Are you practicing CBT to the best of your ability?

It’s been shown that therapists using CBT tend to “drift away” from the CBT they were trained in and practiced initially.

One could say that, over time in practice, therapists become more confident in their skills and how to apply them… But research shows they may actually be practicing the therapy with less fidelity to the model overall.

It might be that they take short cuts and/or neglect important aspects of what has been shown to be effective components of the approach.

For example, therapists practicing CBT initially may diligently set an agenda for each session and assign homework very systematically and collaboratively. Ten years later in their CBT practice, they may be doing less of both.

Similarly, therapists who have seen a client for a significant time (a year or longer) may “neglect” some aspects of practice which were apparent in the early sessions. For example, the therapist is now more directive and less collaborative.

We as therapists (myself included) are all prone to this. What is most important is being aware of when it is happening and taking steps to correct it.

Here are a few simple ways to prevent this “drift” so you can continue to practice the best version of CBT for your clients.

• Top up your training. Many therapists who are experienced in CBT note that skill-based training helps them “recalibrate” and “fine tune” what they are doing.


• Peer supervision or case consultation can be helpful. This helps a lot with therapists who work in relative isolation, as discussions with other therapists of similar orientation and their input may serve to remind them of skills they might return to.


• Keep up with the literature. Carving out time to read practical manuals and go back to well-researched methods described in classic texts can also serve to ensure that day-to-day practice is informed and consistent with best practices.


• Watch DVDs or appropriate YouTube videos of skilled CBT practitioners conducting CBT to enhance continuing learning. (I have developed a list of these which are made available during training)


• Use a system of self-monitoring. In the training arena, the model of Self-Reflection and Self-Practice (SR/SP) has proven to produce skilled practitioners of CBT and other therapies. James Bennet-Levy’s and colleagues’ excellent text CBT from The Inside Out (Guilford, 2015) describes how to monitor your own use of CBT as a therapist (Self-Reflection) and engage in guided practice, sometime on yourself (Self-Practice) to optimize CBT skill acquisition.

With this in mind, I developed the following short checklist of CBT skills, based on the Cognitive Therapy Rating Scale (a measure of therapist competency, which I demonstrate in my intensive CBT training programs).

CBT Therapists are advised to use the list and rate themselves as a check-in on their own implementation of CBT, and set goals for themselves for upcoming sessions in the light of this. Trainees and therapist in CBT supervision I have worked with have found this a very useful tool.



Download this Worksheet

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