Can I be a clin psy if I hate behaviour analysis & CBT?

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m4ddie
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Can I be a clin psy if I hate behaviour analysis & CBT?

Post by m4ddie » Tue Aug 18, 2020 8:20 pm

I absolutely detest applied behaviour analysis and all the behaviour modification approaches - I don’t like how focussed they are on compliance and having been through those types of therapy myself, I think they can be really damaging to people! It feels against my personal values to use behaviour modification techniques on another human being. But every clinical psychology course seems to be mostly focussed on cognitive behavioural approaches :(

Can I become a clin psy without having to do CBT/ABA type work? I’m interested in trauma-informed approaches and newer trauma therapies like sensorimotor psychotherapy, etc - I don’t want to do CBT or DBT!

hawke
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Re: Can I be a clin psy if I hate behaviour analysis & CBT?

Post by hawke » Tue Aug 18, 2020 9:35 pm

Every clinical psychology trainee has to demonstrate competence in 2 areas of therapy, and one of these must be CBT - so you definitely won't get around CBT, but choose your university carefully and you can have a wide choice of second specialism.

My experience of CBT in clinical psychology is that its use is much more considered than in other fields/services (e.g. IAPT). CPs learn to engage critically with the evidence base and the philosophy behind multiple therapies (and indeed, much more than therapy), rather than being very skilled in one modality which they have to use with everyone. So issues around compliance and potential harm should be out there in the open for discussion, even if you have to learn the skills.

m4ddie
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Re: Can I be a clin psy if I hate behaviour analysis & CBT?

Post by m4ddie » Tue Aug 18, 2020 10:23 pm

hawke wrote:
Tue Aug 18, 2020 9:35 pm
Every clinical psychology trainee has to demonstrate competence in 2 areas of therapy, and one of these must be CBT - so you definitely won't get around CBT, but choose your university carefully and you can have a wide choice of second specialism.

My experience of CBT in clinical psychology is that its use is much more considered than in other fields/services (e.g. IAPT). CPs learn to engage critically with the evidence base and the philosophy behind multiple therapies (and indeed, much more than therapy), rather than being very skilled in one modality which they have to use with everyone. So issues around compliance and potential harm should be out there in the open for discussion, even if you have to learn the skills.
Ahhh thank you so much! This is very useful. How can I find out about the specialisms of each individual course? I can’t seem to find that info

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miriam
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Re: Can I be a clin psy if I hate behaviour analysis & CBT?

Post by miriam » Wed Aug 19, 2020 12:42 am

I think maybe you are conflating legitimate reservations about ABA or other forms of hard behaviourism, which are generally done to try to change someone's behaviour without them actively consenting or agreeing the treatment goal, and CBT. Behaviour therapy is something that peaked in the 1970s. Nowadays it is usually done to try to increase communication or reduce harmful behaviour in someone with autism or learning disability coupled with challenging behaviour, where talking therapy is not possible. By contrast, CBT is a form of talking therapy that the person must actively engage in, that can help them to challenge their unhelpful thinking and make different choices in their behaviour, to take steps towards happiness, reduced distress, improved functioning or other goals they have identified.

I have heard of some bad examples of behavioural interventions (most recently a thesis shared on twitter where the goal was to try to shape a child with autism's play behaviour to conform with certain rules for "correct" symbolic play), but nowadays most clinical psychologists in the UK working with clients who are unable to engage in talking therapies but persist in behaviours that are harmful to themselves or others, or prevent them interacting with others have moved away from older forms of behavioural intervention towards positive behaviour support.

Whilst I think it is absolutely legitimate to feel that CBT can be a bit reductive - especially when delivered in time-limited, manualised packages from a very limited choice of pathways (as it can be within the context of IAPT) - the model can also be delivered in very in-depth, individualised ways that also pay attention to the relationship and are every bit as helpful with trauma as any of the trauma therapies you cite. Christine Courtois, for example, does fab work with adults with complex trauma. There is also schema therapy, and "third wave" variants of CBT that deal much more with the process and context of distress, including functions of behaviour and how the person interprets their sensations, emotions and experiences. CBT has a strong evidence base, and is well suited to many common mental health issues that bring people to therapy. Many other modes of therapy draw on or can be combined with elements of CBT with good efficacy.

