‘It was like the unicorn of the therapeutic world’: CBT trainee experiences of acquiring skills in guided discovery

Abstract

Training as a cognitive behavioural therapist involves a considerable role transition for mental health professionals where they are expected to demonstrate competence in a range of new skills that emphasise collaboration and Socratic dialogue. This can be in stark contrast to the more didactic style that trainees are familiar with prior to embarking on their training. Guided discovery (GD) is an integral part of formulation and treatment, yet little is known at present about the experiences of cognitive behavioural therapy (CBT) trainees when learning this new skill; specifically, how they assimilate this with existing ways of working and the challenges this might involve. This research is a preliminary attempt to understand factors that help and hinder GD skill acquisition. Eighteen trainee CBT practitioners completed an online questionnaire with the subsequent data analysed using a grounded theory methodology. Three themes were identified: ‘Competing Selves’, ‘Style’ and ‘Active Engagement and Learning’. These themes were used to develop a preliminary model of factors that enable or inhibit skills in GD. The impact of previous professional roles appears to influence the acquisition of confidence and skill in GD. This paper discusses the implications of the findings for CBT trainers, supervisors and trainees. Key learning aims As a result of reading this paper, readers should: (1) Understand how trainee cognitive behavioural therapists respond to learning how to use guided discovery. (2) Identify potential barriers to acquiring and improving skills in guided discovery. (3) Recognise training strategies that might assist trainees in becoming more proficient in guided discovery.

Maladaptive therapist schemas in CBT practice, training and supervision: A scoping review

“…Didactic teaching, self‐practice of CBT methods and self‐reflection on individual roadblocks to learning CBT offer a number of potential routes to modify therapist beliefs. Wilcockson (2020) has highlighted the need for CBT trainers to consider the significance of role transition for different mental health professionals; therefore, helping trainees to consider the residual influence of their previous professional identity could highlight attitudes towards certain aspects of CBT (Roscoe, Bates, & Blackley, 2022). The status quo points to the value of SP/SR being formally integrated within CBT training curriculums given that voluntary uptake is often low (e.g.…”

“…Elsewhere, Wilcockson (2022) highlights how postqualification, person‐centred counsellors do not practice CBT in accordance with the evidence base, instead adapting it to previous ways of working. Finally, Roscoe, Bates, and Blackley (2022) identified resistance to applying guided discovery among trainees suggesting that their previous professional ‘self’ competes with the emerging CBT ‘therapist self’ when exposed to new theories, interventions and clinical experiences.…”

‘When it goes well, it works fantastically’: motivations to train and their impact on the practice of CBT

“…In short, old ways of conceptualising mental health problems and of treating specific disorders are not forgotten but are voluntarily relinquished to make room for the new emerging knowledge and skills and identity as a CBT therapist. In an attempt to understand factors that help and hinder the development of guided discovery (GD) skills during training, Roscoe et al (2022) developed an online questionnaire and analysed the responses of (n = 18) CBT trainees. Grounded theory was used to develop a model that hypothesised barriers to GD skill acquisition, most notably the concept of 'competing selves' whereby a 'previous professional self' (e.g.…”

“…With a higher number of trainees being recruited, the demographic of candidates has broadened since the inception of IAPT, as practitioners move from professional backgrounds such as clinical psychology, mental health nursing, social work, occupational therapy, counselling and non-‘core professions’ such as Psychological Wellbeing Practitioner (PWP; Liness et al ., 2019). The demands of transitioning to CBT have been described in a comedic fashion as ‘cognitive therapy training stress disorder’ (Worthless et al ., 2002), yet the process is hypothesised to invoke a range of schematic, interpersonal, intrapersonal, emotional and contextual challenges (Robinson et al ., 2012; Roscoe et al ., 2022; Wilcockson, 2020; Wilcockson, 2022; Wolff and Auckenthaler, 2014). For example, high-intensity CBT training is often high-intensity by name and by nature, typically consisting of a three day per week placement, workplace and university-based supervision, written assignments and audio or video assessment of therapeutic skills (Owen et al ., 2021).…”

CBTsupervision behind closed doors: Supervisor and supervisee reflections on their expectations and use of clinical supervision

“…In addition, IAPT recruited health professionals from a wide range of backgrounds including social work, mental health nursing, occupational therapy, clinical psychology and psychological wellbeing practitioners. Previous research suggests there are likely to be challenges related to this role transition (Robinson et al, 2012;Roscoe et al, 2022;Wilcockson, 2020Wilcockson, , 2022, as each enters training with different experiences. This is likely to include different supervision structures that could influence their expectations of what they believe the role entails (Johnston & Milne, 2012;Liness et al, 2019).…”