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The academy of cognitive therapy: Purpose, history, and future prospects
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The Academy of Cognitive Therapy: Purpose, History, and Future Prospects Keith S. D o b s o n , University of Calgary J u d i t h S. B e c k a n d A a r o n T. Beck, Beck Institute f o r Cognitive Therapy a n d Research a n d The University of Pennsylvania The Academy of Cognitive Therapy (ACT) was developed as a means to identify and credential mental health professionals who demonstrate competence in cognitive therapy. Its missions include certifying clinicians from all disciplines as competent cog~zitive therapists and educating"the public about this empirically supported treatment. This article reviews the history of ACT, its current activities, and future prospects. It is argued that A CT fulfills several important roles and is a valuable resourcefor mental health professionals and consumers.
T H E ACADEMYo r COGNITIVE THERAPY (ACT) was cre.1. ated in 1996 as an organization to benefit both mental health professionals and the public. The principal function of ACT is to assess the competency of clinicians in cognitive therapy and to certify them in this type of psychotherapy. Since its inception, however, other aspects in its evolution have occurred, and several more are planned. In this article, we describe the purpose and short history of ACT. We then present the credentialing process that has been adopted by ACT and end with future prospects for the Academy.
P u r p o s e a n d History As is well known to readers of this journal, one of the most important developments in the field of psychotherapy in the latter part of the 20th century was that of the cognitive-behavioral therapies (cf. Dobson, 2001). A m o n g the various approaches to cognitive-behavioral therapy (CBT), cognitive therapy has had a specific role. Originated by Aaron T. Beck, M.D., cognitive therapy was one of the first CBT approaches to develop a manualized treatment (Beck, Rush, Shaw, & Emery, 1979). Cognitive therapy has adopted a consistent view of the nature of psychopathology, and has developed a series o f treatment techniques that have been shown over time to have efficacy in the treatment of a n u m b e r of disorders (cf. Butler & Beck, 2001). Given the conceptual clarity and integrative ability of cognitive therapy (Alford & Beck, 1997), coupled with the increasing empirical support for the treatment approach, it is not surprising that cognitive therapy has been given p r o m i n e n c e in graduate programs (Crits-
Cognitive and Behavioral Practice 12, 263-266, 2005 1077-7229/05/263-26651.00/0 Copyright © 2005 by Association for Advancement of Behavior Therapy. All rights of reproduction in any form reserved.
Cristoph et al., 1995). The emergence of training institutes, internship programs, and workshops in the field have also contributed significantly to the broad dissemination of cognitive therapy to various mental health professionals. In like fashion, books in the popular press (Burns, 1980; Greenberger & Padesky, 1995; Young & Klosko, 1993) have advocated the approach to consumers of mental health services, increasing the public d e m a n d for trained cognitive therapists. By the middle of the last decade the growth and popularity o f cognitive therapy had increased to the point where important professional and consumer issues began to emerge. As a result of these pressures, 36 directors of cognitive therapy programs met in Philadelphia in October 1996 to discuss the merits of creating an organization to educate the public about cognitive therapy and to certify qualified mental health professionals in cognitive therapy. T h e p r o g r a m directors at the initial c o n f e r e n c e decided that it was important to certify individuals as cognitive therapists for several reasons: • Cognitive therapy is a distinct empirically supported psychotherapy, which must maintain its own identity. O n e way to create a community of like-minded therapists is to create an organization uniquely situated to recognize qualified colleagues. • There has been confusion in the field, particularly in the distinction between cognitive-behavioral therapies in general (as well as some therapies that selectively employ cognitive techniques) and cognitive therapy in particular. • Many therapists had b e g u n to identify themselves as cognitive therapists, when their overall practice does not reflect such an orientation. Consumers, agencies, insurance companies, and researchers may be misled by erroneous self-labeling. Given the above concerns, the Academy was established as a way to address these issues. ACT was established as a
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Dobson et al. n o n p r o f i t organization, which has two major missions: to benefit consumers t h r o u g h education, a n d to identify h e a l t h professionals who have b e e n awarded ACT cred e n t i a l i n g in r e c o g n i t i o n o f their d e m o n s t r a t i o n o f a s o u n d knowledge o f the theory o f cognitive therapy a n d c o m p e t e n c e in its practice. F r o m the outset, ACT has been multidisciplinary and international. Founding fellows, who consisted of an original group of identified experts, include internationally recognized leaders in the field. As d e s c r i b e d on the ACT Web site (www.academyofct. org), ACT certification provides the following advantages a n d benefits: • i n c l u s i o n o n the A C T list o f c e r t i f i e d cognitive therapists; • d o c u m e n t a t i o n of c o m p e t e n c e in cognitive therapy for e m p l o y m e n t , p r o m o t i o n , o r t e n u r e purposes; • description o f m e m b e r s ' practices, publications, a n d presentations on the ACT Web site; • p r o m o t i o n of the effectiveness o f cognitive therapy to consumers, insurers, m a n a g e d care companies, a n d behavioral health-care institutions; • referrals of patients seeking cognitive therapy through an i n t e r n a t i o n a l referral database; • favorable consideration by insurers a n d m a n a g e d care panels; • o p p o r t u n i t i e s to guide the d e v e l o p m e n t o f cognitive therapy by serving on the governing b o a r d a n d committees o f the Academy; • participation in c o n t i n u i n g e d u c a t i o n p r o g r a m s s p o n s o r e d by ACT. A n o t h e r excellent benefit o f b e l o n g i n g to ACT is the o p p o r t u n i t y to participate in the organization's Webbased listserve, as the listserve is used to discuss a variety o f clinical, educational, theoretical, a n d research issues. T h e questions are r e s p o n d e d to by b o t h experts in these areas a n d by the g e n e r a l m e m b e r s h i p . M e m b e r s h i p in ACT allows access to the p r o m i n e n t leaders in the field. ACT is n o t a m e m b e r s h i p organization, in that it is n o t o p e n to anyone with an interest in cognitive therapy. Nor is c r e d e n t i a l i n g by ACT available to students in m e n t a l h e a l t h disciplines. Individuals who apply for certification must d o c u m e n t the c o m p l e t i o n o f their postgraduate education a n d professional licensing, as well as specific training in cognitive therapy. T h e y are r e q u i r e d to submit a written case s u m m a r y with a cognitive conceptualization a n d an a u d i o t a p e of actual treatment, which are evalu a t e d by the C r e d e n t i a l i n g Committee. A l t h o u g h ACT has existed for a relatively b r i e f time, it has already u n d e r t a k e n a n u m b e r of d e v e l o p m e n t a l steps. A B o a r d o f Directors has b e e n established. Official i n c o r p o r a t i o n as a n o n p r o f i t organization, based in the State o f Pennsylvania, has b e e n c o m p l e t e d . T h e criteria a n d p r o c e d u r e s for certification have b e e n established
a n d enacted. As o f J a n u a r y 2005, t h e r e were over 500 fellows a n d certified m e m b e r s . New applications are received a n d processed weekly. In addition to the credentialing process, the ACT b o a r d is moving to ensure c o n s u m e r e d u c a t i o n a n d advocacy related to cognitive t h e r a p y a n d that its m a n d a t e as a not-for-profit organization is fulfilled. These issues are discussed m o r e fully below. However, as credentialing is a n o t h e r p u r p o s e of ACT, to ensure the public has access to well-trained, e x p e r i e n c e d cognitive therapy practitioners, that process is d e s c r i b e d first.
