WORK SAMPLE GUIDE FOR CERTIFICATION

The final step in the Beck Institute CBT Certification process is completing and submitting a
Work Sample. The Work Sample consists of two parts: 1. A Case Write-up of a real client and
their conceptualization and treatment (without the client’s full name) and 2. An actual
recording of a live CBT session with this client (without client’s full name). Both parts of the
Work Sample (Case Write-up and Recorded Therapy Session) are to be submitted at the same
time according to the instructions provided. You may not use a client you submitted for
supervision.

Case Write-Up: Summary and Conceptualization

PART ONE: INTAKE INFORMATION

IDENTIFYING INFORMATION AT INTAKE:

Age: Report the client’s age at the time the Session Recording was made.

Gender Identity and Sexual Orientation: What was the client’s reported identity and
sexual orientation at the time of the Recorded Session?

Cultural Heritage: What did the client say their cultural heritage was?

Religious/Spiritual Orientation: What did the client say their orientation was (if any)?

Living Environment: What kind of structure does the client live in (e.g., apartment, single
house, homeless, etc.)? In what environment do they live (e.g., inner city, farm, suburb)?
Who else lives in their household? What is their relationship to the client?

Employment Status: What kind of work does the client do (e.g., laborer, office worker,
manager, professional)? Is this work paid or unpaid? How long has the client worked at this
job? Is it full-time or part-time? How satisfied is the client with their work? If relevant, state
“takes care of home and family” or, if relevant, “unemployed.”

Socioeconomic Status: What is the client’s socioeconomic status (SES; as defined by the
American Psychological Association: social standing or class measured as a combination
of education, income, and occupation), State “high SES,” “middle SES” or “low SES.”

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CHIEF COMPLAINT, MAJOR SYMPTOMS, MENTAL STATUS, AND DIAGNOSIS:
Chief Complaint: Why did the client seek treatment at this time?

Major Symptoms: What symptoms did the client have in these four areas:

Emotional:

Cognitive:

Behavioral:

Physiological:

Mental Status: How did the client appear? What was their mental status, including
orientation, memory, and other characteristics that could negatively influence their ability
to fully participate in therapy?

Diagnosis (from the Diagnostic and Statistical Manual or International Classification of

Disease): What was the name and current Diagnostic and Statistical Manual of the
American Psychiatric Association (DSM-5) or International Classification of Diseases
(current ICD-10) diagnostic code for the client’s disorder(s)? Include relevant descriptors.

CURRENT PSYCHIATRIC MEDICATIONS, ADHERENCE, AND SIDE EFFECTS;

CONCURRENT TREATMENT:
Psychiatric Medications: What medications was the client taking at intake or later on?
What was the dosage and the condition for which the medication was prescribed?

Adherence to Treatment Recommendations: What was the client’s attitude toward

taking prescribed medications and following other treatment recommendations made by
psychiatrists and other medical treatment providers?

Side Effects: If applicable, what side effects did the client experience?

Concurrent Treatment: If applicable, what other treatment was the client receiving for
his psychiatric or psychological condition?

CURRENT SIGNIFICANT RELATIONSHIPS: At intake, what significant relationships did the

client have? What were the relationships like?

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 PART TWO: HISTORICAL INFORMATION
BEST LIFETIME FUNCTIONING (INCLUDING STRENGTHS, ASSETS AND RESOURCES): At
what age did the client experience their highest level of functioning and how long did
this last? What made this the best period? What strengths did they show? What beliefs
did they have about themselves, about others, and about the future? How did others see
them?

HISTORY OF PRESENT ILLNESS: When did the client’s symptoms first appear, how long have
they persisted, and how severe have they been? What has their impact been on the
client’s functioning?

HISTORY OF PSYCHIATRIC, PSYCHOLOGICAL OR SUBSTANCE USE PROBLEMS AND

IMPACT ON FUNCTIONING: What were the client’s previous psychiatric diagnoses (if
any) and/or substance use conditions (if any)? How old was the client at the time of
diagnosis? How severe was the condition(s) and how long did it (they) last? How did the
condition(s) impact the client’s functioning?

