It is a great honor, pleasure and responsibility to be the president elect of the IACP. First of all I would like to express my gratitude and thanks to the board members of IACP and to all of the members of the IACP community for nominating and electing me as the next president. No doubt, this will sometimes be an exhausting but mostly a very rewarding task. I will do the best I can to deserve such a unique and significant post. I would also like to express my sincere thanks
to Simon Rego, who does a great job in continuing to offer this excellent newsletter for the members of ACT and IACP. When he asked me to write a column as the incoming president, I realized the beauty and difficulty of expressing myself to the members of two distinguished communities that I have always found to be supportive, educative, encouraging and compassionate. There is still more than a year to take over the position of the incoming president. Knowing that our present president, my dear friend and colleague Stefan Hofmann is irreplaceable (in many different ways) I do not see him as an outgoing president but as a reliable partner to collaborate with in order to achieve IACP’s ultimate goals. Being a member of the IACP board for long enough, I had the unique privilege to work with giant role models such as Robert Leahy, Keith Dobson, Lata McGinn and Stefan Hoffman who have all been presidents of the IACP and contributed highly to the field of cognitive psychotherapy. I have no doubt that they will all collaborate and help guiding me through the right path to materialize our future mutual goals. One of my targets for the future will no doubt be improving communication and liaison with other CBT societies around the globe that share similar interests and goals to promote and disseminate CBT. These collaboration efforts will hopefully conclude by establishing a truly inclusive and integrative world federation of CBT. This can only be done through cooperation, communication, respecting different needs and via elegant care to preserve the uniqueness of each association while integrating mutual and multidimensional efforts.

I believe the time has come to talk not only about disseminating CBT but emphasizing the significance of disseminating good practice in CBT. Although CBT has long been recognized for its efficacy confirmed by the hundreds of meta-analytic studies conducted, some media reports emerge from time to time that challenge its effectiveness and claim its clinical significance is exaggerated. Most of these reports appear as “expert” opinions and are either not based on scientific data or stated without careful analysis of the conclusions drawn. Although experienced CBT therapists and researchers can easily identify the defects and pitfalls of such published material, this may cause confusion in the minds of many young mental health professionals who are not familiar with psychotherapy literature. Scott Miller’s post in his blog in November 2015 (www.scottdmiller.com) highlights the headline from one of Sweden’s largest daily newspapers that states “The one sided focus on CBT is damaging Swedish mental health...” and continues by saying that Swedish National Audit Office concludes that “When all you have is CBT, mental health suffers.” He posited that after spending 7 billion crowns, the National Audit Office concluded that CBT had no effect on the outcome of people disabled by depression and anxiety and nearly a quarter of people treated with CBT dropped out. He concluded that the treatment approach does not account for the variance in outcome and therefore supports the old “dodo bird” verdict. This contradicts with the good news that states “The extent of evidence for effectiveness of CBT have reached to such an extent that professional and governmental organizations recognize its value and thus CBT is strongly advocated for treatment of anxiety disorders, unipolar depression and eating disorders in some national guidelines.” We, as CBT therapists, obviously find the former type of news to be concerning and have to further investigate these kinds of contradictory findings.

Many studies do not adequately describe their treatment procedures and therefore, cannot reliably be measured in terms of adherence and competence. It is our need and perhaps duty to define better the key principles that constitute good practice of CBT.

Clinicians’ self-reports of doing CBT may not always be a reliable predictor of their adherence and competence in pursuing good practice of CBT. The appropriateness and quality of its implementation and delivery needs to be defined better. No doubt, it has been a major advancement to establish internet based treatments. Unfortunately some professionals are keen to distort the reality and persist in making the most unfortunate interpretation out of a brilliant advancement in the field. If we look at the Guardian Post written by Oliver Burkeman on January 7, 2016 (www.theguardian.com/science/2016/jan/07/therapy-wars- revenge-of-freud-cognitive-behavioural-therapy?CMP=fb_gu) titled as “Therapy wars: the revenge of Freud”, we will hear about the story of a British woman called Rachel from Oxfordshire who sought therapy from the NHS for depression. According to the article, she was asked to sit through a group of PowerPoint presentations that promised “improving mood states” and received CBT from a computer in between sessions. She remarked “I don’t think anything has ever made me feel as lonely and isolated as having a computer program ask me how I felt on a scale of one to five” and carried on stating “I may be mentally ill, but I do know that a computer does not feel bad for me.” No doubt that as CBT experts we all know that computerized CBT is not there to replace therapists, but can we imagine how a young therapist candidate may be influenced by a media-coverage like these? The same article emphasizes the significance of client therapist relationship in treatment outcome and tries to imply that CBT is a treatment approach in which therapist-client relationship is totally ignored despite many books and articles written by CBT experts about the significance of this issue. Unfortunately it also refers to CBT as a discipline that views painful emotions as “something to be eliminated” (quoted from the Guardian).

