CBT and ACT - an integrated strategy

CBT and ACT - an integrated strategy

Whilst we’ve seen some progress towards process based CBT and a more integrated approach to the different forms of cognitive behavioural therapy, there is still a tendency towards CBT “separatism”. In particular, some proponents of the ACT model argue that Acceptance and Commitment Therapy is fundamentally different or superior to other forms of CBT. Drawing on philosophical differences between functional contextualism and the rational - empirical school, ACT purists argue that conceptual differences prevent an integrated approach to CBT.

In this brief article I wanted to offer an alternative perspective that supports the process based approach brilliantly outlined in Steve Hayes’ recent book “Process Based CBT”.

How ACT and Mainstream CBT Work Together

ACT focuses on process and perspective in thinking, including the rules of language in thought construction. so in other words – how we think, rather than what we think.

CBT focuses on content, process, and perspective. So in other words what we think and how we think.

For many psychological problems, it’s often important to integrate content, process and perspective when altering the clients relationship with unhelpful or problematic cognitions.

When working with panic disorder for example,  it’s helpful to challenge irrational thoughts about cardiac death, teach the client to notice and normalise their reactions to catastrophic thoughts and reframe the thoughts as an oversensitive internal alarm system.

Thought challenging and defusion are different ends of the same cognitive continuum. I think it’s unhelpful to present them as opposites, when we can help our clients to see them as complimentary alternatives to changing their relationship with thoughts.

In my personal experience as a practising clinician, clients often (but not always) need to challenge the content of their thoughts en route to defusion. Sometimes we need to know what we are letting go off before we let go of the cognitive and behaviour struggle.

In the UK,ACT is professionally recognised by the BABCP as a third wave cognitive behavioural therapy.

It’s important to learn the ACT disciplines of defusion and acceptance, whilst recognising that this does not exclude appropriate thought challenging.

As you can tell, I am a CBT integrationist, not an ACT separatist!

I know that there are philosophical differences between CT and ACT, however we should acknowledge these differences rather than using them to mutually exclude the other approach.

There are enough anti-CBT publicists primarily from the psychoanalytic tradition and its derivatives, without perpetuating the problem by entering our own into internecine battles.

ACT, CT, CBT, DBT, IBT, MBCT and REBT all share the same therapeutic tradition and approach. in the UK each of these approaches is acknowledged as a first, second or third wave form of cognitive behavioural therapy. If we support the emerging process based CBT strategy, they are all methodologies with an established CBT tradition that spans back to the 1950s.

To find out how we integrate the different forms of evidence based CBT into our clinical work, visit https://www.Eiretherapy.ie/

Quality Assurance for CBT

Quality Assurance - Why It's Important to Check Therapist Credentials Before Starting Cognitive Behavioural Therapy

Over the last two years there has been a significant increase in counsellors and therapists offering Cognitive Behavioural Therapy (CBT). 

Whilst it's encouraging to see so many therapists from other therapeutic areas finally engaging in CBT, this has also contributed to a level of confusion about what being a Cognitive Behavioural Psychotherapist actually involves.

This confusion has been propagated in part by the growth of online therapy and psychology directories. 

These directories have managed to attain a virtual monopoly on top ranked searches for therapy in the UK. 

A couple of well-known psychology directories offer therapist verification; however, they also allow counsellors and therapists from other disciplines to advertise CBT services without checking their specific CBT training or credentials. 

To test this out, we tried ten searches for CBT in different areas of the UK and found that less than 10% of the results listed in a popular psychology directory were verifiable Cognitive Behavioural Psychotherapists. 

The title Cognitive Behavioural Psychotherapist is not a protected professional term, which means that anybody can use the title without the recognised professional training, clinical practice and supervision. 

We have also seen social media advertisements offering training courses to become a “Cognitive Behavioural “Therapist” with as few as sixteen hours online training.

So how do we protect the public and ensure that people make informed choices when it comes to booking and paying for private CBT?