If you dislike CBT and also DBT (arguably a third wave approach, which couples mindfulness and skills training - often with a focus on emotion regulation - with CBT to provide what should be a strengths-focused supportive and collaborative intervention for people with intense emotional swings that lead to self-harm or self-destructive behaviours) could it be that you are more focused on the word "behavioural" than what it actually means in practice within these acronyms? Or might it be that you've had negative experiences justified by this term? If so, it would be helpful perhaps to think about whether your experience was representative of a particular therapeutic model. Either way, before you make your judgement about what you hate or want to avoid in your career I think it is worth finding out more about CBT and these wider models.
Miriam

See my blog at http://clinpsyeye.wordpress.com

m4ddie
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Re: Can I be a clin psy if I hate behaviour analysis & CBT?

Post by m4ddie » Wed Aug 19, 2020 1:21 am

miriam wrote:
Wed Aug 19, 2020 12:42 am
I think maybe you are conflating legitimate reservations about ABA or other forms of hard behaviourism, which are generally done to try to change someone's behaviour without them actively consenting or agreeing the treatment goal, and CBT. Behaviour therapy is something that peaked in the 1970s. Nowadays it is usually done to try to increase communication or reduce harmful behaviour in someone with autism or learning disability coupled with challenging behaviour, where talking therapy is not possible. By contrast, CBT is a form of talking therapy that the person must actively engage in, that can help them to challenge their unhelpful thinking and make different choices in their behaviour, to take steps towards happiness, reduced distress, improved functioning or other goals they have identified.

I have heard of some bad examples of behavioural interventions (most recently a thesis shared on twitter where the goal was to try to shape a child with autism's play behaviour to conform with certain rules for "correct" symbolic play), but nowadays most clinical psychologists in the UK working with clients who are unable to engage in talking therapies but persist in behaviours that are harmful to themselves or others, or prevent them interacting with others have moved away from older forms of behavioural intervention towards positive behaviour support.

Whilst I think it is absolutely legitimate to feel that CBT can be a bit reductive - especially when delivered in time-limited, manualised packages from a very limited choice of pathways (as it can be within the context of IAPT) - the model can also be delivered in very in-depth, individualised ways that also pay attention to the relationship and are every bit as helpful with trauma as any of the trauma therapies you cite. Christine Courtois, for example, does fab work with adults with complex trauma. There is also schema therapy, and "third wave" variants of CBT that deal much more with the process and context of distress, including functions of behaviour and how the person interprets their sensations, emotions and experiences. CBT has a strong evidence base, and is well suited to many common mental health issues that bring people to therapy. Many other modes of therapy draw on or can be combined with elements of CBT with good efficacy.

If you dislike CBT and also DBT (arguably a third wave approach, which couples mindfulness and skills training - often with a focus on emotion regulation - with CBT to provide what should be a strengths-focused supportive and collaborative intervention for people with intense emotional swings that lead to self-harm or self-destructive behaviours) could it be that you are more focused on the word "behavioural" than what it actually means in practice within these acronyms? Or might it be that you've had negative experiences justified by this term? If so, it would be helpful perhaps to think about whether your experience was representative of a particular therapeutic model. Either way, before you make your judgement about what you hate or want to avoid in your career I think it is worth finding out more about CBT and these wider models.
Thank you!

alexh
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Re: Can I be a clin psy if I hate behaviour analysis & CBT?

Post by alexh » Wed Aug 19, 2020 1:00 pm

I started training from a similar position and so have been very surprised that the journey has taken me towards what I would describe as radical, contextual behaviourism based on relational frame theory (as described by the Barnes-Holmes group in Ghent and their collaborators).

Lancelot
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Re: Can I be a clin psy if I hate behaviour analysis & CBT?

