Conclusions and Recommendations

Looking ahead, CBT will probably continue to be successful as a cost-efficient, short-term treatment. In the public sector, where CBT is a recommended treatment for most common mental health problems, the government is committed to expanding its mental health provisions. In the charitable sector CBT is also likely to be a treatment of choice for organisations that compete for limited funding and where there is need to manage long waiting lists due to demands on their services. In the private sector CBT is expected to remain popular due to its endorsement by health insurance companies. It seems imperative that counselling psychology as a profession continues to engage with, and contribute to, all these services.

The high level of dissatisfaction reported by the participants concerning their training, if common among trainees, may pose a significant challenge in this regard. It is possible that dissatisfaction with academic tuition or clinical supervision could lead trainees to become

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disengaged from CBT theory and with the exploration of its diverse practices and applications. Potentially, this could impact negatively on their training in CBT and the quality of CBT they offer clients in these services. It is essential to ask, therefore, how prevalent these concerns are among trainees and what can be done to address them.

It is possible that unrealistic expectations are common among trainees in many different aspects of their professional training in counselling psychology (Efstathiou, 2017; Szymanska 2002). Concerning CBT, this study suggests that trainees may not be fully aware of the need for self-directed learning and continuous professional development beyond their initial course training. It seems that trainees may believe that their occupational training in counselling psychology will provide them with all the expertise they need to practice CBT proficiently. Thus, the distinction and clarity of expectation between ‘expertise’ and ‘working knowledge’ may need to be explored more fully. One area that might potentially help, if not being addressed already, would be for courses to provide prospective trainees with clearer information about the range of theoretical and practical skills trainees will need to develop in order to acquire a ‘working knowledge’ of CBT. Trainees interested in pursuing CBT vocationally might also be better informed about the benefits of acquiring additional training experiences before, during, and after completing their course. While courses may be addressing this issue in different ways, further research is needed to explore the extent of the problem, its potential impact on trainees and the steps that could be taken to redress it.

The participants described aspects of CBT that they enjoyed and which they felt contributed positively to their therapist ‘toolbox’. However, based on their placement and supervisory experiences they were sceptical and critical of CBT as an approach. While this

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may not be a problem per se, it was associated with frustration and work dissatisfaction during their placements. Furthermore, it appeared to lead some participants to look sceptically at CBT theory in the light of their negative experiences and to conclude that they were a reflection of common practice across a range of CBT services. The dissatisfaction they felt could in part be explained by the ‘conflicting paradigms’ that sometimes existed between themselves and their CBT supervisors concerning the best way to conduct therapy. As previously reported by trainees and qualified counselling psychologists in other studies, this difference in perspectives was attributed to the participants’ belief that counselling psychology values should be expressed in their work.

However, many of the participants’ concerns could be attributed to their supervisors’ guidance or to their placements’ operating policies and procedures. These concerns, often perceived to be commonplace in other services, were frequently presented as evidence of problems with CBT itself. This possible conflation between specific concerns about CBT practice and its general use appeared to shape the participants’ perceptions of CBT. Courses could possibly help trainees to look further at how different practitioners and services interpret and implement CBT’s theory in practice. In turn this might enable trainees to achieve a greater appreciation of the diverse ways CBT can be practised, and a critical appraisal of how supervisors or placements are applying CBT and promoting its best practice.

Negative supervisory experiences were the focal point of much of the participants’ criticism, but the perspectives of their supervisors on issues such as pluralism and the role of the therapeutic relationship was beyond the scope of this study. It is possible that some CBT supervisors may place less emphasis on the therapeutic relationship than do others.

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Given the importance to trainees of their professional values, this may have influenced their perception and experience of CBT. Thus, it could help trainees to achieve greater satisfaction in their work if they were able to establish a shared understanding with their supervisors. Further research on the extent to which trainees express concerns in this area, as well as the views of CBT supervisors on the ‘working alliance’ and the use of PCT and PDT concepts when conceptualising the therapeutic relationship could be helpful. Given the reported benefits of addressing the therapeutic relationship as a key determinant of positive outcomes for clients, the pluralistic training of counselling psychology places trainees in a strong position to contribute positively to the current theory and practice of CBT. We need to ensure that we are making the most of this opportunity.