Assessing the Development of Competence during Postgraduate Cognitive-Behavioral Therapy Training

By Barnfield, Tracey V.; Mathieson, Fiona M. et al. | Journal of Cognitive Psychotherapy, July 1, 2007 | Go to article overview

Assessing the Development of Competence during Postgraduate Cognitive-Behavioral Therapy Training


Barnfield, Tracey V., Mathieson, Fiona M., Beaumont, Graeme R., Journal of Cognitive Psychotherapy


This article investigates the development of competency in cognitive-behavioral therapy (CBT) as a result of a postgraduate training course in CBT in Wellington, New Zealand. Thirteen experienced mental health professionals attended the half-time 30-week-long course. Preliminary data are presented on the development of knowledge as assessed at the beginning and end of the course by a modified version of the Behaviour Therapy Scale (Freiheit & Overholser, 1997), other-rated competence as measured by the Cognitive Therapy Scale-Revised (Blackburn, Milne, & James, 1997), and supervisor and student evaluations of competence in particular skill areas. All students improved in specific CBT skills as a result of training. The extent that students improved and variations around the other outcome measures, together with the limitations of this pilot study and suggestions for improvements for future investigations, are discussed.

Keywords: competence; psychotherapy training; cognitive therapy; rating scales

As part of the current trend toward managed care (Stern, 1993), there is a growing demand for mental health service providers to provide short-term evidence-based psychotherapies (Ruth & Fonaghy, 1996). There is empirical support for the efficacy of cognitive-behavioral therapy (CBT) for a wide range of disorders (described in Leahy, 2004). This has seen its growth as an integral part of treatment service provision. Subsequently, a number of training programs for mental health professionals have been developed, but there is a need to ascertain whether they are effective so as to ensure optimal use of resources.

One measure of training program effectiveness is the actual level of competence that a graduate of the program demonstrates. Therapist competence is typically inferred from results of therapy outcome studies (Stein & Lambert, 1995) rather than being directly assessed within the structure of training programs. While patient change is the desired corollary of competence, it is an insufficient and unreliable measure because changes in the patient may be associated with a variety of variables that are independent of the therapist's competence (James, Blackburn, Milne, & Reichfelt, 2001).

If the effectiveness of training programs is in part to be measured by the demonstrated competence of its graduates, then a reasonable definition of competence should be found (Binder, 1993). Competency has been defined in various ways, but there are common factors in such definitions. These are theoretical knowledge (Padesky, 1996; Shaw & Dobson, 1988), ability to conceptualize (Padesky, 1996), and skillful use of intervention techniques (Beutler, Crago, & Arizmendi, 1986; Padesky, 1996; Shaw & Dobson, 1988). These core features of adherence, skill, and interpersonal effectiveness can provide useful and measurable aspects of therapist competence.

In recent years, there has been a small but growing body of research examining the development of CBT competence as a result of training. The bulk of this research has focused on one or more of the three areas of competence identified previously.

Shaw and Wilson-Smith (1988) investigated the process of training and monitoring of competence for the National Institute of Mental Health trial of CBT for depression (Elkin, Parloff, Hadley, & Autry, 1985). Therapist skill was assessed using the Cognitive Therapy Scale (CTS) (Young & Beck, 1980), an 11-item rating scale designed to assess competency in applying CBT. Significant training effects over time were found for most trainees. The training aimed to bring all trainees up to a predetermined competence level, resulting in variable amounts of input for each trainee. This study, therefore, does not measure the effect of a standard training course.

Investigations of the acquisition of competence via standard training courses include a U.K.-based pilot study (Williams, Moorey, & Cobb, 1991). …

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