Therapist drift: The influence of clinicians’ and patients’ characteristics, and their cultural underpinnings

The main aim of this thesis was to explore therapist drift in the delivery of Cognitive Behavioural Therapy (CBT) in contexts outside the Anglo/European one. Since most of the research on therapist drift has come from these Anglo/European locations, this investigation was based on the premise that therapist drift could manifest differently in different cultural settings. In addition to these cultural factors, this thesis also aimed to explore what clinician-related variables could influence CBT delivery (e.g. anxiety, experience, age, personality), along with other patient-centred variables (e.g. patients’ emotional state, gender, ethnicity, and preferences within the CBT delivery process). For the purposes of this thesis, a series of empirical studies were carried out to explore therapist drift in the delivery of CBT in several countries, but with particular emphasis in Latin American countries. The studies consisted of: 1) A systematic review regarding cultural adaptations of CBT for Latin American patients; 2) A comparative study assessing therapist drift in Latin America and the United Kingdom; 3) A vignette-based study evaluating the influence of patients’ mood and gender and clinicians’ country of origin on CBT delivery; and 4) A comparative study of clinicians’ and patients’ perceptions of the importance of CBT techniques. The results from these studies indicated that different patterns of drift can be found in different cultural settings. These patterns can be influenced by both patients’ and clinicians’ characteristics. Clinicians are encouraged to identify whether these aspects are affecting their practice, and to take actions to reduce such impacts. Researchers are also encouraged to keep investigating therapist drift and its cultural underpinnings, so we can obtain better insight about how patients from different cultural settings might benefit from therapy.