So You Say You Are an Expert”: False CBT Identity Harms Our Hard-Earned Gains

[DynamicDidactic]

Another really good article in the Behavior Therapist
http://www.abct.org/docs/PastIssue/37n8.pdf

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[PsychBiker]

I would not call this a really good article. I understand the point being made and I don't necessarily disagree with it, but he is really pulling straws to create a sound argument for CBT in particular, not to mention the mudslide of slippery slopes in the article.

 

[WisNeuro]

The article isn't really trying to make an argument for CBT. It's making an argument against practitioners claiming that they are experts in the delivery of CBT without adequate training and the possible harm to the profession and public health.

 

[PsychBiker]

Sorry, poor sequence of words. I what meant was he poorly applied his general argument by using CBT as an exemplar.

 

[WisNeuro]

Well, considering it was in the ABCT newsletter, I don't see what else he could have used as an exemplar though.

 

[xXIDaShizIXx]

SDN: "Where arguments can start from anything."

 

[WisNeuro]

Not much of an argument, rather than a misconception.

 

[xXIDaShizIXx]

Not much of an argument, rather than a misconception.

Should have put "/sarcasm".

 

[PsychBiker]

CBT is not therapy. CBT is counseling.

 

[Ollie123]

I very much agree with the broader point...that we do an extremely inadequate job with regards to quality control across the board in this field. I think lack of effort is part of the problem, but I also think part of it just boils down to the nature of our work. Therapy is inherently more abstract/nebulous and process/outcome measures are also more nebulous. Measurement is so much trickier, I think learned helplessness plays a role.

I have no idea what the other discussion is about or what on earth could be meant by "CBT is counseling and not therapy" might mean (unless its just a joke about the ridiculousness of the discussions we see here, per earlier posts). The article is clearly written in a way in which one could substitute in any other EBP and make the exact same point...something the author himself even points out.

 

[smalltownpsych]

My main issue with this article was that it seems as though it is asking for extra credentialing beyond a doctorate in clinical psychology to practice an evidence-based treatment. Isn't part of being a clinical practitioner learning the basic principles underlying psychological disorders and then applying treatment to an individual? My take is that if a clinical psychologist is not familiar with how CBT works and haven't practiced with how to apply it that is a problem in itself. I don't see myself as an expert in CBT and conceptualize and treat from more of an object relations standpoint, but I still use a lot of techniques and principles from CBT and DBT. I have even stolen a few ideas from ACT as I had a supervisor who was a staunch supporter of that and have found that useful, too. It almost seems like this article is saying that I should stop using these tools unless I become board certified as a CBT guy which I wouldn't want to do.

 

[WisNeuro]

I'm actually ok with extra credentialing to say that you are proficient in a type of therapy modality. You can still say that you are a general clinician who utilizes certain methods eclectically, but, if you advertise yourself as something (e.g., CBT, PE, CPT, etc, psychologist for XXX disorder) then you should have some specialized training in that area beyond watching an hour long web didactic. I think the article was more on people billing themselves as experts in something, when they really aren't.

 

[Therapist4Chnge]

I am a big supporter of EBTs, specialized training, and boarding….because the alternative is mostly gross exaggeration and moonbeam therapies. Look no further than the Psychology Today clinician ads/directory for hundreds of examples of unqualified experts.

 

[AcronymAllergy]

Agreed with the above. I personally don't have a huge problem with further specialized training and credentialing, although it'd be nice to first show that doing so improves care/outcomes (or something similar) relative to the alternative. The VA is strongly pushing the use of EBTs and associated templates (e.g., for CBT, PE, CPT), and there's been pushback from some of the psychologists with whom I work (particularly those who've been practicing a while). Their points are typically similar to those mentioned by smalltownpsych--that essentially all appropriately-trained practicing psychologists should be able to do these things, and have likely been using elements of the various modalities in their treatments for years. However, I do think it's important to differentiate, say, "CBT- and ACT-informed ecclectic therapy" (my own terminology) from stringent existing protocols (e.g., CBT-i, cognitive therapy for chronic pain, etc.).

I agree that all competently-trained psychologists should be able to provide many of these EBTs in their areas of competence and will likely have some exposure to various others, and that psychologists shouldn't be using (or claiming to use) EBT elements in which they aren't formally trained. Unfortunately, that just doesn't seem to be how things always work. And there's really no formal way yet available to many folks to determine if you actually are competent in something. A psychologist could pick up a book on ACT, read through it, and feel that they're doing a solid job of applying it, but may be providing a very different intervention than folks who've also gone through ACT workshops, had their sessions reviewed, and the like.

 

[futureapppsy2]

CBT is not therapy. CBT is counseling.

Come again?