Post by Lancelot » Thu Aug 20, 2020 10:32 am

m4ddie wrote:
Tue Aug 18, 2020 8:20 pm
I absolutely detest applied behaviour analysis and all the behaviour modification approaches - I don’t like how focussed they are on compliance and having been through those types of therapy myself, I think they can be really damaging to people! It feels against my personal values to use behaviour modification techniques on another human being. But every clinical psychology course seems to be mostly focussed on cognitive behavioural approaches :(

Can I become a clin psy without having to do CBT/ABA type work? I’m interested in trauma-informed approaches and newer trauma therapies like sensorimotor psychotherapy, etc - I don’t want to do CBT or DBT!
I would say an emphatic no. Trainees need to be open to approaches they will practice on placement. It is unethical to not use a therapy that could benefit your client and has evidence of its effectiveness, or not undertake the work that is required of you on placement. All clinical psychology course expect competency in CBT (whether they achieve that is another matter). True you do not have to work in that model post-qual in certain services but you would definitely need to be willing to in training.

You are better finding a training that would, definitely, not require you to undertake a placement or achieve competency in CBT, which is likely to be counselling and psychotherapy courses.

lingua_franca
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Re: Can I be a clin psy if I hate behaviour analysis & CBT?

Post by lingua_franca » Fri Aug 21, 2020 10:09 am

I'm autistic and lately I've noticed quite a number of people in online autism discussion groups lumping CBT in with ABA. There is good evidence for the use of CBT in the treatment of anxiety and depression in autistic people, but I suspect people are just hearing the word 'behavioural', assuming it must be like ABA, and reacting accordingly. Don't be put off by wording.

I agree with Miriam that CBT can feel very narrow and constraining in certain contexts. (Arguably it's been diluted to the point that it's no longer CBT - orange squash made from concentrate is hardly the same as a glass of freshly squeezed orange juice, even though there are similarities.) In those circumstances it might well feel focused on compliance - people who for whatever reason don't "do the homework" may end up feeling shamed and patronised, for example - but this is a risk with any time-limited therapy that is heavily focused on measurable outcomes. The issue isn't the modality, but the way it's sometimes delivered.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

alexh
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Re: Can I be a clin psy if I hate behaviour analysis & CBT?

Post by alexh » Sat Aug 22, 2020 7:10 pm

What's the problem with ABA? Isn't it just the same, it can be done badly or well?

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workingmama
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Re: Can I be a clin psy if I hate behaviour analysis & CBT?

Post by workingmama » Sun Aug 23, 2020 10:15 am

I'd try, in so far as is possible, to separate out what worked for you and what your experience of an intervention was with a specific therapist, with what the evidence base is for an approach in general based on data from multiple clinicians. I've had therapy that was ineffective and therapy that was effective. I have developed a preference for specific therapies and therapist attributes that work well for me and my individual formulation. This is based again on a straw poll of one. That doesn't mean that I discount the potential utility of my 'less preferred' approaches for others, or that I assume that all clinicians will (mis)use specific approaches in the way that I might have observed. Professionally I have my preferred approaches, but I try to stay open to the evidence base as much as possible, and to understand why. and in what way, those approaches have gained 'good evidence' (itself open to contest of course!).

I came to the course dead set against CBT, but now find myself using lots from CBT in my work. I feel that it is one of the approaches that most easily lends itself to being explained to the client/patient, and therefore I feel I can share my way of working with them better so that it is a joint piece of work. Other people may feel the same about 'their' preferred way of working. For me, it's a way of being able to be more transparent and to reduce the power imbalance in the room. I guess it's all in how we think about the approach and the meanings we ourselves make of them (who knew?).

Hope this adds to the conversation for you.
Fail, fail again, fail better.

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miriam
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Re: Can I be a clin psy if I hate behaviour analysis & CBT?

Post by miriam » Sun Aug 23, 2020 11:48 pm

alexh wrote:
Sat Aug 22, 2020 7:10 pm
What's the problem with ABA? Isn't it just the same, it can be done badly or well?
I'd say so. My only point is that behavioural interventions can be done to people, without them playing an active part in consenting or setting the treatment goals, unlike talk therapies. That's more because of being used with less able or communicative individuals. But as a result, the experience of the individual will be dependent on their experience of the process and whether they benefit from the outcomes. And that relies more on the judgement/ethics of the individuals involved than any inherent problem in the model.
Miriam

See my blog at http://clinpsyeye.wordpress.com

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