A DOCTORAL THESIS EXAMINING THE FIELD OF THERAPIST DRIFT IN COGNITIVE BEHAVIOURAL THERAPY, AND THE EXPLORATION OF META-COMPETENCE IN COGNITIVE BEHAVIOURAL THERAPY
Authors: Campbell-Lee Denika , Barton Stephen , Armstrong Peter 
Published: August 2023

Area of study The area of study for both the literature review and the empirical paper is Cognitive Behavioural Therapy (CBT). The literature review is a scoping review exploring the current literature related to therapist drift within the school of CBT, and the empirical paper explores meta-competence in CBT by comparing three groups of CBT therapists: trainees; recently experienced; and experienced. Important research questions Studies have outlined the importance of treatment fidelity when it comes to delivering CBT (Cukrowicz et al., 2011; Perepletchikova., 2011), however therapist drift appears to be a phenomenon that causes significant impact on the delivery of the evidence-based treatment. The scoping review aims to discover the current empirical evidence relating to therapist drift and whether there are significant implications associated. It also aims to explore what the theoretical claims are regarding therapist drift, and whether there is a consensus amongst researchers. This review has not been done before, and as therapist drift is seen to have a significant impact on CBT, it is important to have a compilation of sources related to drift. The question that guided the review is - What are the theoretical claims and empirical evidence for ‘therapist drift’ in Cognitive-Behavioural Therapy?The results feature a number of sources discovered through a search strategy using four electronic databases. The results are separated into two categories: sources related to theoretical claims; and sources related to empirical evidence. There is a discussion regarding the specifics of what has been found and a consideration of strengths and weaknesses of the sources and the review strategy. The empirical paper focuses on the identification of CBT higher order skills; meta-competencies (MCs). It explores MCs through comparing therapists of different levels of experience, and in which clinical scenarios they are likely to be prioritised. Although there is a general acknowledgement of MCs, there has been no empirical evidence exploring its existence or clinical implications. This research is the first exploratory study looking into MCs. The question that guided the research is – ‘Identifying higher-order therapy skills: Is there a difference between experienced and trainee therapists regarding meta-competence?’ The paper features detailed background research regarding competence and meta-competence in the field of CBT, the methodology used to test the question, and results which highlight the statistical tests used to test the hypotheses, and if they were accepted. The results highlight some differences found between the groups, and the paper discusses how these findings relate to future research and clinical practice. The literature review and empirical paper are somewhat linked. The literature review supports the presence of drift (related to the adherence (presence of) to features in CBT protocol), and how it is defined, and the empirical project explores the use of meta-competence in complex scenarios. The empirical project found evidence of clinicians using a putative meta-competency (reflection), which may encourage them to individualise therapy, moving away from standardised protocol, to work with complexity. Consequently, it can also help therapists adhere to a protocol (how to deliver it in this particular situation?). This provides further reason to explore the effects of drift (e.g. can it have positive implications?) and whether factors such as chronicity and patient complexity makes drift more inevitable.