Competence in CT

The guidelines we have presented are intended to increase the efficacy of CT with severely depressed patients. The manner in which therapists adhere to such guidelines is also likely to have a significant influence on treatment outcome. In a recent study comparing medication and CT with more severely depressed patients, experienced CT therapists demonstrated outcomes that were comparable to those achieved with antidepressant medication; however, medication significantly outperformed CT therapists who were less experienced (DeRubeis et al., 2005). These findings are consistent with an earlier multisite trial, in which sites whose therapists had greater expertise in CT demonstrated better outcomes (Elkin et al., 1989;Jacobson & Hollon, 1996). Together these results suggest that when working with more severely depressed patients, the level of practitioner competence is particularly critical. The most widely used measure for assessing competence in CT, the Cognitive Therapy Scale (Young & Beck, 1980), has documented reliability when used by expert raters (Dobson, Shaw, & Vallis, 1985; Vallis, Shaw, & Dobson, 1986). Generally, scores of 40 and above are considered to be within the range of competent CT.

With respect to methods for increasing one's competence, therapists may want to consider the following possibilities. First, ongoing monitoring of competence is highly recommended and can be achieved through consultation with colleagues or expert trainers in CT. Information about CT training and consultation can be obtained by contacting the Academy of Cognitive Therapy. In a recent study, Sholomskas et al. (2005) compared the influence of multiple training methods on the effectiveness of trainees' demonstration of particular strategies in role plays. Results suggested a clear advantage for participation in a didactic seminar plus 3 hours of individual case supervision, compared to simply reading the manual, or reading the manual plus participation in Web-based training. Second, more experience in the specific provision of CT is helpful in maximizing therapist competence, particularly treatment early in one's training of patients who demonstrate high "suitability" for CT (James, Blackburn, Milne, & Reichfelt, 2001). As therapists gain CT experience treating a greater number of patients, their ability to apply CT strategies flexibly may increase; thus, they may achieve competence with a greater variety of patients.

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