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Measuring therapist cognitions contributing to therapist drift: a qualitative study

Published online by Cambridge University Press:  29 January 2021

Tiffany Rameswari ,
Brett Hayes  and
Ramesh Perera-Delcourt Open the ORCID record for Ramesh Perera-Delcourt [Opens in a new window]
Tiffany Rameswari
Affiliation:
Department of Psychology, City, University of London, London, UK
Brett Hayes
Affiliation:
Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, UK
Ramesh Perera-Delcourt*
Affiliation:
Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, UK
*
*Corresponding author. Email: ramesh@perera-delcourt.co.uk
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Abstract

Therapist beliefs have been identified as a contributing factor to ‘therapist drift’ in cognitive behavioural therapy (CBT). Scales have been developed to measure therapist beliefs, but none explicitly measure ‘therapy-interfering cognitions’, and there is no research on their usage. The aim of this study was to explore how best to conceptualise such a scale’s content and usage, based on clinicians’ perceptions and experiences of current scales. Three focus groups were conducted, involving 12 participants who were either qualified or trainee CBT therapists. Transcripts were analysed using thematic analysis. Four main themes were generated: (1) The Awareness and Importance of Cognitions, (2) Factors Fuelling Therapist Cognitions, (3) Addressing Therapist Cognitions, and (4) Using the Scale. Participants thought it important to be aware of and address therapist cognitions (not underlying beliefs). Participants emphasised that therapist cognitions are not just products of the individual, but are influenced by external factors. A scale could enable therapists to do better work through reflective practice, as long as it was used not just to identify cognitions but also to support changes in therapist behaviour. A scale could also meet a perceived need for making this part of routine practice. However, participants discussed how therapists might have reservations about disclosing cognitions in this way. Recommendations for current practice, and future research developing such a scale, are made.

Key learning aims

  1. (1) To describe the phenomenon of therapist drift, and the contributions of therapist beliefs to this.

  2. (2) To explore the usage of current scales for measuring therapist beliefs.

  3. (3) To understand, based on therapist experience, how to address therapist beliefs in current practice using scales.

Keywords

qualitative methodsself-reflectionsupervisiontherapist competencetreatment adherence
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 14 , 2021 , e7
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2021

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References

Further reading

Bennett-Levy, J., Thwaites, R., Haarhoff, B., & Perry, H. (2015). Experiencing CBT from the Inside Out: A Self-practice/Self-reflection Workbook for Therapists. London, UK: Guilford Press.Google Scholar
Haarhoff, B., & Thwaites, R. (2015). Reflection in CBT. London, UK: Sage.Google Scholar
Whittington, A., & Grey, N. (2014). How to Become a More Effective CBT Therapist. Chichester, UK: John Wiley & Sons, Ltd.Google Scholar

