Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-28T05:53:01.012Z Has data issue: false hasContentIssue false
  • English
  • Français

Attitudes and applications of chairwork amongst CBT therapists: a preliminary survey

Published online by Cambridge University Press:  15 July 2021

Matthew Pugh ,
Tobyn Bell Open the ORCID record for Tobyn Bell [Opens in a new window] ,
Glenn Waller Open the ORCID record for Glenn Waller [Opens in a new window]  and
Emma Petrova
Matthew Pugh*
Affiliation:
Central and North West London NHS Foundation Trust, London, UK
Tobyn Bell
Affiliation:
Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
Glenn Waller
Affiliation:
University of Sheffield, Sheffield, UK
Emma Petrova
Affiliation:
Central and North West London NHS Foundation Trust, London, UK
*
*Corresponding author. Email: matthewpugh@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Chairwork refers to a collection of experiential interventions which utilise chairs, their positioning, movement, and dialogue to facilitate therapeutic change. Chair-based methods are used in several models of psychotherapy, including cognitive behavioural therapy (CBT). However, little is known about cognitive behavioural therapists’ use and attitudes towards chairwork. A mixed methods survey was conducted of 102 therapists who provided CBT. Overall, training in chairwork was weak amongst CBT therapists (35%). Quantitative results indicated that most therapists perceived chairwork to be clinically effective and consistent with the cognitive behavioural model, but did not feel competent using these methods. Perceived competence was highest amongst therapists who had been trained in chairwork and practised it frequently, but was unrelated to CBT accreditation or clinical experience. Qualitative feedback identified a number of factors that encouraged the use of chairwork (e.g. overcoming limitations associated with verbal restructuring methods), as well as inhibitors (e.g. therapist anxiety and limited access to training). These preliminary findings highlight a need for further research relating to cognitive behavioural chairwork and suggest that increased training in experiential interventions could go some way towards improving outcomes in CBT.

Key learning aims

As a result of reading this paper, readers should:

  1. (1) Understand cognitive behavioural therapists’ attitudes towards chairwork.

  2. (2) Appreciate therapists’ anxiety and avoidance in relation to chairwork.

  3. (3) Identify the key factors that facilitate or inhibit the use of cognitive behavioural chairwork.

Keywords

CBTchairworkrole playsurvey
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 14 , 2021 , e21
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further reading

Pugh, M. (2019a). Cognitive Behavioural Chairwork: Distinctive Features. Oxon, UK: Routledge.CrossRefGoogle Scholar
Pugh, M. (2019b). A little less talk, a little more action. A dialogical approach to cognitive therapy. The Cognitive Behaviour Therapist, 12, 1–24.CrossRefGoogle Scholar

