Transfer of training and therapist factors in Cognitive Behaviour Therapy : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Auckland, New Zealand

Abstract

There is a call for the training of greater numbers of therapists in the use of Cognitive Behaviour Therapy (CBT) in order to meet the needs of growing populations worldwide. However, issues relating to transfer of training and therapist competence have been noted following the training process (Beidas & Kendall, 2010; Carroll, Martino, &Rounsaville, 2010; Kendall et al., 2004). To date, research investigating the impact that therapist characteristics, or effects,may have on therapist competence hasfocused on demographic data(McManus, Westbrook, Vasquez-Montez, Fennell, &Kennerley, 2010), with limited attentiongiven to therapist factors that may have a theoretical or empirical association with competence.To date, studies have reported mixed results concerning the relationshipbetween observed competenceand therapist self-confidence in using CBT (Brosnan, Reynolds, & Moore, 2006; Beidas & Kendall, 2010), anda positive relationship between observed competence and current practice (Mannix et al., 2006). Studies investigating therapy behaviours have suggestedpositive relationships between observed competence and career growth (Orlinsky&Rønnestad, 2005), and negative relationships with organisational barriers (Fadden, 1997; Kavanagh et al.,1993). The present study is an exploratory investigation of therapist competence and therapist factorsboth during and following postgraduate diploma training in CBT.Therapist factors investigated in the present study were therapist selfconfidence in using CBT, current CBT practice, perception of career growth, and perception of organisational barriers. Two separate studies were conducted.Study One employed a longitudinal design.Competence and therapist factorswere assessedfor trainees (N=16) at three time points during the diploma practicum. Training transfer was measured at 12 months follow-up.Study Two employed a cross-sectional design to investigate relationships between competence and therapist factorsfollowing training.Study Two participants were 20 postgraduate practitioners who had completed the practicum1 to 9 years prior to assessment within the present study. Results showed that 94% (N=16) of Study One participants were rated competent at the end of the practicum. Two of the nine participants who completed Study One showed evidence of training transfer at 12 months followup. Positive relationships between observed competence, self-confidence, and career growthwere consistently found throughout the training. However, at the end of training participants rated as more competent reportedpractice with fewer clients and a greater perception of organisational barriers. Results for Study Two showed65% of participants were rated competent 1-9 years following training. All relationships between observed competence and therapist factors were negative 1-9 years following training. Also, more competent participantsreportedlower self-confidence, less career growth, and practice with fewer clients, while the opposite was found for participants rated as less competent. These findings suggest that supervised practicum training in CBT increases trainee observed and self-reported competence, although the maintenance of training gains appears problematic. The implications of the findings are discussed and recommendations made for further research.