HISTORY OF PSYCHIATRIC, PSYCHOLOGICAL OR SUBSTANCE USE TREATMENT, TYPE,

LEVEL OF CARE, AND RESPONSE: What treatments has the client already received for
psychiatric and/or substance use? How old was the client when provided with this
treatment? What type of treatment was it and how long did it last? What was the client’s
attitude about treatment? What was their response to treatment?

DEVELOPMENTAL HISTORY (Relevant Learning, Emotional, and Physical Development):

What were significant adverse life events from the client’s lifetime that have had an
impact on the client’s functioning (e.g., learning problems, bullying, medical conditions,
accidents, and trauma)?

PERSONAL, SOCIAL, EDUCATIONAL, AND VOCATIONAL HISTORY: What were the client’s
significant positive and negative relationships like with family, friends, teachers, persons in
authority, and peers?

MEDICAL HISTORY AND LIMITATIONS: What medical conditions did the client have? How
severe were they? What limitations, if any, did they impose on the client’s life?

CURRENT NON-PSYCHIATRIC MEDICATIONS, TREATMENT, ADHERENCE, AND SIDE

EFFECTS: What non-psychiatric medications (including homeopathic and over-the-
counter medication) did the client taking at intake or during treatment? Why did they
take the medication? What side effects did the medication have?

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610-664-3020
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 PART THREE: THE CASE CONCEPTUALIZATION DIAGRAM (CCD)
COGNITIVE CONCEPTUALIZATION DIAGRAM (CCD): Complete the CCD in its entirety and
attach it to this Case Write-Up. Make sure that you choose situations in which the
meanings of the automatic thoughts differ from one another, if there are different
themes.

PART FOUR: THE CASE CONCEPTUALIZATION SUMMARY

HISTORY OF CURRENT ILLNESS, PRECIPITANTS AND LIFE STRESSORS: What were the
internal and external problems the client was dealing with? How did the problems
contribute to the onset of symptoms? (Internal stressors could include illnesses, injuries,
memories, images or sensations. External stressors might include problems at
work/school, relationships, or not meeting performance standards).

MAINTAINING FACTORS: What helped maintain the client’s symptoms? (Maintaining factors
could include the continuation of internal or external stressors, the way the client
processed information, maladaptive cognitions about and reactions to negative emotion,
dysfunctional thought processes, maladaptive behavior, and/or skill deficits).

VALUES AND ASPIRATIONS (OPTIONAL): What has been most important to your client in life
(values)? What does your client want from life or how do they want their life to be
(aspirations)?

NARRATIVE SUMMARY, INCORPORATING HISTORICAL INFORMATION, PRECIPITANTS,

MAINTAINING FACTORS, AND CASE CONCEPTUALIZATION DIAGRAM
INFORMATION: Provide a narrative summary of the completed CCD (starting at the top
of the page) to explain why the client’s reactions to current problematic situations make
sense. Optional: Integrate aspirations and values into your explanation.

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 PART FIVE: TREATMENT PLAN
OVERALL TREATMENT PLAN: What were your broad therapy goals?

PROBLEM LIST/CLIENT’S GOALS AND EVIDENCE-BASED INTERVENTIONS: Problems are

the flip side of goals. What CBT interventions did you use for each problem/goal?

PART SIX: COURSE OF TREATMENT AND OUTCOME

THERAPEUTIC RELATIONSHIP: What was your client’s attitude toward treatment and toward
you? What did you do to maintain a positive relationship? If relevant, how did you solve
problems in the relationship?

NUMBER AND FREQUENCY OF TREATMENT SESSIONS, LENGTH OF TREATMENT: How

often were therapy sessions conducted? Were they standard CBT sessions (if not, how
were they different)? How long was the client in treatment?

COURSE OF TREATMENT SUMMARY: How did the treatment process unfold? What was the
client’s motivation like? How easy or difficult was it to treat this client and why?