The Credentialing Process M e m b e r s h i p in ACT is based on d e m o n s t r a t e d knowledge of a n d c o m p e t e n c e in the practice o f cognitive therapy. Typically, applicants first begin the process by completing Part I o f the application, d e s c r i b e d on the ACT Web site. 1 Part I involves providing d e m o g r a p h i c information, t r a i n i n g / d e g r e e , practice, a n d h e a l t h information, a n d p a y m e n t o f an application fee. Applicants must h o l d an advanced professional degree in any mental health profession (e.g., psychiatry, psychology, social work, nursing) a n d a c u r r e n t license for their profession (if available in their locale) in o r d e r to apply for certification. Applicants must also attest that they are n o t the subject of an ethics c o m p l a i n t or disciplinary process, or legal action, a n d that they possess malpractice insurance as neeessary in their profession a n d geographical r e g i o n to practice as a qualified mental health professional. Two letters of reference from professionals who can attest to their work in cognitive t h e r a p y are also required. T h e i n f o r m a t i o n p r o v i d e d in Part I is evaluated by the Credentials Committee. O n c e the Credentials Committee has a p p r o v e d the first p a r t o f the application, the applicant is invited to c o m p l e t e a n d submit the s e c o n d p a r t o f the application, which is r e l a t e d to the d e m o n s t r a t i o n o f clinical c o m p e t e n c e in cognitive therapy. In o r d e r to c o n d u c t this review, a description o f training in cognitive therapy, a case write-up, an a u d i o t a p e o f an actual cognitive therapy session, a n d an application fee are required. T h e r e q u i r e d training can take place in a n u m b e r of forms (e.g., formal graduate program, postgraduate course, workshop, a n d training, o r formal i n t e r n s h i p o r externship p r o g r a m ) . Whatever form it takes, though, certain experiences are required. F o r example, there are a series o f publications in the field that are c o n s i d e r e d core to a cognitive therapist's training. These are listed o n the ACT Web site (these references are r e p r o d u c e d h e r e in the Reference list, with an asterisk to d e n o t e them; o t h e r references that are r e c o m m e n d e d can also be f o u n d on 1Applicants also can obtain information through e-mail at info@ academyofct.org or by calling the ACT membership office at (610) 664-1273.
A c a d e m y of Cognitive Therapy
the ACT Web site), a n d applicants m u s t attest that they have r e a d at least five books in the area, a n d a m i n i m u m o f three of the r e q u i r e d books. Further, the a p p l i c a n t must have c o m p l e t e d the t r e a t m e n t o f at least 10 patients using cognitive therapy, for a m i n i m u m total o f 40 hours o f clinical training (and a m i n i m u m o f 10 hours of supervision). I n f o r m a t i o n a b o u t the n a t u r e o f the patients is r e q u i r e d in the a p p l i c a t i o n process. T h e case history that is p a r t of the application process must be written using a particular format, which fits the cognitive case conceptualization that is e x p e c t e d to be p a r t o f all cognitive therapy (J. Beck, 1995). T h e case description begins with a general history a n d description, which is to i n c l u d e such e l e m e n t s as identifying inform a t i o n , c h i e f c o m p l a i n t , history o f p r e s e n t illness, psychiatric history, p e r s o n a l a n d social history, m e d i c a l history, m e n t a l status observations, a n d a p p l i c a b l e DSM-IV diagnoses. A case f o r m u l a t i o n follows the case history. This section includes such issues as precipitants o f the c u r r e n t disorder, a cross-sectional view o f c u r r e n t cognitions a n d behaviors, a l o n g i t u d i n a l view o f cognitions a n d behaviors (i.e., core beliefs, rules, or assumptions), strengths a n d assets, a n d a working hypothesis that is d i r e c t e d toward t r e a t m e n t interventions. T h e t r e a t m e n t p l a n follows, i n c l u d i n g a p r o b l e m list, t r e a t m e n t goals, a n d p l a n for treatment. T h e final section o f the case write-up is a description o f the course of treatment. T h e a p p l i c a n t is e x p e c t e d to address a n u m b e r of key features o f cognitive therapy in this section, i n c l u d i n g the n a t u r e a n d quality of the therapeutic relationship, any relationship issues that were enc o u n t e r e d , the m a j o r cognitive therapy interventions that were used (including a rationale that links these interventions with the patient's t r e a t m e n t goals a n d the working hypothesis), t r e a t m e n t obstacles, a n d t r e a t m e n t o u t c o m e . Applicants are also e n c o u r a g e d to explain any unusual aspects o f the case that warrant consideration. In a d d i t i o n to the written case, applicants m u s t provide an a u d i o t a p e o f an actual t h e r a p y session (or, if the a p p l i c a n t is n o t English-speaking, a certified transcript of an actual therapy