Being Flexible While Maintaining Fidelity in Cognitive Behavioral Therapy of Depression

Cognitive Therapy or Cognitive Behavioral Therapy (CBT) for depression is a well-studied, research-supported treatment. Contrary to common misconceptions about manual-based treatments, CBT can be provided with considerable flexibility. As the first manual-based treatment to be developed, it is remarkable that it is so principle-based and flexible. There is flexibility in focusing on the goals and topics of importance to clients. Therapists have discretion in determining how much to use various CBT strategies and determining how they might be used to meet the diverse needs of clients with depression. Because of the flexibility of CBT, therapists also have many options for determining what approach to use when a client does not initially respond well to an intervention. To ensure that CBT offers the therapeutic benefits that have been identified and supported in clinical trials, the treatment also needs to be provided with fidelity to the manual. Despite their limitations, observer ratings of competence remain the standard for ensuring that CBT is provided with fidelity.