MEASURES OF PROGRESS: What quantitative measures (or assessments of functioning) did

you use at intake? How did you monitor progress during treatment?

OUTCOME OF TREATMENT: How much change was there in the client’s symptoms, level of
functioning, and/or sense of well-being? What was the clients’ overall level of satisfaction
with the treatment provided?

Scoring for Case Write-Up

There are 23 sub-sections on the Case Write-Up. Each of the items will be scored separately.

You are required to complete all items in the Case Write-Up. If you don’t complete a section,
you won’t be able to submit your Case-Write Up. The range of possible total scores will be 0-
50. Items in the Cognitive Conceptualization Diagram, Narrative Summary of
Conceptualization, and Problems Lists/Goals/EBT’s Sections are weighted more heavily than
other sections. These sections require minimum scores of 4 on each item to pass; 12 out of 15
possible points. The remaining sections must total to a minimum score of 28 out of 35
possible points. A total score of 40 is the minimum passing score. The scoring grid is as
follows:

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 Case Write-up Scoring Grid
Item Scoring Range Your Score

Part One: Intake Information

Identifying Information (Age, Gender Identity, Cultural
Heritage, Religious/Spiritual Orientation, Living
0-1
Environment, Employment Status, Socioeconomic
Status)

Chief Complaint 0-3

Current Psychiatric Medications 0-1

Current Significant Relationships 0-2

Part Two: Historical Information

Best Lifetime Functioning 0-2

History of Present Illness 0-2

History of Psychiatric, Psychological, or Substance 0-2

Use Problems

Impact on Functioning of Psychiatric, Psychological, 0-2

or Substance Use Problems

History of Psychiatric, Psychological, or Substance 0-2

Use Treatment, Type, Level of care, and Response

Developmental History 0-3

Personal, Social, Educational, and Vocational History 0-3

Medical History and Limitations 0-2

Non-Psychiatric Medications, Treatment, Adherence 0-1

and Side Effects

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Part Three: Case Conceptualization 0-5
Diagram(CCD) ***

Part Four: Case Conceptualization Summary

History of Current Illness 0-2

Maintaining Factors 0-2

Values and Aspirations (Optional) -- --

Narrative Summary, Incorporating Historical 0-5

Information, Precipitants, Maintaining Factors, and
CCD Information***

Part Five: Treatment Plan

Client’s Broad Goals, Problem List, Evidenced-Based 0-5
Interventions Broad Goals***

Part Six: Course of Treatment and Outcome

Therapeutic Relationship 0-1

Number of and Frequency of Treatment Sessions, 0-1

Length of Treatment

Course of Treatment Summary 0-1

Measures of Progress 0-1

Outcome of Treatment 0-1

Totals for Shaded Items Must Equal at least 12

Minimum Score of “4” on Each Shaded Item

Totals for Unshaded Items Must Equal at least 28

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 Total Score

Your Total Score Must Equal at Least 40 (Maximum

Score: 50)

Recording of a Live Session

The second part of the Work Sample is the recording of a live therapy session with the client
described in the Case Write-Up. The work sample must be original work completed by the
applicant without assistance. The client recorded must not have been discussed during
supervision. The recorded therapy session should be a standard Cognitive Behavior Therapy
session. It will be rated on the Cognitive Therapy Rating Scale (CTRS). The CTRS has 11 items;
each item is scored on a scale of 0-6. A score of 44 is the minimum passing score. A copy
of the CTRS is included with this Guide.

Beck Institute for Cognitive Behavior Therapy

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 Cognitive Therapy Rating Scale (CTRS)

Therapist: ________________ Client: _____________________ Date: ____________

Tape ID#: ________________ Rater: _____________________ Date: ____________

Session#: ______ ÿ Videotape ÿ Audiotape ÿ Transcript ÿ Live Observation

DIRECTIONS: For each time, assess the therapist on a scale from 0 to 6, and record the rating
on the line next to the item number. Descriptions are provided for even-numbered scale
points. If you believe the therapist falls between two of the descriptors, select the intervening
odd number (1, 3, 5). For example, if the therapist set a very good agenda but did not establish
priorities, assign a rating of a 5 rather than a 4 or 6.

