Pre-Conference Workshops

A programme of 12 one-day Workshops will be held on Tuesday 3rd September

The workshops will run from 9.30-17.00. These workshops offer participants an opportunity to develop practical skills in the assessment and treatment of a range of problems.


Workshop One

Surprising New Developments in CBT for Obsessions and Compulsions

David A Clark, University of New Brunswick, Canada

For 50+ years exposure and response prevention (ERP) has been the gold standard psychological treatment for obsessive compulsive disorder (OCD). Much progress has been made in our understanding of the cognitive basis of obsessions and compulsions, and yet treatment advances have not kept pace. Meta-analyses of outcome studies indicate that effect sizes for OCD have not improved appreciably with the advent of cognitive and “third wave” interventions. And yet, only 60% of individuals with OCD show a significant treatment response to standard ERP and a mere 25% achieve symptom-free status. This workshop presents the latest developments in cognitive-behavioral theory and treatment, with special focus on obsessions. In the last decade new concepts and processes have been discovered that can enhance treatment of OCD symptoms that do not respond well to standard ERP. Workshop topics addressed include (a) an introduction to the CBT model of OCD and its subtypes, (b) dealing with disorder-specific ruptures in the therapeutic relationship, (c) developing an individualized cognitive case formulation, (d) strengthening patient commitment to CBT treatment, (e) maximizing homework compliance, and (f) utilizing specific cognitive and behavioral intervention strategies to address the biased cognitive processes responsible for the persistence of the disorder. These topics are understood within a conceptual framework that integrates the generic cognitive appraisal and inhibitory learning models of OCD.

The workshop attendee will learn how to incorporate new symptom-subtype concepts and processes into a cognitive behavioural assessment, case conceptualization and treatment of specific types of obsessions and compulsions like mental contamination, pathological doubt, repugnant obsessions, and order/symmetry compulsions

Key learning objectives:

  1. To increase knowledge of the most recent advances in the CBT model of OCD and its subtypes.
  2. To identify, assess and counter the specific OCD-related threats to the working alliance.
  3. To develop individualized symptom-subtype cognitive case formulations.
  4. To strengthen patient acceptance of the treatment rationale as well as homework compliance through active psychoeducation exercises.
  5. To integrate cognitive intervention strategies with standard ERP to target specific cognitive beliefs and biases.
  6. To transform ERP into empirical hypothesis-testing and inhibitory learning experiences.

David A. Clark, PhD, is Professor Emeritus, Department of Psychology, University of New Brunswick, Canada and a practicing clinical psychologist with 30+ years in providing cognitive behavioural treatment for OCD. He received his PhD from the Institute of Psychiatry is a Fellow of the Canadian Psychological Association, Founding Fellow/Trainer Consultant of the Academy of Cognitive Therapy, and ad hoc consultant with the Beck Institute. He was a founding member of the Obsessive Compulsive Cognitions Working Group, and recipient of the Aaron T. Beck Award in 2008. He has co-authored several publications with Prof. Beck including Cognitive Therapy for Anxiety Disorders (Guilford, 2010), and The Anxiety and Worry Workbook (Guilford, 2012). He is sole author of The Mood Repair Toolkit (Guilford, 2014) and Controlling Your Mind: A Workbook for Depression, Anxiety and Obsessions (Robinson, 2018). A comprehensive revision his 2004 OCD clinician handbook is scheduled for release in November, 2019 and retitled Cognitive-Behavioral Therapy for OCD and Its Subtypes (Guilford Press).

References

Clark, D. A. (2018) Controlling Your Mind: A Workbook for Depression, Anxiety and Obsessions. London: Robinson.

Jacoby, R. J., & Abramowitz, J. S. (2016). Inhibitory learning approaches to exposure therapy: A critical review and translation to obsessive-compulsive disorder. Clinical Psychology Review, 49, 28-40.

Rachman, S., Coughtrey, A., Shafran, R. & Radomsky, A. (2015). Oxford Guide to the Treatment of Mental Contamination. Oxford: Oxford University Press.


