Topic 10: CBT Competence & Myths {by 12/7}

There are two short readings due this week (J. Beck – 1 Chapter; Wright et al. – 1 Chapter).  For this discussion, share at least two main thoughts: (1) Once you graduate from Assumption College with your degree (and later get licensed) what can you do to maintain and improve your competence as a cognitive-behavioral therapist? (2) Name at least one CBT stereotype/myth/criticism you have heard from other people/professionals. What are your thoughts when you hear such comments? Your original post should be posted by the beginning of class 12/7. Have your two replies posted no later than 12/9.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

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38 Comments (+add yours?)

  1. Liisa Biltcliffe
    Dec 04, 2017 @ 16:30:21

    1. One way to maintain and improve my competence as a cognitive-behavioral therapist is to attend workshops and lectures on various topics regarding CBT. Joining certain reputable organizations such as ACT would help keep me up to date on what is out there and keep me connected to CBT publications. Always learning, always keeping my ears open, practicing on myself a bit (i.e. utilizing some of the worksheets) so that I have an idea of what clients experience…these are all ways to maintain and improve my competence as a cognitive-behavioral therapist. In addition, I think that keeping in contact with professional colleagues could help as well because they may know of workshops or lectures and also they can provide feedback as to certain situations if necessary.
    2. One criticism I heard recently is that CBT is “too short” for some clients; the amount of session allotted in other words. My response to that was that some clients do need a bit longer, such as those who have a personality disorder, schizophrenia, or bipolar disorder, and that CBT does allow for that. But in general, for people who have Major Depressive Disorder or an anxiety disorder the short timeframe works out well. Besides I think that for some people, they don’t necessarily think in terms of being independent of a therapist, of learning what they need in order to do these techniques on their own. That is one of the main goals of CBT, is to teach to clients to be able to do these techniques themselves, to help them feel a sense of self-efficacy. The other criticism I have heard is that CBT therapists lack empathy or are “cold,” which I don’t really understand because as a therapist, you need to have empathy in order to build that therapeutic alliance/relationship.

    Reply

    • Stephanie Welch
      Dec 05, 2017 @ 15:21:20

      Liisa,
      I think for the “cold” comment of CBT therapist, the person may be talking about therapist being more of an expert than a friend. Some clients expect a therapist to be his or her friend, some are looking for the professional aspect, and some clients just don’t want to be in therapy so they want the therapist to do all the work. Also, some places have rules for physical contact. A therapist that refrains from hugging or a pat on the back may be considered cold but are really trying to maintain that therapeutic boundary with the client.

      Reply

    • Chiara Nottie
      Dec 07, 2017 @ 11:06:39

      Hi Liisa,
      I also think workshops and lectures will be a great way to maintain and learn skills regarding CBT after we graduate. I thought about subscribing to popular psychology publications would be a good way to maintain knowledge as well, but I like your similar idea of joining a reputable organization such as ACT. I’ve also heard people assume CBT is too short. I can understand how people avoid CBT if they think it is too short of a process. I think as a new generation of CBT counselors we should try to advertise CBT more, to make sure people know how flexible CBT can be in regards to session amount.

      Reply

  2. Julie Crantz
    Dec 05, 2017 @ 18:31:43

    1) One of the ways in which I can maintain and improve my competence as a cognitive-behavioral therapist is to join a professional organization, such as the Association for Behavioral and Cognitive Therapies or the Academy of Cognitive Therapy. I will plan on attending professional conferences and workshops sponsored by the professional organizations to further enhance my knowledge of CBT and to network with other professionals practicing CBT. Continuing education will be an important part of my future as a cognitive-behavioral therapist. Attending workshops hosted by Assumption College will be very helpful for advancing my skills as a cognitive-behavioral therapist. I also hope to meet with my colleagues on a regular basis to share best practices and to receive feedback and support on my more challenging client cases.
    2) One of the criticisms I have heard about CBT is regarding the homework assignments that are tasked to clients to complete outside of therapy sessions and whether or not homework is necessary. Certain clients may not have the desire or drive to complete the homework, they may not be adept at writing, they may not have the cognitive competence to complete homework, and they may view homework as a burden. Although some of these challenges may hold some truth, there are solutions for overcoming all of them. Homework assignments are an absolute necessity for CBT and the time spent on them is completely worthwhile. Homework enhances CBT and is vital to help a client learn adaptive coping skills and to ultimately become his or her own therapist. Practicing techniques outside of session via homework assignments is key and although I can understand the criticism, it is easy to refute it and support the need for homework in CBT.

    Reply

    • Olivia Grella
      Dec 07, 2017 @ 11:12:19

      Hi Julie, I like how you touched upon how receiving feedback is important to staying a competent cognitive-behavioral therapist. Receiving feedback can be very beneficial because it’s helping you notice some areas that you may need to work on a little better than others. It could also be difficult to realize those things by yourself at times. So I think seeing feedback as something positive, rather than viewing it as someone being overly critical, is very beneficial to remaining a competent therapist.

