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Trainee self-assessment of cognitive behaviour therapy competence during and after training

Published online by Cambridge University Press:  22 January 2020

Sarah Beale ,
Sheena Liness  and
Colette R. Hirsch
Sarah Beale*
Affiliation:
Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
Sheena Liness
Affiliation:
Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, UK
Colette R. Hirsch
Affiliation:
Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, UK
*
*Corresponding author. Email: sarah.beale@kcl.ac.uk
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Abstract

Large-scale cognitive behavioural therapy (CBT) training and implementation programmes, such as the pioneering Improving Access to Psychological Therapies (IAPT) initiative in the UK, aim to develop a workforce of competent therapists who can deliver evidence-based interventions skilfully. Self-awareness of competence enables CBT therapists to accurately evaluate their clinical practice and determine professional development needs. The accuracy of self-assessed competence, however, remains unclear when compared with assessments conducted by markers with expertise in CBT practice and evaluation. This study investigated the relationship between self- and expert-rated competence – assessed via therapy recordings rated on the Cognitive Therapy Scale Revised (CTS-R) scale – for a large sample of IAPT CBT trainees during training and, for the first time, at post-training follow-up. CBT trainees (n = 150) submitted therapy recordings at baseline, mid-training and end-of-training. At 12+ month follow-up, a subset of former trainees (n = 30) submitted recordings from clinical practice. There were positive relationships (r = .27 to .56) between self and expert CTS-R scores at all time points. The proportion of tapes demonstrating significant agreement between self and expert ratings (CTS-R difference <5 points) increased significantly across training and remained stable at follow-up. Findings indicate that accurate self-awareness of competence can be developed during structured CBT training and retained in the workplace. These outcomes are encouraging given the importance of self-awareness to CBT practice and accreditation. Future investigation into the development and maintenance of accurate self-awareness of competence is warranted.

Key learning aims

  1. (1) What is the relationship between self-ratings and expert ratings of CBT competence during training and at post-training follow-up?

  2. (2) Does agreement between self and expert competence ratings improve with CBT training?

  3. (3) How does agreement between self and expert ratings change across training for more- and less-competent trainees?

  4. (4) Can accurate self-awareness of competence be retained post-training in the workplace?

Keywords

cognitive behavioural therapy (CBT)competenceIAPTself-assessmenttraining
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 13 , 2020 , e1
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Further reading

Loades, M. E., & Myles, P. J. (2016). Does a therapist’s reflective ability predict the accuracy of their self-evaluation of competence in cognitive behavioural therapy? The Cognitive Behaviour Therapist, 9.CrossRefGoogle Scholar
Waltman, S. H., Frankel, S. A., & Williston, M. A. (2016). Improving clinician self-awareness and increasing accurate representation of clinical competencies. Practice Innovations, 1, 178.CrossRefGoogle Scholar

