How Can a Busy Therapist Improve Their Skills in CBT?
I sometimes get questions from therapists who realize that their grad school training didn’t really equip them to use CBT under real-world conditions. With the personal and professional demands we all face it isn’t simple, but there are a number of good options for improving CBT skills once you’re in practice.
The first options that come to mind for most therapists are reading and attending workshops. These can be valuable but they have significant limitations. Reading a good book or article is very different from having the opportunity to discuss the material, see interventions demonstrated, or gain supervised experience. Likewise, workshops can be interesting and useful, but a one or two day workshop does not give you the opportunity to try out the interventions in practice then return for follow-up. Actually, the available research shows that the traditional one-day workshop by itself does little to improve one’s skill in CBT. Reading and workshops can be useful, but consider other options as well:
- Look for an organized training program. If there is a Center for Cognitive Therapy in your area (or in the nearest large city), good training may be easily available. A number of the CT centers around the country offer extended training programs designed to meet the needs of practicing clinicians. These programs vary from Center to Center but typically meet for 60 or 70 hours over the course of a year and include readings, lectures, video, experiential exercises, and opportunities for consultation. The Academy of Cognitive Therapy maintains a listing of CBT training programs that can be found at http://www.academyofct.org/cbt-training-programs/. Information about our intensive training program can be found at http://behavioralhealthassoc.com/educationalPrograms.php.
- Consider bringing organized training to where you are. If your employer, local professional association, or a group of 20 like-minded colleagues are interested, it may well be feasible to arrange for training to come to you. Many of the programs listed by the Academy of Cognitive Therapy (http://www.academyofct.org/cbt-training-programs/) also provide on-site training.
- Participate in an organized CBT training program via distance education. With the internet, the benefits of intensive training in CBT are available pretty much anywhere. The Academy of Cognitive Therapy’s directory of CBT training programs (http://www.academyofct.org/cbt-training-programs/) lists several distance education programs including ours.
- Find a consultant or supervisor. If you can locate someone in your area who is qualified to provided supervision or consultation in CBT, supervised experience combined with reading and workshops can give you a solid foundation. To locate possible consultants or supervisors check the “therapist finder” function at Academy of Cognitive Therapy (www.academyofct.org) and ABCT (www.abct.org) and look for seasoned CBT practitioners in your area.
- Obtain feedback. Feedback is important for developing any skill but practicing therapists only get useful feedback if they seek it out. Routinely ask clients for negative feedback (i.e. “Have you noticed any problems?” or “Is there anything you’d like us to do differently?”) and to respond to negative feedback by taking it seriously and by letting the client know that you appreciate their input. If you have access to supervision or consultation, record sessions and play sections for your supervisor or consultant. This will enable them to provide you with more specific feedback.
- Self-assess. Periodically record a therapy session and rate it using the Cognitive Therapy Rating Scale (which can be downloaded from http://www.academyofct.org/resources/) to get a sense of your strengths and weaknesses in applying CBT and then choose one or two aspects to focus on improving.
- Organize a peer consultation group. Locate a few like-minded colleagues who are interested in meeting regularly to discuss cases, raise questions, and discuss readings. Meet regularly, and make it clear that the goal is to learn, not to try to impress each other. It may take a little effort to stay on task rather that just BS-ing but you will find that this can be really valuable.
An increasing number of organizations offer distance education and online training in CBT. Some provide excellent training, others are more questionable. How do you figure out which programs are worth considering? Since each person’s background and needs are unique, I can’t make that comparison for you (also, I have my own program at http://behavioralhealthassoc.com/educationalPrograms.php, so I’m biased), but here are a few points to consider in deciding which programs suit your needs:
- What do they cover? Some programs have a very narrow focus on one specific topic, some cover only the basics, and some cover the basics as well as their application with a broad range of problems.
- Do they provide in-depth training? If they spend just a few hours on a big topic, you know the coverage will be superficial. (I just received a mailing for a one-day worksop that covers Solution-Focused Therapy, Strategic Therapy, Motivational Interviewing, Narrative Therapy, CBT, ACT, and Mindfulness. We spend 10 days on CBT alone. I wonder which goes into the most depth.)
- Is it an extended program or a one-day workshop? The research on training in CBT shows that one-day workshops are much less effective than more extended programs.
- Do they just lecture at you, or do they combine lecture with demonstrations, experiential exercises, and readings? It is much easier to master the material if it is presented through text, lecture, demonstration, and practice.
- Who are the faculty and what are their credentials? Are they certified by the Academy of Cognitive Therapy as a trainer/consultant? How long have they been providing distance education in CBT?
- Which version of CBT do they teach? Many programs present mainstream Cognitive Therapy and CBT. However, some presenters teach their own idiosyncratic approach. Cognitive Therapy has a strong empirical base and is widely recognized as one of the most influential cognitive-behavioral approaches. If the presenter is teaching his or her unique approach, it may have little empirical support.
- How is the material presented? Video-based programs may seem like a good idea, but it means sitting in front of a screen for the duration of the program. With an audio-based program, you can listen while commuting, doing chores, etc.
- Does the program meet at specified times or can you complete the program on your own schedule? A program that you can complete on your own schedule is easier to fit into a busy life, but you’ll need to make time for it. If you tend to procrastinate, a program that meets at a scheduled time and that imposes deadlines may help you stay on track.
- Is there an option for achieving certification in CBT? What must you do to achieve certification? Programs where participants must demonstrate mastery of the material covered in order to achieve certification are much more credible that programs where everyone who sends in their money gets a certificate.
It can take some effort to compare the options that are available but doing this improves your chances of choosing a program that will meet your needs.