Competência em terapia cognitivo-comportamental: propriedades psicométricas de uma medida e seu uso em estágio supervisionado

Abstract

The expressive increase in the number of cognitive-behavioral therapists contrasts with the reduced concern about the most effective training processes and the best competency assessment strategies of beginning and experienced therapists. Thus, three studies were conducted on training and competence in cognitive-behavioral therapy. The first one aimed to describe the state of the art on cognitive-behavioral therapists training. The topics of publications, training strategies and measures of competence employed in articles indexed by PsycNET and published between 2011 and 2016 were analyzed. It was observed that the analyzed scientific production (N = 24) can be considered reduced and that the articles deal with five themes: Training Modalities, Training to work in Specific Clinical Conditions, Training to work with Specific Clients, Personal Development of the Therapist and Training for the Domain of Techniques or Specific Models. The training strategies that have been most used are expanded training and supervision. Competency assessment commonly occurs by examining the therapist's practice. Since no valid and reliable measures were found for this purpose in Brazil and given the need to define how and which competences will be developed during the training, the objective of the second study was to present the process of translation and adaptation of the Cognitive Therapy Scale Revised (CTS) -R) and the analysis of their psychometric properties. After obtaining a Brazilian version of the CTS-R based on international guidelines for translation and adaptation of measures, experienced therapists conducted evaluations of video-recorded therapy sessions with the instrument and trainees were evaluated during clinical supervision by their supervisors and also self-assessed. Evidence of validity was obtained according to internal structure and evidence of validity based on relations with external variables, as well as reliability estimates based on internal consistency and inter-rater reliability. As this measure proved to be adequate, it was used to evaluate the development of competences of trainee therapists. The objective of this study was to analyze the applicability of this instrument for self-evaluation. There was a significant increase in competency throughout the training and, in both self-evaluation and evaluation by supervisors, the trainees tended to be considered competent from the first collection. Therefore, the Brazilian version of the CTS-R seems a valid and reliable measure also for self-assessment by beginning therapists. Besides the analysis of the limitations of this research, especially those related to external validity, the possible contributions of the studies to the advance of the training of cognitive-behavioral therapists in Brazil are discussed as final considerations of the dissertation, emphasizing that it should be based on evidence.