session). T h e t a p e d session may b e from the written case, b u t this is n o t a r e q u i r e m e n t o f the application process. It should also be n o t e d that there is considerable latitude in the type o f case that the applicant presents for evaluation. Age, gender, culture, presenting p r o b l e m s , a n d p r i m a r y i n t e r v e n t i o n m e t h o d s can all vary, as is true in n o r m a l clinical practice. I n d e e d , o n e of the implicit aspects o f the evaluation process used by ACT is to m a k e it as naturalistic as possible. Evaluation criteria a n d p r o c e d u r e s have b e e n a d o p t e d for b o t h the case write-up a n d audiotape. Materials are evaluated by m e m b e r s o f the C r e d e n t i a l Committee. F o r the written case, the r e q u i r e d e l e m e n t s are j u d g e d as ab-
sent, present but deficient, o r satisfactory. Each e l e m e n t is assigned a score, a n d a criterion has b e e n d e v e l o p e d for the a p p l i c a n t to be c o n s i d e r e d to have passed. In like measure, the a u d i o t a p e is r a t e d using the Cognitive Therapy Scale (CTS; Young & Beck, 1980). A cutoff score has b e e n established as the m i n i m u m e x p e c t e d level of cognitive therapy c o m p e t e n c e . T h e CTS was selected as the p r i m a r y m e a s u r e o f c o m p e t e n c e , as it has b e e n u s e d in o t h e r r e s e a r c h p r o j e c t s a n d has b e e n shown to possess a d e q u a t e reliability a n d validity for t h e c u r r e n t purp o s e ( D o b s o n , Shaw, & Vallis, 1985; Vallis, Shaw, & Dobson, 1986). As the above description reveals, the evaluation process for ACT is comprehensive. Its focus on g e n e r a l professional credentialing, specific cognitive t h e r a p y training, a n d the ability o f the a p p l i c a n t to conceptualize a n d work with actual cognitive therapy cases is seen as a chall e n g i n g yet a p p r o p r i a t e process to credential m e n t a l health professionals in cognitive therapy. It is also n o t e d that a l t h o u g h there are several aspects to the ACT cred e n t i a l i n g process, n o n e by itself is daunting. It is r a t h e r in the integration of the characteristics that a specialist in cognitive therapy can be recognized.
Accomplishments and Future Prospects Despite the b r i e f history o f ACT, it has a c c o m p l i s h e d a great deal. T h e Web site, www.academyofct.org, offers a wealth o f i n f o r m a t i o n to consumers a n d m e n t a l h e a l t h professionals. ACT m e m b e r s have u n d e r t a k e n a n u m b e r o f projects for consumers, f r o m v o l u n t e e r i n g to do free screening for psychiatric disorders as p a r t o f d e s i g n a t e d p r o g r a m s to offering low-cost o r p r o b o n o t r e a t m e n t to insolvent patients. A n u m b e r o f ACT m e m b e r s are involved in psychiatric residency p r o g r a m s a n d have exc h a n g e d course syllabi a n d training strategies to make their cognitive therapy p r o g r a m s m o r e effective. ACT m e m b e r s travel nationally a n d internationally to offer training to mental health professionals in cognitive therapy a n d consult with organizations worldwide to help t h e m develop their own training programs. ACT has s p o n s o r e d symposia a b o u t various aspects o f cognitive t h e r a p y at the a n n u a l c o n f e r e n c e of t h e Association for A d v a n c e m e n t o f Behavior T h e r a p y (AABT; now known as the Association for Behavioral a n d Cognitive Therapies). At its annual i n f o r m a t i o n m e e t i n g at AABT, ACT has s p o n s o r e d presentations o f innovative cognitive therapy topics by A a r o n T. Beck, M.D., a n d has established an annual award to h o n o r those leaders in cognitive t h e r a p y who have m a d e a substantial a n d significant i m p a c t on the field. ACT will c o n t i n u e its several missions. It will c o n t i n u e to evaluate a p p l i c a n t s for certification t h o u g h its cred e n t i a l i n g system. It will c o n t i n u e to p r o m o t e cognitive t h e r a p y t h r o u g h s p o n s o r i n g t r a i n i n g initiatives a n d
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c o n f e r e n c e s , t h r o u g h b r i n g i n g t o g e t h e r c o g n i t i v e therapy e d u c a t o r s , a n d t h r o u g h e n c o u r a g i n g t h e g r o w t h o f research in cog-nitive therapy. E d u c a t i o n o f b o t h c o n s u m e r s a n d interested m e n t a l h e a l t h professionals, t h r o u g h the s h a r i n g o f clinical, r e s e a r c h , a n d e d u c a t i v e e x p e r t i s e via t h e I n t e r n e t , will persist as an i m p o r t a n t service. W h a t o t h e r actions m i g h t b e in the f u t u r e o f t h e Academy? F o r o n e , the issue o f c r e d e n t i a l i n g in m e n t a l h e a l t h has i n c r e a s e d in p r o f i l e in r e c e n t years. W i t h the d e v e l o p m e n t o f e m p i r i c a l l y s u p p o r t e d t r e a t m e n t s a n d t h e inc r e a s e d r e c o g n i t i o n o f t h e n e e d for t r a i n i n g in these areas in p r o f e s s i o n a l a c c r e