Workshop Two

Adapting Cognitive Behavioural Interventions for Autism

Ailsa Russell, University of Bath

Autistic people are disproportionately affected by mental health problems, particularly anxiety and depression. Cognitive behavioural interventions have been found to be effective in treating co-occurring mental health problems if adapted to meet the needs of autistic people. This workshop will provide an introduction to Autism and the rationale for adapting CBT. The main adaptations to assessment, formulation and intervention will be presented. Practice exercises will be used to bring the principles to life. The focus will be cognitive behavioural practice with autistic people 14 years and older who do not have an intellectual disability.

This workshop aims to improve therapist knowledge about and confidence in working with autistic people. The intended learning outcomes may also be helpful in adapting practice for people with social communication difficulties who do not have a formal diagnosis.

Key learning objectives:

  1. To become familiar with the key adaptations to CBT for mental health problems in the context of Autism
  2. To understand the rationale for the adaptations to CBT
  3. To gain classroom-based skills practice in the key adaptations
  4. To become familiar with the evidence base

Dr Ailsa Russell is a Reader in Clinical Psychology at the University of Bath. She has worked in national specialist and adult autism services and community based adult autism services. She has led on two clinical trials investigating the usefulness of adapted CBT for co-occurring mental health problems, specifically treating Obsessive Compulsive Disorder (OCD) and Depression.

References

Hollocks MJ, Lerh JW, Magiati I, Meiser-Stedman R, Brugha TS. Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychological medicine. 2018 Jul 25:1-4.

Anderson, S. & Morris, J. (2006) Cognitive Behaviour Therapy for people with Aspergers Syndrome Behavioural and Cognitive Psychotherapy 34(3):293-303

Cooper, K., Loades, M.E. and Russell, A. (2018) Adapting psychological therapies for Autism Research in Autism Spectrum Disorders 45; 43-50

Russell, A.J., Jassi, A. and Johnston, K. (2019) OCD and Autism: A clinician’s guide to adapting CBT Jessica Kingsley Publishers: London


Workshop Three

Feedback-informed treatment: an evidence-based method to identify and resolve obstacles to effective CBT

Jaime Delgadillo, University of Sheffield

CBT is effective for the treatment of depression and anxiety problems; however, it is also known that at least 30% of patients do not show reliable improvement and some deteriorate. Recent studies have demonstrated that it is possible to improve the efficiency and effectiveness of CBT using feedback-informed treatment (Delgadillo et al., 2017, 2018; Janse et al. 2017), which combines routine outcome monitoring with individualized case formulation and trouble-shooting skills. Feedback-informed treatment bridges between nomothetic and idiographic approaches to assessment and formulation: it uses insights from clinical population data to understand possible obstacles that might be relevant to individual patients. In this way, therapists are able to identify and resolve problems in a timely manner, adjusting protocol-driven treatments when necessary.

This workshop will focus on the integration of routine outcome monitoring, case formulation, and clinical trouble-shooting skills in CBT. Participants will learn about the current evidence-base on predictors of treatment outcomes and will also consider practical skills on how to (a) identify, (b) formulate and (c) address obstacles to improvement. The feedback-informed treatment model covered in this workshop has been empirically tested in a large multi-site randomised controlled trial (Delgadillo et al., 2018).

The workshop will equip participants with practical guidelines on how to combine routine outcome monitoring and clinical case formulation to improve CBT outcomes.

Key learning objectives:

Participants will learn about:

  1. The current evidence base on feedback-informed treatment.
  2. How to successfully integrate routine outcome monitoring and prognostic methods in CBT practice.
  3. How to identify, formulate and address common obstacles to improvement.

Jaime Delgadillo is a Lecturer in Clinical Psychology at the University of Sheffield and a CBT therapist in RDASH NHS Foundation Trust. His research focuses on outcome measurement, prediction and feedback. He has led the development and implementation of personalised care technologies in NHS psychological services.

