Sunday, 20 April 2014

How to Pass your CTSR


For CBT therapists, the CTS-R (Cognitive Therapy Scale - Revised) is akin to a driving test. You tape a therapy session and your every intervention is assessed against twelve criteria. To pass, you (in my experience) need to get at least 2 out of 5 on each of the 12 scales and a minimum average overall rating of 3.

The authors have provided a detailed CTS-R Manual which is well worth reading as it provides a detailed rationale and guidance. However, the manual is 30 pages long, so I have found its useful to have a one page summary - or crib - to read just before you go in for your "CBT driving test".

So here is my personalised CTS-R 1 page summary

I hope it proves useful. If you have some more tips, feel free to add them to the comments.
I'm also including some extra tips below, because, as with your driving test, doing your CTS-R can be quite a nerve-racking experience and you need all the help you can get

1) Choose your clients for CTS-R recordings carefully
Just as you wouldnt want to do your driving test going through Spaghetti Junction at rush hour, you wouldnt want to record a CTS-R session with a client with bipolar disorder or noticeable personality disorder. Of course you might want to record sessions with such a client and ask for feedback - but they are not the right clients to use when you are in training and trying to pass your CTS-R.

2) Pick the right stage of therapy
You wouldn't pass the CTS-R in an assessment session at the very beginning or in the last review session, and in general sessions at the beginning and end of therapy are not ideal. If you are doing short-term CBT, probably sessions 3-8 would be about right.

3) Practise before you submit a recording - and listen to it
I you want the pass on all items, you had better start getting into the habit of agenda setting, summarising regularly etc. Then listen to your recordings and mark yourself, and see what you need to improve on

4) Help your assessor understand your interventions
By this I don't mean reacting defensively when the assessor misses your brilliant piece of guided discovery or formulation. Much better instead to do one of the following
* Include with your tape a written explanation, minute by minute of your interventions. e.g. 10-20 mins - guided discovery regarding how to overcome fears
* Include with your tape details of the client including formulation and summary of treatment plan, therapist goals etc
* If possible, use a client which the assessor is familiar with e.g. you might have brought to supervision last time. If so, make sure you have considered implementing ideas brought up in supervision
* In the session itself, signpost what you are doing. For example, use phrases such as "to summarise" or "now that we have set an agenda". Your assessor is only human!

Those are my top tips -but what do you think?
Good luck, and dont forget to help others with your own ideas in the comments.

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