References

Bennett-Levy, J. (2019). Why therapists should walk the talk: the theoretical and empirical case for personal practice in therapist training and professional development. Journal of Behavior Therapy and Experimental Psychiatry, 62, 133–145.CrossRefGoogle ScholarPubMed
Bennett-Levy, J., & Beedie, A. (2007). The ups and downs of cognitive therapy training: what happens to trainees’ perception of their competence during a cognitive therapy training course? Behavioural and Cognitive Psychotherapy, 35, 61–75.CrossRefGoogle Scholar
Bennett-Levy., J., & Lee, N.K. (2014). Self-practice and self-reflection in cognitive behaviour therapy training: what factors influence trainees’ engagement and experience of benefit? Behavioural and Cognitive Psychotherapy, 42, 48–64.CrossRefGoogle Scholar
Bennett-Levy, J., Thwaites, R., Chaddock, A., & Davis, M. (2009). Reflective practice in cognitive behavioural therapy: the engine of lifelong learning. In Stedmon, J. & Dallos, R. (eds), Reflective Practice in Psychotherapy and Counselling (pp. 115–35). Milton Keynes, UK: Open University Press.Google Scholar
Birt, L., Scott, S., Cavers, D., Campbell, C., & Walter, F. (2016). Member checking: a tool to enhance trustworthiness or merely a nod to validation? Qualitative Health Research, 26, 1802–1811. https://doi.org/10.1177/1049732316654870 CrossRefGoogle ScholarPubMed
Blackburn, I. V., 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
Branch, R. (2012). Therapist development and self-care in CBT. In Dryden, W. & Branch, R. (eds), The CBT Handbook (pp. 421–438). London, UK: Sage.Google Scholar
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.CrossRefGoogle Scholar
Braun, V., & Clarke, V. (2013). Successful Qualitative Research: A Practical Guide for Beginners. London, UK: SAGE.Google Scholar
Braun, V., & Clarke, V. (2019a). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11, 589–597. doi: 10.1080/2159676X.2019.1628806 CrossRefGoogle Scholar
Braun, V., & Clarke, V. (2019b). To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qualitative Research in Sport, Exercise and Health. doi: 10.1080/2159676X.2019.1704846 CrossRefGoogle Scholar
Clark, A. L., & Watson, D. (1995). Constructing validity: basic issues in objective scale development. Psychological Assessment, 7, 309–319.CrossRefGoogle Scholar
Davis, M. L., Thwaites, R., Freeston, M. H., & Bennett-Levy, J. A. (2015). Measurable impact of a self-practice/self-reflection programme on the therapeutic skills of experienced cognitive-behavioural therapists. Clinical Psychology and Psychotherapy, 22, 176–184. doi: 10.1002/cpp.1884 CrossRefGoogle ScholarPubMed
Deacon, B. J., Farrell, N. R., Kemp, J. J., Dixon, L. J., Sy, J. T., Zhang, A. R., & McGrath, P. B. (2013). Assessing therapist reservations about exposure therapy for anxiety disorders: the therapist beliefs about exposure scale. Journal of Anxiety Disorders, 27, 772–780.CrossRefGoogle ScholarPubMed
Emery, S., Wade, T. D., & McLean, S. (2009). Associations among therapist beliefs, personal resources and burnout in clinical psychologists. Behaviour Change, 26, 83–96.CrossRefGoogle Scholar
Farrand, P., Perry, J., & Linsley, S. (2010). Enhancing self-practice/self-reflection (SP/SR) approach to cognitive behaviour training through the use of reflective blogs. Behavioural and Cognitive Psychotherapy, 38, 473–477. doi: 10.1017/S1352465810000238 CrossRefGoogle ScholarPubMed
Freeston, M., Thwaites, R., & Bennett-Levy, J. (2019). ‘Courses for Horses’: designing, adapting and implementing self-practice/self-reflection programmes. The Cognitive Behaviour Therapist, 12, 1–19.Google Scholar
Gale, C., & Schroder, S. (2014). Experiences of self-practice/self-reflection in cognitive behavioural therapy: a meta-synthesis of qualitative studies. Psychology and Psychotherapy: Theory, Research and Practice, 87. doi: 10.1111/papt.12026 CrossRefGoogle Scholar
Green, J. & Thorogood, N. (2014). Qualitative Methods for Health Research. London, UK: Sage.Google ScholarPubMed
Grey, N., Deale, A., Byrne, S., & Liness, S. (2014). Making CBT supervision more effective. In Whittington, A. & Grey, N. (eds), How to Become a More Effective CBT Therapist (pp. 269–283). Chichester, UK: John Wiley & Sons, Ltd.Google Scholar
Haarhoff, B. (2006). The importance of identifying and understanding therapist schema in cognitive therapy training and supervision. New Zealand Journal of Psychology, 35, 126–131.Google Scholar