References

Delgadillo, J., Overend, K., Lucock, M., Groom, M., Kirby, N., McMillan, D., Gilbody, S., Lutz, W., Rubel, J.A., and de Jong, K. (2017). Improving the efficiency of psychological treatment using outcome feedback technology. Behaviour Research and Therapy, 99, 89-97.

Delgadillo, J., de Jong, K., Lucock, M., Lutz, W., Rubel, J., Gilbody, S., Ali, S., Aguirre, E., Appleton, M., Nevin, J. and O'Hayon, H. (2018). Feedback-informed treatment versus usual psychological treatment for depression and anxiety: a multisite, open-label, cluster randomised controlled trial. The Lancet Psychiatry, 5(7), 564-572.

Janse, P. D., De Jong, K., Van Dijk, M. K., Hutschemaekers, G. J., & Verbraak, M. J.(2017). Improving the efficiency of cognitive-behavioural therapy by using formal client feedback. Psychotherapy Research, 27(5), 525–538.


Workshop Four

Working with complex issues in psychosis: suicidality, violence and substance misuse

Gillian Haddock, University of Manchester


Workshop Five

Maximising your effectiveness as a CBT therapist: helping your client get the most out of each session that you provide

Abi Bradbury, Denis Convery, Jen Hague, Stephen Kellett, Catherine Machin and Alison Pickard, University of Sheffield

This workshop will bring together various streams of research concerning delivery of CBT including the notion of treatment integrity (i.e. the combination of treatment fidelity and treatment competency), the defining features of effective therapists (i.e. therapist effects and particularly the role of the therapist’s personality), therapeutic drift, use of supervision, resilience, reflection in and on action and self-compassion/compassion fatigue.

This workshop is designed for therapists who work with a high volume of often complex patients – also that may also not be that suitable for CBT at times. The aim of the workshop is to support therapists in their difficult and challenging roles by focussing on the factors, in particular, that have plasticity and are therefore potential mechanisms of personal and clinical change. The everyday clinical practice of attendees should be nourished and changed by attendance, as the workshop will focus on enabling therapists to maximise their helpfulness by focussing (and having equipoise) between what the therapist brings to therapy, their organisational context, the therapeutic relationship and the CBT model itself.

Key learning objectives:

  1. To be more aware of what disables personal therapeutic effectiveness
  2. To be more aware of enables personal therapeutic effectiveness
  3. To be better able to articulate an effective model of self-care and resilience to achieve more consistency of outcomes across patients
  4. To have greater personal insight into the personal style that informs your personal delivery of CBT.

The workshop leaders are all experienced therapists, trainers and supervisors at the University of Sheffield IAPT High Intensity Course.

References

Norcross, J. C. (Ed.). (2011). Psychotherapy relationships that work (2nd ed.). New York: Oxford University Press.

Waller, G. and Turner, H. (2016) Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behaviour Research and Therapy, 77, 129-137.


Workshop Six

Mindful Parenting

Susan Bogels, University of Amsterdam, Center for Mindfulness the Netherlands

Despite its inherent joys, the challenges of parenting can produce considerable stress. These challenges multiply- and the quality of parenting may suffer- when a parent or child has mental health issues, or when parents are in conflict. Even under optimal circumstances, the constant changes as children develop can tax parents' inner resources, often undoing the best intentions and parenting courses.

Mindful Parenting (Bögels & Restifo, 2014) is an eight-week structured mindfulness training program, based on MBSR and MBCT. It is designed for use in mental health care contexts, for parents who have mental health problems that interfere with parenting, or whose children have mental health problems. The program's eight sessions focus on mindfulness-oriented skills for parents, such as parenting with beginner’s mind, awareness and acceptance of strong emotions in parent and child, mindfully responding to (as opposed to reacting to) parenting stress, fostering compassion., and taking care of ones inner child The program is now also adapted for other settings such as prevention.

