Most client’s are highly anxious, the chances of them remembering session content accurately, much less applying it, are therefore slim. But review of therapy records usually provides no evidence of session summary or detailed specification of homework. At most therapists may write ‘activity scheduling’, ‘thought records’ or ‘continue exposure’. Compare this vaguenness with the specificity of a medical prescription “take ‘x’ 3 times a day after meals’. I remember a client with Multiple Sclerosis who was in agony with his symptoms for a couple of weeks before it was discovered he had inadvertently been prescribed a sub-therapeutic dose of medication. The lack of specificity about CBT homework means that it cannot be easily corrected and in essence there is no accountability as there is in medicine. Below replace ‘students’ with ‘clients’:
If CBT is primarily educational then we have to teach properly. But training does not equip therapists to teach, even worse therapeutic interventions are often not modelled by tutors first!
Despite therapists endeavours clients lose out because of poor therapist training, psychological therapists often come off CBT courses less confident than when they began.
Dr Mike Scott