Concerned About Fidelity? The
Importance of Utilizing a Systematic
Approach to
Cognitive-Behavioral Therapy If You Want to Develop a Fidelity Measurement Tool
by Aldo R. Pucci, Psy.D. ( http://nacbt.americommerce.com )
Sometimes spouses accuse each other of sexual infidelity. What
does this really mean? Well, there was a rule that they agreed to
follow -- to forsake all others. If that rule is broken, there is
infidelity. Without such a rule, one cannot be sexually unfaithful.
It is almost a weekly occurrence today for a mental health center from
somewhere in the USA to contact me with the following scenario:
MH
Center: Could you help us to develop a fidelity measurement?
Me: Why do you want to utilize a fidelity measurement?
MH
Center: We practice cognitive-behavioral therapy, and we want to make
certain that our therapists implement it correctly.
Me: What approach to CBT do you practice at your center?
I hear crickets.
MH Center:
What do you mean?
Me: Well, there is no such thing as "cognitive-behavioral therapy" as
a distinct psychotherapeutic approach. CBT is a very general term for
a
classification of therapy. There are different approaches to
cognitive-behavioral therapy, like Rational Emotive Behavior Therapy,
Rational Behavior Therapy, Rational Living Therapy, and Cognitive-Therapy.
MH
Center: We are not sure.
Me: Ok. Well, is the approach that you take systematic.
I hear more crickets.
MH
Center: We are not sure.
Me: Without a systematic approach to cognitive-behavioral
therapy, you have very little to which to be faithful. In other
words, it is very difficult to assess whether the therapist is doing what he or she is
supposed to be doing during sessions and at any given point in the therapy if you do not know what they are supposed to do at any given point.
Some
approaches are much more systematic than others. Among the most
systematic approaches are Dr. Maxie Maultsby's Rational Behavior Therapy and
my Rational Living Therapy (http://www.rational-living-therapy.org)
In my
estimation, I rank the major approaches to CBT the following way (from most
systematic to least):
Rational Living Therapy (Most Systematic)
Rational Behavior Therapy
Cognitive Therapy
Rational Emotive Behavior Therapy
Each approach to CBT is outstanding and has its strengths.
With Rational Living Therapy, for example, there are three phases of each
session (in this order) -- review of homework, instruction, invitation to
client to discussion what is on his or her mind. RLT also has a
systematic agenda for each session. This session's instruction builds
on the previous sessions' instruction. The rational self-counseling
topics are presented in an order that makes psychotherapeutic sense (for
example, teaching the client that our thoughts cause our feelings and
behaviors before teaching him or her how to examine thoughts).
Advantages to a
Systematic Approach to CBT
1. It
helps the therapist know what to do any any given point in the therapy.
2. It
helps the therapist know where he or she is in the process at any given
point.
3. It
helps the client know where he or she is in the process at any given point,
which helps the client see the light at the end of the tunnel.
4. It
makes it much easier to develop a fidelity measurement tool.
5.
Anyone who is trained in the systematic approach can pick up where you left
off.
6. The
system can be replicated.
7. It is
much easier to conduct research with a systematic approach.
Therefore, if you want to develop a fidelity measurement, learn or develop a
systematic approach to which you can be faithful.
Today,
many treatment centers and facilities are very interested in having their
staff trained in cognitive-behavioral therapy. For information on
in-house training options for CBT certification, please write me at
aldo@nacbt.org
(c) Copyright, 2009 by Aldo R. Pucci. All Rights Reserved.