The original declarative procedural reflective (DPR) model is a well-established model of therapist knowledge and skill development. To date, although it has been used to guide reflection and discussion around personal and practitioner selves, it has not emphasised the various intersecting identities of practitioners and how these interact within wider concepts such as power, society, service contexts and the patient and supervisory relationships. The learning, development and implementation of CBT skills does not occur in a vacuum or separate to the practitioner identities however relatively little has been written on this. This paper aims to expand the original DPR model to illustrate potential ways that social context, identity and power could be considered within CBT training, delivery and supervision. It delineates and explores the additional components of the model (i.e. practitioner identity(s), context/society and power) and then provides examples of how this framework could inform key CBT activities (including low-intensity CBT).

There has been limited consideration of the training and support needs of therapists from minoritised ethnic backgrounds. This study quantitatively evaluates a novel application of self-practice/self-reflection (SP/SR) to CBT therapists from minoritised ethnic backgrounds. The study aimed to explore the impact of the SP/SR programme on (1) therapists’ skills in working with ethnicity in their clinical practice; (2) their ethnic identity development; and (3) their perceived levels of personal and professional wellbeing, during the intervention and at follow-up. A multiple baseline single case experimental design was adopted. Measures were developed and adapted for this evaluation and weekly outcomes relating to therapist skill development, ethnic identity development, and personal and professional wellbeing were collected. The outcomes of six participants were analysed using visual and statistical analysis. The results indicated that the SP/SR programme significantly improved therapist skills in identifying and addressing similarities and differences in ethnicity within therapy during the intervention. Improvements were also seen across other skills, ethnic identity developmental and wellbeing outcomes between the baseline and SP/SR phases, with some participants showing significant improvements. Outcomes from the follow-up phase presented a more mixed picture. Therefore, the findings give some support for the SP/SR programme in developing therapist skills in working with ethnicity, as well as highlighting differential outcomes for participants related to their levels of experience and engagement. The findings may have possible implications for the personal and professional development of ethnically minoritised therapists, as well as future quantitative SP/SR research.

Key learning aims

1. (1) To provide an overview of self-practice/self-reflection (SP/SR) and its theoretical underpinnings.

2. (2) To summarise the current issues around the development of cultural competence, particularly for therapists from minoritised ethnic backgrounds.

3. (3) To introduce and describe a novel SP/SR programme for CBT therapists from minoritised ethnic backgrounds.

4. (4) To highlight the importance of considering ethnicity within clinical practice, both in terms of the provision of culturally competent therapy as well as to support the personal and professional development of therapists from minoritised ethnic backgrounds.

Many white psychotherapists may lack the skills required to work effectively with service users from minoritised ethnicities. This article proposes that the nature of this skills deficit can be understood through applying the Declarative-Procedural-Reflective (DPR) model of therapist skill development. The DPR model has been used in a range of psychotherapeutic contexts, and it provides a systematic account of how therapists from all modalities develop and can improve their skills. Adapting this model to white therapists’ skills in working with service users from minoritised ethnicities allows the identification of specific areas of skills deficit, and therefore clear recommendations as to how to address those deficits. The application of the DPR model to this context suggests that there are clear areas of skills deficit in terms of knowledge base, the practical skills of carrying out therapy, and the ability of therapists to reflect on their work with service users from minoritised ethnicities. I conclude by making a number of suggestions as to how those deficits could be addressed, both by individual therapists and at a systemic level.