0 1 2 3 4 5 6

Poor Barely Adequate Mediocre Satisfactory Good Very Good Excellent

If the descriptions for a given item occasionally do not seem to apply to the session you are
rating, feel free to disregard them and use the more general scale below:

Please do not leave any item blank. For all items, focus on the skill of the therapist, taking into
account how difficult the patient seems to be.

Part I. GENERAL THERAPEUTIC SKILLS

___1. AGENDA
0 Therapist did not set agenda.

2 Therapist set agenda that was vague or incomplete.

4 Therapist worked with patient to set a mutually satisfactory agenda that included
specific target problems (e.g., anxiety at work, dissatisfaction with marriage.)

6 Therapist worked with patient to set an appropriate agenda with target problems,
suitable for the available time. Established priorities and then followed agenda.

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___2. FEEDBACK
0 Therapist did not ask for feedback to determine patient’s understanding of, or response
to, the session.

2 Therapist elicited some feedback from the patient, but did not ask enough questions to
be sure the patient understood the therapist’s line of reasoning during the session or to
ascertain whether the patient was satisfied with the session.

4 Therapist asked enough questions to be sure that the patient understood the therapist’s
line of reasoning throughout the session and to determine the patient’s reactions to
the session. The therapist adjusted his/her behavior in response to the feedback, when
appropriate.

6 Therapist was especially adept at eliciting and responding to verbal and non-verbal
feedback throughout the session (e.g., elicited reactions to session, regularly checked
for understanding, helped summarize main points at end of session.

___3. UNDERSTANDING
0 Therapist repeatedly failed to understand what the patient explicitly said and thus
consistently missed the point. Poor empathic skills.

2 Therapist was usually able to reflect or rephrase what the patient explicitly said, but
repeatedly failed to respond to more subtle communication. Limited ability to listen
and empathize.

4 Therapist generally seemed to grasp the patient’s “internal reality” as reflected by both
what the patient explicitly said and what the patient communicated in more subtle
ways. Good ability to listen and empathize.

6 Therapist seemed to understand the patient’s “internal reality” thoroughly and was
adept at communicating this understanding through appropriate verbal and non-verbal
responses to the patient (e.g., the tone of the therapist’s response conveyed a
sympathetic understanding of the client’s “message”). Excellent listening and empathic
skills.

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___4. INTERPERSONAL EFFECTIVENESS
0 Therapist had poor interpersonal skills. Seemed hostile, demeaning, or in some other
way destructive to the patient.

2 Therapist did not seem destructive, but had significant interpersonal problems. At
times, therapist appeared unnecessarily impatient, aloof, insincere or had difficulty
conveying confidence and competence.

4 Therapist displayed a satisfactory degree of warmth, concern, confidence,

genuineness, and professionalism. No significant interpersonal problems.

6 Therapist displayed optimal levels of warmth, concern, confidence, genuineness, and

professionalism, appropriate for this particular patient in this session.

___5. COLLABORATION
0 Therapist did not attempt to set up a collaboration with patient.

2 Therapist attempted to collaborate with patient, but had difficulty either defining a
problem that the patient considered important or establishing rapport.

4 Therapist was able to collaborate with patient, focus on a problem that both patient
and therapist considered important, and establish rapport.

6 Collaboration seemed excellent; therapist encouraged patient as much as possible to

take an active role during the session (e.g., by offering choices) so they could function
as a “team.”

___6. PACING AND EFFICIENT USE OF TIME

0 Therapist made no attempt to structure therapy time. Session seemed aimless.

2 Session had some direction, but the therapist had significant problems with structuring
or pacing (e.g., too little structure, inflexible about structure, too slowly paced, too
rapidly paced).

4 Therapist was reasonably successful at using time efficiently. Therapist maintained

appropriate control over flow of discussion and pacing.

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6 Therapist used time efficiently by tactfully limiting peripheral and unproductive
discussion and by pacing the session as rapidly as was appropriate for the patient.

