CBT: Cognitive-Behavioral Therapy Fidelity Measurement

Concerned About Fidelity?  The Importance of Utilizing a Systematic
Approach to Cognitive-Behavioral Therapy
If You Want to Develop a Fidelity Measurement Tool

by Aldo R. Pucci, Psy.D.


Sometimes spouses accuse each other of sexual infidelity.  What does this really mean?  Well, there was a rule that they agreed to follow — to forsake all others.  If that rule is broken, there is infidelity.  Without such a rule, one cannot be sexually unfaithful.

It is almost a weekly occurrence today for a mental health center from somewhere in the USA to contact me with the following scenario:

MH Center: Could you help us to develop a fidelity measurement?

           Me: Why do you want to utilize a fidelity measurement?

MH Center: We practice cognitive-behavioral therapy, and we want to make certain that our therapists implement it correctly.

           Me: What approach to CBT do you practice at your center?

I hear crickets.

MH Center: What do you mean?

           Me: Well, there is no such thing as “cognitive-behavioral therapy” as a distinct
psychotherapeutic approach.  CBT is a very general term for a
classification of therapy.  There are different approaches to cognitive-behavioral
therapy, like Rational Emotive Behavior Therapy, Rational Behavior Therapy, Rational
Living Therapy, and Cognitive-Therapy.

MH Center: We are not sure.

           Me: Ok.  Well, is the approach that you take systematic.

I hear more crickets.

MH Center: We are not sure.

           Me: Without a systematic approach to cognitive-behavioral therapy, you have very little to
which to be faithful.  In other words, it is very difficult to assess whether the therapist is
doing what he or she is supposed to be doing during sessions and at any given point in
the therapy if you do not know what they are supposed to do at any given point.

Some approaches are much more systematic than others.  Among the most systematic approaches are Dr. Maxie Maultsby’s Rational Behavior Therapy and my Rational Living Therapy (http://www.rational-living-therapy.org)

In my estimation, I rank the major approaches to CBT the following way (from most systematic to least):

Rational Living Therapy (Most Systematic)
Rational Behavior Therapy
Cognitive Therapy
Rational Emotive Behavior Therapy


Each approach to CBT is outstanding and has its strengths.

With Rational Living Therapy, for example, there are three phases of each session (in this order) — review of homework, instruction, invitation to client to discussion what is on his or her mind.  RLT also has a systematic agenda for each session.  This session’s instruction builds on the previous sessions’ instruction.  The rational self-counseling topics are presented in an order that makes psychotherapeutic sense (for example, teaching the client that our thoughts cause our feelings and behaviors before teaching him or her how to examine thoughts).

Advantages to a Systematic Approach to CBT

1. It helps the therapist know what to do any any given point in the therapy.

2. It helps the therapist know where he or she is in the process at any given point.

3. It helps the client know where he or she is in the process at any given point, which helps the client see the light at the end of the tunnel.

4. It makes it much easier to develop a fidelity measurement tool.

5. Anyone who is trained in the systematic approach can pick up where you left off.

6. The system can be replicated.

7. It is much easier to conduct research with a systematic approach.

Therefore, if you want to develop a fidelity measurement, learn or develop a systematic approach to which you can be faithful.

Today, many treatment centers and facilities are very interested in having their staff trained in cognitive-behavioral therapy.  For information on in-house training options for CBT certification, please write me at aldo@nacbt.org

     (c) Copyright, 2009 by Aldo R. Pucci.  All Rights Reserved.

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