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CBT in Turkey – Advances in Cognitive Therapy Newsletter

1. Introduction

Before Cognitive therapy (CT) completed (filled in) the gaps of the picture already formed by Behaviour Therapy (BT), making it a more comprehensive and meaningful approach for many clients and therapists, there was only BT. BT initially faced many challenges and resistances both from the biologically and analytically oriented professionals working in the field of psychology and psychiatry in late 1970’s and early 1980’s. Many of these professionals tended to reject the idea of BT. Dynamically oriented therapists had reservations about BT due to the myth that it merely consists of techniques that are aimed to resolve symptoms without emphasizing the “underlying causes”, as a consequence of the dominance of analytical school that prevailed the area of psychology and psychiatry at those times.

Biologically oriented psychiatrists, on the other hand, tended to reject any kind of therapeutic approach for treatment of psychiatric disorders. Thus both biologically and analytically oriented professionals found BT too simplistic, mechanistic, superficial and manipulative.

On 1980s’, there were only a few qualified psychologists who favoured BT and who did their best to widespread the idea and concept of BT by giving lectures and running workshops in a sporadic fashion. They could run systematic courses only in a university setting, where they worked dedicating themselves teaching their students behaviour therapy. When Prof. Mehmet Sungur, a psychiatrist trained in the UK and worked with Prof. Isaac Marks, tried to establish the Turkish Association of Cognitive and Behaviour Psychotherapy (TACBP) for the first time, he contacted two senior professors of psychology, to collaborate with. One of them was Prof. Işık Savaşır, who unfortunately died recently, had trained many psychologists some of them becoming trainers of the TACBP educational task force today. The other was Prof. Perin Yolaç, who is still taking part in training the younger professionals and who was appointed as the vice president of the TACBP during the establishment phase.

These two well recognized and experienced psychologists accepted the invitation of Prof. Sungur that resulted with the integration of psychologists and psychiatrists to establish the TACBP which increased the recognition and power of the association.

The introduction of Cognitive Therapy (CT) later completed the gaps of BT practice and reduced the resistance of psychodynamically oriented therapists. Some of them thinking that CT could be a good partner for psychoanalysis for an “arranged marriage”. The empirically supported data published later favouring CBT helped to reduce the resistance of biologically oriented professionals as well. When they made presentations in pharmacology congresses, they did not refer to CBT as an “adjunt” to medication any more but started accepting CBT as an alternative or integrative way to help their clients.

 

2. The current practice of CBT in Turkey

CBT practice is becoming more and more popular amongst psychologists, psychiatrists and nurses. Key area that CBT is applied are adult mental health with special focus on anxiety disorders, depression and eating disorders. Sexual and relationship problems, social and communication skills training and relapse prevention for addictions and psychological disorders are other areas that people use CBT as a preferred therapeutic approach. It is also used by a small proportion of professionals in treatment of schizophrenia.There is a considerable demand from child and adolescent therapists to learn more about practice of CBT in younger client populations.

 

Some demand from general medicine disciplines such as  gastroentorology is made for learning CBT for  treating  gastrointestinal system’s functional disorders.

Individual therapy is the most common form of treatment given.

TACBP provides CBT training to professionals from different disciplines such as psychiatrists, psychologists, counsellors and nurses. Prof. Mehmet Sungur runs courses in addition to TACBP courses to increase the number of qualified CBT therapists.

The health care system at present in Turkey only permits psychiatrists and clinical psychologists to work on a private basis. Thus other psychologists, counsellors and nurses are accepted as auxillary staff and mainly based in schools and hospital settings. Therefore the majority of CBT therapists in Turkey are psychiatrists and clinical psychologists. They are almost in equal proportions. Most outpatient services are given in private practice and some in outpatient clinics of university and state hospitals. The costs of health care in private practice are covered by clients themselves and most of the private insurance companies do not pay towards the costs of private psychiatric care. For those who work for the government, the state pais towards the costs in state and university hospitals.

Every year seminars and workshops are given by members of the TACBP in different national psychiatry symposiums and congresses on different topics to promote the use of CBT. Courses that aim to reach the minimal standards of training of EABCT (European Association of CBT) are conducted every year and at the moment there are more than 250 professionals who are trained according to these standards. Some professionals who have finished training are helping Prof. Sungur to train the new trainees.

