Trainees in Cognitive Behavioural Therapy underestimate their therapeutic skills

For psychotherapists, the research literature can sometimes make for uncomfortable reading. Yes, most people benefit from therapy, but other findings are less welcome, such as that therapeutic outcomes are unrelated to therapist experience, and that therapists tend to overestimate their skills.

A new study of trainee cognitive behavioural therapists bucks this trend. Freda McManus and a her team have found that several dozen trainee CBT therapists tended to underestimate, not overestimate, how good they were at conducting CBT therapy.

Finding out how accurate therapists are at judging their own skills is important because quality control in therapy often relies on therapists seeking out extra help and supervision when they think they need it.

The new data come from 26 trainees enrolled on the Diploma in Cognitive Behavioural Therapy and 38 trainees enrolled on the MSc in Advanced Cognitive Behavioural Therapy - both courses are at the University of Oxford and the Oxford Cognitive Therapy Centre. The Diploma and MSc students submitted two to six video recordings of therapy sessions they'd conducted. They watched these tapes themselves and rated their own performances. These self ratings were then compared against ratings provided by expert supervisors on the training courses.

Overall the trainees tended to underestimate their skills as compared with ratings provided by their supervisors. Splitting the trainees into two groups - more and less competent - it was the more competent trainees who tended to underestimate themselves. The less competent trainees' self ratings didn't differ from the ratings they received from supervisors.

"These results are encouraging in suggesting that CBT therapists may be less susceptible to over-estimation of their competence than has been previously reported," the researchers said, "which is likely to have benefits for the delivery of CBT interventions in routine clinical practice."

Why would trainees be underestimating their skills? One explanation lies in a concept known as "defensive pessimism" - a way for high performers to ensure they still receive support and remain motivated to improve their standards. Potentially this is a good thing for clients, but the trainees could suffer in terms of job satisfaction and morale.

There are some question marks over the new findings. For example, the rating scale that was used to assess CBT performance (the Cognitive Therapy Scale) is known to be rather unreliable. Also, it's possible that the supervisors' ratings were lenient so as not to demoralise their students. A strength of the study is that the participants were not self-selected - they were all obliged to submit their therapy recordings. By contrast, an earlier study that reported over-confidence in CBT therapists was a highly selective sample obtained by inviting participation. It's possible that sample may have been biased towards particularly over-confident therapists.
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McManus, F., Rakovshik, S., Kennerley, H., Fennell, M., & Westbrook, D. (2011). An investigation of the accuracy of therapists’ self-assessment of cognitive-behaviour therapy skills. British Journal of Clinical Psychology DOI: 10.1111/j.2044-8260.2011.02028.x

Post written by Christian Jarrett for the BPS Research Digest.