AbstractThe advent of Improving Access to Psychological Therapies (IAPT) and the agenda of evidence based therapies has fundamentally changed the landscape of the delivery of psychological therapies in the United Kingdom (UK), providing rapid access to therapies for people with common mental health problems (Clark, Layard, Smithies, Richards, Suckling and Wright 2009). The primary therapy presently being delivered is High Intensity Cognitive Behavioural Therapy (CBT) in the High Intensity format. Accreditation as a CBT therapist requires four year’s professional training (one year as a CBT therapist and three years as a core professional (e.g. mental health nursing, social work, etc.) or demonstrably equivalent Knowledge, Skills and Attitudes (KSA) to that core profession) to provide a foundation in generic clinical skills. These different forms of core professional training are considered to meet equivalent minimum standards by the accrediting agency, the British Association for Behavioural and Cognitive Psychotherapy (BABCP), but they also have their own idiosyncrasies. If there are differences in clinical practice between the core professions, this has implications for the evidence base of CBT, which should be delivered homogenously, and also the training methods, which may need to be modified to account for the differing professional backgrounds.
The broad aim of this thesis is to explore how these different core professions transition to becoming CBT therapists, comparing initial skills at the start of training, describing the transition process, and describing how CBT is practiced post transition for each professional grouping. To meet these aims and objectives, three phases of the present research are proposed:
1) Phase one: A quantitative study to compare the level of CBT skills in 12 domains of the Cognitive Therapy Scale (revised) (CTS-r) at the start of training in each core profession and a further study comparing self-and supervisor ratings in the same 12 domains.
2) Phase two: Aqualitative study, using reflective reports to explore how each core profession learns CBT.
3) Phase Three: A focus group with two professional groups to explore how different core professions practice CBT.
Results of the research found that
a. Students without a core profession, but equivalent experience (KSA) outperformed mental health nurses, counsellors and occupational therapists in a number of CTS-r domains and were equivalent in the remainder in both studies. b. Mental health nurses and counsellors both learned through their existing skills (technical rationality and experience-as-client) respectively. Both groups resisted some aspect of practice initially and some of this was resolved through cognitive dissonance or behavioural reinforcement. There was less intra personal conflict for the KSA group due to less conflicting expectations. All groups adopted reflective practice.
c. Mental health nurses substituted nursing practice for CBT practice and there was some shame of their previous nursing practice. However when nursing added to the role (risk assessment, knowledge of healthcare systems) nursing practice was maintained – a “CBT-plus” approach. Counsellors retained some of their original identity and did not fully adopt CBT resulting in a complex mix of counselling, CBT, and the individual.
There are variations in initial skills, learning processes, and post qualification practice between the core professions. The non-professionalised group (KSA) exhibit higher levels of core skills and a smoother transition process compared with the core professions, contradicting conventional research that professionalization adds value. This has implications for the delivery of CBT according to the evidence base in practice, and the validity of aspects of the research underpinning it. Recommendations to address training at the core professional and CBT level are made to ensure greater consistency in learning of CBT.
|Date of Award||2017|
|Supervisor||Gail Steptoe-Warren (Supervisor), Christine Grant (Supervisor) & David Hughes (Supervisor)|