How to Become a More Effective CBT Therapist Mastering Metacompetence in Clinical Practice

How to Become a More Effective CBT Therapist explores effective ways for therapists to move beyond competence to “metacompetence”, remaining true to the core principles of CBT while adapting therapeutic techniques to address the everyday challenges of real-world clinical work. This innovative text explores how to:

• Work most effectively with fundamental therapeutic factors such as the working alliance and diversity;
• Tackle complexities such as co-morbidity, interpersonal dynamics and lack of progress in therapy;
• Adapt CBT when working with older people, individuals with long-term conditions (LTCs), intellectual disabilities, personality disorders and psychosis;
• Develop as a therapist through feedback, supervision, self-practice and training.

Adrian Whittington is Director of Education and Training at Sussex Partnership NHS Foundation Trust. A Consultant Clinical Psychologist, Adrian is passionate about enabling wider access to evidence-based psychological therapies. Adrian was a director of postgraduate training programmes in CBT before taking up his current role. He works clinically with people with anxiety disorders and depression and teaches on the postgraduate CBT training programme at the University of Sussex.

Nick Grey is Joint Clinical Director and Consultant Clinical Psychologist at the Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust. A BABCP-accredited practitioner, supervisor, and trainer, Nick is also Honorary Lecturer at the Institute of Psychiatry and editor of A Casebook of Cognitive Therapy for Traumatic Stress Reactions (2009).

About the Contributors x

Foreword by David M. Clark xv

Foreword by Tony Roth xvii

I The Foundations 1

1 Mastering Metacompetence: The Science and Art of Cognitive Behavioural Therapy 3
Adrian Whittington and Nick Grey

2 The Central Pillars of CBT 17
David Westbrook

3 Developing and Maintaining a Working Alliance in CBT 31
Helen Kennerley

4 Working with Diversity in CBT 44
Sharif El-Leithy

II Handling Complexity 63

5 Working with Co-Morbid Depression and Anxiety Disorders: A Multiple Diagnostic Approach 65
Adrian Whittington

6 Collaborative Case Conceptualization: Three Principles and Five Steps for Working with Complex Cases 83
Robert Kidney and Willem Kuyken

7 Transdiagnostic Approaches for Anxiety Disorders 104
Freda McManus and Roz Shafran

8 When and How to Talk about the Past in CBT 120
Gillian Butler

9 “Is it Them or is it Me?” Transference and Countertransference in CBT 132
Stirling Moorey

10 What To Do When CBT Isn’t Working? 146
Michael Worrell

III Adapting for Specific Client Groups 161

11 CBT with People with Long-Term Medical Conditions 163
Jane Hutton, Myra S. Hunter, Stephanie Jarrett and Nicole de Zoysa

12 CBT with People with Personality Disorders 178
Kate M. Davidson

13 CBT with People with Psychosis 191
Louise Johns, Suzanne Jolley, Nadine Keen and Emmanuelle Peters

14 CBT with Older People 208
Steve Boddington

15 CBT with People with Intellectual Disabilities 225
Biza Stenfert Kroese

IV Mastering Metacompetence 239

16 Using Self-Practice and Self-Reflection (SP/SR) to Enhance CBT Competence and Metacompetence 241
Richard Thwaites, James Bennett-Levy, Melanie Davis and Anna Chaddock

17 Using Outcome Measures and Feedback to Enhance Therapy and Empower Patients 255
Sheena Liness

18 Making CBT Supervision More Effective 269
Nick Grey, Alicia Deale, Suzanne Byrne and Sheena Liness

19 Take Control of your Training for Competence and Metacompetence 284
Adrian Whittington

An Afterword about Therapist Style 300
Simon Darnley and Nick Grey

Index 306

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