The expected course of change for clients undertaking cognitive behavioural therapy as predicted by experienced and novice clinicians : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology, Massey University, Palmerston North, New Zealand
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Date
2015
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Massey University
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Abstract
Change, in the direction of improvement, is one of the main outcomes sought
when treating mental health issues such as depression and anxiety. Historically, the focus
of research has centred on change following the end of therapy, with recent discussions
indicating that to promote better practice, understanding how the individual client
changes, session-by-session, over the course of therapy is paramount. By incorporating a
measure of progress at each session, it is proposed that clinicians will improve their
ability to determine what reflects progress for clients, when intervention is required, and
which aspects of therapy must be prioritised. Furthermore, the scientist-practitioner gap,
where deficiencies in how practice influences research and how research influences
practise have been identified and may be managed by actively collecting data about client
progress. Practicing clinicians can then utilise research methods to both understand their
own practice as well as provide insight into their practice that can influence further
investigations. Using the primary therapy modality used to train New Zealand clinical
psychologists, cognitive behavioural therapy (CBT), the present study aimed to provide
an insight into what pattern of change was expected by both experienced and trainee
clinicians when considering a client with depression and a client with anxiety undertaking
a 12 session protocol of CBT, and how this compared to the current research literature. In
addition, this study aimed to identify the pattern of change that was expected to occur for
each client when considering overall symptoms, mood, and behavioural change. This was
done by inviting experienced and trainee clinicians to complete an online
task/questionnaire where participants were encouraged to plot session-by-session scores
on three separate measures pertaining to each type of change using a specially designed
graph. Despite the limitations of using hypothetical cases, findings showed that there
were no significant differences in predictions made by experienced or trainee clinicians,
with clinicians overall predicting a decelerating curvilinear progression of change. When
explored further, results indicated that clinician predictions differed from the research
literature in a number of ways. Whether or not this can be attributed to lack of awareness
of the research literature, or is reflective of the true nature of clinical practice, still
requires further exploration.
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Keywords
Cognitive behavioural therapy (CBT), Clinical psychologists, Psychotherapy evaluation