In this workshop the theoretic underpinnings of Mindful Parenting (Bögels et al., 2010), the rationale, and the build-up of the program, are outlined, and demonstrated with several imaginary and meditation practices that participants can experience. Video-examples are also shown. Results of Mindful Parenting in a mental health care context on outcomes such as parental and child psychopathology, parenting stress, and parenting, are presented, and mediating mechanisms, such as general mindfulness, mindful parenting, and parental experiential avoidance, are discussed. Furthermore, results of Mindful Parenting in a preventive context is reviewed.

Mindful parenting can be used while guiding parents with children with mental disorders, but is also relevant as a general attitude for professionals working with clients.

Key learning objectives:

  1. Insight in theories, working mechanisms and effects of mindful parenting
  2. Overview of the 8-week mindful parenting program
  3. Experiencing the key practices of mindful parenting
  4. Assessment of parent and child effects

Prof. Dr. Susan Bögels is a clinical psychologist and psychotherapist, specialized in Cognitive Behaviour Therapy and mindfulness training for children and their families. She works as professor in family mental health at the University of Amsterdam and as a mindfulness trainer and teacher trainer at the Center for Mindfulness in Amsterdam.

References

Bögels, S., & Restifo, K. (2013). Mindful parenting: A guide for mental health practitioners. Springer or Norton.

Bögels, S. M., Hellemans, J., van Deursen, S., Römer, M., & van der Meulen, R. (2014). Mindful parenting in mental health care: effects on parental and child psychopathology, parental stress, parenting, coparenting, and marital functioning. Mindfulness, 5(5), 536-551.


Workshop Seven

How to Teach DBT Skills to Adults and Young People

Catherine Parker and Marie Wassberg, Derbyshire Healthcare NHS Foundation Trust

DBT Skills Training is an essential part of the DBT treatment programme developed by Marsha Linehan for the treatment of Borderline Personality Disorder over 30 years ago. Since then, there have been numerous studies exploring and validating this approach for different populations. Currently, DBT is cited by NICE as a treatment of choice for women with a diagnosis of BPD who self-harm. This approach is based on a formulation which hypothesises a deficit in self-management skills, particularly in emotion regulation.

This workshop will introduce the DBT formulation, which gives rise to the 4 sets of skills taught in a DBT programme. We will briefly discuss the particular group processes involved in working with both adults and young people who present with dysregulation problems.

We will focus on key skills in each of the 4 sets of skills, which feature in the central dialectic – Acceptance vs Change – that DBT attempts to resolve:

There will be demonstrations of DBT skills teaching, and a chance for some in-session practice. We welcome clinicians with no prior DBT experience, as well as those who would like to brush up on their DBT skills.

While DBT was initially developed for patients with Borderline Personality Disorder, many of its principles and practical interventions have been used trans-diagnostically to good effect. Skills deficits can interfere with the progress of CBT therapy across disorders. If they are acknowledged and integrated into CBT formulations, weaving DBT skills into the intervention plan can help therapy to stay on track.

Mindfulness is now being used routinely in many other therapeutic interventions, and the DBT approach to teaching this skill, in particular the introduction of the concept of Wise Mind, is key to the development of effective functioning and self-management.

Distress Tolerance and Emotion Regulation skills are essential for self-management, while Interpersonal Effectiveness is based on conflict resolution and uses many standard assertiveness skills. DBT takes a very practical and accessible approach to increasing effectiveness in many areas, including interpersonal situations, which often requires the skilful blend of all 4 skill sets.

Key learning objectives:

Catherine Parker completed the British Isles DBT intensive programme in 2001 with Michaela Swales, Heidi Heard and Sue Clark. She was one of the founder members of the Derbyshire DBT Service; for over 15 years, she delivered the full DBT programme, including DBT skills groups, for adults with Borderline Personality Disorder. During this time, she delivered DBT workshops within her NHS Trust and local universities, as well as a range of presentations at the BABCP Conference. She has been the Chair of the DBT SIG since 2013. With a core profession in social work, Catherine practiced as an ASW for many years within a Community Mental Health Team in Derbyshire, before training as a CBT therapist at Sheffield Hallam University. She qualified in CBT in 2008, and has practiced as an accredited CBT psychotherapist in both primary and secondary care settings. She is the Service Manager & Clinical Lead of the CBT Service in the Derbyshire Healthcare NHS Foundation Trust, treating service users with severe and complex needs, as well as supervising both CBT and DBT therapists.

