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
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Date
2012
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Massey University
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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.
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Keywords
Psychotherapists, Cognitive behaviour therapists, Cognitive therapy, Training of