Beyond the Label: Relationship Between Community Therapists’ Self-Report of a Cognitive Behavioral Therapy Orientation and Observed Skills

Abstract

Policy-makers, payers, and consumers often make decisions based on therapists' reported theoretical orientations, but little is known about whether these labels represent actual or potential skills. Prior to CBT training, therapists (n = 321) reported theoretical orientations. Experts rated CBT competency using the Cognitive Therapy Rating Scale Therapy at pre-, mid-, and post-training. CBT- and non-CBT identified therapists showed equivalent, non-competent baseline CBT skills. CBT-identified therapists showed greater CBT skills at mid-training, but by end of training, groups evidenced equivalent achieved competency. Baseline CBT orientations were neither valid, nor useful markers of later competency. Policy, clinical and research implications are discussed.

Clinical psychology trainees' self versus supervisor assessments of practitioner competencies

“…Generally, the research on mental health practitioners' self-assessment highlights discrepancies in the degree of concordance between self-assessments and external raters (e.g., supervisors; Creed et al, 2016;Walfish, McAlister, O'donnell, & Lambert, 2012;Waltman, Frankel, & Williston, 2016), which is commonly used as a proxy for self- assessment accuracy (Neimeyer, Taylor, Rozensky, & Cox, 2014), and suggests that practitioners tend to both over-and under-estimate their level of competence (Loades & Myles, 2016). However, the literature is limited in the extent to which it can generalise to clinical psychology trainees (Creed et al, 2016;Loades & Armstrong, 2016).…”

“…Generally, the research on mental health practitioners' self-assessment highlights discrepancies in the degree of concordance between self-assessments and external raters (e.g., supervisors; Creed et al, 2016;Walfish, McAlister, O'donnell, & Lambert, 2012;Waltman, Frankel, & Williston, 2016), which is commonly used as a proxy for self- assessment accuracy (Neimeyer, Taylor, Rozensky, & Cox, 2014), and suggests that practitioners tend to both over-and under-estimate their level of competence (Loades & Myles, 2016). However, the literature is limited in the extent to which it can generalise to clinical psychology trainees (Creed et al, 2016;Loades & Armstrong, 2016). To start, research primarily involves practitioners other than psychologists, who have several years of clinical experience outside their training (e.g., nursing; Belar et al, 2001;McManus et al, 2012;Walfish et al, 2012), which makes it difficult to establish the effects of early clinical experience on psychology trainees' ability to self-assess (Esposito et al, 2015;Halonen et al, 2003).…”

“…The cube model of competence development is a prominent framework for understanding competency development across the lifespan of professional psychology (Rodolfa et al, ), from postgraduate school to post licensure (Fouad et al, ). Competency‐based models emphasise that, in a rapidly changing world where knowledge is continually growing and new evidence‐based interventions emerge, to be effective the practitioner needs to both develop and to maintain competence (Creed, Wolk, Feinberg, Evans, & Beck, ). While educators, supervisors and assessors hold responsibility for the former, the licensed practitioner needs to take responsibility to maintain their competence (McManus, Rakovshik, Kennerley, Fennell, & Westbrook, ).…”

Predictors of clinician use of exposure therapy in community mental health settings

“…We also included clinician years of experience, which predicts EBP use in other samples (e.g., Aarons, 2004; Becker, Smith, & Jensen-Doss, 2013). In addition, we examined whether clinicians who had participated in an evidence-based practice initiative that included some aspect of training in exposure (i.e., the Beck Community initiative [Creed, Wolk, Feinberg, Evans, & Beck, 2016], the Philadelphia Alliance for Child Trauma Services [Beidas et al, 2016], and Prolonged Exposure [Foa et al, 2005]) were more likely to use exposure for anxiety relative to those clinicians who did not participate. As lack of preparation time has been a cited barrier to exposure (e.g., (Ringle et al, 2015), we also examined clinician caseload size.…”

Non-participants in policy efforts to promote evidence-based practices in a large behavioral health system

“…Although our raters achieved perfect reliability, our classification of agencies as adopter or non-adopter agencies was not confirmed with observation or chart review. Recent research cautions that therapist report of the services they deliver may be inaccurate, overestimating the amount of EBP present [46]. An additional limitation of our classification is that agency leaders were not specifically queried on the NREPP registry but probed regarding general practices; we may have missed report of some EBP as a result.…”