Nancy J. Rubin

Guiding Principles and Recommendations for the Assessment of Competence

This article presents guiding principles for the assessment of competence developed by the members of the American Psychological Association’s Task Force on Assessment of Competence in Professional Psychology. These principles are applicable to the education, training, and credentialing of professional psychologists, and to practicing psychologists across the professional life span. The principles are built upon a review of competency assessment models, including practices in both psychology and other professions. These principles will help to ensure that psychologists reinforce the importance of a culture of competence. The implications of the principles for professional psychology also are highlighted.

Competency Assessment Models

This article describes characteristics of alternative assessment models deployed in the measurement of professional competencies across the professional life span based on the work of the American Psychological Association Task Force on the Assessment of Competence in Professional Psychology. Assessments of knowledge, decision making, performance and personal attributes, as well as integrated practice-based skills and tasks are described and compared on the basis of their validity, feasibility and practicality, fidelity, and relevance at difference stages of professional development. It is acknowledged that no single assessment can evaluate all competencies and that assessments can be combined in complementary ways. Assessments deployed in the nursing, dental, and medical professions are reviewed and contrasted with current practices in psychology. At the licensure level, differences in the assessments deployed among the 4 healthcare professions are described, and their candidate fees and number of candidates assessed annually are documented. Ideas for developing new assessments in psychology are discussed on the basis of the needs and financial resources available to psychology and the experiences of other healthcare professions.

Challenges to the Assessment of Competence and Competencies

Challenges to the assessment of competence and competencies in professional psychology are discussed in this article. These include difficulties in defining competencies in precise and measurable terms; reaching agreement within the profession about the key elements of each competence domain; establishing an armamentarium of tools for assessing all components of competence, including the knowledge base, skills, and attitudes (and their integration); determining appropriate agreed-upon minimal levels of competence for individuals at different levels of professional development and when “competence problems” exist for individuals; assuring the fidelity of competency assessments; and establishing mechanisms for providing effective evaluative feedback and remediation. But even if these challenges JAMES W. LICHTENBERG received his PhD in counseling psychology from the University of Minnesota. He is a professor of counseling psychology and the associate dean for graduate programs and research at the University of Kansas. His areas of professional interest and research include social interaction processes and dynamics, legal and ethical issues in counseling and psychotherapy, and clinical training. SANFORD M. PORTNOY received his PhD in clinical psychology from the University of Massachusetts. He is on the faculty of the Massachusetts School of Professional Psychology, where he serves as director of the Center for the Study of Psychology and Divorce, and is a member of Needham Psychotherapy Associates in Needham, Massachusetts, and of Portnoy Associates in Newton, Massachusetts. His professional and research interests include the psychology of divorce and the effects of the legal divorce process on families, couples therapy, and teaching legal professionals the skills to relate more effectively to their clients. MURIEL J. BEBEAU received her PhD in educational psychology from Arizona State University. She is a professor in the School of Dentistry at the University of Minnesota, faculty associate in the university’s Center for Bioethics, and director of the Center for the Study of Ethical Development. Her scholarly work integrates the psychology of morality with ethics and dentistry to design and validate assessment strategies and teaching methods to promote professional ethical development. IRENE W. LEIGH received her PhD in clinical psychology from New York University. She is a professor in the clinical psychology doctoral program at Gallaudet University in Washington, DC. Her presentations, research, and publications have focused on deaf people and issues related to identity, multiculturalism, parenting, attachment, depression, and cochlear implants. PAUL D. NELSON received his PhD from the University of Chicago. He recently retired as the deputy director of education and director of graduate and postdoctoral education and training for the Education Directorate of the American Psychological Association. His focus has been on graduate

Recognizing, assessing, and intervening with problems of professional competence.

