Academic journal article New Zealand Journal of Psychology

Making It Stick: Factors That Help and Hinder Ongoing Practice after Cognitive Therapy Training

Academic journal article New Zealand Journal of Psychology

Making It Stick: Factors That Help and Hinder Ongoing Practice after Cognitive Therapy Training

Article excerpt

In response to government mental health workforce development initiatives some university departments in New Zealand have developed specific Cognitive Behaviour Therapy (CBT) training courses. There is evidence that graduates gain competency in the practice of CBT as a result of training (Milne, Baker, Blackburn, James & Reichelt., 1999; James, Blackburn, Milne & Reichelt, 2001, Barnfield, Mathieson & Beaumont, 2007), but it has been argued that the extent of skill transfer following CBT training also needs to be assessed (Milne et al, 1999). There is no guarantee that graduates will actually apply skills in the work setting. For example Kavanagh, Piatkowska, Clark & O'Halloran (1993) assessed the implementation of training in CBT family interventions for schizophrenia and found only 18% of therapists had applied their learned skills.

This study investigates the extent of self-reported implementation of CBT skills, supervision availability and ongoing training following an intensive CBT training course.

There are a small number of studies in the area of skill transfer into clinical practice following CBT training. Based on graduate self report three months after completing training, Myles & Milne (2004) found there was a significant increase in self reported CBT skill use in the workplace. A postal survey of graduates of a year long CBT course in the United Kingdom was conducted by Ashworth, Williams & Blackburn (1999). Most of the graduates reported continuing to read books on CBT, completing a Cognitive Therapy formulation for at least half of their clients and receiving supervision. The graduates rated the receipt of ongoing supervision as the most important factor in improving knowledge and skills. A quarter of the graduates reported they were specifically employed to deliver CBT, but almost all reported continuing to use CBT with some or most of their caseload. Although most reported they were interested in additional training, they reported little participation in further training or workshops. This study, however, was limited by not investigating factors that influenced the ability of the graduates to use their new skills in the workplace.

The use of new skills in the workplace by graduates is influenced by a variety of organisational factors. Those that facilitate ongoing use of skills include support from supervisors and colleagues (Corrigan & McCracken, 1997, Heaven, Clegg & Mcguire, 2006; Kennedy-Merrick, Haarhoff, Stenhouse, Merrick & Kazantzis, 2008), having ongoing contact with those from the same training course (Milne, Keegan, Westerman and Dudley, 2000) and regular opportunities to use the skills (Goldstein & Ford, 2002). There are also a number of organisational factors that have been shown to hinder the ongoing use of skills following training. These include constraints on time (Fadden, 1997; Hull & Swan, 2003; Le Fevre & Goldbeck, 2001) shortages of staff and resources, increased demands for documentation and difficulties in integrating casework with other work requirements (Corrigan & McCracken, 1997).

There are several studies that specifically investigate barriers to the transfer of CBT skills following training. In a survey of UK psychiatrists trained in CBT, Whitfield, Connolly, Davidson, & Williams (2006) found that 84% engaged in some therapeutic CBT activity after training, but only 49% received CBT supervision. Reasons given for not engaging in CBT included inadequate 'protected time' and that

CBT had not been included in 'job plans'. The researchers concluded that supervision requirements were not being adequately met. A recent New Zealand study (Kennedy-Merrick et al, 2008) found that graduates of an intensive CBT training programme perceived the way that client care is organised was a barrier to skill transfer.

In New Zealand, case management forms a large part of some disciplines' functions. …

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