      Reply

  3. Stephanie Welch
    Dec 05, 2017 @ 21:05:29

    1) Once I graduate from Assumption College with my degree, I can monitor my own automatic thoughts, take continuing education classes, and consult with my colleagues to maintain and improve my competence as a cognitive-behavioral therapist. Monitoring personal automatic thoughts improves competence by allowing the therapist to recognize his or her thoughts about a client or the progress of the therapy sessions. It is always good to keep yourself healthy and address thoughts and feelings before it affects the client, therapeutic relationship, and/or leads to burnout. Taking some continuing education classes benefits the competency of CBT because it keeps the therapist up to due on new CBT techniques. It also lets the therapist learn about something that he or she may not know about such as the treatment of OCD. Consulting with colleagues will allow me seek advice about any potential problems with clients and can be useful in making decisions regarding clients. Perhaps something is not working for a client and a colleague has an idea of something to try instead. The colleague may recognize when there is not a good therapeutic fit and the client will benefit from a referral to another therapist.
    2) I am going to actually make this broader because I have not heard any specific stereotype/myth/criticism about CBT. So I will instead use a statement that I have heard throughout my life from other people: “Only crazy people seek out therapy and if you go to a therapist, it must mean that you are crazy.” My thought when I hear such comments is that I wonder why people assume such things. Perhaps it is because they have not had therapy themselves. My other thought is why do people think you have to be crazy. The reasons for therapy are so much broader than mental illness. What if you just need some help or advice or have existential questions. Maybe the person needs to think about some decisions or life changes such as career counseling. Maybe someone is having at a horrible point in their lives and needs someone to listen to them. Furthermore, mental illness does not mean that you are crazy. When other people think of mental illness, I think that they tend to view it to the extreme. I think that the media can influence other people thoughts regarding therapy in general because the media gives a negative portrayal of mental illness as the extreme end of an individual having hallucinations and delusions compelling them to commit crimes.

    Reply

    • Olivia Grella
      Dec 07, 2017 @ 11:18:09

      Hi Stephanie, I really appreciate how you brought up the topic that “only people who are crazy get treatment.” I think this is something that people say a lot because seeking therapy is highly stigmatized, like you mentioned. I feel like it is very difficult to stop this from happening though, especially when media often portrays mental illness and therapy as something negative or they only show one extreme or the other. I think this is something that we will have to face when we begin practicing because some clients are going to come in with those thoughts and be very resistant to treatment or be feared of being labeled this way which could hinder their progress in therapy as well.

      Reply

    • Shay Young
      Dec 09, 2017 @ 13:41:38

      Steph, interestingly enough I have heard the same comment. I think a lot of people are under the impression that to be a therapist or to be in the mental health field in general, that you must have some sort of personal issues yourself. People make that assumption for whatever reason. I’m not sure where it stems from. Maybe they assume that therapist study mental health so that they can apply their learnings to themselves. Even if they do apply what they learn to themselves, as long as they can be effective at their job and are for the most part psychologically well, who cares. We all have automatic thoughts and core beliefs, its natural. I remember I worked at friendly’s for a bit, before college. I told my boss I was going to school for psychology. His response was, “I don’t know, you’re not crazy enough.” I remember thinking how absurd of a statement that way, so absurd that it stuck with me. It’s a really odd assumption, that even today I’m not sure what to make of it.

      Reply

  4. Matthew Collin
    Dec 06, 2017 @ 11:56:27

    1.) One thing I can do once I graduate to maintain my competence as a CBT therapist is to first keep up with the current research, and learn how to integrate new techniques and skills that are empirically supported to treat a specific set of symptoms, or something I should include in everyday CBT practice. I find this to be extremely important. I hope I work for an organization that values this type of continuing education for their therapists. I fear that I’ll fall, behind on research simply because of access to that information. I will no longer be affiliated with an institution, which makes it hard to gather and collect updated research.
    Another important thought I want to keep in mind is my ability to keep calm and maintain confidence in my skills as a therapist. Working at the emergency mental health department at UMass memorial, I’ve learned a lot of de-escalation techniques to try to keep people calm. Although, this does not work in most cases, I have integrated skills like validating how frustrated and irritable a patient is, and have had some confidence at asking particular CBT questions in order for them to direct focus on what they’re thinking, rather than the dehumanization process of going through a sectioned mental health screening. Sometimes it’s hard when someone is calling you names, and every derogatory term they can conjure up, but it’s so important to maintain confidence and calmness. Otherwise, from what I have experienced, if you do not do this, someone escalates into someone who doesn’t want to listen to what you have to say, or sees you as a confidant in their suffering.
    The final thing I really want to take away with me wherever I conduct therapy is that I must keep in mind that most human suffering is not always (and most of the time it isn’t) an innate suffering. We tend to think that people behave in ways that are innately part of them, but when you dig deeper, and analyze their environments, it’s clear that other human beings, social constructs, and prejudice have caused the suffering to be inflicted upon them. I believe Dr. Victor Frankl and a few others said that we like to think prejudice and inflictors of suffering as only being capable of the immoral, but we need to realize how our own actions cause suffering and pain on others. I intend to make a conscious effort to realize this as I am interacting with clients in order to promote the best possible outcome for them.

    2.) A myth I have heard about CBT is that it lends itself to not form great therapeutic alliances with patients. I use to believe this, simply because I met a lot of CBT therapists who took it too much in the direction of a scientist, instead of a therapist. The therapy seemed too rigid, awkward, and not validating feelings. It was almost like I was seeing someone plugging and playing thoughts in behaviors into an equation.
    After reanalyzing my thoughts, it wasn’t CBT, but it was the individual conducting the CBT that made it awkward, and untheraputic. CBT actually lends itself into forming a better relationship that most other therapies. This is simply because you involve the client in his/her therapy rather than being this all knowing magician who is the only one who can accurately analyze his/her thoughts and behaviors. It’s important to include basic Rogerian techniques in order to make good therapy, and to create a strong therapeutic alliance. This, included with CBT, I know find to be one of the best ways at forming productive relationships with clients.

