Therapist stuck points during training in cognitive processing therapy: Changes over time and associations with training outcomes

Many practitioners have doubts or concerns about evidence-based treatments. The objective of this study was to evaluate such doubts and concerns, or therapist stuck points, during training in cognitive processing therapy (CPT). Data were collected from 57 therapists participating in a CPT Learning Collaborative. At three points during training, therapists were assessed for therapist stuck points related to CPT. Training outcomes were also assessed including therapists' completion of training requirements, fidelity to the CPT protocol, and ongoing use of CPT after training. Results indicated that therapist stuck points decreased during training (ds = 0.46-0.51, ps ≤ .001), especially among therapists attending a higher percentage of consultation calls. Therapist stuck points also predicted training outcomes. Higher therapist stuck points at the end of training and less reduction in therapist stuck points over the course of training predicted lower likelihood of completing training requirements (odds ratios, ORs = 0.89, ps = .005-.031). Less reduction in therapist stuck points also predicted worse fidelity (β=-0.31, p=.042). Finally, higher therapist stuck points at the beginning and end of training predicted lower likelihood of continued use of CPT (ORs = .84-91, ps ≤.031) and treating a lower number of CPT patients (rate ratios, RRs = 0.94-0.96, ps ≤ .047) at 12 months posttraining. Results suggest therapist stuck points are associated with worse training outcomes but also decrease during training. Practical suggestions are provided for therapists to identify and address their stuck points and for trainers, supervisors, and consultants to address stuck points of trainees.