References

Arntz, A. (2018). Modifying core beliefs. In Hayes, S. C. & Hofmann, S. G. (eds), Process-Based CBT: The Science and Core Clinical Competencies of Cognitive Behavioral Therapy (pp. 339–361). Oakland, CA, USA: New Harbinger.Google Scholar
Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. New York, USA: Basic Books.Google Scholar
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive Therapy of Depression. New York, USA: Guilford Press.Google Scholar
Beck, J. S. (1995). Cognitive Therapy: Basics and Beyond. New York, USA: Guilford Press.Google Scholar
Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence-based practice: a critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice, 17, 1–30.Google ScholarPubMed
Bell, T., Mackie, L., & Bennett-Levy, J. (2015). ‘Venturing towards the dark side’: the use of imagery interventions by recently qualified cognitive-behavioural therapists. Clinical Psychology and Psychotherapy, 22, 591–603.CrossRefGoogle ScholarPubMed
Bell, T., Montague, E., Elander, J., & Gilbert, P. (2020). ‘A definite feel-it moment’: embodiment, externalization and emotion during chair-work in compassion-focused therapy. Counselling and Psychotherapy Research, 20, 143–153.CrossRefGoogle Scholar
Bennett-Levy, J. (2003). Mechanisms of change in cognitive therapy: the case of automatic thought records and behavioural experiments. Behavioural and Cognitive Psychotherapy, 31, 261–277.CrossRefGoogle Scholar
Bennett-Levy, J., Turner, F., Beaty, T., Smith, M., Paterson, B., & Farmer, S. (2001). The value of self-practice of cognitive therapy techniques and self-reflection in the training of cognitive therapists. Behavioural and Cognitive Psychotherapy, 29, 203–220.CrossRefGoogle Scholar
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.CrossRefGoogle Scholar
Borkovec, T. D., Newman, M. G., & Castonguay, L. G. (2003). Cognitive-behavioral therapy for generalized anxiety disorder with integrations from interpersonal and experiential therapies. CNS Spectrums, 8, 382–389.CrossRefGoogle ScholarPubMed
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical Psychology Review, 26, 17–31.CrossRefGoogle ScholarPubMed
Chadwick, P. (2003). Two chairs, self-schemata and a person-based approach to psychosis. Behavioural and Cognitive Psychotherapy, 31, 439–449.CrossRefGoogle Scholar
Cromarty, P., & Marks, I. (1995). Does rational role-play enhance the outcome of exposure therapy in dysmorphophobia? A case study. The British Journal of Psychiatry, 167, 399–402.CrossRefGoogle ScholarPubMed
de Oliveira, I. R. (2008). Trial-Based Thought Record (TBTR): preliminary data on a strategy to deal with core beliefs by combining sentence reversion and the use of analogy with a judicial process. Brazilian Journal of Psychiatry, 30, 12–18.CrossRefGoogle Scholar
de Oliveira, I. R. (2015). Trial-Based Cognitive Therapy: A Manual for Clinicians. New York, USA: Routledge.Google Scholar
de Oliveira, I. R., Hemmany, C., Powell, V. B., Bonfim, T. D., Duran, É. P., Novais, N., … & Cesnik, J. A. (2012a). Trial-based psychotherapy and the efficacy of trial-based thought record in changing unhelpful core beliefs and reducing self-criticism. CNS Spectrums, 17, 16–23.CrossRefGoogle ScholarPubMed
de Oliveira, I. R., Powell, V. B., Wenzel, A., Caldas, M., Seixas, C., Almeida, C., … & de Oliveira Moraes, R. (2012b). Efficacy of the trial-based thought record, a new cognitive therapy strategy designed to change core beliefs, in social phobia. Journal of Clinical Pharmacy and Therapeutics, 37, 328–334.CrossRefGoogle ScholarPubMed
Elliott, R., Fischer, C. T., & Rennie, D. L. (1999). Evolving guidelines for publication of qualitative research studies in psychology and related fields. British Journal of Clinical Psychology, 38, 215–229.CrossRefGoogle ScholarPubMed
Ellis, A. (2001). The rise of cognitive behavior therapy. In O’Donohue, W. T., Henderson, D. A., Hayes, S. C., Fisher, J. E. & Hayes, L. J. (eds), A History of Behavioral Therapies: Founders’ Personal Histories (pp. 183–194). Reno, NV, USA: Context Press.Google Scholar
Epstein, S. (2014). Cognitive-Experiential Theory: An Integrative Theory of Personality. Oxford, UK: Oxford University Press.CrossRefGoogle Scholar
Farrell, N. R., Deacon, B. J., Dixon, L. J., & Lickel, J. J. (2013). Theory-based training strategies for modifying practitioner concerns about exposure therapy. Journal of Anxiety Disorders, 27, 781–787.CrossRefGoogle ScholarPubMed
Gilbert, P. (2010). Compassion Focused Therapy: Distinctive Features. London, UK: Routledge. CrossRefGoogle Scholar
Greenberg, L. S., & Malcolm, W. (2002). Resolving unfinished business: relating process to outcome. Journal of Consulting and Clinical Psychology, 70, 406–416.CrossRefGoogle ScholarPubMed
Greenberger, D., & Padesky, C. A. (1995). Mind Over Mood: A Cognitive Therapy Treatment Manual for Clients. New York, USA: Guilford Press.Google Scholar
Harned, M. S., Dimeff, L. A., Woodcock, E. A., & Contreras, I. (2013). Predicting adoption of exposure therapy in a randomized controlled dissemination trial. Journal of Anxiety Disorders, 27, 754–762.CrossRefGoogle Scholar
Hauke, G., Lohr, C., & Pietrzak, T. (2016). Moving the mind: embodied cognition in cognitive behavioural therapy (CBT). European Psychotherapy, 13, 154–178.Google Scholar
Hayes, S. C., & Hoffman, S. G. (2018). Process-Based CBT: The Science and Core Competencies of Cognitive Behavioral Therapy. Oakland, CA, USA: New Harbinger.Google Scholar
Hudson, J. L., Rapee, R. M., Lyneham, H. J., McLellan, L. F., Wuthrich, V. M., & Schniering, C. A. (2015). Comparing outcomes for children with different anxiety disorders following cognitive behavioural therapy. Behaviour Research and Therapy, 72, 30–37.CrossRefGoogle ScholarPubMed