The immediate answer is to check CBT credentials by visiting the UK CBT register at www.cbtregisteruk.com

This is the only quality assurance check to confirm whether your Cognitive Behavioural Psychotherapist is professionally accredited by the British Association of Behavioural and Cognitive Psychotherapy (BABCP). 

The BABCP is the UK professional body for the practice and maintenance of professional standards in CBT. The UK CBT register is used by all of the major insurance providers and many other professional bodies to check the status of CBT psychotherapists before permitting insurance panel registration. At Think CBT, we are verified providers for all of the major insurance providers in the UK and you can see what we offer by visiting www.thinkcbt.com you can also check the UK independent CBT registry at https://cbtpages.com/

So what are the minimum training standards and thresholds for professional practice as a CBT psychotherapist in the UK?

To apply for provisional accreditation with the BABCP, the applicant must be able to demonstrate the following criteria:

• A minimum of 12 months in a psychological core profession such as HCPC registered clinical psychologist, psychiatrists, social worker or professionally accredited counsellor. There is an extensive portfolio exercise known as the KSA assessment for individuals without a core profession to demonstrate the equivalent.
• Completion of a BABCP approved level 2 post-graduate training programme. Not all master’s level CBT training programmes in the UK fully meet the rigorous standards applied by the BABCP. 
• A minimum of 450 hours specialist post-graduate level CBT training. This also involves written assignments, logs, case studies and research assignments totalling approximately 25,000 words 
• A minimum of 40 hours professional CBT supervision  delivered by a recognised CBT supervisor.
• Presentation of eight clinical cases for full supervision.
• Three written case studies of up to 4,000 words per case study to demonstrate competency in clinical practice.
• A minimum of 200 hours of supervised clinical work as a trainee CBT practitioner.
• Two written references covering clinical supervision and wider professional practice.

Once these criteria have been met, the therapist may apply for provisional accreditation by the BABCP. Provisional accreditation lasts for 12-18 months, during which time the provisionally accredited CBT psychotherapist must demonstrate adherence to the BABCP codes of practice and professional standards. 

This includes a minimum of 90 minutes clinical supervision each month by a recognised CBT supervisor and engagement in a further five CBT training / learning activities.

Only at the end of this period is the psychotherapist permitted to apply for full accreditation as a CBT Psychotherapist.

The reason why the BABCP accreditation standards are so rigorous, is to help ensure the highest standards of professional practice and to protect the public.

What if my therapist isn’t on the UK CBT register?

Whilst there are some therapists who can meet these minimum training and practice standards without electing to join the BABCP, it’s important to personally check your therapists credentials if they are not on the UK CBT register. 

It’s also worth noting that the similarly sounding BACP which represents the wider counselling profession does not accredit or professionally uphold CBT standards. BACP accreditation does not mean that your therapist is a CBT specialist.

If your counsellor or therapist is offering specialist CBT service and is not professionally accredited by the British Association of Behavioural and Cognitive Psychotherapy (BABCP), our advice is to use the following simple check-list:

• Do they have a minimum of 450 hours specialist post-graduate level training in CBT?
• Have they completed 40 hours of CBT specific clinical supervision?
• Have they completed a minimum of 200 hours of supervised practice as a CBT Practitioner?
• Have they completed and past a level 2 BABCP accredited post-graduate training programme?

Some therapists have completed post-graduate level CBT training and will offer credentials that provide an equivalent to the above criteria, however it’s often difficult to compare and quality assure without independent professional advice.

This is what we offer at Think CBT

If you work with a Think CBT Psychotherapist, you can be assured that you are working with an accredited CBT expert. We only offer services that we are professionally qualified and accredited to deliver and we only work with clients when we are confident that we can help. WE quality assure our team members so that our clients don’t have to worry. 

If you want advice or guidance on any of the above points, contact Think CBT via info@thinkcbt.com or by visiting our website at www.thinkcbt.com

Disclaimer: the information in this article reflects the opinions of Think CBT and does not represent the position of any other professional / membership body.