Marie Wassberg has been a DBT Therapist since 2010. She trained with Dr. Elizabeth Malmquist and Dr. Anita Linnér in Sweden, as well as with Professor Alan Fruzzetti and Professor Jill Rathus (USA), both leading clinicians in the field of DBT for adolescents.

Marie is also a BABCP accredited CBT therapist. She qualified in 2003 and studied at Goldsmiths University in London with Professors Windy Dryden and Michael Neenan. She is also trained in Trauma Focused-CBT (TF-CBT), including Supervisor training, in 2013 with Dr. Laura Murray (USA); Prolonged Exposure (PE) 2012 with Professor Edna Foa (USA); and DBT for Schools (STEPS-A), 2018 with Dr. Elizabeth Dexter-Mazza and Dr. James Mazza (USA). Marie qualified as a social worker in 1998 and has experience of working in the profession in both Sweden and England.

Marie has been involved with developing many DBT- informed programmes in different settings, mainly for children, adolescents and young adults aged from 18-25 years, both in Sweden and in England.

Marie has been a very welcomed guest lecturer at universities in Sweden, a facilitator at workshops, conferences and training events throughout the UK (NOTA 2015, 2016, 2017, 2018 and BABCP 2018), in Sweden (Schools, Social Services and Care homes) and the USA (ATSA 2016 and 2018). She has also offered training and supervision to other professionals who work with children and adolescents on how to improve relationships and regulate emotions in a DBT-informed approach.

References

DBT Skills Training Manual, Second Edition by Marsha Linehan (Guilford Press, 2014)

DBT with Suicidal Adolescents by Alec Miller, Jill Rathus & Marsha Linehan (Guilford Press, 2007)


Workshop Eight

Treating PTSD in Survivors of Domestic Violence

Pippa Stallworthy, South West London and St George's Mental Health Trust

Although survivors of domestic violence have high rates of mental health problems (PTSD 64%, depression 48% and a suicide rate of 18%, Golding 1999) the treatment needs of this population have received relatively little attention by mental health services. PTSD in domestic violence survivors occurs in the context of a betrayal of trust and often chronic trauma. There may be issues of ongoing risk to both women and children. Substance misuse is common. These issues can present challenges to services and clinicians.

This workshop will be useful for those with some knowledge of the cognitive model of PTSD (Ehlers and Clark, 2000) and some experience of treating PTSD.

This workshop aims to build skills and confidence in working with this population by highlighting the key practical and psychological issues to help clinicians design and deliver safe and effective PTSD treatment. It also summarises useful clinical resources

CBT will meet the needs of survivors of Domestic Violence more effectively and deliver improved outcomes, including more accurate risk assessment and reduced drop-out. This benefits not only the female and male survivors, but also their children who are at increased risk of mental health problems themselves.

References

Golding, J.M. (1999). Intimate Partner Violence as a Risk Factor for Mental Disorders: A Meta-Analysis. Journal of Family Violence, 14, 2, 99-132

Kubany, E.S. and Ralston, T.C. (2008). Treating PTSD in Battered Women: A Step by Step Manual for Therapists and Counsellors. Oakland. New Harbinger Publications Inc.

Oram, S. Trevillion, k., feder, G. and Howard, L.M. (2013). Prevalence of experiences of Domestic violence among psychiatric patients: systematic review. The British Journal of Psychiatry, 202, (2): 94-99.


Workshop Nine

Providing Help at the Point of Need: CBT-oriented Single-Session and One-at-a-Time Therapies

Windy Dryden, Goldsmiths University of London

International data indicate that the modal number of sessions that people have is '1', followed by '2'', then '3' and so forth (Young, 2018). And yet therapists are not often trained to offer very brief therapy. In this workshop, I will discuss how CBT therapists might get the most out of the single-session and one-at-a-time literature to provide needs-based therapeutic services. After providing key definitions, I will discuss the nature and assumptions of SST and OAAT Therapy as well as dealing with commonly held misconceptions of this field. Good practice in CBT-oriented SST and OAAT will be outlined and demonstrations with audience volunteers will be carried out. Participants will be given an opportunity to use SST/OAAT in the workshop setting. Finally, barriers to SST and OAAT Therapy will be highlighted and remedies proffered.

