Qualified Staff

The success of CBT is critically dependent upon the expertise and experience of the staff. Most programs include personnel with qualifications in medicine, psychology, nursing, and physical and occupational therapy. These staff should have received additional training in pain management. It is important to note that unlike pharmacological interventions, where the quality of the medicine is controlled in the manufacturing process, psychological treatments are essentially manufactured de novo each time they are delivered.25 Programs should therefore use protocols that provide clear guidance to the sequence and structure of therapy sessions and provide a framework in which clinical skills are practiced. Regular supervision should occur to ensure adherence to the protocol, facilitate sustained clinical competence and development, and aid problem solving when the team need to deviate from the protocol for therapeutic purposes. Staff cohesion flourishes where they have good opportunities to work together, to discuss patient's needs and how they are best met, to train together, and where there is mutual respect and clarity of the roles of different disciplines. This is not to suggest that there is no substantial overlap between disciplines in some skills and knowledge, but in a team which functions well this contributes to a consistent message to patients and not to disputes about professional boundaries.

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