Background: The widening scope of cognitive therapy models and strategies poses a challenge for designing cognitive therapy training. What are the core skills to be learned? What do learners view as important to learn and what are the skills and knowledge they focus on? Aims: The present study describes the perceptions of CT trainees of both what is important and what is difficult to learn. We also analyse what the trainees focus on when evaluating their professional learning. In addition, we report on changes in self-assessed skills during the training. Method: Quantitative and qualitative data were collected after 2 years of training (n = 39) in three programmes and after the entire 4-year training in four programmes (n = 53). Results: Significant progress was reported in all domains of therapist skills, most clearly in cognitive and constructivist strategies. The trainees practised most those skills they considered important to be learned and, consequently, they also attained a higher level of mastery in these skills. The trainees’ learning orientation and foci of self-reflections remained relatively unchanged. They focused on technical and conceptual skills and knowledge, whereas interpersonal skills were peripheral in their self-reflection. Conclusions: Pedagogical and theoretical implications of the findings are discussed.

A new model of therapist skill development is presented. Grounded in information processing theory, it provides a comprehensive framework that accounts for a range of phenomena encountered by trainers and trainees – for example, why different training methods are needed for different elements of therapist skill. The model features three principal systems: declarative, procedural and reflective (DPR). Reflection is identified as central to therapist skill development and, accordingly, a pivotal role is given to a reflective system, which enables therapists to reflect and build on their conceptual (declarative) knowledge and procedural skills. The DPR model incorporates a taxonomy of therapist skills, and explains why different skills develop in different ways at different rates. It highlights the centrality of therapists' perceptual skills, and of when-then rules, plans, procedures and skills (rules that determine when to implement what interventions with which patient under what conditions) in the development of therapist expertise. It makes a distinction between personal and professional selves (the self-schema vs. the self-as-therapist schema); and it identifies the role of the personal self in therapist skill development. While there are still many questions to be investigated, it is hoped that the model will stimulate researchers and provide guidance for trainers.

Experiential training and personal therapy have rich traditions in various therapies as strategies to enhance self-awareness and therapist skills. However, personal experiential work has not traditionally been part of cognitive therapy (CT) training. The purpose of the present study is to map the impact of personal experiential work on CT skills in a group of CT practitioners. Fourteen cognitive therapists undertook training courses utilizing a structured approach to self-practice of CT techniques, known as self-practice/self-reflection (SP/SR). Six therapists from one training group engaged in “co-therapy” sessions with a partner, while eight therapists from another training group practised CT techniques on their own. Both groups engaged in regular written reflections about their experience. Follow-up 1-5 months after the courses identified six areas of self-reported skill enhancement: Refinement of specific CT skills; Enriched communication of the conceptual framework of CT; Increased attention to the therapeutic relationship; Empathic attunement; Therapist self-reflection; and Therapeutic flexibility. The results suggested that SP/SR enhances the “professional artistry” of therapists, a finding consistent with literature suggesting that reflection is a key process in the development of therapist expertise. It is concluded that SP/SR represents a promising training strategy for cognitive therapists.