    Reply

    • Julie Crantz
      Dec 07, 2017 @ 12:24:07

      Hi Matt, I can understand why some people might think that CBT doesn’t allow for the formation of a positive therapeutic relationship between therapist and clients. They may focus on the science of it all, but there is much more to it. One of the aspects of CBT I am most impressed by is that it fully supports the creation of a positive therapeutic alliance and the therapist and client work together as a team. That in itself is a valuable skill that helps in all areas of life for clients. Team work is essential in the workplace, in families, with significant others, etc. I really appreciate how we will engage our future clients in the process and empower them to be part of treatment.

      Reply

    • Liisa Biltcliffe
      Dec 09, 2017 @ 15:56:27

      Matt, I agree with your comment about how individual it is regarding the therapeutic alliance, that it depends on the person/therapist and the fit between therapist and client. It’s not really the “technique” (CBT) itself, but rather the fit. I think it can be easy, too, to just blame one thing or another when actually it is a combination of things (such as the therapist’s style and the client’s temperament, etc.).

      Reply

  5. Olivia Grella
    Dec 06, 2017 @ 12:47:20

    There are many ways in order to maintain and improve my competence as a cognitive-behavioral therapist. One way is to attend workshops and lectures that are given be certain groups that go over and review CBT skills. This will allow me to learn from others and also stay updated as to what might be new in the CBT field. It can also help review some of the areas in CBT that I don’t utilize as often as others. Also, just keeping updated with the current CBT research will help maintain and improve my competence as a cognitive-behavioral therapist. Staying updated on newer and more effective treatments will help me to become a better therapist because it allows me to make changes as evidence shows otherwise. I also think that it is important for me to stay in check with my own mental health. The chapters this week mentioned doing some of the assignments we give to clients ourselves to help us not only be familiar with them, but to also help us monitor how we are doing. I think that being away of my own automatic thoughts and such will help me do more effective therapy. This way I would not let my own personal difficulties interfere with what was happening in session with a client.

    One criticism that I heard about CBT is that it is too strict and rigid in its practice so that it doesn’t allow us to be flexible to anything that goes against those guidelines. Basically stating that cognitive-behavioral therapists are very mechanical in therapy. My thoughts on this is that it is completely untrue. I do believe that CBT has a lot more guidelines than some other orientations, but there is still room to be flexible and creative within session. Although we may all follow similar guidelines, no two therapists who do CBT will do it the same. Also, CBT will not be the same for each client because that client is also bringing in their own personal factors that will change the flow of treatment. So I do not believe that this criticism is true about CBT at all.

    Reply

    • Julie Crantz
      Dec 07, 2017 @ 12:04:22

      Hi Olivia, You make a great point about staying current with CBT research. It will be very helpful to keep updated on latest research on treatments that are empirically shown to be effective. I especially appreciate when you mention keeping one’s own mental health in check. It is difficult to help others when we do not help ourselves. It is vital for us to be mentally healthy and to ask for help when we are going through our own struggles. Plus, sitting in the client’s chair offers us an important perspective of what it is like to be treated by a CBT therapist. And, practicing CBT techniques on ourselves is not only beneficial for our own mental health, but also offers significant insight into what our clients may experience during homework assignments and what challenges they may face.

      Reply

  6. Chiara Nottie
    Dec 06, 2017 @ 14:25:16

    1. After I graduate from Assumption College and later get my license there are few things I can do to maintain and improve my competence as a cognitive behavioral therapist. I can first learn from supervision of a more experienced CBT therapist during my beginning attends at therapy. I can continue to attend workshops related to CBT concepts, to learn from experts of a particular therapeutic approach to certain disorders. I think workshops are a great way to maintain skills as a therapist because they are like academic lectures, which can refresh my memory about certain topics, or introduce new information to me. I can stay aware of latest research by subscribing to psychology publications. I think continuing to read about the professional field will, similar to the workshops, keep information fresh in my mind. I can also test my skills and knowledge by comparing how well I do something, for example a case formulation, compared to AADPRT standards.
    2. My neighbor is a counselor who works with clients who have been sexually assaulted. I told her the program I was in was based around CBT. She was kind but not too impressed with CBT and seemed to prefer other approaches better, such as DBT. She ultimately just did not think CBT does enough. I was taken aback that a professional who has been working in the mental health field for a while, particularly with crisis interventions, did not seem more knowledgeable about CBT. I assume with counseling clients who have been sexually assaulted a lot of CBT techniques would be implemented since CBT therapy is a choice of therapy recommended for PTSD (not necessarily preferred but still). I don’t believe she utilizes DBT as her standard therapeutic orientation, but it was nonsense for her to approve of DBT and not CBT since they share so much in common. In fact, they are very similar except for a few aspects regarding specific types of homework utilized in DBT, such as a diary card. Also CBT is very versatile and allows clients to work on issues outside of therapy sessions, with homework assignments, and goals. I am glad I have learned about other therapeutic orientations from this program because I now know what conditions some orientations are best suited for compared to others, and how popular orientations, such as CBT, DBT, IPT, etc. overall compare to each other empirically.

