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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Massey University
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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.
Cognitive behavioural therapy (CBT), Clinical psychologists, Psychotherapy evaluation