d i t a t i o n a n d t r a i n i n g standards, it is h i g h l y likely t h a t this r o l e will c o n t i n u e to b e o f c e n t r a l i m p o r t a n c e . In particular, s t a n d a r d s s u c h as t h o s e set by ACT, w h i c h o p e r a t e w i t h i n a p a r t i c u l a r m o d e l o f t h e r a p y b u t across d i f f e r e n t p r o f e s s i o n a l g r o u p s , will s e r v e as a n i m p o r t a n t a n t i d o t e to p o t e n t i a l p r o f e s s i o n specific claims to special expertise. P r o m o t i o n o f enh a n c e d t r a i n i n g standards, a n d p u b l i c awareness o f t h e s e standards, will b e c e n t r a l to A C T ' s future. C o m m u n i c a t i o n a m o n g , a n d s u p p o r t for; A C T ' s m e m b e r s will persist. W h i l e it is u n l i k e l y that A C T will directly b e c o m e i n v o l v e d in l o b b y i n g f o r the f u n d i n g o f t h e service p r o v i d e d by its m e m b e r s , it is likely t h a t such l o b b y i n g will take place. If so, A C T will w o r k to e n s u r e that its c r e d e n t i a l i n g process is a c c u r a t e l y p r e s e n t e d a n d used. Efforts t h a t h a v e alr e a d y b e e n m a d e to e n s u r e t h a t A C T ' s c r e d e n t i a l i n g process is o p e n to i n t e r n a t i o n a l a p p l i c a n t s also m a k e s it likely t h a t i n c r e a s e d g l o b a l i z a t i o n efforts will be n e e d e d . Finally, t h e e n h a n c e m e n t o f p u b l i c awareness o f e m p i r i cally s u p p o r t e d t r e a t m e n t s in g e n e r a l a n d c o g n i t i v e therapy in p a r t i c u l a r will likely o c c u p y an i n c r e a s i n g r o l e for ACT. In short, t h e r e is m u c h to do. As c o g n i t i v e t h e r a p y c o n t i n u e s to o c c u p y a c e n t r a l p l a c e in the array o f psyc h o t h e r a p i e s in the early 21st century, a n d as its f u t u r e only seems b r i g h t e r (Norcross, H e d g e s , & Prochaska, 2002), it is likely that A C T will b e c o m e an increasingly significant o r g a n i z a t i o n in the years to c o m e .
References Asterisks preceding a reference denote publications that are listed on ACT's Web site and considered essential to a cognitive therapist's training.
Alford, B. A., & Beck, A. T. (1997). The integrative power of cognitive the~= apy. New York: The Guilford Press. * Beck, A. T. (1976). Cognitive therapy and the emotional disonters. New York: International Universities Press. *Beck, A. T., Emery, G., & Greenberg, R. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books. * Beck, A. T., Freeman, A., & Associates. (1990). Cognitive therapy ofpersonality disorders. NewYork: The Guilford Press. * Beck, A. T., Rush, A.J., Shaw, B. E, & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press. * Beck, A. T., Wright, E D., Newman, C. E, & Liese, B. S. (1993). Cog~itioe therapy of substance abase. New York: The Guilford Press. * Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: The Guilford Press. Burns, D. D. (1980). Feeling good. NewYork: Avon Books. Butler, A., & Beck. J. S. (2001). Cognitive therapy outcomes: A review of meta-analyses. Tidsskrift for Norsk PsykologJ'orening, 38, 698-706. Crits-Cristoph, E, Chambless, D. L., Frank, E., Brody, C., & Karp, J. (1995). Training in empirically validated treatments: What are clinical psychology students learning? Professional Psychology: Research and Practice, 26, 514-522. * Dattilio, E M., & Padesky, C. A. (1990). Cognitive therapy with couples. Sarasota: Professional Resource Exchange. Dobson, ~ S. (Ed.). (2001). Handbook of cognitive-behavioral therapies (2nd e d.). New York: The Guilford Press. Dobson, K. S., Shaw, B. E, & Vallis, T. M. (1985). Reliability of a measure of the quality of cognitive therapy. B~JtishJournal of Clinical Psychology, 24, 295-300. *Freeman, A,, Pretzex;J., Fleming, B., & Simon, K. M. (1990). Clinical applications of cognitive therapy. New York: Plenum Press. Greenberger, D., & Padesky, C. (1995). Mind over mood: Changing how you feel by changing the way you think. New York: The Gnilford Press. *Leahy, R. (1996). Cognitive therapy: Basic principles and applicatious. Northvale, NJ: Jason Aronson. Norcross, J. c., Hedges, M., & Prochaska, J. O. (2002). The face of 2010: A Delphi poll on the future of psychotherapy. P~vfessional Psychology: Research and Practice, 33, 316-322. Padesk); C. A., & Greenbergel; D. (1995). Clinician's guide to mind over mood. NewYork: The Guilford Press. * Persons, J. B. (1989). Co~zitive therapy in practice: A case formulation approach. NewYork: Norton. Vallis, T. M., Shaw, B. E, & Dobson, IC S. (1986). The Cognitive Therapy Scale: Psychometric properties. Journal of Consulting and Clinical Psychology, 54, 31-385. Young, J. E., & Beck, A. T. (1980). The Cognitive Therapy Scale. Unpublished manuscript, University of Pennsylvania, Philadelphia. Young, J. E., & Klosko, J. S. (1993). Reinventing your life. New York: Penguin Books. Address correspondence to Keith S. Dobson, Department of Psychology, University of Calgary, Calgary, Alberta, Canada T2N 1N4; e-mail: [email protected]. This article was accepted under the editorship of Anne Marie Albano.
