A requirement of any psychological therapy is the development of a positive therapeutic relationship. The
development of a shared view about the nature of the person’s problems in a safe relationship free of stigma
and shame is a key prerequisite.132 This is particularly important in the context of schizophrenia. The experience
of psychosis itself (for example hostile commanding voices, persisting paranoia) or the experience of treatment
(for example compulsory treatment) can create difficulties in building up a trusting therapeutic relationship.
The skills and competencies required to deliver these interventions effectively are acquired through
training, and maintained through clinical supervision and practice. Training is essential in the acquisition
of knowledge, competences and skills to deliver interventions.133 Structuring treatment appropriately and
assessing treatment fidelity, as well as measuring clinical outcomes routinely to monitor treatment response
is important.133 Clinical supervision is essential to the delivery of psychological therapy services, both during
training and to ensure the ongoing safety and quality of subsequent practice. It is a requirement of all
professional bodies accrediting psychological therapists.133
A competence framework for knowledge, skills and values in implementing psychological therapies for
people with psychosis is being developed.134