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Unread August 27th, 2005, 09:58 PM
James Pretzer James Pretzer is offline
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Join Date: Jun 2004
Posts: 283
Default Inexperienced or Incompetent?

You are right that there are many therapists who say they are doing CBT but who do it badly in a variety of ways. Since CBT is an approach that has many specific techniques, one of the most common errors is to simply barrage the client with techniques without taking time to form a collaborative relationship and develop a conceptualization. When therapists do this it greatly decreases the effectiveness of CBT and sometimes can be quite harmful.

My experience is that sometimes the problem is simply that the therapist is inexperienced and a little supervised experience solves the problem. Sometimes the problem is that the therapist learned CBT 20 or 30 years ago and hasn't kept up on recent developments. However, often the problem is that a therapist without training in CBT decides that reading a book or attending a one-day workshop equips them to do CBT. Stop and think about it. Would anyone read a volume of Freud and declare themselves a Psychoanalyst or attend a one-day workshop and declare that they know Gestalt Therapy? For some reason, people get the impression that CBT is so simple that there is no need to actually learn how to do it right.

After more than 20 years training therapists in CBT, my experience has been that some therapists get adequate CBT training in grad school if they get extensive supervised experience through practicum and internships. However, most therapists finish grad school with quite limited training in CBT. Reading, workshops, and conferences can help a lot but it takes much more than a single book or workshop to provide a solid grounding in CBT.

How much does it take? Our intensive training program involves ten day-long sessions, reading two or more texts, demos, videos, role-plays etc. (see post #6 in the thread re finding training in CT at http://www.behavior.net/bolforums/showthread.php?t=161). It provides participants with a solid foundation in CT and they get enough practice and feedback so that when we rate tapes of real-life therapy sessions using the Cognitive Therapy rating scale, most participants do well. I certainly wouldn't mind having a little more class time and having individual or small group supervision but the feedback we get is that this type of training works quite well.

It would be great if there was some way to make sure that everyone who claims to be doing CBT was doing it well. However, there isn't much that leaders in CBT can do to stop therapists from doing CBT without adequate training, knowledge, and skill. Anyone can claim to do CBT whether or not they know what they are doing. The main things that leaders in CBT have done is to publish many high-quality texts and journals, to establish a number of professional organizations, to offer a variety of training opportunities, and to offer several certification programs. Those who want to learn how to do CBT well have a variety of opportunities. Unfortunately, there is no practical way to stop people from claiming that they are doing CBT when they are just using a random assortment of techniques they picked up somewhere. It's not as though we could send the therapy police after them even if we wanted to.

One thing that I would recommend is that all authors of texts on CBT and all workshop leaders make a point of explicitly mentioning the importance of establishing a therapeutic relationship, the importance of basing interventions on a clear understanding of the client and his or her problems, and the importance of adequate training (which can include educating oneself by reading widely, attending workshops, and taking advantage of any supervision opportunities that are available). Maybe we can get the word out.
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