The Academy of Cognitive Therapy: Purpose, History, and Future Prospects Keith S. D o b s o n , University of Calgary J u d i t h S. B e c k a n d A a r o n T. Beck, Beck Institute f o r Cognitive Therapy a n d Research a n d The University of Pennsylvania The Academy of Cognitive Therapy (ACT) was developed as a means to identify and credential mental health professionals who demonstrate competence in cognitive therapy. Its missions include certifying clinicians from all disciplines as competent cog~zitive therapists and educating"the public about this empirically supported treatment. This article reviews the history of ACT, its current activities, and future prospects. It is argued that A CT fulfills several important roles and is a valuable resourcefor mental health professionals and consumers.
T H E ACADEMYo r COGNITIVE THERAPY (ACT) was cre.1. ated in 1996 as an organization to benefit both mental health professionals and the public. The principal function of ACT is to assess the competency of clinicians in cognitive therapy and to certify them in this type of psychotherapy. Since its inception, however, other aspects in its evolution have occurred, and several more are planned. In this article, we describe the purpose and short history of ACT. We then present the credentialing process that has been adopted by ACT and end with future prospects for the Academy.
P u r p o s e a n d History As is well known to readers of this journal, one of the most important developments in the field of psychotherapy in the latter part of the 20th century was that of the cognitive-behavioral therapies (cf. Dobson, 2001). A m o n g the various approaches to cognitive-behavioral therapy (CBT), cognitive therapy has had a specific role. Originated by Aaron T. Beck, M.D., cognitive therapy was one of the first CBT approaches to develop a manualized treatment (Beck, Rush, Shaw, & Emery, 1979). Cognitive therapy has adopted a consistent view of the nature of psychopathology, and has developed a series o f treatment techniques that have been shown over time to have efficacy in the treatment of a n u m b e r of disorders (cf. Butler & Beck, 2001). Given the conceptual clarity and integrative ability of cognitive therapy (Alford & Beck, 1997), coupled with the increasing empirical support for the treatment approach, it is not surprising that cognitive therapy has been given p r o m i n e n c e in graduate programs (Crits-
Cognitive and Behavioral Practice 12, 263-266, 2005 1077-7229/05/263-26651.00/0 Copyright © 2005 by Association for Advancement of Behavior Therapy. All rights of reproduction in any form reserved.
Cristoph et al., 1995). The emergence of training institutes, internship programs, and workshops in the field have also contributed significantly to the broad dissemination of cognitive therapy to various mental health professionals. In like fashion, books in the popular press (Burns, 1980; Greenberger & Padesky, 1995; Young & Klosko, 1993) have advocated the approach to consumers of mental health services, increasing the public d e m a n d for trained cognitive therapists. By the middle of the last decade the growth and popularity o f cognitive therapy had increased to the point where important professional and consumer issues began to emerge. As a result of these pressures, 36 directors of cognitive therapy programs met in Philadelphia in October 1996 to discuss the merits of creating an organization to educate the public about cognitive therapy and to certify qualified mental health professionals in cognitive therapy. T h e p r o g r a m directors at the initial c o n f e r e n c e decided that it was important to certify individuals as cognitive therapists for several reasons: • Cognitive therapy is a distinct empirically supported psychotherapy, which must maintain its own identity. O n e way to create a community of like-minded therapists is to create an organization uniquely situated to recognize qualified colleagues. • There has been confusion in the field, particularly in the distinction between cognitive-behavioral therapies in general (as well as some therapies that selectively employ cognitive techniques) and cognitive therapy in particular. • Many therapists had b e g u n to identify themselves as cognitive therapists, when their overall practice does not reflect such an orientation. Consumers, agencies, insurance companies, and researchers may be misled by erroneous self-labeling. Given the above concerns, the Academy was established as a way to address these issues. ACT was established as a
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Dobson et al. n o n p r o f i t organization, which has two major missions: to benefit consumers t h r o u g h education, a n d to identify h e a l t h professionals who have b e e n awarded ACT cred e n t i a l i n g in r e c o g n i t i o n o f their d e m o n s t r a t i o n o f a s o u n d knowledge o f the theory o f cognitive therapy a n d c o m p e t e n c e in its practice. F r o m the outset, ACT has been multidisciplinary and international. Founding fellows, who consisted of an original group of identified experts, include internationally recognized leaders in the field. As d e s c r i b e d on the ACT Web site (www.academyofct. org), ACT certification provides the following advantages a n d benefits: • i n c l u s i o n o n the A C T list o f c e r t i f i e d cognitive therapists; • d o c u m e n t a t i o n of c o m p e t e n c e in cognitive therapy for e m p l o y m e n t , p r o m o t i o n , o r t e n u r e purposes; • description o f m e m b e r s ' practices, publications, a n d presentations on the ACT Web site; • p r o m o t i o n of the effectiveness o f cognitive therapy to consumers, insurers, m a n a g e d care companies, a n d behavioral health-care institutions; • referrals of patients seeking cognitive therapy through an i n t e r n a t i o n a l referral database; • favorable consideration by insurers a n d m a n a g e d care panels; • o p p o r t u n i t i e s to guide the d e v e l o p m e n t o f cognitive therapy by serving on the governing b o a r d a n d committees o f the Academy; • participation in c o n t i n u i n g e d u c a t i o n p r o g r a m s s p o n s o r e d by ACT. A n o t h e r excellent benefit o f b e l o n g i n g to ACT is the o p p o r t u n i t y to participate in the organization's Webbased listserve, as the listserve is used to discuss a variety o f clinical, educational, theoretical, a n d research issues. T h e questions are r e s p o n d e d to by b o t h experts in these areas a n d by the g e n e r a l m e m b e r s h i p . M e m b e r s h i p in ACT allows access to the p r o m i n e n t leaders in the field. ACT is n o t a m e m b e r s h i p organization, in that it is n o t o p e n to anyone with an interest in cognitive therapy. Nor is c r e d e n t i a l i n g by ACT available to students in m e n t a l h e a l t h disciplines. Individuals who apply for certification must d o c u m e n t the c o m p l e t i o n o f their postgraduate education a n d professional licensing, as well as specific training in cognitive therapy. T h e y are r e q u i r e d to submit a written case s u m m a r y with a cognitive conceptualization a n d an a u d i o t a p e of actual treatment, which are evalu a t e d by the C r e d e n t i a l i n g Committee. A l t h o u g h ACT has existed for a relatively b r i e f time, it has already u n d e r t a k e n a n u m b e r of d e v e l o p m e n t a l steps. A B o a r d o f Directors has b e e n established. Official i n c o r p o r a t i o n as a n o n p r o f i t organization, based in the State o f Pennsylvania, has b e e n c o m p l e t e d . T h e criteria a n d p r o c e d u r e s for certification have b e e n established
a n d enacted. As o f J a n u a r y 2005, t h e r e were over 500 fellows a n d certified m e m b e r s . New applications are received a n d processed weekly. In addition to the credentialing process, the ACT b o a r d is moving to ensure c o n s u m e r e d u c a t i o n a n d advocacy related to cognitive t h e r a p y a n d that its m a n d a t e as a not-for-profit organization is fulfilled. These issues are discussed m o r e fully below. However, as credentialing is a n o t h e r p u r p o s e of ACT, to ensure the public has access to well-trained, e x p e r i e n c e d cognitive therapy practitioners, that process is d e s c r i b e d first.