    Reply

    • Liisa Biltcliffe
      Dec 09, 2017 @ 16:01:09

      Chiara, that’s really interesting about your neighbor being so blasé about CBT when she says she utilizes DBT, because as you stated DBT is based in CBT. I have actually heard someone else say something similar and it just does not make any sense to me. If a person really knows DBT, then he or she should know it is derived from CBT. It is just weird to me.

      Reply

    • Sarah Hine
      Dec 09, 2017 @ 16:07:49

      Chiara,
      First, I wanted to say I like your idea of continuing to test therapeutic skills. Even when we become more experienced therapists, it is important to see how our work matches up to standards of the field. Second, I think your neighbor’s reaction to CBT is similar to others’ reactions who work with specific populations or disorders. When people work with specific disorders such as sexual assault, substance abuse, family therapy etc., some might assume CBT would not work because it is not flexible enough to adjust to treating disorders other than depression. I would agree with your reaction to her comment. I think CBT can certainly be adjusted to work with client who have been sexually assaulted, and I think the structure and homework would be really helpful in ensuring that goals are being met and treatment is progressing in tangible ways.

      Reply

  7. Alana Kearney
    Dec 06, 2017 @ 18:37:31

    There are many ways to maintain and/or improve one’s own competence as a CBT therapist. After our years at Assumption, I intend to attend various workshops, lectures, and conventions that will be offered in the field. These meetings offer many benefits to all therapists. For starters, they will allow me to keep updated on the most recent research and developments within cognitive behavioral therapy. As we know, CBT is empirically based, which is proven by the vast amount of research that is constantly being done in the field. It is important as therapists to stay on top of the most recent developments in order to incorporate new skills into therapy that have been shown to be particularly beneficial to clients. In addition, these conventions and workshops will introduce me to various other therapists in our field. I intend to learn from the advice from others, engage in thoughtful conversations, and collaborate with others who share our same passion for CBT.
    I once talked to a friend who was seeking a counselor for depression and I suggested finding a therapist who focuses on CBT, but she believed they wouldn’t be able to help her. She thought it was a rigid approach that just seeks to shift negative thoughts into positive ones. However, as we all have learned, CBT is much more than that. It seeks to challenge core beliefs and automatic thoughts in order to help the client see their lives in a more realistic light. CBT helps clients consider more perspectives in order to explore more flexible ways of thinking. When I hear comments like this, I get very defensive because I believe and know that CBT is useful for a variety of disorders and has been proven effective in treating depression.

    Reply

    • Venessa Wiafe
      Dec 09, 2017 @ 00:27:47

      Hi Alana,

      I really like how you touched upon wanting to attend workshops, conventions, and lectures to keep yourself updated on the most recent information involved in CBT. It is indeed important to stay updated, and as future therapists, I believe that we should definitely take the initiate to make sure we utilize the various resources we have at our disposal to make sure that is done. I also believe that attending workshops will shed light on new and different techniques that we can utilize as therapists during sessions with clients. Every client is different and like Dr. V. stated during his lecture in class on Thursday, therapists shouldn’t use the same approach for each client. I think workshops will definitely expand our knowledge and help us acknowledge different ways to help each and every one of our clients in the best way possible that’s suitable for them.

      Reply

  8. shay
    Dec 06, 2017 @ 23:21:32

    1} Once graduated from assumption with my degree, there are still ways in which I can maintain and improve competence as a CBT therapist. One way is to stay educated. Even though the schooling may be other with, and there are still resources available that one could use to educate themselves. There are academic journals and educational books. Dr. V’s book will be out soon for purchase. There are psychology conferences and seminars one could attend if they have the right connections. I am a part of Connecticut’s Psychological Association and through that I have been able to attend some pretty informative and awesome seminars and workshops. These workshops are run by counselors, psychologist, psychiatrists, and mental health counselors who have Phd’s and are more than competent. Staying active in the psychology community can help one stay knowledgeable and updated with new research, new techniques or any other skills that may be beneficial in practice.
    We could also continue to practice the skills on ourselves such as the Behavioral experimentation worksheet, the automatic thoughts worksheet, or the downward arrow technique etc. Those are skills that we can still use long after we graduate. Practicing these worksheets on ourselves may help in explaining them to our clients, as well as maintain our competence, familiarity and knowledge. Saving notes, important class handouts and as well as buying the more important textbooks can always be used as references in case something is forgotten or a clinician needs a touchup on certain areas.
    (2) I honestly haven’t heard any criticism or negative/ positive talk about CBT. Most people don’t entirely know what it is, so I always have to describe it. I have however heard some general myths about therapy in general, so ill share those instead. I have heard that in therapy clients just sit on a couch and talk aimlessly. I think this is derived from early psychoanalytic therapy where the client would just partake in free association and go on and on with little input from the clinician. A lot of therapy offices today don’t even have couches. When I hear this comment I usually assume the person is a little ignorant on the matter. It is not necessarily a bad thing, and just means they are not in the field or they may have never had therapy. Also whenever I say I am a psychology student, often times people make a comment and ask if I’m going to start analyzing them now. At first I didn’t mind this comment, but now it has become more and more annoying. It really implies that psychologists have nothing else to do but analyze the mundane. I have started saying something along the lines of “no in this particular moments there’s nothing to analyze.” Or “we analyze problematic behaviors.” Sometimes I feel like people don’t entirely know what to say regarding psychology so they just try to make conversation anyway they can. I think that CBT probably has a lot of myths associated with it, but so does psychology and therapy as a whole.