(continued)

Getting back to the point I started with, we need to define our discipline better by referring to key principles and guidelines that constitute a good practice of CBT. That takes us back to issues of adherence and competence. Adherence measures tell how much therapists do what they are supposed to do, while competence measures tell how well therapists do what they are expected to do. In their commentary to the article “The effects of CBT as an anti-depressive treatment is falling: a meta-analysis” that appeared in a prior (June 2015) issue of this newsletter, Aaron Beck and Scott Waltzman elegantly discussed their concerns about the validity of the conclusions drawn by the authors of this article. In their discussion, they also refer to issues of measuring therapist adherence and competence. There is increasing data that shows that improving competence improves treatment outcomes. I want to draw attention to that fact that the term “CBT” may be losing its specificity. Dissemination is a necessary but not sufficient construct. If we only rely on dissemination, this may result in discrediting of the approach due to lack of competent adherence. The time has come to emphasize the significance of “dissemination of good-practice.” This requires clarification of treatment procedures, defining the optimum pre-requisites that constitute a reasonable CBT. An effort that we initiated many
years ago as a task force of EABCT under the leadership of Isaac Marks (Common Language in Psychotherapy Procedures; www. commonlanguagepsychotherapy.org) aimed to serve this goal where therapists explain what they do in their daily practice (with a case illustration) in order to facilitate the use of the same procedures to describe a therapeutic intervention. The lack of a widely agreed empirical definition ends up with various therapists using the same term to describe different procedures, which slows down the evolution of psychotherapy into a science.

We need to define the role and limits of low therapist input treatments such as internet based ones and how they can be competently utilized within a health care system and which patients would benefit from lower intensity interventions and which requires more contact with the therapist.

To conclude, CBT is the treatment approach with the strongest current evidence base for many psychological problems. However, when problems are identified as suitable to be treated by cognitive behavioral approaches, CBT may not be readily available and when CBT is available, the question of whether it is always CBT remains to be better analyzed. When professionals refer to patients as “treatment refractory”, we need to find out whether this labeling is appropriate. This can only be done if client perceptions of what was done in treatment match with well-defined procedures of what should have been done in sessions and in between sessions. We need to make sure that effective components of CBT, such as in session and in between session activities are competently designed, as good adherence does not necessarily imply competent delivery. One of my aims will be working on defining “optimum” standards of training instead of “minimum” standards by having close collaboration with societies such as Academy of Cognitive Therapy (ACT) and European Association of Behaviour and Cognitive Therapies (EABCT) that have different standards for certification and accreditation of cognitive behavior therapists. Setting up similar standards in certification and accreditation procedures of CBT trainings may be an important issue to consider during my presidency.

I am hoping that my background experiences both with EABCT and ACT will help facilitate this cooperation and collaboration between the two major CBT societies. Having served in different positions including the presidency and particularly having worked as a member of the first training and accreditation committee of EABCT gave me the chance to learn about different and common needs of various European associations serving under the same umbrella. Having had a longstanding bond with ACT as a founding fellow and certified supervisor and trainer, I am hoping that both communities will be willing to cooperate in order to find common ground to set joint guidelines in certification and accreditation procedures.

Bridging the perceived gaps within the CBT family is another issue to be taken seriously considering the increasing demand to learn more about the “third wave” therapies which are sometimes perceived to be totally distinct approaches. An important initial step was taken at the last ABCT convention in Chicago where Steven Hayes and Stefan Hoffman had a dual conversation regarding how to fill in the perceived gaps. The IACP board will be happy to facilitate bridging these gaps given the task to take part in doing this.

And last, but not least, I would like to mention two major CBT congresses that will be organized in Europe in the year 2017.One of these congresses will be the 9th International Congress
of Cognitive Psychotherapy (ICCP) that will be held in Cluj- Napoca, Romania (www.iccp2017.org) and the other one will be the 47th Congress of the European Association for Behavioural and Cognitive Therapies (EABCT) organized by the Turkish Association of Cognitive and Behavioural Therapies (TACBT) that will be held in Istanbul, Turkey (www.eabct2017.org) That gives me two hats to wear as the president elect of IACP and the president of TACBT. I will give more details about both of the congresses in forthcoming newsletters.

I thank you all for giving me the opportunity to take a leading role in this distinguished and highly esteemed CBT community. I look forward to serving you in the best way I can over the next few years. Please do not hesitate to guide me to serve you better.

 Sincerely,

Mehmet Sungur, MD

President-Elect IACP

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