 

3. Organization of CBT in Turkey

There is only one CBT organisation in Turkey in the name of “Kognitif ve Davranıs Terapileri Dernegi” (Turkish Association of Cognitive and Behaviour Psychotherapies-TACBP). It was founded in 1995. The first president was Prof. Mehmet Sungur and some members of the first board such as Prof. Perin Yolac, Assoc. Prof. Ceylan Das Tugrul and Assoc. Prof. Hakan Turkcapar, Dr. Mehmet Sayilgan and Assoc. Prof. Gonca Boyacioglu Soygut served as trainers of TACBP initially. The idea to establish an association of CBTcame from Prof. Mehmet Sungur, trained in the UK in BT working with Prof. Isaac Marks and a fellow founder of ACT (Academy of Cognitive Therapy). Two well recognized psychology professors, Prof. Savasır and Prof. Yolac, joined him to establish the association. TACBP joined EABCT in the year 1996 with about 40 members. At present TACBP has about 400 members, consisting mainly of psychiatrists, psychologists, counsellors and some nurses. Since its establishment, many well recognized authorities in the CBT field, such as Isaac Marks, Paul Salkovskis, Padmal de Silva, Thomas Dowd, Frank Dattilio, Arthur Freeman, Michael Crowe, Patricia Gillan, Patricia D’ardenne, Keith Dobson, Mark Freeston, Nikolas Kazantzis, Tom Borkovec, Philip Kendall, Dominic Lam, Ray Novaco, Donna Sudak, Gillian Haddock, Kelly Koerner, Adam Radomsky, Stefan Hofman, Tammie Ronen, Michael Rosenbaum and many others contributed to our members by running courses and workshops.

The TACBP hosted the 31st EABCT Congress in Istanbul successfully and the theme of the Congress was “Clinical Science” which reflected the motive to establish closer links between science and daily practice. Prof. Mehmet Sungurwas the president of the Congress and the President of the EABCT while Nur Kavuncu, Ph.D. served as the main organizer.

The main goal of the TACBP is to promote the practice of CBT amongst professionals in Turkey working in the areas of psychology and psychiatry to ensure “good plus ethical practice” given to clients, supply adequate training to its members and bridge links with other foreign CBT organizations that aim similar goals.

TACBP is led by a board that is elected by its members in every two years. Board members meet in every two months to discuss matters related with the goals of the association.

 

4. Training Activities and Standarts of Training

 

MINIMUM TRAINING STANDARDS OF TURKISH ASSOCIATION OF

COGNITIVE AND BEHAVIORAL PSYCHOTHERAPIES

 

1.         BASIC REQUIREMENTS

 

1.1       All applicants are considered on an individual basis but they are expected to have an approved basic qualification in a core helping profession, such as psychology, psychiatry, nursing, counselling and social work. Those who are suggested by two members of the association followed by approval of the board members as having sufficient knowledge and experience in treatment of clinical disorders will be candidates for consideration as trainees.

 

1.2       Candidates must be able to demonstrate personal qualities that make them suitable for the practice of cognitive and behaviour therapy.

 

1.3       Candidates will be required to use cognitive and behaviour therapy in a systematic way as their main, or one of their main therapeutic models.

 

 

2.         LENGTH OF TRAINING

 

2.1       Training will encompass relevant Core Professional training.  This total period will be 350 hours.

 

 

3.         THEORETICAL AND SKILLS TRAINING

 

3.1       At a general level, training will allow the acquisition of a critical understanding of the relevance of studies in psychopathology, cognitive and behavioural psychology.

 

3.2       All trainees will have covered a minimum curriculum that will provide a broad-based      understanding of the theoretical basis of cognitive and behaviour therapies and their application across a wide range of problem areas.

 

3.3       Skills training are an essential component of the acquisition of knowledge and experience and will be 50 % of a trainee’s total training programme.

 

3.4       Such knowledge and skills will have been acquired through structured teaching and self directed study. The Turkish Association of Cognitive and Behaviour Psychotherapy training programme (350 hours) consist of 4 modules which follows a hierarchy of the art of cognitive and behaviour therapy such as theoretical basis of learning principles, cognitive and behavioural analyses and clinical application of cognitive and behavioural therapies to different clinical disorders. Each trainee will complete the requirements of the training programme such as homework assignments, exams, case report etc. A training log must specify the length of study, number of taught hours and a record of the lecturers, tutors or mentors participating in a candidates training.

 

3.5       Candidates are expected to demonstrate an understanding of theoretical aspects of cognitive and behaviour therapy and its application by the production of a formal assessment essay, exam or research project, as required in most post-qualification cognitive and behaviour therapy courses.