THIS ARTICLE WAS AUTHORED by members of a workgroup on students with competence problems associated with the Council of Chairs of Training Councils, which is affiliated with the Education Directorate of the American Psychological Association. Nadine J. Kaslow and Nancy J. Rubin took primary responsibility for crafting this manuscript. Nadine J. Kaslow is the workgroup chair. To the extent possible, the remaining authors are listed in the order of their contributions: Nadine J. Kaslow, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine; Nancy J. Rubin, Department of Psychiatry and Behavioral Medicine, University of Alabama School of Medicine—Tuscaloosa Campus; Linda Forrest, Counseling Psychology and Human Services, University of Oregon; Nancy S. Elman, Psychology in Education, University of Pittsburgh; Barbara A. Van Horne, Department of Psychology, University of Wisconsin-Madison; Sue C. Jacobs, Applied Health and Educational Psychology, Oklahoma State University; Stephen K. Huprich, Department of Psychology, Eastern Michigan University; Sherry A. Benton, Counseling Services, Kansas State University; Victor F. Pantesco, Department of Clinical Psychology, Antioch University New England; Stephen J. Dollinger, Department of Psychology, Southern Illinois University; Catherine L. Grus, Education Directorate, American Psychological Services; Stephen H. Behnke, Ethics Office, American Psychological Association; David S. Shen Miller, Counseling Psychology and Human Services, University of Oregon; Craig N. Shealy, Department of Graduate Psychology, James Madison University; Laurie B. Mintz, Educational, School, and Counseling Psychology, University of Missouri-Columbia; Rebecca Schwartz-Mette, Department of Psychology, University of Missouri-Columbia; Kristi Van Sickle, Department of Psychology, James A. Haley VA Hospital in Tampa; Beverly E. Thorn, Department of Psychology, University of Alabama. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Nadine J. Kaslow, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Grady Hospital, 80 Jesse Hill Jr. Drive, Atlanta, GA 30303. E-mail: nkaslow@emory.edu Professional Psychology: Research and Practice Copyright 2007 by the American Psychological Association 2007, Vol. 38, No. 5, 479–492 0735-7028/07/

Mindfulness-based cognitive therapy for the treatment of headache pain: a pilot study.

12.00 DOI: 10.1037/0735-7028.38.5.479

Mindfulness-based cognitive therapy for the treatment of headache pain: A mixed-methods analysis comparing treatment responders and treatment non-responders

Objective:This pilot study reports the findings of a randomized controlled trial (RCT) investigating the feasibility, tolerability, acceptability, and initial estimates of efficacy of mindfulness-based cognitive therapy (MBCT) compared to a delayed treatment (DT) control for headache pain. It was hypothesized that MBCT would be a viable treatment approach and that compared to DT, would elicit significant improvement in primary headache pain-related outcomes and secondary cognitive-related outcomes. Materials and Methods:RCT methodology was employed and multivariate analysis of variance models were conducted on daily headache diary data and preassessment and postassessment data for the intent-to-treat sample (N=36), and on the completer sample (N=24). Results:Patient flow data and standardized measures found MBCT for headache pain to be feasible, tolerable, and acceptable to participants. Intent-to-treat analyses showed that compared to DT, MBCT patients reported significantly greater improvement in self-efficacy (P=0.02, d=0.82) and pain acceptance (P=0.02, d=0.82). Results of the completer analyses produced a similar pattern of findings; additionally, compared to DT, MBCT completers reported significantly improved pain interference (P<0.01, d=−1.29) and pain catastrophizing (P=0.03, d=−0.94). Change in daily headache diary outcomes was not significantly different between groups (P’s>0.05, d’s⩽−0.24). Discussion:This study empirically examined MBCT for the treatment of headache pain. Results indicated that MBCT is a feasible, tolerable, acceptable, and potentially efficacious intervention for patients with headache pain. This study provides a research base for future RCTs comparing MBCT to attention control, and future comparative effectiveness studies of MBCT and cognitive-behavioral therapy.

Health care perceptions of the standardized patient.

