In-Session Stuck Points and Pitfalls of Community Clinicians Learning CBT: Qualitative Investigation

Waltman, Scott H.; Hall, Brittany; McFarr, Lynn; Beck, Aaron T.; Creed, Torrey A.

doi:10.1016/j.cbpra.2016.04.002

Cited by 30 publications

(22 citation statements)

References 26 publications

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“…Consistent with prior examination of CBT fidelity among graduate-level practitioners (Waltman et al, 2017), expert interviews that informed our content development revealed training difficulties in agenda setting and session pacing, structuring and reviewing client goals, and interpersonal effectiveness, in addition to need for cultural responsiveness. These are important communication and EBPI competencies that the ITS can support to augment traditional social work and other training.…”

Section: Discussion and Applications To Practicesupporting

confidence: 58%

Modernizing Training in Psychotherapy Competencies With Adaptive Learning Systems: Proof of Concept

Renn

Areán

Raue

et al. 2020

Research on Social Work Practice

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Purpose: This proof-of-concept study assessed the feasibility, acceptability, and effectiveness of an intelligent tutoring system (ITS) as a classroom adjunct to improve training bachelor of social work (BSW) students in client engagement strategies. Methods: We codeveloped the ITS with 11 undergraduate students and pilot tested it with six BSW students enrolled in a class on telephone-based cognitive behavioral therapy (tCBT). Student competencies in tCBT were assessed by expert review of role-plays. We also examined time spent using ITS and relation with competency. Results: The majority of students (81.8%) in Wave 1 and all of the students who submitted role-plays in Wave 2 passed the clinical skills role-play. Students advancing through the ITS more quickly had better tCBT competency ratings than those progressing more slowly. Discussion: One of the most challenging aspects of training is how to competently deliver evidence-based practices. ITS has the potential to streamline and scale such training.

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Section: Discussion and Applications To Practicesupporting

confidence: 58%

Modernizing Training in Psychotherapy Competencies With Adaptive Learning Systems: Proof of Concept

Renn

Areán

Raue

et al. 2020

Research on Social Work Practice

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“…This suggests an opening toward a therapist-identified stuck point that signals the need for training and implementation support when clients are perceived to have difficulty grasping EBP concepts (Waltman et al, 2017). Indeed, Modifying Presentation and Extending adaptations were both often described with similar intentions of engaging or enhancing client learning of an EBP strategy.…”

Section: Discussionmentioning

confidence: 99%

Therapist adaptations to evidence-based practices and associations with implementation outcomes in child therapy sessions.

Yu¹,

Brookman‐Frazee²,

Kim³

et al. 2022

Journal of Consulting and Clinical Psychology

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Objective: Community therapists inevitably adapt evidence-based practices (EBPs) to meet the needs of their clients and practice settings. Yet, the implications of spontaneous, therapist-driven adaptations for EBP implementation outcomes are not well understood. We used a sequential QUAN → qual mixed-methods design to examine how different types of therapist-described adaptations were associated with observerrated extensiveness of therapist delivery of EBP content and technique strategies at the session level. Method: Data were drawn from an observational study of a system-driven implementation of multiple EBPs into public children's mental health services. Community therapists (n = 103) described adaptations they made in 680 sessions with 273 clients (50.92% female, 49.08% male, M age = 9.72 years, 70.70% Hispanic/ Latinx). Coders classified therapist-described adaptations into five types: (a) Modifying Presentation, (b) Integrating, (c) Extending, (d) Reducing, and (e) Generalizing. Independent observers rated the extensiveness of EBP strategy delivery from session recordings using the EBP Concordant Care Assessment (ECCA) Observational Coding System. Results: Quantitative analyses using multilevel regression revealed that Modifying Presentation adaptations were associated with higher extensiveness of EBP technique delivery, whereas Extending adaptations were associated with lower extensiveness of EBP content and technique delivery. Qualitative analysis of adaptation descriptions identified explanations for the quantitative findings. Conclusions: Findings suggest that Modifying Presentation adaptations, associated with higher extensiveness, involved creative use of activities and materials, language modification, and personalization of EBP content to meet clients' diverse needs, whereas Extending adaptations, associated with lower extensiveness, involved slowing EBP pacing in response to client challenges. Implications for provider training are discussed.What is the public health significance of this article? Community therapists adapt evidence-based practices (EBPs) when implemented in public children's mental health services, yet how such adaptations impact EBP delivery is unclear. Findings from the present study suggest that sessions in which community therapists tailored presentation of EBP concepts in creative ways to meet clients' diverse needs were associated with higher extensiveness of EBP technique delivery. In contrast, sessions in which therapists slowed down intervention pacing and relied on repetition of didactic content were associated with lower extensiveness of EBP content and technique delivery. These findings may have implications for the targeted design of supportive training strategies in the community implementation of EBPs for diverse youth.

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“…Case formulation obviates an eclectic approach and bag of tricks mentality. Authors[ 33 ] recently argued, “We have no data to suggest that an ‘a la carte’ approach to CBT produces positive patient outcomes”. The selection, timing, and targets of various interventions are launched by case conceptualization.…”

Section: Content Of Supervisionmentioning

confidence: 99%

“…Teaching trainees the rudiments of guided discovery is important yet quite challenging[ 48 ]. Many supervisees perceive guided discovery as a common pitfall in clinical practice[ 33 ]. Simply stated, guided discovery involves helping young patients form more adaptive conclusions and flexible attitudes based on their personal data base.…”

Section: Content Of Supervisionmentioning

confidence: 99%

Best practices in supervising cognitive behavioral therapy with youth

Friedberg

2018

WJCP

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Clinical supervision of cognitive behavioral therapy (CBT) with youth ensures better patient care and fosters trainees' professional development. However, often insufficient attention is directed toward disseminating best practices in supervision of CBT with youth. This Therapeutic Advances contribution aims to communicate the core content of supervision. Additionally, the key supervisory practices associated with CBT with youth are described. Supervisory outcomes are summarized and recommendations for supervisory practices are made.

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In-Session Stuck Points and Pitfalls of Community Clinicians Learning CBT: Qualitative Investigation

Cited by 30 publications

References 26 publications

Modernizing Training in Psychotherapy Competencies With Adaptive Learning Systems: Proof of Concept

Modernizing Training in Psychotherapy Competencies With Adaptive Learning Systems: Proof of Concept

Therapist adaptations to evidence-based practices and associations with implementation outcomes in child therapy sessions.

Best practices in supervising cognitive behavioral therapy with youth

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