Hyett, M. P., Bank, S. R., Lipp, O. V., Erceg-Hurn, D. M., Alvares, G. A., Maclaine, E., … & McEvoy, P. M. (2018). Attenuated psychophysiological reactivity following single-session group imagery rescripting versus verbal restructuring in social anxiety disorder: results from a randomized controlled trial. Psychotherapy and Psychosomatics, 87, 340–349.CrossRefGoogle ScholarPubMed
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive Therapy and Research, 36, 427–440.CrossRefGoogle ScholarPubMed
Kellogg, S. (2019). Transformational chairwork: therapeutic change using the four dialogues. InPsych, 41, 16–21.Google Scholar
Lazarus, A. A. (1966). Behaviour therapy vs. non-directive therapy vs. advice in effecting behaviour change. Behaviour Research and Therapy, 4, 209–212.CrossRefGoogle ScholarPubMed
Levita, L., Duhne, P. G. S., Girling, C., & Waller, G. (2016). Facets of clinicians’ anxiety and the delivery of cognitive behavioral therapy. Behaviour Research and Therapy, 77, 157–161.CrossRefGoogle ScholarPubMed
Lipsky, M. J., Kassinove, H., & Miller, N. J. (1980). Effects of rational-emotive therapy, rational role reversal, and rational-emotive imagery on the emotional adjustment of community mental health center patients. Journal of Consulting and Clinical Psychology, 48, 366–374.CrossRefGoogle ScholarPubMed
Michalak, J., Burg, J., & Heidenreich, T. (2012). Don’t forget your body: mindfulness, embodiment, and the treatment of depression. Mindfulness, 3, 190–199.CrossRefGoogle Scholar
Moreno, J. L. (1987). The Essential Moreno: Writings on Psychodrama, Group Method, and Spontaneity. New York, USA: Springer.Google Scholar
Mueser, K. T. (2018). Interpersonal skills. In Hayes, S. C. & Hofmann, S. G. (eds), Process-Based CBT: The Science and Core Clinical Competencies of Cognitive Behavioral Therapy (pp. 309–324). Oakland, CA, USA: New Harbinger.Google Scholar
Paivio, S. C., & Greenberg, L. S. (1995). Resolving ‘unfinished business’: efficacy of experiential therapy using empty-chair dialogue. Journal of Consulting and Clinical Psychology, 63, 419–425.CrossRefGoogle Scholar
Parker, Z. J., & Waller, G. (2019). Psychotherapists’ reports of technique use when treating anxiety disorders: factors associated with specific technique use. The Cognitive Behaviour Therapist, 12, 1–12.CrossRefGoogle Scholar
Perls, F. S. (1973). The Gestalt Approach and Eye Witness to Therapy. New York, USA: Bantam.Google Scholar
Pugh, M. (2019a). Cognitive Behavioural Chairwork: Distinctive Features. Oxon, UK: Routledge.CrossRefGoogle Scholar
Pugh, M. (2019b). A little less talk, a little more action: a dialogical approach to cognitive therapy. The Cognitive Behaviour Therapist, 12, 1–24.CrossRefGoogle Scholar
Pugh, M., & Broome, N. (2020). Dialogical coaching: an experiential approach to personal and professional development. Consulting Psychology Journal: Practice and Research, 72, 223–241.CrossRefGoogle Scholar
Rakovshik, S. G., & McManus, F. (2010). Establishing evidence-based training in cognitive behavioral therapy: a review of current empirical findings and theoretical guidance. Clinical Psychology Review, 30, 496–516.CrossRefGoogle ScholarPubMed
Roth, A. D., & Pilling, S. (2007). The competencies required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders. London, UK: Department of Health.Google Scholar
Sanchez, V. C., Lewinsohn, P. M., & Larson, D. (1980). Assertion training: effectiveness in the treatment of depression. Journal of Clinical Psychology, 36, 526–529.CrossRefGoogle ScholarPubMed
Saulsman, L. M., Ji, J. L., & McEvoy, P. M. (2019). The essential role of mental imagery in cognitive behaviour therapy: what is old is new again. Australian Psychologist, 54, 237–244.CrossRefGoogle Scholar
Speed, B. C., Goldstein, B. L., & Goldfried, M. R. (2018). Assertiveness training: a forgotten evidence-based treatment. Clinical Psychology: Science and Practice, 25, e12216.Google Scholar
Teasdale, J. D. (1997). The relationship between cognition and emotion: the mind-in-place in mood disorders. In Clark, D. M. & Fairburn, C. G. (eds), The Science and Practice of Cognitive Behaviour Therapy (pp. 67–93). Oxford, UK: Oxford University Press.Google Scholar
Teasdale, J. D., & Barnard, P. J. (1993). Affect, Cognition, and Change: Re-Modelling Depressive Thought. Hove, UK: Lawrence Erlbaum Associations.Google Scholar
Waller, G., Stringer, H., & Meyer, C. (2012). What cognitive behavioral techniques do therapists report using when delivering cognitive behavioral therapy for the eating disorders? Journal of Consulting and Clinical Psychology, 80, 171–175.CrossRefGoogle ScholarPubMed
Wenzel, A. (2018). Cognitive reappraisal. In Hayes, S. C. & Hofmann, S. G. (eds), Process-Based CBT: The Science and Core Clinical Competencies of Cognitive Behavioral Therapy (pp. 325–337). Oakland, CA, USA: New Harbinger.Google Scholar
Westen, D., & Morrison, K. (2001). A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies. Journal of Consulting and Clinical Psychology, 69, 875–899.CrossRefGoogle ScholarPubMed
Wells, A. (1997). Cognitive Therapy of Anxiety Disorders: A Practice Manual and Conceptual Guide. Chichester, UK: John Wiley and Sons.Google Scholar
Young, J. E. (1990). Cognitive Therapy for Personality Disorders: A Schema-Focused Approach (1st edn). Sarasota, FL, USA: Professional Resource Exchange.Google Scholar
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy: A Practitioner’s Guide. New York, USA: Guilford Press.Google Scholar
Submit a response

Comments

No Comments have been published for this article.