Haarhoff, B., Gibson, K., & Flett, R. (2011). Improving the quality of cognitive behaviour therapy case conceptualization: the role of self-practice/self-reflection. Behavioural and Cognitive Psychotherapy, 39, 323–339.CrossRefGoogle ScholarPubMed
Haarhoff, B., & Kazantzis, N. (2007). How to supervise the use of homework in cognitive behavior therapy: the role of trainee therapist beliefs. Cognitive and Behavioral Practice, 14, 325–332.Google Scholar
Haarhoff, B., & Thwaites, R. (2015a). Reflecting on the therapeutic relationship in CBT. In Haarhoff, B. & Thwaites, R. (eds), Reflection in CBT (pp. 64–85). London, UK: Sage.Google Scholar
Haarhoff, B., & Thwaites, R. (2015b). Using self-reflection to promote CBT therapist self-care. In Haarhoff, B. & Thwaites, R. (eds), Reflection in CBT (pp. 165–180). London, UK: Sage.Google Scholar
Haarhoff, B., Thwaites, R., & Bennett-Levy, J. (2015). Engagement with self-practice/self-reflection as a professional development activity: The role of therapist beliefs. Australian Psychologist, 50, 322–328.CrossRefGoogle Scholar
Hyers, L. L. (2018). Diary Methods. New York, USA: Oxford University Press.CrossRefGoogle Scholar
Kennerley, H., Kirk, J., & Westbrook, D. (2017). An Introduction to Cognitive Behaviour Therapy: Skills and Applications (3rd edn). London, UK: Sage.Google Scholar
Laireiter, A.-R., & Willutzki, U. (2003). Self-reflection and self-practice in training of cognitive behaviour therapy: an overview. Clinical Psychology and Psychotherapy, 10, 19–30.CrossRefGoogle Scholar
Leahy, R. L. (2001). Overcoming Resistance in Cognitive Therapy. New York, USA: Guilford Press.Google Scholar
Lent, R. W., Cinamon, R. G., Bryan, N. A., Jezzi, M. M., Martin, H. M., & Lim, R. (2009). Perceived sources of change in trainees’ self-efficacy beliefs. Psychotherapy: Theory, Research, Practice, Training, 46, 317–327.CrossRefGoogle ScholarPubMed
McLean, S., Wade, T. D., & Encel, J. S. (2003). The contribution of therapist beliefs to psychological distress in therapists: an investigation of vicarious traumatization, burnout and symptoms of avoidance and intrusion. Behavioural and Cognitive Psychotherapy, 31, 417–428.CrossRefGoogle Scholar
Millward, L. (2012). Focus Groups. In Breakwell, G.M., Smith, J.A. & Wright, D.B (eds), Research Methods in Psychology (4th edn) (pp. 411–438). London, UK: Sage.Google Scholar
Moorey, S. (2014). ‘Is it them or is it me?’ Transference and countertransference in CBT. In Whittington, A. & Grey, N. (eds), How to Become a More Effective CBT Therapist: Mastering Metacompetence in Clinical Practice (pp. 132–145). Chichester, UK: John Wiley & Sons, Ltd.Google Scholar
Nowell, L., Norris, J.M., White, D.E., & Moules, N.J. (2017). Thematic analysis: striving to meet the trustworthiness criteria. International Journal for Qualitative Methods, 16, 1–13.CrossRefGoogle Scholar
Parker, Z. J., & Waller, G. (2017). Development and validation of the negative attitudes towards CBT scale. Behavioural and Cognitive Psychotherapy, 45, 629–646.CrossRefGoogle ScholarPubMed
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
Saunders, B., Sim., J., Kingstone, T., Baker, S., Waterfield, J., Bartlam, B., Burroughs, H., & Jinks, C. (2018). Saturation in qualitative research: exploring its conceptualization and perationalization. Quality & Quantity, 52, 1893–1907.CrossRefGoogle Scholar
Schneider, K., & Rees, C. (2012). Evaluation of a combined cognitive behavioural therapy and interpersonal process group in the psychotherapy training of clinical psychologists. Australian Psychologist, 47, 137–146.CrossRefGoogle Scholar
Thwaites, R., & Haarhoff, B. (2015). Developing your self-supervision practice: Using reflection to increase therapeutic effectiveness and enhance CBT skill development. In Haarhoff, B. & Thwaites, R. (eds), Reflection in CBT (pp. 50–63). London, UK: Sage.Google Scholar
Thwaites, R., Cairns, L., Bennett-Levy, J., Johnston, L., Lowrie, R., Robinson, A., Turner, M., Haarhoff, B., & Perry, H. (2015). Developing metacompetence in low intensity CBT interventions: evaluating a Self-Practice/Self-Reflection programme for experienced low intensity CBT practitioners. Australian Psychologist, 50, 311–321. doi: 10.1111/ap.12151 CrossRefGoogle Scholar
Waller, G. (2009). Evidence-based treatment and therapist drift. Behaviour Research and Therapy, 47, 119–127. doi: 10.1016/j.brat.2008.10.018 CrossRefGoogle ScholarPubMed
Waller, G., & Turner, H. (2016). Therapist drift redux: why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behaviour Research and Therapy, 77, 129–137. doi: 10.1016/j.brat.2015.12.005 CrossRefGoogle ScholarPubMed
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