Clinicians’ Perspectives on Cognitive Therapy in Community Mental Health Settings: Implications for Training and Implementation

  • Shannon Wiltsey Stirman
  • Ana Gutiérrez-Colina
  • Katherine Toder
  • Gregory Esposito
  • Frances Barg
  • Frank Castro
  • Aaron T. Beck
  • Paul Crits-Christoph
Original Article


Policymakers are investing significant resources in large-scale training and implementation programs for evidence-based psychological treatments (EBPTs) in public mental health systems. However, relatively little research has been conducted to understand factors that may influence the success of efforts to implement EBPTs for adult consumers of mental health services. In a formative investigation during the development of a program to implement cognitive therapy (CT) in a community mental health system, we surveyed and interviewed clinicians and clinical administrators to identify potential influences on CT implementation within their agencies. Four primary themes were identified. Two related to attitudes towards CT: (1) ability to address client needs and issues that are perceived as most central to their presenting problems, and (2) reluctance to fully implement CT. Two themes were relevant to context: (1) agency-level barriers, specifically workload and productivity concerns and reactions to change, and (2) agency-level facilitators, specifically, treatment planning requirements and openness to training. These findings provide information that can be used to develop strategies to facilitate the implementation of CT interventions for clients being treated in public-sector settings.


Evidence-based psychosocial treatments Cognitive therapy Dissemination and implementation 



The preparation of this article was funded in part by National Institute of Mental Health grants K99-MH080100, T32MH019836, P20 MH71905and R24MH070698, and the NIMH and VA-funded Implementation Research Institute through an award from the National Institute of Mental Health (R25 MH080916-01A2) and the Department of Veterans Affairs, Health Services Research & Development Service, Quality Enhancement Research Initiative (QUERI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health, the National Institutes of Health or the Department of Veterans Affairs.


None for any author.


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Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2012

Authors and Affiliations

  • Shannon Wiltsey Stirman
    • 1
    • 2
  • Ana Gutiérrez-Colina
    • 3
  • Katherine Toder
    • 4
  • Gregory Esposito
    • 5
  • Frances Barg
    • 6
    • 7
  • Frank Castro
    • 1
    • 2
  • Aaron T. Beck
    • 4
  • Paul Crits-Christoph
    • 4
  1. 1.Women’s Health Sciences Division, National Center for PTSDVA Boston Healthcare SystemBostonUSA
  2. 2.Department of PsychiatryBoston UniversityBostonUSA
  3. 3.Department of PsychologyUniversity of GeorgiaAthensUSA
  4. 4.Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.University of PennsylvaniaPhiladelphiaUSA
  6. 6.Department of Family Medicine and Community Health, School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  7. 7.Department of AnthropologyUniversity of PennsylvaniaPhiladelphiaUSA

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