    Reply

    • Noella Teylan-Cashman
      Dec 07, 2017 @ 01:27:48

      Shay,

      I 100% relate to your frustration – whenever I told people I was a psych major, they would reply, “Oh, so you’re diagnosing me right now, huh,” or sometimes, “oh so you’re reading my mind” (uhhhh no? since when does therapist = mindreader? Obviously this person is confused).

      I also wrote about the common misconception about the psychoanalytic therapy in my post! Many people think that’s all that therapy is and have no idea that there are so many other (superior) treatment modalities that are empirically based. It can be extremely discouraging to talk to people about the profession of psychology, because you realize how much they don’t actually know. I hope that we can change this in the near future so that more people can be knowledgeable about the benefits of therapy.

      Reply

      • Shay Young
        Dec 09, 2017 @ 14:08:37

        Noella that’s so funny! I have heard those two exact same comments being the diagnosing and mindreader comments. It is a bit ridiculous. I also don’t understand the mindreader comment either. Its baffling what people assume or how therapy has been so misconstrued. I’m glad you can understand the frustration. I also agree with your hopes for the future. Relevant to what Dr. V said in class, I hope that we can get to place where psychology is more respected and that we can weed out some of the incompetent therapists who are ruining the reputation and validity of the field.

        Reply

    • Chiara Nottie
      Dec 07, 2017 @ 11:18:13

      Hi Shay,
      I think a lot of us understand the importance of remaining educated after we graduate to maintain our skills in CBT, which is a good sign! It is reassuring to have publications by professionals we know and trust available to read. I’m glad you haven’t heard much criticism about CBT. I have not heard many myths or critics either. I also have not heard much positive commentary about CBT either. I think even though I have not heard too much criticism towards CBT it is still concerning that I have not heard much praise either. I assume this means most people maybe unaware of CBT all together, which is not great. I find it helpful to correct people’s misconceptions about CBT but it is hard to know who does and does not know about CBT.

      Reply

    • Alana Kearney
      Dec 08, 2017 @ 13:51:55

      Hey Shay!
      I think we all can relate to your comment on how psychology majors are viewed to the world. When we were given the second prompt question for this week’s blog, I turned to both my parents and a few friends around and I asked “what myths have you heard about CBT?” and one friend responded with “what’s CBT?” and my parents said “only what you’ve told us.” It really is a shame how little people actually know about what happens in therapy because just hearing the basics of CBT as an undergrad made me reconsider my whole career. It seemed very structured and planned out, but moreover it seemed like it actually worked for so many people. I once had another psychology major in undergrad tell me she wouldn’t take classes on topics like CBT because they were “hippie dippy” psychology classes. The only way people will truly understand how beneficial our field is is by speaking out for what we know is true.

      Reply

  9. Luke Dery
    Dec 06, 2017 @ 23:54:51

    1. There seem to be so many methods of improving as a therapist, it can be overwhelming to know what does and doesn’t work. I’ve been to a handful of CE workshops, many of which I found helpful as a beginning therapist. However, while the generalized knowledge was good as a new learner, I couldn’t see it being helpful 5-10 years down the line in my career. I did find CE’s to be helpful for learning new general information or general techniques. I was recently reading an article about Common Factors, which is a process in which psychologists look at various techniques and components across different orientations/styles of therapy to determine which of these factors typically lead to better client outcomes. I read into this topic more, and I figured I’d share in this post some information people who study common factors have found in their research related to becoming a more effective therapist. One important factor was engaging in deliberate practice of therapy skills. What this means is actually practicing skills outside of sessions and making improvements. They noted that therapists who have the best client outcomes in the first 8 years of therapy do this SEVEN TIMES more than their peers. They discussed some methods of training in which therapists are played videos and have to generate the best response within a minuscule time frame. For example, the video may have a person saying, “I feel like there’s no reason to live,” and the therapist has to think of a good response quickly, then reviews their responses and brainstorms better ones with supervisors. This also aids in developing contextualized knowledge so that cookie-cutter responses instead become tailored to situations, tone, body language, etc. Also, making major mistakes in a practice setting is much better than making them in a real-life scenario. Therefore, just as we assist our clients in practice, planning, performance, and reflection during interventions (such as exposure activities), we as therapists need to undergo the same process with our work. I found this to make a lot of sense based on my past experience performing music. Learning doesn’t occur during the performance (the therapy session). Learning occurs in the practice and planning, the observation of mistakes throughout the performance, and then the reflection on those mistakes afterwards. Another important focus for continuing to improve would be to find ways to evaluate my deficits and work to improve on them. I’m interested in learning more about tools to measure therapy outcomes to help analyze my own work and make improvements. Part of this involves seeking out supervision and also finding others in the field whose work I can model or use as a guide for my own. I think it’s important to look for mentors, especially in your own orientation, understand their own strengths and weaknesses, and utilize them as a resource to aid growth. Overall, I believe that the way to maintain and improve skills is to find new sources of knowledge (whether it be books or research) and be open to learning new things about a field that is diverse and growing.