The potential implications of CBT-based SST/OAAT are enormous. If offered in walk-in services, it would enable clients to be seen almost immediately and if offered by appointment it would have the capacity to reduce waiting-lists markedly as has been the case where SST/OAAT has been introduced into student counselling services in the UK.

References

Dryden, W. (2017). Single-session integrated CBT (SSI-CBT): Distinctive features. Abingdon, Oxon: Routledge.

Dryden, W. (2019). Single-session therapy: 100 key points and techniques. Abingdon, Oxon: Routledge.

Hoyt, M.F., Bobele, M., Slive, A., Young, J., & Talmon, M. (Eds.). (2018). Single-session therapy by walk-in or appointment: Administrative, clinical, and supervisory aspects of one-at-a-time services. New York: Routledge.


Workshop Ten

Introduction to Mindfulness-integrated Cognitive Behaviour Therapy

Alice Shires, University of Technology Sydney, Australia

As mindfulness-based interventions are increasingly used to address a wide range of psychological disorders, therapists need as much training as possible with complex conditions, especially those accompanied by chronic pain and trauma history. Mindfulness-integrated Cognitive Behaviour Therapy (MiCBT) is an established transdiagnostic intervention specifically designed to address a wide range of clinical and subclinical conditions and prevent relapse. It is an evidence-based integration of traditional CBT and mindfulness meditation in the Burmese Vipassana tradition of Ledi Sayadaw, U Ba Khin and S. N. Goenka, developed into a four-stage approach between 2001 and 2003 and continually piloted and improved across disorders since.

MiCBT is one of the so-called “second-generation mindfulness-based interventions”, as it was developed in a way that maximally preserves the principal teachings of Buddhist psychology while excluding Buddhist religious rituals and cultural assumptions. New and established exposure and cognitive reappraisal techniques are tightly integrated with the practice of ethics, the four-fold cultivation of mindfulness, and the development of insight and advocates an active and discriminative from of awareness. Recent studies in India and Iran demonstrate that MiCBT remains efficacious across various cultures. Controlled studies investigating MiCBT show improvements in people with depression, generalised anxiety, PTSD, performance anxiety, perfectionism, alcoholism, chronic pain, and type-2 diabetes, among other conditions.

Mindfulness integrated CBT( MiCBT) is an evidence-based integration of traditional CBT and mindfulness which offers an explanatory model for the use of mindfulness skills integrated with established cognitive and behavioural techniques and strategies for enabling change and reduction of distress.

References

Cayoun, B. A., Francis, S. E., & Shires, A. G. (2018). The Clinical Handbook of Mindfulness-integrated Cognitive Behavior Therapy: A Step-by-Step Guide for Therapists. Wiley-Blackwell.

Cayoun, B. A. (2014). Mindfulness-integrated CBT for well-being and personal growth: Four steps to enhance inner calm, self-confidence and relationships. John Wiley & Son.

Cayoun, B., Simmons, A., & Shires, A. (2018). Immediate and Lasting Chronic Pain Reduction Following a Brief Self-Implemented Mindfulness-Based Interoceptive Exposure Task: a Pilot Study. Mindfulness, 1-13


Workshop Eleven

Maintaining excellence in CBT practice: is supervision the secret sauce

Sarah Rakovshik, Oxford Cognitive Therapy Centre, Oxford Centre for Psychological Health, Oxford Health NHS Foundation Trust and University of Oxford

“Most of what I know about being a CBT therapist, I learned in supervision.”

If this statement rings as true for you as it does for me, then you have experienced what the evidence base is beginning to show: supervision makes a difference—to therapist competence, to patient recovery, to the wellbeing of staff, to the maintenance of quality therapy in routine clinical practice.