 

 

4.         SUPERVISED CLINICAL PRACTICE

 

4.1       Candidates will have conducted 175 hours of supervised assessment and therapy during training.

 

4.2       All candidates will receive supervision during the period of training for both assessment and therapy, carried out by an accredited (or acceptable) therapist.  Supervision will consist of regular feedback and discussion.  Close supervision will involve the use of live, audio or video and written materials in supervision.

 

4.3       A minimum of 5 clients will be treated during their period of training from assessment to completion and follow up of the clients before a person is seen as having completed their practitioner training.  These cases will cover at least 3 types of problems. Three cases will have been closely supervised using live, audio or video supervision.

 

4.4       Details of supervised clinical practice and case mix will be recorded in the training log.

 

4.5       Supervised practice undertaken as a part of a programme of study will be subjected to formal assessment.  5 cases will be written up and assessed as part of a formal basic and post qualification training programme, or submitted for scrutiny to an approved assessor at the and of a period of self directed training.

 

 

5.              ACCREDITATION OF COGNITIVE AND/OR BEHAVIOURAL PSYCHOTHERAPISTS

 

5.1          To apply to be Accredited by TACBP as Cognitive and/or Behavioural

Pychotherapists, therapists must: have two years’ experience after qualification in their core profession; meet the Minimum Training Standarts and receive regular clinical supervision.

 

There are no laws regulating the training in any kind of psychotherapy yet, including CBT training. Prof. MehmetSungur and Assoc. Prof. Hakan Turkcapar are running courses in Istanbul and Ankara respectively on CBT in anxiety disorders and depression for additional demand coming from professionals working in the area. There is a long waiting list for the future training courses. The overall goals of all of the training courses are donating the participants with the necessary knowledge and skills to practice good CBT while sticking to ethical codes and building and maintaining a good therapeutic working relationship. Regular lectures are given and symposiums and workshops run in national psychiatry congresses to introduce and promote CBT amongst professionals.

 

The Turkish Psychiatry Association has recently established different task forces to promote the use of therapeutic approaches. Prof. Mehmet Sungur is the president of the CBT Task Force of the Turkish Psychiatry Association since its establishment.

 

5.              Discussion and Outlook

 

The main problem facing the TACBP is the lack of qualified supervisors. At this stage there are only a few qualified supervisors in our training programme who have devoted themselves to train the trainees in the last 5 years. Although some of the professionals who complete the present training courses can be an additional source, it is still very difficult to ask these professionals who are extremely busy, to run extra courses in order to supply satisfaction towards the rapidly growing demands for CBT training.

 

Another problem is the financial status of our members that restrict them to attend the European Congresses held in different sites of Europe each year. Psychiatrists and especially psychologists who are not able to do private practice are not well paid and their present monthly salaries can not afford the relatively high registration fees and accomodation expenses of the congresses.

 

6. Future Aspects and Invitation for the 7th ICCP Congress in Istanbul

 

The 7th International Congress of Cognitive Psychotherapy (ICCP) will take place in İstanbul between 2-5 June 2011. ICCP is a regular scientific activity of International Association of Cognitive Psychotherapy (IACP) and is organized with 3 years intervals in different parts of the world. The Turkish Association for Cognitive and Behaviour Psychotherapy (TACBP) is very proud and happy to be chosen as the host association to organize the 7th ICCP in İstanbul, the only city in the world that strecthes onto two continents.

 

Our intention is to deliver our participants a high standard both in terms of scientific quality and unforgetable social programme. That is why we have invited more than 25 leading professionals who will run workshops, give plenaries and conduct masterclinician and masterclass sessions which will be supplemented by audiovisual materials to illustrate how treatment is conducted with a client from the begining to the end. The scientific programme will cover all areas related to CBT including innovative and controversial developments. Please search our websitewww.iccp2011.com for more detailed information and for invited keynotes and workshops so far.

 

As İstanbul is one of the most beautiful cities in the world with a magnificent history ad is well recognized as ‘a city that never sleeps’, we will do our best to make your nights as enjoyable as possible after busy daily scientific schedules.

 

The theme of the Congress reflects the central motive of the event, clinical science, which is aimed to establish closer links between science (emprically validated CBT) and daily practice.

 

I am hoping that many of our colleagues in ACT and IACP will be able to get actively involved in the Congress. As the scientific success of any Congress depends on the contribution of the delegates, please come, join and share with us.

 

I look forward to seeing you in İstanbul establishing closer professional and social links with colleagues from all over the world. Let’s meet in İstanbul where the east meets the west.

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