The Credentialing Process M e m b e r s h i p in ACT is based on d e m o n s t r a t e d knowledge of a n d c o m p e t e n c e in the practice o f cognitive therapy. Typically, applicants first begin the process by completing Part I o f the application, d e s c r i b e d on the ACT Web site. 1 Part I involves providing d e m o g r a p h i c information, t r a i n i n g / d e g r e e , practice, a n d h e a l t h information, a n d p a y m e n t o f an application fee. Applicants must h o l d an advanced professional degree in any mental health profession (e.g., psychiatry, psychology, social work, nursing) a n d a c u r r e n t license for their profession (if available in their locale) in o r d e r to apply for certification. Applicants must also attest that they are n o t the subject of an ethics c o m p l a i n t or disciplinary process, or legal action, a n d that they possess malpractice insurance as neeessary in their profession a n d geographical r e g i o n to practice as a qualified mental health professional. Two letters of reference from professionals who can attest to their work in cognitive t h e r a p y are also required. T h e i n f o r m a t i o n p r o v i d e d in Part I is evaluated by the Credentials Committee. O n c e the Credentials Committee has a p p r o v e d the first p a r t o f the application, the applicant is invited to c o m p l e t e a n d submit the s e c o n d p a r t o f the application, which is r e l a t e d to the d e m o n s t r a t i o n o f clinical c o m p e t e n c e in cognitive therapy. In o r d e r to c o n d u c t this review, a description o f training in cognitive therapy, a case write-up, an a u d i o t a p e o f an actual cognitive therapy session, a n d an application fee are required. T h e r e q u i r e d training can take place in a n u m b e r of forms (e.g., formal graduate program, postgraduate course, workshop, a n d training, o r formal i n t e r n s h i p o r externship p r o g r a m ) . Whatever form it takes, though, certain experiences are required. F o r example, there are a series o f publications in the field that are c o n s i d e r e d core to a cognitive therapist's training. These are listed o n the ACT Web site (these references are r e p r o d u c e d h e r e in the Reference list, with an asterisk to d e n o t e them; o t h e r references that are r e c o m m e n d e d can also be f o u n d on 1Applicants also can obtain information through e-mail at info@ academyofct.org or by calling the ACT membership office at (610) 664-1273.
A c a d e m y of Cognitive Therapy
the ACT Web site), a n d applicants m u s t attest that they have r e a d at least five books in the area, a n d a m i n i m u m o f three of the r e q u i r e d books. Further, the a p p l i c a n t must have c o m p l e t e d the t r e a t m e n t o f at least 10 patients using cognitive therapy, for a m i n i m u m total o f 40 hours o f clinical training (and a m i n i m u m o f 10 hours of supervision). I n f o r m a t i o n a b o u t the n a t u r e o f the patients is r e q u i r e d in the a p p l i c a t i o n process. T h e case history that is p a r t of the application process must be written using a particular format, which fits the cognitive case conceptualization that is e x p e c t e d to be p a r t o f all cognitive therapy (J. Beck, 1995). T h e case description begins with a general history a n d description, which is to i n c l u d e such e l e m e n t s as identifying inform a t i o n , c h i e f c o m p l a i n t , history o f p r e s e n t illness, psychiatric history, p e r s o n a l a n d social history, m e d i c a l history, m e n t a l status observations, a n d a p p l i c a b l e DSM-IV diagnoses. A case f o r m u l a t i o n follows the case history. This section includes such issues as precipitants o f the c u r r e n t disorder, a cross-sectional view o f c u r r e n t cognitions a n d behaviors, a l o n g i t u d i n a l view o f cognitions a n d behaviors (i.e., core beliefs, rules, or assumptions), strengths a n d assets, a n d a working hypothesis that is d i r e c t e d toward t r e a t m e n t interventions. T h e t r e a t m e n t p l a n follows, i n c l u d i n g a p r o b l e m list, t r e a t m e n t goals, a n d p l a n for treatment. T h e final section o f the case write-up is a description o f the course of treatment. T h e a p p l i c a n t is e x p e c t e d to address a n u m b e r of key features o f cognitive therapy in this section, i n c l u d i n g the n a t u r e a n d quality of the therapeutic relationship, any relationship issues that were enc o u n t e r e d , the m a j o r cognitive therapy interventions that were used (including a rationale that links these interventions with the patient's t r e a t m e n t goals a n d the working hypothesis), t r e a t m e n t obstacles, a n d t r e a t m e n t o u t c o m e . Applicants are also e n c o u r a g e d to explain any unusual aspects o f the case that warrant consideration. In a d d i t i o n to the written case, applicants m u s t provide an a u d i o t a p e o f an actual t h e r a p y session (or, if the a p p l i c a n t is n o t English-speaking, a certified transcript of an actual therapy