    2. The main criticism I’ve heard about CBT is that is too “cookie-cutter.” I think that if you look at CBT from the outside, it can seem that way due to the structure. But having learned more about it, I don’t agree. CBT has a plethora of interventions and techniques to be used to tailor to the individual client. Additionally, having planned interventions doesn’t remove the human aspect out of CBT. If the CBT therapist is dry, boring, and emotionless, he or she would most likely be that way using any orientation. Research continuously shows that the therapeutic relationship is the most telling factor as far as creating positive outcomes, and CBT doesn’t rob that from the therapist and client. The cognitive model is easy to understand, and you can really take the work in whatever direction you need. Maybe I’m biased because I generally like structure and planning, but I find these attributes to be what this field needs. The field itself seems to be moving towards an emphasis on results and outcomes, so I believe that orientations like CBT that provide generally better outcomes and teach people sustainable skills will be essential in the future. Furthermore, I want to use techniques that are actually proven to help clients, as I’d rather trust a wealth of research over my own personal feelings.

    Reply

    • Liisa Biltcliffe
      Dec 09, 2017 @ 16:10:18

      Luke, what you say here is a bit similar to what Matt says in that it is quite individual as to how CBT works with clients. In other words, the therapeutic alliance is so important. When I was looking for a program to enroll in, I gravitated towards Assumption because of the CBT program, however, there was a part of me that was hesitant because of how “rigid” I had heard CBT was. I am learning that that is not the case at all, like you said. There is plenty of room for individualism and creativity, while at the same time it is empirically supported. Being in this program has made me realize that CBT is versatile and flexible as well as getting results.

      Reply

      • Matthew Collin
        Dec 09, 2017 @ 17:47:54

        Hi Liisa,
        I was also pretty hesitant to go towards CBT for how “rigid” it seemed to be. I was introduced to CBT via unified protocol, which is essentially an itinerary that the therapist has to follow each session, regardless of what the client is experiencing in that moment in therapy. It kind of threw me off. Luckily, I stuck with it, and received more information on exactly how therapy works in the real world, rather than just research and academic settings.

        Reply

  10. Noella Teylan-Cashman
    Dec 07, 2017 @ 01:20:58

    After earning my Master’s from Assumption, I look forward to starting my career as a beginning therapist. As many others have stated, it is important to stay up-to-date on current techniques and practices. Many agencies offer regular trainings for their staff members in order to help expand their knowledge and skill levels. I hope to seek out an environment like this so I can continue to learn and become the best therapist I can be. Additionally, I think it is important for therapists to be aware of the emerging research in the field (especially regarding the disorders they treat); reviewing research findings can lead to a better understanding of the symptomology and etiology of the disorder(s). I also think that regular supervision, or even staff meetings can be extremely helpful. By meeting with a supervisor (something we will have to do a lot of before we can get licensed!), you are able to ask any questions you may have and brainstorm ideas with someone who is more experienced than you in the field. Staff meetings with colleagues are also beneficial; it is interesting to see professionals in the same field come from very different backgrounds (i.e. age, schooling, area of expertise, etc.). Gathering a room full of people who are so different can generate some extremely thought-provoking conversations. I believe a combination of all the things listed above (among other things I’m sure I forgot) ensure the competency of a practicing therapist.

    As for CBT myths- many people are unaware of what CBT is, so they cannot have an opinion on the matter. I have found that laypeople often are very uneducated regarding the topic of mental health and the process of therapy. Many people’s conception of therapy is the stereotypical Freudian approach– i.e. “Come visit my office, lay on a couch, and tell me what you see in this ink blot” (*Insert aggressive eye roll*). I think as a field, we should aim to spread more awareness of the value CBT has as a practice, and diffuse as many myths as we can about therapy in efforts to break the stigma.

    I have also heard people say “Oh, I thought CBT only worked for depression” – how untrue!

    Reply

    • Alana Kearney
      Dec 08, 2017 @ 13:39:18

      Hey Noella,
      I enjoyed your first comment that you further discussed last night in class. I think it’s especially important to always be able to have a staff on which you can rely. As we each grow individually in the field, it will be important to realize that even though we may be improving, there is always more that can be improved. In other words, it would be wise for us to realize that we do not have all the answers and, therefore, we have no reason to pretend that we do. There is always something to learn from people, especially people we will be working with who come from different educational backgrounds. Keeping an open and willing mind will only help us move closer to that competency we so seek.

      Reply

    • Luke Dery
      Dec 08, 2017 @ 17:15:44

      Noella,

      I agree that the public knowledge of therapy is very limited. Unless they’ve worked in the field or have experiences with therapy, most people don’t really know much except what they see therapists do in movies and the classic stereotypes (“tell me how you feel”). A lot of people don’t understand the different roles in the field (psychiatrist, psychologist, master’s level therapist). I had a close friend tell me about how he was upset that the psychiatrist he met with only met with him for 10 minutes and tried to give him meds, when he actually wanted to talk about his problems for a full session. He didn’t know that there were different roles within mental health treatment. I was talking to another friend about a few months ago about what I do at work, and he said, “Oh really? I thought you just talked about their day and stuff.” It’s frustrating because this distorted knowledge probably keeps people from going to therapy in the first place. But as we discussed in class, we represent the view of this profession, and some therapists actually do the stereotypical behaviors. Just in my brief experience, I’ve met some scary “therapists.” I interned in undergrad with a girl who said, “It’s necessary for me to cry if the client cries.” Recently, a client of mind said he liked our work together because I “let him talk,” and his last counselor at another program would just lecture him for 45 minutes every session. Our field needs a lot of work, and like you said, we have to stick to good methods throughout our careers.