References

Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the Royal Statistical Society Series B (Methodological), 289–300.CrossRefGoogle Scholar
British Association for Behavioural and Cognitive Psychotherapies (BABCP) (2012). BABCP Minimum Training Standards for the Practice of Cognitive Behavioural Therapy. Available at: https://www.babcp.com/files/Accreditation/General/Minimum-Training-Standards-V7-0215.pdfGoogle Scholar
Blackburn, I. M., James, I. A., Milne, D. L., Baker, C., Standart, S., Garland, A., & Reichelt, F. K. (2001). The Revised Cognitive Therapy Scale (CTS-R): psychometric properties. Behavioural and Cognitive Psychotherapy, 29, 431–446.CrossRefGoogle Scholar
Brooker, C., Saul, C., Robinson, J., King, J., & Dudley, M. (2003). Is training in psychosocial interventions worthwhile? Report of a psychosocial intervention trainee follow-up study. International Journal of Nursing Studies, 40, 731–747.CrossRefGoogle ScholarPubMed
Brown, J. D. (1986). Evaluations of self and others: self-enhancement biases in social judgments. Social Cognition, 4, 353–376.CrossRefGoogle Scholar
Brosan, L., Reynolds, S., & Moore, R. G. (2007). Factors associated with competence in cognitive therapists. Behavioural and Cognitive Psychotherapy, 35, 179–190.CrossRefGoogle Scholar
Brosan, L., Reynolds, S., & Moore, R. G. (2008). Self-evaluation of cognitive therapy performance: do therapists know how competent they are? Behavioural and Cognitive Psychotherapy, 36, 581–587.CrossRefGoogle Scholar
Chevron, E. S., & Rounsaville, B. J. (1983). Evaluating the clinical skills of psychotherapists: a comparison of techniques. Archives of General Psychiatry, 40, 1129–1132.CrossRefGoogle ScholarPubMed
Dunning, D., Johnson, K., Ehrlinger, J., & Kruger, J. (2003). Why people fail to recognize their own incompetence. Current Directions in Psychological Science, 12, 83–87.CrossRefGoogle Scholar
Fouad, N. A., Grus, C. L., Hatcher, R. L., Kaslow, N. J., Hutchings, P. S., Madson, M. B., Collins, F.L., & Crossman, R. E. (2009). Competency benchmarks: a model for understanding and measuring competence in professional psychology across training levels. Training and Education in Professional Psychology, 3(4S), S5.CrossRefGoogle Scholar
Gordon, P. K. (2007). A comparison of two versions of the Cognitive Therapy Scale. Behavioural and Cognitive Psychotherapy, 35, 343–353.CrossRefGoogle Scholar
Hool, N. (2010). BABCP Core Curriculum Reference Document. British Association for Behavioural and Cognitive Psychotherapies. Available at: https://www.babcp.com/documentsGoogle Scholar
James, I. A., Blackburn, I. M., Milne, D. L., & Reichelt, F. K. (2001). Moderators of trainee therapists’ competence in cognitive therapy. British Journal of Clinical Psychology, 40, 131–141.CrossRefGoogle Scholar
Kaslow, N. J., Grus, C. L., Campbell, L. F., Fouad, N. A., Hatcher, R. L., & Rodolfa, E. R. (2009). Competency assessment toolkit for professional psychology. Training and Education in Professional Psychology, 3(4S), S27.CrossRefGoogle Scholar
Kazantzis, N., Clayton, X., Cronin, T. J., Farchione, D., Limburg, K., & Dobson, K. S. (2018). The Cognitive Therapy Scale and Cognitive Therapy Scale-Revised as measures of therapist competence in cognitive behavior therapy for depression: relations with short and long term outcome. Cognitive Therapy and Research, 42, 385–397.CrossRefGoogle Scholar
Liness, S., Beale, S., Lea, S., Byrne, S., Hirsch, C. R., & Clark, D. M. (2018). The sustained effects of CBT training on therapist competence and patient outcomes. Cognitive Therapy and Research, 43, 631–641.CrossRefGoogle Scholar
Liness, S., Beale, S., Lea, S., Byrne, S., Hirsch, C. R., & Clark, D. M. (2019). Multi-professional IAPT CBT training: clinical competence and patient outcomes. Behavioural and Cognitive Psychotherapy, 47, 1–14.CrossRefGoogle ScholarPubMed
Liness, S., Lea, S., Nestler, S., Parker, H., & Clark, D. M. (2017). What IAPT CBT high-intensity trainees do after training. Behavioural and Cognitive Psychotherapy, 45, 16–30.CrossRefGoogle ScholarPubMed
Loades, M. E., & Myles, P. J. (2016). Does a therapist’s reflective ability predict the accuracy of their self-evaluation of competence in cognitive behavioural therapy? The Cognitive Behaviour Therapist, 9.CrossRefGoogle Scholar
Lyon, A. R., Stirman, S. W., Kerns, S. E., & Bruns, E. J. (2011). Developing the mental health workforce: review and application of training approaches from multiple disciplines. Administration and Policy in Mental Health and Mental Health Services Research, 38, 238–253.CrossRefGoogle ScholarPubMed
Mannix, K. A., Blackburn, I. M., Garland, A., Gracie, J., Moorey, S., Reid, B., Standart, S., & Scott, J. (2006). Effectiveness of brief training in cognitive behavior therapy techniques for palliative care practitioners. Palliative Medicine, 20, 579–584.CrossRefGoogle ScholarPubMed