But what do we actually know about what makes supervision ‘good’ and how do we continue to provide this when service pressures to prioritise case management and clinical contacts make is easy for supervision to slip to the end of our ‘to do’ list? What do staff burnout and wavering recovery rates tell us about why high-quality supervision is essential?

This workshop is designed for therapists who want to make the most of clinical supervision, both as supervisees and as supervisors. We will look at the evidence for what works, will identify and practice core skills, and will explore innovations that let us make the most the supervision we give and receive.

Key learning objectives:

By the end of this workshop, participants will be able to:

  1. Describe what is known about effective CBT supervision.
  2. Apply the evidence and known principles from education, psychology and business towards improving supervision practice.
  3. Use innovation to increase positive effects of supervision without increasing costs for its provision.

Sarah Rakovshik is the Director of the University of Oxford/ OCTC Postgraduate CBT Programme and the Acting Head of OCTC. Her clinical interests include treatment of co-morbidity and complex presentations, as well as in the potentially positive effects of adverse life events. Her research has focussed on training and supervision, and their effects on therapists’ competence and patients’ outcomes. She has had an international role as a trainer, supervisor and consultant for CBT training programmes and research projects.

References

Alfonsson, S., Parling, T., Spännargård, Å., Andersson, G., & Lundgren, T. (2018). The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review. Cognitive Behaviour Therapy, 47(3), 206-228.

Rakovshik, S. G., McManus, F., Vazquez-Montes, M., Muse, K., & Ougrin, D. (2016). Is supervision necessary? Examining the effects of internet-based CBT training with and without supervision. J Consult Clin Psychol, 84(3), 191-199.


Workshop Twelve

Therapist Drift: Why therapists do dumb things (and how to do fewer of them)

Glenn Waller, University of Sheffield

Ten years ago, the term ‘therapist drift’ was first coined, describing the way in which clinicians fail to deliver evidence-based treatments appropriately. Since that time, the term has been used widely to explain why we act the way we often do in clinic, and evidence has grown to demonstrate how therapist drift affects the delivery of CBT and other therapies. The construct has also been shown to apply to supervisory practice and service configuration.

Most importantly, we now have a much better understanding of the reasons why therapists drift, and how to reduce drift in order to give our patients the best chance of recovery. Such understanding includes formulating around clinicians’ cognitions, knowledge, emotions, social context, and use of safety behaviours.

This workshop will review a decade’s evidence relating to therapist drift. It will formulate why drift happens (stressing that it is often the result of clinicians being well-intentioned), and its impact on patients’ chances of recovery. Finally, it will address ways of overcoming or preventing drift. Clinical experiences will be central to the discussion, including the workshop leader’s own experiences of doing dumb things over the years. Attendees will be encouraged to discuss experiences of drift, and to come up with a plan for how they will enhance their clinical practice and service context to improve patient outcomes.

Key learning objectives:

The aim is not to learn new skills, but to ensure that we use the skills that we already have. It will be demonstrated that this approach could result in vastly better patient benefit than developing new therapies (which are also unlikely to be used fully).

  1. Understanding the evidence that we drift, as therapists, supervisors and services.
  2. Understanding why we drift, and how it can be the result of good intentions.
  3. Planning to overcome our own tendency to drift, and how to make evidence-based practice the norm in our local clinical setting.

Glenn Waller is Professor of Clinical Psychology at the University of Sheffield. He has been making clinical errors (and getting some things right) for 30 years. He teaches widely on the delivery of CBT and therapist drift, and has written over 270 peer-reviewed papers. He is also co-author on four books about the use of CBT for eating disorders. He served on the Guideline Development Group for the 2017 NICE guideline on treating eating disorders.

References

Waller, G. (2009). Evidence-based treatment and therapist drift. Behaviour Research and Therapy, 47, 119-127.

Waller, G., & Turner, H. (2016). Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behaviour Research and Therapy, 77, 129-137.