      Reply

    • Matthew Collin
      Dec 09, 2017 @ 17:44:29

      Hi Noella,

      I wanted to comment on the point you made about how the general public views therapy as being very Freudian. I think a lot of it has to do with how therapy is presented in media, but I also think people want to think that there is some mystical expertise and magic to therapy. When I explain CBT to people, it’s almost as if they could have intuitively figured out things like desensitization, habituation, and how thoughts feelings and emotions are all interrelated. With Freudian theories of psychopathology, there is a provocative notion to it, along with the therapist being the only expert to decrypt behavioral messages.

      Reply

  11. Sarah Hine
    Dec 07, 2017 @ 07:31:25

    In order to maintain and improve my competence as a cognitive-behavioral therapist, it is important to continue educating and training. This is especially important if I come into contact with new or particularly challenging situations in therapy. Education also serves as a way to strengthen current skills and establish new ones. Continual education also involves staying up to date on current research and new techniques and assessments. It is important to continue using effective methods with clients to ensure that they are receiving the best treatment. Next, I can continue to be mindful of my own thoughts and emotions while working with clients, continuing to relate the methods and principles of CBT that I teach clients to my own life. Establishing connections with colleagues and other therapists will be helpful in providing consultation and advice. Additionally, a strong support system at work is important for emotional support in a job that can be challenging. Lastly, I will need to engage in self-care if I expect to be an effective therapist. It is important to remain healthy in order to prevent letting personal problems interfere with clients’ treatment and in order to prevent burning out.

    I have heard that CBT is too “formal” and that it doesn’t allow for flexibility or personal style in therapy. While CBT is certainly organized and has guidelines for the flow of therapy, I think these serve as helpful methods that make therapy more effective. As we have learned in this class, structure ensures that goals are prioritized and worked on throughout the course of therapy. CBT also seems to provide a lot of flexibility, and therapists can adjust their approach based on personal style and specific client needs. There is not a set outline that has to be followed for every session, and I have actually been surprised at the amount of techniques and options that CBT practitioners have access to. I have also come to realize that the structure of CBT in no way limits the importance of the therapeutic relationship, another criticism I have hear about CBT. Developing rapport is a key component to CBT.

    Reply

    • Noella Teylan-Cashman
      Dec 08, 2017 @ 03:23:26

      Sarah,

      I really like how you mentioned the importance of having a strong support system at work — I think this makes all the difference, especially for beginning therapists! The best way for us to grow is to be surrounded by knowledgeable and supportive colleagues/supervisors. I also think that having a strong support system at home is extremely important for competent therapists. Given that our line of work is emotionally draining, we need a strong home-base that allows us to decompress and engage in some of that self-care you also talked about! We need to remember to take care of ourselves as well (and not just other people!), which can be easier said than done at times. Therapists who neglect to do this will find themselves fatigued and burnt out sooner rather than later. We need to remember that we are of no help to our clients if we don’t take care of ourselves before providing therapy to them. As Dr. V said in class today, we have to practice what we preach!

      Reply

  12. Luke Gustavson
    Dec 07, 2017 @ 11:04:00

    1. From what I have seen, no graduate program is all-encompassing. There is no such thing as a degree that can teach a graduate anything with a degree of reliability. Therefore, it is upon the individual to ensure the information they have is practicable and modern. I fully intend to do what I have always done: read. Staying up-to-date on evidence-based psychotherapies like CBT almost requires paying attention to the new research coming out. This will ensure my practice is in line with the evidence, and that is the point.
    Similarly, it appears easy to lose one’s way when practicing within a bubble. Practicing solo is a plan of mine, and this means that I would need to be careful about making therapeutic decisions that could be difficult. I believe agency psychotherapists might have an edge, here: colleagues surround them. They are awash in psychotherapy. Now, this could certainly act against them as not all psychotherapy is good, but the ability to talk with others about psychotherapy on a meta level appears to me to be a beneficial thing. As a result, I think it is a good thing to consider group supervision of some kind. Remaining in contact with other psychotherapists with other specialties and ideas can keep the mind from rusting over.
    2. Perhaps my favorite CBT myth that I have heard is one that seems, at least on the surface, to bear some level of truth. Notably, that CBT is a cookie-cutter approach that does not allow the psychotherapist to tailor their approach to their client. On the surface, this does not sound unreasonable. After all, CBT does have a lot of research surrounding it that by and large dictates generally how a specific disorder should be treated. However, this does not make sense! If we can agree that no two clients will necessarily present major depression the same exact way, what good would CBT – a cookie-cutter psychotherapy – be? That kind of argument immediately discredits the numerous studies done showing its effectiveness and, worse yet, shows the individual making the argument is unfamiliar with the approach except for an outsider’s perspective. The reality is much to the contrary and proven in the research: in order to be effective for two clients whose depression diagnoses are wildly distinct, CBT must be flexible in its approach – capable of being tailored to the individual.

    Reply

    • Luke Dery
      Dec 08, 2017 @ 17:03:40

      Hi Luke,

      I liked your comment about not getting caught in a bubble, and how working in a group environment can help with this. I remember a psych professor I had in undergrad who didn’t know master’s level therapists existed. He taught and had one client, who he’d been working with for 8 years (which is also troubling). Not only is it important for us to stay informed of new research, it’s also important to keep our finger on the pulse of the field in general.