session). T h e t a p e d session may b e from the written case, b u t this is n o t a r e q u i r e m e n t o f the application process. It should also be n o t e d that there is considerable latitude in the type o f case that the applicant presents for evaluation. Age, gender, culture, presenting p r o b l e m s , a n d p r i m a r y i n t e r v e n t i o n m e t h o d s can all vary, as is true in n o r m a l clinical practice. I n d e e d , o n e of the implicit aspects o f the evaluation process used by ACT is to m a k e it as naturalistic as possible. Evaluation criteria a n d p r o c e d u r e s have b e e n a d o p t e d for b o t h the case write-up a n d audiotape. Materials are evaluated by m e m b e r s o f the C r e d e n t i a l Committee. F o r the written case, the r e q u i r e d e l e m e n t s are j u d g e d as ab-
sent, present but deficient, o r satisfactory. Each e l e m e n t is assigned a score, a n d a criterion has b e e n d e v e l o p e d for the a p p l i c a n t to be c o n s i d e r e d to have passed. In like measure, the a u d i o t a p e is r a t e d using the Cognitive Therapy Scale (CTS; Young & Beck, 1980). A cutoff score has b e e n established as the m i n i m u m e x p e c t e d level of cognitive therapy c o m p e t e n c e . T h e CTS was selected as the p r i m a r y m e a s u r e o f c o m p e t e n c e , as it has b e e n u s e d in o t h e r r e s e a r c h p r o j e c t s a n d has b e e n shown to possess a d e q u a t e reliability a n d validity for t h e c u r r e n t purp o s e ( D o b s o n , Shaw, & Vallis, 1985; Vallis, Shaw, & Dobson, 1986). As the above description reveals, the evaluation process for ACT is comprehensive. Its focus on g e n e r a l professional credentialing, specific cognitive t h e r a p y training, a n d the ability o f the a p p l i c a n t to conceptualize a n d work with actual cognitive therapy cases is seen as a chall e n g i n g yet a p p r o p r i a t e process to credential m e n t a l health professionals in cognitive therapy. It is also n o t e d that a l t h o u g h there are several aspects to the ACT cred e n t i a l i n g process, n o n e by itself is daunting. It is r a t h e r in the integration of the characteristics that a specialist in cognitive therapy can be recognized.
Accomplishments and Future Prospects Despite the b r i e f history o f ACT, it has a c c o m p l i s h e d a great deal. T h e Web site, www.academyofct.org, offers a wealth o f i n f o r m a t i o n to consumers a n d m e n t a l h e a l t h professionals. ACT m e m b e r s have u n d e r t a k e n a n u m b e r o f projects for consumers, f r o m v o l u n t e e r i n g to do free screening for psychiatric disorders as p a r t o f d e s i g n a t e d p r o g r a m s to offering low-cost o r p r o b o n o t r e a t m e n t to insolvent patients. A n u m b e r o f ACT m e m b e r s are involved in psychiatric residency p r o g r a m s a n d have exc h a n g e d course syllabi a n d training strategies to make their cognitive therapy p r o g r a m s m o r e effective. ACT m e m b e r s travel nationally a n d internationally to offer training to mental health professionals in cognitive therapy a n d consult with organizations worldwide to help t h e m develop their own training programs. ACT has s p o n s o r e d symposia a b o u t various aspects o f cognitive t h e r a p y at the a n n u a l c o n f e r e n c e of t h e Association for A d v a n c e m e n t o f Behavior T h e r a p y (AABT; now known as the Association for Behavioral a n d Cognitive Therapies). At its annual i n f o r m a t i o n m e e t i n g at AABT, ACT has s p o n s o r e d presentations o f innovative cognitive therapy topics by A a r o n T. Beck, M.D., a n d has established an annual award to h o n o r those leaders in cognitive t h e r a p y who have m a d e a substantial a n d significant i m p a c t on the field. ACT will c o n t i n u e its several missions. It will c o n t i n u e to evaluate a p p l i c a n t s for certification t h o u g h its cred e n t i a l i n g system. It will c o n t i n u e to p r o m o t e cognitive t h e r a p y t h r o u g h s p o n s o r i n g t r a i n i n g initiatives a n d
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c o n f e r e n c e s , t h r o u g h b r i n g i n g t o g e t h e r c o g n i t i v e therapy e d u c a t o r s , a n d t h r o u g h e n c o u r a g i n g t h e g r o w t h o f research in cog-nitive therapy. E d u c a t i o n o f b o t h c o n s u m e r s a n d interested m e n t a l h e a l t h professionals, t h r o u g h the s h a r i n g o f clinical, r e s e a r c h , a n d e d u c a t i v e e x p e r t i s e via t h e I n t e r n e t , will persist as an i m p o r t a n t service. W h a t o t h e r actions m i g h t b e in the f u t u r e o f t h e Academy? F o r o n e , the issue o f c r e d e n t i a l i n g in m e n t a l h e a l t h has i n c r e a s e d in p r o f i l e in r e c e n t years. W i t h the d e v e l o p m e n t o f e m p i r i c a l l y s u p p o r t e d t r e a t m e n t s a n d t h e inc r e a s e d r e c o g n i t i o n o f t h e n e e d for t r a i n i n g in these areas in p r o f e s s i o n a l a c c r