The rising prevalence of mental illness among youth has underscored the critical need for proficient therapists trained in effective methods for treating prevalent mental disorders. As mental health services grapple with resource constraints, the demand for shorter training programs has increased. This study aimed to investigate whether therapist competence improves continuously over a two-year cognitive behavioural therapy (CBT) training course, whether specific CBT skills show greater improvement than generic skills, and whether self-perceived competence varies based on therapist characteristics. Data were gathered from seven different CBT training courses spanning the years 2013–2021 involving a total of 151 Norwegian therapists. Therapist self-assessed their CBT competence using the Cognitive Therapy and Adherence Scale (CTACS). The collected data were analysed using mixed effects models using the R program. The findings revealed a significant increase in self-reported competence throughout the two-year training period. Notably, skills related to case formulation and CBT techniques displayed the most substantial improvements, indicating a high level of competence attained by the conclusion of training. No significant interactions were identified between time and therapist characteristics. The outcomes of this study support the efficacy of in-depth training through an extended CBT course spanning multiple semesters. The observed progress in CBT skills suggests that investments in therapist training can yield high levels of competence. Furthermore, this investment appears warranted regardless of therapists’ individual characteristics.

This is report of the successful use of behavioral treatment in a medical crisis. The intubation process inadvertently punctured a patient's throat during the application of general anesthesia while having a routine arthroscopy. This resulted in a rapidly spreading infection, spiking temperature and dehydration. To locate the puncture, a barium swallow x-ray was necessary, but the patient's weakened condition made standing impossible. A friend and experienced therapist accompanying the patient helped him stand for the several minutes necessary to complete the barium swallow by countering the hypotensive state with angry imagery to stimulate an adrenalin surge. Several principles of effective therapeutic practice were demonstrated by this case, including the importance of the alliance, of technical eclecticism, of engaging the patient in the treatment process, and therapist experience.