      Reply

  13. Lindsey
    Dec 07, 2017 @ 11:09:44

    1. I can maintain or improve my competency as a licensed CBT therapist by attending networking events, workshops, and partaking in professional associations that offer additional training. I’ve already enjoyed several workshops offered by Assumption College and have been exposed to a number of clinicians who have offered different insights. I intend to continue this post-licensure. Keeping up with research and being open to listen to new perspectives are of utmost importance as my career evolves.
    2. The primary stereotype or myth that I’ve heard about CBT surrounds its rigidity. The assumption/myth is evidence-based practices are so formal that it might be insensitive to the client’s needs (i.e. maybe the client just wants to talk and talk and talk without resolution – aka – Rogerian) CBT shouldn’t be as harsh as Ellis or as soft as Rogerian. There is a happy-medium supported by ample R&D. As CBT therapists, we need to set accurate expectations about our therapeutic orientation at the very beginning of therapy – everything from psychoeducation to collaboration/goal-setting/homework commitment to the termination process – all the while while building a warm rapport with the client. I think this is the where CBT therapists can knock it out of the park or fall flat. Setting accurate expectations from the very beginning is crucial for progress but doing it without warmth or empathy will make for a counter-productive recovery process.

    Reply

    • Venessa Wiafe
      Dec 09, 2017 @ 00:19:59

      Hi Lindsay,

      I like the fact that you’ve already taken the initiative to attend workshops offered by our own graduate school. That’s an impressive move. Even though you are still on your successful road to your masters degree, you’ve been making moves that will indeed assist you in your journey. I think it’s good to attend workshops as you are in the masters program, so that you can engage in lectures in class, yet also get different takes and perspectives on CBT, it’s use, and it’s effectiveness. I would say that you’re alrwady on the right path to sustain your competency, and if you keep it up, you will definitely be an amazing expert in the near future.

      Reply

  14. Venessa Wiafe
    Dec 07, 2017 @ 13:33:01

    1. I am a firm believer in the phrase, “practice makes perfect”. I have learned so much thus far in regard to CBT and I know that this is just the beginning. So much more information on CBT, its methods, and treatment planning is on its way. I know I can’t just learn about all of CBT’s aspect in graduate school and believe I will automatically be an expert forever. With that being said, post graduation and after I pass my licensure exam, I will definitely take a lot of action to secure my expertise in CBT. I found that doing homework worksheets that I have learned about and received thus far in my CBT-related course is really effective. I was able to learn how the CBT exercises work, as well as how useful it can be. I will definitely complete more technique worksheets whenever possible to help me recall how each one functions, so I can be an expert at working on them with my future clients during therapy sessions. I will also review all the vital information that my course books possess in regard to CBT, so that I can continuously refresh my memory on the psychoeducation of CBT. This will also allow me to still have a good understanding of everything CBT is composed of. Going over my hard copy lecture notes as well as my personal written class notes will also assist me with refreshing my memory in CBT and not losing touch on how beliefs and thoughts clients may have negatively effects them. I will also view online CBT sessions every now and then, as it will help me remember the structure of CBT. Making sure I have the latest version of the DSM at my disposal will help me learn of the current symptoms of disorders my clients will have. As long as I spend time utilizing all of these sources, I believe that I will be able to maintain my CBT competence and be a great therapist to assess my future clients in need of help.

    2. A CBT myth I have heard of before is that “CBT only cures the symptoms a client may have and not the client as a whole”. I feel like since CBT follows a specific structure, examines beliefs and thoughts, and modifies them immensely throughout therapy sessions, individuals may believe that therapists only care about changing their negative thoughts and beliefs to positive ones, and not considering what the client wants. What people fail to learn about, however, is the fact that therapists do take their clients’ goals and expectations in therapy highly into consideration. Their goals are like the driving force of therapy as they work hard towards achieving them with their client. Intense examination and modification shows that the therapist cares about eradicating what is causing the client to not live in an adaptive fashion anymore. Once the negativity in their life is transformed into being more positive in nature, they can definitely become much more happier and live better lives, which furthermore is curing the client as a whole.
    Another myth I have come across is that “CBT is too short, so it can’t be that effective”. CBT is in fact short, but the structure of CBT is what makes it effective. Even with a client having a set amount of sessions, he can get so much accomplished. It isn’t about the duration of time being spent in therapy, because therapists can hold so many sessions with a client and still get nothing accomplished. Timing should’t be the reason for people to believe that CBT is ineffective, and it definitely shouldn’t be what people are focused and worried about. It is all about following a structured plan, making sure all measurable and important goals are achieved, and of course, having the most appropriate form of treatment is applied in therapy for the client.

    Reply

    • Sarah Hine
      Dec 09, 2017 @ 16:15:44

      Vanessa,
      It is so important that we remember there is more to learn beyond grad school. We will not know everything about CBT after we graduate, and we will have to continue learning and practicing skills if we want to become more knowledgeable and competent therapists. I also agree with the importance of reviewing things we learned in class when we are actually in the field. It is easy to forget what you learn in the classroom once you are caught up in the flow of work. It will be helpful to look back at those notes and those papers we wrote in order to remind ourselves of the skills we learned during school. I think that perspective also gives me a push to make my coursework more meaningful as we are still in school but looking forward to beginning our careers as therapists.

      Reply

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Adam M. Volungis, PhD, LMHC

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