The Importance of the Essentials of CBT
By Judith S. Beck, PhD
President, Beck Institute
The foundation for effective Cognitive Behavior Therapy consists of several essential components: conceptualizing cases according to the cognitive model, structuring therapy sessions, collaborating with clients, and between session work (the “Action Plan”). At Beck Institute, we are often asked why we place such a strong emphasis on these essentials by clinicians who are eager to learn a variety of techniques. We tell them that conceptualization, structure, collaboration, and Action Plans create the therapeutic environment in which clients benefit most from treatment. Without the essentials, techniques alone simply aren’t as effective.
Research has shown that when therapists adhere to the model developed by my father, Dr. Aaron T. Beck, their clients benefit. When therapists drift from the model, their clients do not benefit as much, even if therapists are using evidenced-based strategies. When therapists drift, the treatment they provide is less focused and client outcomes suffer. We also know from experience and research that therapists’ adherence to the model for one session or one time period does not guarantee they will routinely follow the model at other times. The explanations for drift are many. Sometimes changing allegiance to one modality is intentional; on the other hand, even therapists dedicated to using CBT can unintentionally drift over time.
We have found that even when experienced clinicians whose chosen orientation is CBT revisit the essentials, they learn strategies to make their treatment more effective.
As the standard-bearer for excellence in CBT, we emphasize the importance of the essentials of CBT in several ways. Our supervision program requires trainees to submit multiple recorded sessions for scoring, using the Cognitive Therapy Rating Scale (CTRS). The CTRS has proven helpful for evaluating therapists’ adherence to CBT as it was developed. Trainees must demonstrate consistent adherence to and competence in applying the model to successfully complete supervision.
We also require all clinicians pursuing Beck Institute Certification to complete our on-demand course, Basics of CBT: Essentials I. This course provides foundational CBT concepts, ensures adherence to the cognitive model in the practice of CBT, and helps establish consistency in excellence across a broad range of disciplines, settings and populations served. We have found that even when experienced clinicians whose chosen orientation is CBT revisit the essentials, they learn strategies to make their treatment more effective. For newer therapists, the course provides a framework around which future learning in specific diagnoses and populations will be built.
Expertise in the essentials is necessary for delivering excellent CBT. And we know that excellent CBT improves the lives of patients, their families, and their communities worldwide.