specific to couples and spending more time formulating their problems before working on solutions. Gain increased knowledge on Attend a seminar or workshop were Attended Workshop, This was helpful in affirming my

11 working with psychosis from a psychological perspective. Increase my knowledge on treatment of personality disorders other than BPD. Obtain some specialist supervision and consultation re risk assessments, and for review of formal reports. working with psychosis from a psychological perspective is covered, including input from consumers. Otherwise, consult with peer support workers at the DHB where I am employed. Attend a conference if possible, and undertake readings on the other 9 personality disorders, with less focus on Anti-social due to previous knowledge of, and experience with, this condition. Identify potential supervisors who could provide specialist supervision on assessment of risk and report standards. The Psychology of Psychosis: from Theory to Practice, XXX Purchased a number of texts about personality disorders and I am continuing to read them. Attended XXXXXX Personality Disorders Conference XXXX. Made contact with an appropriate person and made a supervision agreement with them. role as psychologist within a MDT. After attending this workshop I was more informed in influencing colleagues and made some modification to my approach to working with clients who were experiencing psychosis. Over 70% of presentations at this conference were on BPD indicating that there is gap in the study and practice of other personality disorders. I left the conference interested in undertaking research on other personality disorders in order to make a contribution in this area. This interest has been supported by the ongoing readings I have since undertaken. I have become particularly interested in personality disorder in the workplace and narcissism in sport. My previous knowledge of Anti-social personality disorder from my work with Correctional clients was affirmed. I am feeling more assured about my formal reports now that I have a process in place for systematic review of reports and other consultation if I need it. I have been provided with some useful feedback and areas of further reading and research. The next step is for me to go to a medico-legal conference. Increase my knowledge and Identify potential persons who could Made some contact with potential Still working towards the

12 confidence to work with adolescents, particularly in relation to sexual offending. Explore peer supervision options. Explore what electronic materials are available for psychometric tests that I regularly use, and what new tests are available in areas I assess such as personality dysfunction. provide consultation to me on an as need basis, Ask experts in this area to recommend references to me. Identify potential psychologists who may be interested in joining a peer support group. Review relevant guidelines on peer supervision. Go through the information I have been sent by test providers. Look up what electronic test materials are available starting with MCMI-III, MMPII-R, WAIS-IV, WMS-IV, PAI, STAXI-2. Then check out what other tests are available that measure similar constructs. Read up on the validity of tests not previously known to me as per independent research articles. persons but have yet to find a person I can enter an arrangement with. Have undertaken a literature review and have done readings in the area. Found 6 colleagues who were interested in joining for peer supervision. Read APS guidelines on peer supervision. Took a leadership role in getting a group up and running. Developed a structure and schedule for monthly 1.5 hour sessions. Started sessions. Found the organisations that have the licences for the tests I use and the options they offer in terms of electronic administration, scoring, and reporting. Looked into a test not previously familiar with the BPI (Basic Personality Inventory). objective of finding a person to consult with on a regular basis, but feeling less concerned about it after having done professional development through readings of research papers. Continuing with readings and may do further literature review. Developing and interest in putting together a treatment group as may be more effective option. Group has been formed for 4 months now. It has been hard to get momentum with not everybody being able to come every month. Structure and timing of sessions may need further review. I will continue to use pen and paper administration but will start electronic scoring and trial computer generated interpretative reports. I plan to trial the BPI. I have been reflecting on ethics around the costs of tests particularly in relation to electronic services, and how ones previously in the public domain have been commercialised.