Applying CBT in complex clinical practice: reflections from Dr Helen Kennerley
In this reflection, Dr Helen Kennerley explores applying cognitive behavioural therapy (CBT) in complex clinical practice, focusing on formulation, professional judgement, and maintaining core CBT principles when working with uncertainty and complexity.
As clinicians, we often return to established models of cognitive behavioural therapy (CBT) while adapting to the evolving realities of our work. This piece outlines OCTC’s approach to CBT in contemporary clinical practice.
The aim is to remain grounded in established CBT principles while recognising the complexities clinicians encounter across settings and populations.
Why this topic matters in practice
In clinical work, CBT is rarely applied in straightforward ways. Many practitioners encounter complexity — whether related to comorbidity, presentation, context or service constraints — that require flexibility and careful judgement.
Over time, I have found that clinicians often seek support not in learning new techniques, but in strengthening confidence in applying core principles. Questions such as “How do I adapt formulation in this context?” or “How do I maintain fidelity to CBT while responding to complexity?” are common across disciplines and levels of experience.
This updated edition reflects these questions. It does not attempt to resolve complexity but supports clinicians to work effectively within it.
Designing the work for mixed professional backgrounds
A central consideration in developing this edition was accessibility across different professional groups. CBT is used by clinicians, trainees, supervisors, and professionals across roles, each bringing different perspectives and experience.
The aim has been to present material that supports shared understanding while respecting these differences. Rather than assuming a single level of expertise, the text supports reflection, application, and discussion across contexts.
The material draws on established CBT theory and clinical practice, rather than prescribing a way of working or implying specific outcomes.
Psychological perspectives on CBT practice
CBT continues to be grounded in models that emphasise the interaction between thoughts, emotions, behaviours and physiology. These models remain relevant, but their application requires ongoing interpretation in practice.
This edition focuses on formulation as a collaborative, evolving process; the role of cognitive and behavioural interventions in broader contexts; and adapting approaches to individual needs.
Where clinical terminology is used, it is intended to be accessible and explained in context. The focus remains on helping clinicians understand how models inform practice, rather than presenting them as fixed frameworks.
Bringing evidence into everyday conversations
A key challenge for many clinicians is translating evidence into day-to-day clinical interactions. Evidence-based practice forms the foundation of CBT, but applying this evidence in clinical conversations requires flexibility.
This work emphasises using formulation to guide decision-making, maintaining curiosity and collaboration in sessions, and balancing structure with responsiveness.
This is not intended as an instruction or protocol. Rather, it offers a perspective on how clinicians might integrate evidence within their own practice frameworks.
What I hope participants take away
I hope readers find support in reflecting on their own clinical work. Specifically, I hope this text contributes to increased confidence in applying CBT principles, greater comfort with complexity and uncertainty, and a stronger emphasis on formulation-led thinking.
These are intended as learning aims rather than guarantees of outcome.
Find out more
An Introduction to Cognitive Behavioural Therapy: Skills and Applications, Fourth Edition
Sage Publishing
View book details and scan the QR code to access a 25% discount using code SAGEAUTH25.
About the presenter
Dr Helen Kennerley is a Consultant Clinical Psychologist with extensive experience in cognitive behavioural therapy. Her work focuses on developing and applying CBT approaches across clinical contexts, alongside training and supervision.
Editorial note
Clinical review: Dr Helen Kennerley, Consultant Clinical Psychologist
Editorial development and publication: Maria Brunsden, Marketing Communications Lead, Oxford Cognitive Therapy Centre (OCTC) / Oxford Centre for Psychological Health (OCPH)
