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Transition to cognitive behavioural therapy from different core professional backgrounds: three grounded theory studies

Published online by Cambridge University Press:  02 September 2020

Matthew D. Wilcockson
Matthew D. Wilcockson*
Affiliation:
Coventry University and Coventry and Warwickshire Partnership Trust, Coventry, UK
*
Corresponding author. Email: ab3504@coventry.ac.uk
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Abstract

Aim:

Transition between roles is widely recognised to be a complex process that involves training, socialisation into the new culture, exiting a previous role culture, and dealing with the transition process itself, and dealing with loss of identity and initial incompetence in the new role. Moving from core profession to high intensity (CBT) therapist is an example of such a role transition.

As a result, complete transition is not guaranteed, which may affect completeness of learning, and how CBT is practiced post qualification. It is recognised in a number of studies that professional cultures are present in professions such as nursing and counselling, and these professions may have different filters for viewing CBT, and different training needs.

Method:

A grounded theory analysis (Glaserian) of each of three core professions’ (mental health nurses, counsellors, and an unprofessionalised group) reflective reports (7 per profession) was undertaken, incorporating information from their learning journals throughout the year independently of each other. The reflective reports incorporate reflections on the process of transition and learning, and is a mandatory requirement of the course. Through an inductive process described in the article, a theory of transition was developed for each group.

Results:

Three different theories of transition are presented. Nurses absorbed knowledge but resisted practice changes, especially being clinically observed. Practice changes occurred through behavioural consequences and cognitive dissonance and reflection is structured and compartmentalised generally. The conflict between counselling and CBT is felt more deeply emotionally but resolved through experiencing ‘self as client’ for most counselling participants. Practice conflicts are mostly resolved with this group, but some ideological ones are not. The KSA group have a relatively smooth transition unaffected by previous experiences. Inability to use previous coping strategies for dealing with distress is influential, inducing crises for the nursing and counselling groups.

Implications:

Learning is delayed by trying to avoid clinical practice, and excessive identification only with the aspects of CBT that fit with existing identity and practice with nursing and counselling groups. Adaptations to training may be beneficial to enforce observation of practice at an earlier stage to drive change. The nursing role does appear to undermine learning. Reflection does eventually drive the learning process as noted in other studies, but this does not occur spontaneously with nurses or counsellors. Identification with the new role appears influential in a relatively complete change, which is consistent with theory. Recommendations to adopt CBT coping strategies early in the training are made, as is a session of individual support to address profession-based conflicts. Potential implications for the evidence base are noted. Transitional models provide a framework for educators and students.

Key learning aims

  1. (1) To appreciate the importance of successful role transitions and their effect on future practice.

  2. (2) To become familiar with the key issues in transitioning between different core professions and an IAPT high-intensity role.

  3. (3) To critically reflect on personal experience in transitioning to cognitive behavioural therapy, and the impact it has had on clinical practice.