Mathieson, F. M., Barnfield, T., & Beaumont, G. (2009). Are we as good as we think we are? Self-assessment versus other forms of assessment of competence in psychotherapy. The Cognitive Behaviour Therapist, 2, 43–50.CrossRefGoogle Scholar
McLeod, B. D., Southam‐Gerow, M. A., Tully, C. B., Rodriguez, A., & Smith, M. M. (2013). Making a case for treatment integrity as a psychosocial treatment quality indicator for youth mental health care. Clinical Psychology: Science and Practice, 20(1), 14–32.Google ScholarPubMed
McManus, F., Rakovshik, S., Kennerley, H., Fennell, M., & Westbrook, D. (2012). An investigation of the accuracy of therapists’ self‐assessment of cognitive‐behaviour therapy skills. British Journal of Clinical Psychology, 51, 292–306.CrossRefGoogle ScholarPubMed
Meichenbaum, D., & Lilienfeld, S. O. (2018). How to spot hype in the field of psychotherapy: a 19-item checklist. Professional Psychology: Research and Practice, 49, 22.CrossRefGoogle Scholar
Miller, W. R., Yahne, C. E., Moyers, T. B., Martinez, J., & Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology, 72, 1050–1062.CrossRefGoogle ScholarPubMed
NHS England (2016). The Five Year Forward View for Mental Health. London: NHS England. Available at: https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdfGoogle Scholar
Nissen‐Lie, H. A., Rønnestad, M. H., Høglend, P. A., Havik, O. E., Solbakken, O. A., Stiles, T. C., & Monsen, J. T. (2017). Love yourself as a person, doubt yourself as a therapist? Clinical Psychology & Psychotherapy, 24, 48–60.CrossRefGoogle ScholarPubMed
Norem, J. K., & Cantor, N. (1986). Defensive pessimism: harnessing anxiety as motivation. Journal of Personality and Social Psychology, 51, 1208.CrossRefGoogle ScholarPubMed
Parker, Z. J., & Waller, G. (2015). Factors related to psychotherapists’ self-assessment when treating anxiety and other disorders. Behaviour Research and Therapy, 66, 1–7.CrossRefGoogle ScholarPubMed
Perlesz, A. J., Stolk, Y., & Firestone, A. F. (1990). Patterns of learning in family therapy training. Family Process, 29, 29–44.CrossRefGoogle ScholarPubMed
Rakovshik, S. G., McManus, F., Vazquez-Montes, M., Muse, K., & Ougrin, D. (2016). Is supervision necessary? Examining the effects of internet-based CBT training with and without supervision. Journal of Consulting and Clinical Psychology, 84, 191–199.CrossRefGoogle ScholarPubMed
Reichelt, F. K., James, I. A., & Blackburn, I. M. (2003). Impact of training on rating competence in cognitive therapy. Journal of Behavior Therapy and Experimental Psychiatry, 34, 87–99.CrossRefGoogle ScholarPubMed
Rozek, D. C., Serrano, J. L., Marriott, B. R., Scott, K. S., Hickman, L. B., Brothers, B. M., Lewis, C. C., & Simons, A. D. (2018). Cognitive behavioural therapy competency: pilot data from a comparison of multiple perspectives. Behavioural and Cognitive Psychotherapy, 46, 244–250.CrossRefGoogle ScholarPubMed
Schoenwald, S. K., Garland, A. F., Chapman, J. E., Frazier, S. L., Sheidow, A. J., & Southam-Gerow, M. A. (2011). Toward the effective and efficient measurement of implementation fidelity. Administration and Policy in Mental Health and Mental Health Services Research, 38, 32–43.CrossRefGoogle ScholarPubMed
Schmidt, I. D., Strunk, D. R., DeRubeis, R. J., Conklin, L. R., & Braun, J. D. (2018). Revisiting how we assess therapist competence in cognitive therapy. Cognitive Therapy and Research, 42, 369–384.CrossRefGoogle Scholar
Singla, D. R., Weobong, B., Nadkarni, A., Chowdhary, N., Shinde, S., Anand, A., Fairburn, C. G., Dimijdane, S., Velleman, R., Weiss, H., & Patel, V. (2014). Improving the scalability of psychological treatments in developing countries: an evaluation of peer-led therapy quality assessment in Goa, India. Behaviour Research and Therapy, 60, 53–59.CrossRefGoogle ScholarPubMed
Stirman, S. W., Gutner, C., Crits-Christoph, P., Edmunds, J., Evans, A. C., & Beidas, R. S. (2015). Relationships between clinician-level attributes and fidelity-consistent and fidelity-inconsistent modifications to an evidence-based psychotherapy. Implementation Science, 10, 115.CrossRefGoogle Scholar
Walfish, S., McAlister, B., O’Donnell, P., & Lambert, M. J. (2012). An investigation of self-assessment bias in mental health providers. Psychological Reports, 110, 639–644.CrossRefGoogle ScholarPubMed
Waller, G. (2009). Evidence-based treatment and therapist drift. Behaviour Research and Therapy, 47, 119–127.CrossRefGoogle ScholarPubMed
Waltman, S. H., Frankel, S. A., & Williston, M. A. (2016). Improving clinician self-awareness and increasing accurate representation of clinical competencies. Practice Innovations, 1, 178.CrossRefGoogle Scholar
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