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A deeper look at how therapists experience working with Black clients in clinical practice using Cognitive Behaviour Therapy: a grounded theory

Hanchard, J. (2019). A deeper look at how therapists experience working with Black clients in clinical practice using Cognitive Behaviour Therapy: a grounded theory. (Unpublished Doctoral thesis, City, University of London)


As the use of Cognitive Behaviour Therapy (CBT) becomes more prevalent in clinical practice, over the last four decades, more recently there has been an increasing call for the adaptation of CBT following concerns that traditional CBT approaches may not account for particular and unique experiences encountered by marginalised populations (David, 2009; Eamon, 2008). Research has found that CBT may be more effective if it was culturally adapted to meet the needs of Black minority groups (Rathod et al. 2015; Naeem, 2015) and that therapists commonly ‘drift’ away from evidenced based techniques (Waller et al. (2012). Yet there has been a lack of studies exploring the efficacy and experience from the perspective of therapists in relation to minority racial groups and treatment outcomes.

This study attempted to understand CBT from the perspective of the therapist. The aim was to understand how therapists use CBT to work with Black African, Black Caribbean and Black British clients, if there are instances of adaptations to the CBT protocol and what this might look like. Qualitative interviews were conducted with seven therapists, including Counselling and Clinical Psychologists and CBT therapists working mostly within primary care NHS and the Improving Access to Psychological Therapies (IAPT) service.

From the data four main categories were developed. The Core Category: ‘CBT in practice: A process of working with Black clients.’ The four categories were: (1) Appropriateness, (2) Therapy congruency, (3) Developing my therapy style, and (4) Curiosity. The results revealed a tentative theory to explain a process of how therapists use methods of adapting CBT to work more effectively with Black clients, to increase therapeutic rapport and engagement, including aspects around culture, religion, language, psychological-mindedness, acculturation to the host country, education and age.

The implications of this study contribute to the field of Counselling Psychology by helping to demonstrate some practical applications of CBT with clients who present from African and Caribbean ethnic backgrounds and to assist with sustained therapy engagement.

Publication Type: Thesis (Doctoral)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
H Social Sciences > HT Communities. Classes. Races
Departments: Doctoral Theses
Doctoral Theses > School of Arts and Social Sciences Doctoral Theses
School of Health & Psychological Sciences > Psychology
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