Keywords

CBTcognitive behavioural therapygrounded theorytraining
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 13 , 2020 , e35
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Adams, J., Hayes, J., & Hopson, B. (1976). Transition: Understanding and Managing Personal Change. Martin Roberts, LondonGoogle Scholar
Ashforth, B. (2000). Role Transitions in Organizational Life: An Identity-Based Perspective. Routledge.CrossRefGoogle Scholar
BABCP (2018). Knowledge Skills and Attitudes [online]. https://www.babcp.com/Accreditation/CBP/KSA.aspx [16/11/18]Google Scholar
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. (2012). Self-practice and self-reflection in cognitive behaviour therapy training: what factors influence trainees’ engagement and experience of benefit? Behavioral and Cognitive Psychotherapy, 40, 1–17.Google Scholar
Bennett-Levy, J., Lee, N. K., Travers, K., Pohlman, S., & Hamernik, E. (2003). Cognitive therapy from the inside: enhancing therapist skills through practising what we preach. Behavioural and Cognitive Psychotherapy, 31, 143–158.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
Binnie, J. (2008). From CPN to CBT: a reflective account of the transition from community psychiatric nurse to cognitive behavioural therapist. Issues in Mental Health Nursing, 29, 1273–1276.CrossRefGoogle ScholarPubMed
Birks, M., & Mills, J. (2015). Grounded Theory: A Practical Guide. London, UK: Sage.Google Scholar
Bor, R., Miller, R., Gill, S., & Evans, A. (2008). Counselling in Health Care Settings: A Handbook for Practitioners. Basingstoke, UK: Palgrave Macmillan.Google Scholar
Bray, J. (1999) An ethnographic study of psychiatric nursing. Journal of Psychiatric & Mental Health Nursing, 6, 297–305.CrossRefGoogle ScholarPubMed
Brown, S. (2017). Is counselling women’s work? Therapy Today, 28, 8–11.Google Scholar
Butler, A. C., Rice, H. J., Wooldridge, C. L., & Rubin, D. C. (2016). Visual imagery in autobiographical memory: the role of repeated retrieval in shifting perspective. Consciousness and Cognition, 42, 237–253.CrossRefGoogle ScholarPubMed
Carlsson, J., Norberg, J., Sandell, R., & Schubert, J. (2011). Searching for recognition: the professional development of psychodynamic psychotherapists during training and the first few years after it. Psychotherapy Research, 21, 141–153.CrossRefGoogle Scholar
Chaddock, A., Thwaites, R., Bennett-Levy, J., & Freeston, M. H. (2014). Understanding individual differences in response to self-practice and self-reflection (SP/SR) during CBT training. The Cognitive Behaviour Therapist, 7, E14.CrossRefGoogle Scholar
Chan, P. A., & Rudman, M. J. (1998) Paradigms for mental health nursing: fragmentation or integration? Journal of Psychiatric and Mental Health Nursing, 5, 143–146.CrossRefGoogle ScholarPubMed
Charmaz, K. (2014). Constructing Grounded Theory. London, UK: Sage.Google Scholar
Cooper, J. (2007) Cognitive Dissonance: 50 Years of a Classic Theory. London, UK: Sage.Google Scholar
Crawford, P., Brown, B., & Majomi, P. (2008). Professional identity in community mental health nursing: a thematic analysis. International Journal of Nursing Studies, 45, 1055–1106.CrossRefGoogle ScholarPubMed
Currie, G., Finn, R., & Martin, G. (2010). Role transition and interaction of relational and social identity: new nursing roles in the English NHS. Organisational Studies, 31, 941–961.CrossRefGoogle Scholar
Dalziel, A. (2009). A Rooster in the Hen House [online], http://www.bacp.co.uk/student/rooster.php [22/12/16]Google Scholar
Deacon, M., & Fairhurst, E. (2008). The real-life practice of acute inpatient mental health nurses: an analysis of ‘eight interrelated bundles of activity’. Nursing Inquiry, 15, 330–340.CrossRefGoogle ScholarPubMed
De la Paz, M. M. (2011). Professional Counsellors Perceptions of Knowledge, Barriers, Support and Action of Professional Advocacy [online]. PhD dissertation, University of New Orleans (Paper 1301), https://scholarworks.uno.edu/cgi/viewcontent.cgi?article=2285&context=td [14/6/2017]Google Scholar
Eide, B., & Eide, F. (2012). The Dyslexic Advantage: Unlocking the Hidden Potential of the Dyslexic Brain. London, UK: Penguin.Google Scholar
Ellemers, A., Van Knippenberg, A., & Wilke, H. (1990). The influence of permeability of group boundaries and stability of group status on strategies of individual mobility and social change. British Journal of Social Psychology, 29, 233–246.CrossRefGoogle ScholarPubMed
Festinger, L. (1957). A Theory of Cognitive Dissonance. Stanford, CA, USA: Stanford University Press.Google Scholar
