Reflections on the competency framework for counselling psychologists in cancer care

As a counselling psychologist working within the cancer service, I appreciate the new competency framework for practitioner psychologists. This guidance is not only timely but also essential for navigating the complex psychological difficulties faced by individuals diagnosed with cancer. The framework emphasises a holistic, person-centred approach that aligns with the core values of counselling psychology, reinforcing our commitment to each client's unique experiences.

The significance of competencies for counselling psychologists

Holistic and person-centred care: The framework emphasises the importance of viewing clients holistically, integrating their psychological, social, and spiritual dimensions. This perspective is vital because cancer is not just a medical diagnosis; it significantly impacts individuals' identities, sense of self, relationships, and overall quality of life. 

Many of my clients express a 'loss of self' following their diagnosis. They often struggle with grief not only for the person they once were but also for the life they envisioned for themselves. Alongside this loss of identity, I see how cancer can strain relationships with family and friends, leading to feelings of isolation or misunderstanding. The shift in roles within their families, whether as caregivers or partners, can create additional stress. The uncertainty surrounding prognosis adds layers of fear and existential questioning that can be overwhelming.

By employing the competencies related to assessment, I gather comprehensive bio-psycho-social-spiritual-sexual information to understand my clients' experiences. This understanding allows me to tailor my therapeutic approach to meet my clients' specific needs. I strive to create a safe and supportive space where clients can explore their thoughts and feelings, navigate  the emotional complexities of their cancer journey and ultimately foster resilience and a renewed sense of agency. 

Person-centred approaches: The person-centred approach is foundational to my work as a counselling psychologist, emphasising the importance of seeing each client as unique with their own experiences, values, and needs. This approach fosters a therapeutic alliance built on trust, empathy, and unconditional positive regard, allowing clients to feel safe and supported as they navigate their cancer journey.

In practice, this means actively listening to clients, validating their feelings, and encouraging them to express their concerns regarding their diagnosis and treatment. I find that each person's experience of cancer is multifaceted and influenced by a variety of factors, including their psychological state, social support systems, and cultural background. By prioritising the client's perspective, I aim to empower them to take an active role in their care, facilitating their journey towards acceptance and adjustment.

In addition to the person-centred approach, I integrate Acceptance and Commitment Therapy (ACT) and Compassion-Focused Therapy (CFT) into my practice. ACT encourages clients to accept their thoughts and feelings rather than fight against them, promoting psychological flexibility and helping them align their actions with their values despite the challenges of living with cancer. This approach has proven particularly helpful for clients struggling with uncertainty and fear, as it fosters resilience and empowers them to engage fully in their lives.

CFT complements this by addressing self-criticism and fostering self-compassion, which can be particularly beneficial for individuals experiencing feelings of inadequacy or shame related to their illness. By cultivating a compassionate inner voice, clients can better navigate the emotional landscape associated with cancer, enhancing their overall psychological wellbeing.

The combination of these approaches allows for flexibility in therapy, which I find essential as clients progress through different stages of their cancer experience. Emotional responses can vary widely over time, requiring a responsive and compassionate therapeutic stance.

Addressing grief and loss of identity: Many of my clients with cancer face existential concerns and a profound sense of loss, not just of health but of who they once were. In my practice, I often engage clients in processing these feelings, recognising that the journey involves grieving the life they once had. This requires sensitivity and an understanding of the stages of grief, which are crucial for effective intervention. The competencies related to loss, grief, and existential concerns serve as a guiding framework for these discussions, enabling me to support clients through these challenging emotions. 

Spirituality and meaning-making: Spirituality plays a significant role in clients' understanding of their cancer journey. As counselling psychologists, we are uniquely positioned to facilitate discussions around spiritual and existential concerns, helping clients connect with their values and beliefs. This is particularly relevant for those confronting their mortality as they explore what truly matters and foster a renewed sense of hope and meaning.

Collaborative care and multidisciplinary work: Working within a multidisciplinary framework has enriched my practice immensely. Collaborating with oncologists, cancer specialist nurses (CNS), physiotherapists, surgeons, and other healthcare professionals ensures that we provide comprehensive care that addresses clients' and their families' physical and emotional needs. I genuinely believe that when we work together, we can offer a more integrated approach that enhances the overall experience of care.

Assessment and formulation skills: Effective assessment and formulation are crucial in my work. Understanding the unique context of each client's experience, including their treatment trajectory and social support systems, allows for more tailored interventions that resonate with my client's unique needs. This personalised approach is something I find deeply rewarding, as it empowers clients to engage in their healing process.

Trauma-informed care: The competencies related to trauma-informed care are crucial, especially as many clients carry past traumas that resurface during their cancer experience. Being aware of these dynamics allows me to create a safe and supportive therapeutic environment. For instance, clients undergoing treatment may have memories triggered by physical examinations or procedures, and being attuned to these responses is essential for effective support.

Evaluation and continuous improvement: The framework highlights the importance of evaluation skills in our practice. Regularly seeking feedback from clients not only informs our therapeutic processes but also enhances the overall quality of care provided to individuals with cancer. I am dedicated to self-reflection and ongoing improvement, not only for our well-being but also for the benefit of those we serve.

Self-care and professional support: The framework emphasises the significance of self-care for counselling psychologists working in cancer care. Engaging with clients who are navigating life-threatening illnesses can evoke profound emotional responses and moral distress. I find that regular supervision and peer-support are crucial in maintaining my mental health, enabling me to provide the best possible care.

Promoting the application of competencies: To further promote the application of these competencies, the Division of Counselling Psychology (DCoP) could facilitate initiatives focused on collaboration and knowledge-sharing among counselling psychologists. Workshops that integrate these competencies into everyday practice could enhance our collective skills and ultimately benefit our clients.

Advocating for the inclusion of these competencies in training programs and continuing professional development will empower both emerging and established psychologists to deliver high-quality, person-centred care within cancer services.

The competencies outlined in this framework are instrumental in guiding psychologists as we navigate the complexities of cancer care. They offer a structured yet flexible approach that aligns with our core values of holistic, person-centred care. 

I find my work to be incredibly rewarding. There is something deeply fulfilling about being present for clients as they navigate their cancer journeys. It is a privilege to witness my clients' resilience and growth, especially when they begin to reclaim aspects of their identity that they thought were lost. Those moments when a client expresses relief or even joy amid their struggles are what keep me motivated.