e d i t a t i o n a n d t r a i n i n g standards, it is h i g h l y likely t h a t this r o l e will c o n t i n u e to b e o f c e n t r a l i m p o r t a n c e . In particular, s t a n d a r d s s u c h as t h o s e set by ACT, w h i c h o p e r a t e w i t h i n a p a r t i c u l a r m o d e l o f t h e r a p y b u t across d i f f e r e n t p r o f e s s i o n a l g r o u p s , will s e r v e as a n i m p o r t a n t a n t i d o t e to p o t e n t i a l p r o f e s s i o n specific claims to special expertise. P r o m o t i o n o f enh a n c e d t r a i n i n g standards, a n d p u b l i c awareness o f t h e s e standards, will b e c e n t r a l to A C T ' s future. C o m m u n i c a t i o n a m o n g , a n d s u p p o r t for; A C T ' s m e m b e r s will persist. W h i l e it is u n l i k e l y that A C T will directly b e c o m e i n v o l v e d in l o b b y i n g f o r the f u n d i n g o f t h e service p r o v i d e d by its m e m b e r s , it is likely t h a t such l o b b y i n g will take place. If so, A C T will w o r k to e n s u r e that its c r e d e n t i a l i n g process is a c c u r a t e l y p r e s e n t e d a n d used. Efforts t h a t h a v e alr e a d y b e e n m a d e to e n s u r e t h a t A C T ' s c r e d e n t i a l i n g process is o p e n to i n t e r n a t i o n a l a p p l i c a n t s also m a k e s it likely t h a t i n c r e a s e d g l o b a l i z a t i o n efforts will be n e e d e d . Finally, t h e e n h a n c e m e n t o f p u b l i c awareness o f e m p i r i cally s u p p o r t e d t r e a t m e n t s in g e n e r a l a n d c o g n i t i v e therapy in p a r t i c u l a r will likely o c c u p y an i n c r e a s i n g r o l e for ACT. In short, t h e r e is m u c h to do. As c o g n i t i v e t h e r a p y c o n t i n u e s to o c c u p y a c e n t r a l p l a c e in the array o f psyc h o t h e r a p i e s in the early 21st century, a n d as its f u t u r e only seems b r i g h t e r (Norcross, H e d g e s , & Prochaska, 2002), it is likely that A C T will b e c o m e an increasingly significant o r g a n i z a t i o n in the years to c o m e .
References Asterisks preceding a reference denote publications that are listed on ACT's Web site and considered essential to a cognitive therapist's training.
Alford, B. A., & Beck, A. T. (1997). The integrative power of cognitive the~= apy. New York: The Guilford Press. * Beck, A. T. (1976). Cognitive therapy and the emotional disonters. New York: International Universities Press. *Beck, A. T., Emery, G., & Greenberg, R. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books. * Beck, A. T., Freeman, A., & Associates. (1990). Cognitive therapy ofpersonality disorders. NewYork: The Guilford Press. * Beck, A. T., Rush, A.J., Shaw, B. E, & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press. * Beck, A. T., Wright, E D., Newman, C. E, & Liese, B. S. (1993). Cog~itioe therapy of substance abase. New York: The Guilford Press. * Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: The Guilford Press. Burns, D. D. (1980). Feeling good. NewYork: Avon Books. Butler, A., & Beck. J. S. (2001). Cognitive therapy outcomes: A review of meta-analyses. Tidsskrift for Norsk PsykologJ'orening, 38, 698-706. Crits-Cristoph, E, Chambless, D. L., Frank, E., Brody, C., & Karp, J. (1995). Training in empirically validated treatments: What are clinical psychology students learning? Professional Psychology: Research and Practice, 26, 514-522. * Dattilio, E M., & Padesky, C. A. (1990). Cognitive therapy with couples. Sarasota: Professional Resource Exchange. Dobson, ~ S. (Ed.). (2001). Handbook of cognitive-behavioral therapies (2nd e d.). New York: The Guilford Press. Dobson, K. S., Shaw, B. E, & Vallis, T. M. (1985). Reliability of a measure of the quality of cognitive therapy. B~JtishJournal of Clinical Psychology, 24, 295-300. *Freeman, A,, Pretzex;J., Fleming, B., & Simon, K. M. (1990). Clinical applications of cognitive therapy. New York: Plenum Press. Greenberger, D., & Padesky, C. (1995). Mind over mood: Changing how you feel by changing the way you think. New York: The Gnilford Press. *Leahy, R. (1996). Cognitive therapy: Basic principles and applicatious. Northvale, NJ: Jason Aronson. Norcross, J. c., Hedges, M., & Prochaska, J. O. (2002). The face of 2010: A Delphi poll on the future of psychotherapy. P~vfessional Psychology: Research and Practice, 33, 316-322. Padesk); C. A., & Greenbergel; D. (1995). Clinician's guide to mind over mood. NewYork: The Guilford Press. * Persons, J. B. (1989). Co~zitive therapy in practice: A case formulation approach. NewYork: Norton. Vallis, T. M., Shaw, B. E, & Dobson, IC S. (1986). The Cognitive Therapy Scale: Psychometric properties. Journal of Consulting and Clinical Psychology, 54, 31-385. Young, J. E., & Beck, A. T. (1980). The Cognitive Therapy Scale. Unpublished manuscript, University of Pennsylvania, Philadelphia. Young, J. E., & Klosko, J. S. (1993). Reinventing your life. New York: Penguin Books. Address correspondence to Keith S. Dobson, Department of Psychology, University of Calgary, Calgary, Alberta, Canada T2N 1N4; e-mail: [email protected]. This article was accepted under the editorship of Anne Marie Albano.