Gijbels, H. (1995). Mental health nursing skills in an acute admission environment: perceptions of mental health nurses and other mental health professionals. Journal of Advanced Nursing, 21, 460–465.CrossRefGoogle Scholar
Glaser, B. G. (1992). Emergence vs Forcing: Basics of Grounded Theory Analysis. Mill Valley, CA, USA: Sociology Press.Google Scholar
Glaser, B. G. (1998). Doing Grounded Theory: Issues and Discussions. Mill Valley.Google Scholar
Grant, A., Mills, J., Mulhern, R. & Short, N. (2010). Cognitive Behavioural Therapy in Mental Health Care (2nd edn). London, UK: Sage.CrossRefGoogle Scholar
Henderson, P. (2010). The pull to academic assessment… ‘The Wrong Hoops’ about assessment of written work in counsellor training. Therapy Today, 21, 43.Google Scholar
House, R. (2011). Pluralistic, post-professional, postmodern? A debate whose time has come… a pluralistic framework for counselling and psychotherapy: implications for research. Therapy Today, 22, 38–40.Google Scholar
Kashdan, T. B., Uswatte, G., & Julian, T. (2006). Gratitude and hedonic and eudaimonic well-being in Vietnam war veterans. Behaviour Research and Therapy, 44, 177–199.CrossRefGoogle ScholarPubMed
Kubler-Ross, E. (1969). On Death and Dying. New York, USA: Macmillan.Google Scholar
Mobini, S., & Grant, A. (2007). Clinical implications of attentional bias in anxiety disorders: an integrative literature review. Psychotherapy: Theory, Research, Practice, Training, 44, 450–462.CrossRefGoogle Scholar
Piaget, J., & Cook, M. (1952). The Origins of Intelligence in Children (Vol. 8, No. 5, p. 18). New York: International Universities Press.CrossRefGoogle Scholar
Price, M., Tone, E. B., & Anderson, P. L. (2011). Vigilant and avoidant attention biases as predictors of response to cognitive behavioral therapy for social phobia. Depression and Anxiety, 28, 349–353.CrossRefGoogle ScholarPubMed
Reupert, A. (2006). The counsellor’s self in therapy: an inevitable presence. International Journal for the Advancement of Counselling, 28, 95–105.CrossRefGoogle Scholar
Robinson, S., Kellett, S., King, I., & Keating, V. (2012). Role transition from mental health nurse to IAPT high intensity psychological therapist. Behavioural and Cognitive Psychotherapy, 40, 351–366.CrossRefGoogle ScholarPubMed
Rønnestad, M. H., & Skovholt, T. M. (2003). The journey of the counselor and therapist: research findings and perspectives on professional development. Journal of Career Development, 30, 5–44.CrossRefGoogle Scholar
Simmons, O. E. (2008). Stages of a Classic (Glaserian) Grounded Theory Study [online], http://www.groundedtheory.com/what-is-gt.aspx [28/4/2020]Google Scholar
Tajfel, H., & Turner, J. C. (1986) The social identity theory of intergroup behavior. In The Psychology of Intergroup Relations, Worchel, S. & Austin, W. G. (eds), pp. 7–24. Chicago, USA: Nelson-Hall.Google Scholar
Van Zomeren, M., Leach, C. W., & Spears, R. (2010). Does group efficacy increase group identification? Resolving their paradoxical relationship. Journal of Experimental Social Psychology, 46, 1055–1060.CrossRefGoogle Scholar
Walls, P., Parahoo, K., & Fleming, P. (2010). The role and place of knowledge and literature in grounded theory: Paula Walls, Kader Parahoo and Paul Fleming discuss how novice researchers can justify the use of grounded theory while avoiding breaking any of its tenets. Nurse Researcher, 17, 8–17.CrossRefGoogle Scholar
Westbrook, D., Kennerley, H., & Kirk, J. (2011). An Introduction to Cognitive Behaviour Therapy: Skills and Applications. London, UK: Sage Publications.Google Scholar
Wilcockson, M. D. (2018). The Role of the Core Professions in the IAPT High Intensity Role. PhD thesis, available at: www.ethos.bl.ukGoogle Scholar
Williams, D. (2008) Life Events and Career Change: Transition Psychology in Practice. Paper Presented to the British Psychological Society’s Occupational Psychology Conference, January 1999 [online], <http://www.eoslifework.co.uk/transprac.htm> [20/122017]+[20/122017]>Google Scholar
Wolff, S., & Auckenthaler, A. (2014). Processes of theoretical orientation development in CBT trainees: what internal processes do psychotherapists in training undergo as they ‘integrate’? Journal of Psychotherapy Integration, 24, 223–237.CrossRefGoogle Scholar
Worden, J. W. (2018). Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner (2nd edn). Springer Publishing Company.CrossRefGoogle Scholar
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