John Swan

Complexity and collaboration in routine practice of CBT: What doesn't work with whom and how might it work better?

There is compelling evidence from specialist research centres for the efficacy of cognitive-behavioural therapy (CBT) with a variety of psychiatric disorders but effectiveness in routine clinical practice has yet to be established. The complex tasks confronting those generalist practitioners who see a broad range of referrals are analysed in terms of the breadth of treatable disorders, the variable nature of patient characteristics and the pressures of work. This analysis suggests that effectiveness and efficiency in routine practice of CBT will be compromised unless therapists work in small teams and adopt some of the rigours and objectivity of the research context. In particular, it is suggested that clinical practice should include routine assessment of complexity and severity of problems at a screening interview and quality of collaboration after a trial period of treatment. Therapy for those cases with high complexity and poor collaboration should incorporate peer-aided clinical supervision and periodic review.

A SURVEY OF PSYCHIATRISTS COMPLETING A COGNITIVE BEHAVIOURAL PSYCHOTHERAPY DIPLOMA COURSE

There is widespread support for training in Cognitive Behavioural Psychotherapy (CBP) amongst psychiatrists and from the Royal College of Psychiatrists. One possible way to gain such training is to undertake a diploma or certificate course, a growing number of which exist in the United Kingdom. We report on a postal questionnaire survey of psychiatrists who have completed a CBP diploma course. Psychiatrists described the course as altering their clinical practice and found the skills learned, the format of multidisciplinary learning and of supervision all useful and helpful. However, individuals who undertook a CBP diploma were concerned about their ability to apply these skills and undergo further training, given the time constraints within busy consultant jobs.

An Introduction to the Art and Science of Cognitive Behavioural Psychotherapy

This chapter focuses on the theory and practice of cognitive behavioural theory (CBT) and psychotherapy, and it begins by exploring the empirical foundation of CBT. Following this the authors describe and consider key methods and techniques used commonly by CB therapists or P/MH nurses who wish to use CBT skills and interventions, namely, the therapeutic relationship, assessment strategies, case conceptualisation, structure, cognitive techniques and behavioural interventions. The chapter also considers competence in CBT and how to develop competence before reminding readers of the necessity and value of engaging in clinical supervision. Finally, the authors speak to how P/MH nurses can use CBT skills and techniques in a variety of mental health settings. They conclude that P/MH nursing curricula in the Occidental world invariably include material and experience of CBT skills, theory and techniques, and mental health service users overwhelmingly state their desire for more ‘talk therapy’. Accordingly, while P/MH nurses might not necessarily use all the skills, techniques and interventions captured in this chapter, there is a broad consensus in the relevant theoretical, clinical, empirical and policy literature that P/MH nurses in various settings can and should consider the more widespread use of CBT skills—even though the authors acknowledge that this is not without challenges and the need for some adaptation.