OBJECTIVES Our recent pilot study demonstrated mindfulness-based cognitive therapy (MBCT) is a potentially efficacious headache pain treatment; however, it was not universally effective for all participants. This study sought to explore patient characteristics associated with MBCT treatment response and the potential processes of change that allowed treatment responders to improve and that were potentially lacking in the non-responders. DESIGN We implemented a mixed-methods analysis of quantitative and qualitative data. The sample consisted of 21 participants, 14 of whom were classified as treatment responders (≥50% improvement in pain intensity and/or pain interference) and seven as non-responders (<50% improvement). SETTING The study was conducted at the Kilgo Headache Clinic and the University of Alabama Psychology Clinic. INTERVENTION Participants completed an 8-week MBCT treatment for headache pain management. MEASURES Standardized measures of pain, psychosocial outcomes, and non-specific therapy factors were obtained; all participants completed a post-treatment semi-structured interview. RESULTS Quantitative data indicated a large effect size difference between responders and non-responders for pre- to post-treatment change in standardized measures of pain acceptance and catastrophizing, and a small to medium effect size differences on treatment dose indicators. Both groups showed improved psychosocial outcomes. Qualitatively, change in cognitive processes was a more salient qualitative theme within treatment responders; both groups commented on the importance of non-specific therapeutic factors. Barriers to mindfulness meditation were also commented on by participants across groups. CONCLUSIONS Results indicated that change in pain related cognitions during an MBCT intervention for headache pain is a key factor underlying treatment response.

The Communal Coping Model of Catastrophizing: Patient–Health Provider Interactions

As the use of standardized patients (SPs) for education and assessment continues to grow, there becomes an ever‐increasing cohort of patients in our clinical practices who have participated as SPs. The present study is part of a five‐year longitudinal study to examine the impact of participation as a standardized patient on the perceptions of the standardized patients own health care. SPs participating in the 1993, 1994 and 1995 Objective Structured Clinical Examinations (OSCE) for medical students at the end of their third year were requested to respond to mailed questionnaires before, immediately after and one year after their participation in the OSCE(s). Results indicated that, while overall the SPs perceptions of their interactions with their doctors were positive both before and after participation in the OSCE, as a group, their perceptions of their own health care was significantly worse at one year post‐OSCE. Additionally, when divided according to SP experience, that is novice versus experienced SP, most of the items on which there were changes were mutually exclusive between the groups. If these significant negative changes are due to the SPs becoming more educated consumers of medical care, this can be seen as a positive outcome. However, if the changes are due to variables particular to the third‐year medical student OSCEs themselves, debriefing of the SPs following their participation in the OSCE may be warranted.

Academic Courses in Biofeedback

OBJECTIVE The study sought to elucidate and refine the interpersonal, communicative dimension of the communal coping model (CCM) of catastrophizing. The primary aim was twofold. First, we examined the relations among pain intensity, catastrophizing, and pain behaviors as they function within the patient-health provider relationship. Second, we investigated the role of catastrophizing and pain behaviors in potentially influencing patient satisfaction with the provider, provider attitudes, and provider behavior. Mediation models were examined. DESIGN The study was cross-sectional design with repeated measures. SETTING   This study was conducted at a university-based family medicine clinic and a private practice rheumatology clinic. Nineteen health providers and 49 chronic pain patients receiving treatment in a medical setting completed the study. OUTCOME MEASURES   Patient outcome measures included pain intensity, catastrophizing, pain behaviors, and patient satisfaction with the provider. Health provider outcome measures were an assessment of provider attitudes and length of medical exam. RESULTS The patients level of catastrophizing entering the medical exam significantly predicted the interactive dynamics between the patient and the health provider during the exam and patient satisfaction after the exam. The patients perceptions of pain and catastrophic thought processes may be interpersonally expressed to health providers via exaggerated pain behaviors. CONCLUSIONS Current findings indicate suggestions for refining the CCM. Results suggest that alleviation of catastrophic cognitions may facilitate more effective interpersonal communication within the patient-health provider relationship. Identification of those factors that improve patient-provider dynamics has important implications for the advancement of treatment for chronic pain and reducing the costs associated with persistent pain.

The Competency Movement Within Psychology: An Historical Perspective

The data presented here represent a sampling of the activities in programs offering academic courses in biofeedback that responded to the Education Committees effort to develop a directory of such courses. A diversity of type and number of training experiences, equipment, resources, and approaches to training are represented. The committee is currently working on a format to share the wealth of course materials gathered in addition to the directory, which has already been published (Biofeedback Society of America, 1987).