Learning from therapists about the challenges and opportunities of training in cognitive behavioral therapy for psychosis: qualitative findings from a US-based service evaluation

BackgroundCBT for psychosis (CBTp) is a care standard for people with psychosis in the United States (US). However, CBTp access is poor. The context differs from the UK, where CBTp was primarily developed. This US-based service evaluation addresses a knowledge gap and forms a pilot study: a broad goal was to learn about CBTp training's impact on therapists. Specific aims were to: 1) describe the challenges and opportunities of CBTp training by interviewing therapists competent in formulation-driven CBTp; 2) make recommendations for practice and research.MethodsTherapists' experiences of a 3-day CBTp workshop and 12-month consultation period in a US outpatient service were evaluated via focus groups. Participants were eight of ten therapists achieving CBTp competency.ResultsThematic analysis of focus group content yielded four themes: 1) Before CBTp: Support and medication; 2) Hope and possibility; 3) A reality check; 4) The future: Ongoing development or "flavor of the week".DiscussionTherapist perspectives help elucidate barriers and facilitators for US CBTp implementation, from the challenge for therapist-case managers of accommodating CBTp, to the potential of shared therapeutic models for team cohesion. Recommendations include clarifying how best to use CBTp within large caseloads, and mixed method longitudinal studies of training.