Evidence-based treatment and therapist drift

• Published in: Behaviour research and therapy Vol. 47; no. 2; pp. 119 - 127
• Main Author: Waller, Glenn
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-02-2009; Elsevier; Elsevier Science Ltd
• Subjects: Adherence; Attitude of Health Personnel; Behavior modification; Behavior therapy. Cognitive therapy; Biological and medical sciences; Clinical Competence; Clinical psychology; Cognition & reasoning; Cognitive behaviour therapy; Cognitive therapy; Cognitive Therapy - methods; Cognitive Therapy - standards; Cognitive-behavioural therapy; Evidence based; Evidence-Based Medicine; Evidence-based therapy; Female; Humans; Male; Medical sciences; Physician-Patient Relations; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Therapist drift; Therapists; Therapy; Treatments; Young Adult; Adherence; Cognitive-behavioural therapy; Evidence-based therapy; Therapist drift; Human; Cognitive therapy; Treatment; Evidence-based practice; Behavior therapy
• ISSN: 0005-7967; 1873-622X
• DOI: 10.1016/j.brat.2008.10.018

Cognitive-behavioural therapy (CBT) has a wide-ranging empirical base, supporting its place as the evidence-based treatment of choice for the majority of psychological disorders. However, many clinicians feel that it is not appropriate for their patients, and that it is not effective in real life-settings (despite evidence to the contrary). This paper addresses the contribution that we as clinicians make to CBT going wrong. It considers the evidence that we are poor at implementing the full range of tasks that are necessary for CBT to be effective – particularly behavioural change. Therapist drift is a common phenomenon, and usually involves a shift from ‘doing therapies’ to ‘talking therapies’. It is argued that the reason for this drift away from key tasks centres on our cognitive distortions, emotional reactions, and use of safety behaviours. A series of cases is outlined in order to identify common errors in clinical practice that impede CBT (and that can make the patient worse, rather than better). The principles behind each case are considered, along with potential solutions that can get us re-focused on the key tasks of CBT.