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Beliefs Can Interfere with Treatment Adherence

judith-beck_1024w.jpgI recently read an interesting case description on a professional listserv about a “difficult” client who was not fully adherent with treatment. Apparently he argued with his therapist and did little homework outside of the session. It was apparent to me that the therapist had made a mistake. She was continuing to try to deliver “standard” CBT treatment, without attending to the therapeutic relationship sufficiently. I hypothesized that the client had an interfering belief:

“If I refrain from arguing with my therapist and comply fully with treatment……[something bad will happen or it will mean something bad about me.” ].

I don’t have enough details about the case to understand how the client would finish this assumption, but some clients might answer:

“I’ll feel so distressed that I won’t be able to stand it,” or “it will mean she’s in control, and I’m not.”

Until such interfering beliefs are elicited, evaluated, and effectively responded to, this client is unlikely to make much progress.

–Posted by Judith S. Beck, Ph.D., Director, Beck Institute

Role of therapist competence in CBT for Depression

The role of therapist competence in cognitive behavioral therapy (CBT) outcomes was the subject of a naturalistic process-outcome study conducted at the Center for Cognitive Therapy, an outpatient clinic at the University of Pennsylvania. Sixty-nine clients presenting with depression, some with comorbid presenting problems, were treated by one of eighteen CBT therapists at the Center. Therapist competence was measured by clients and experts. The findings, published in Psychotherapy and Psychosomatics, were that more competent therapists achieved better outcomes with depression patients, regardless of degree of morbidity. The clinical implication of this finding is that “initial selection of therapists will enhance treatment outcomes,” and this contradicts the idea that more competent therapists should focus on more complex cases.

Study authors: W. Kuyken, D. Tsivrikos