Part II. CONCEPTUALIZATION, STRATEGY, AND TECHNIQUE

___7. GUIDED DISCOVERY

0 Therapist relied primarily on debate, persuasion, or “lecturing.” Therapist seemed to be
“cross-examining” patient, putting the patient on the defensive, or forcing his/her point
of view on the patient.

2 Therapist relied too heavily on persuasion and debate, rather than guided discovery.
However, therapist’s style was supportive enough that patient did not seem to feel
attacked or defensive.

4 Therapist, for the most part, helped patient see new perspectives through guided
discovery (e.g., examining evidence, considering alternatives, weighing advantages and
disadvantages) rather than through debate. Used questioning appropriately.

6 Therapist was especially adept at using guided discovery during the session to explore
problems and help patient draw his/her own conclusions. Achieved an excellent
balance between skillful questioning and other modes of intervention.

___8. FOCUSING ON KEY COGNITIONS OR BEHAVIORS

0 Therapist did not attempt to elicit specific thoughts, assumptions, images, meanings, or
behaviors.

2 Therapist used appropriate techniques to elicit cognitions or behaviors; however,

therapist had difficulty finding a focus or focused on cognitions/behaviors that were
irrelevant to the patient’s key problems.

4 Therapist focused on specific cognitions or behaviors relevant to the target problem.

However, therapist could have focused on more central cognitions or behaviors that
offered greater promise for progress.

6 Therapist very skillfully focused on key thoughts, assumptions, behaviors, etc. that were
most relevant to the problem area and offered considerable promise for progress.

Beck Institute for Cognitive Behavior Therapy

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___9. STRATEGY FOR CHANGE
(Note: For this item, focus on the quality of the therapist’s strategy for change, not on how
effectively the strategy was implemented or whether change actually occurred.)

0 Therapist did not select cognitive-behavioral techniques.

2 Therapist selected cognitive-behavioral techniques; however, either the overall strategy

for bringing about change seemed vague or did not seem promising in helping the
patient

4 Therapist seemed to have a generally coherent strategy for change that showed
reasonable promise and incorporated cognitive-behavioral techniques.

6 Therapist followed a consistent strategy for change that seemed very promising and
incorporated the most appropriate cognitive-behavioral techniques.

___10. APPLICATION OF COGNITIVE-BEHAVIORAL TECHNIQUES

(Note: For this item, focus on how skillfully the techniques were applied, not on how
appropriate they were for the target problem or whether change actually occurred.)

0 Therapist did not apply any cognitive-behavioral techniques.

2 Therapist used cognitive-behavioral techniques, but there were significant flaws in the
way they were applied.

4 Therapist applied cognitive-behavioral techniques with moderate skill.

6 Therapist very skillfully and resourcefully employed cognitive-behavioral techniques.

___11. HOMEWORK
0 Therapist did not attempt to incorporate homework relevant to cognitive therapy.

2 Therapist had significant difficulties incorporating homework (e.g., did not review
previous homework, did not explain homework in sufficient detail, assigned
inappropriate homework).

Beck Institute for Cognitive Behavior Therapy

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4 Therapist reviewed previous homework and assigned “standard” cognitive therapy
homework generally relevant to issues dealt with in session. Homework was explained
in sufficient detail.

6 Therapist reviewed previous homework and carefully assigned homework drawn from
cognitive therapy for the coming week. Assignment seemed “custom tailored” to help
patient incorporate new perspectives, test hypotheses, experiment with new behaviors
discussed during session, etc.

Beck Institute for Cognitive Behavior Therapy

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Bala Cynwyd, PA 19004
610-664-3020
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 CTRS Detailed Score Report

Tape ID# or Therapist: _____________________________ Date of Rating: ____________

Total Score: ___________

Part I. GENERAL THERAPEUTIC SKILLS

______ 1. Agenda

______ 2. Feedback

______ 3. Understanding

______ 4. Interpersonal Effectiveness

______ 5. Collaboration

______ 6. Pacing and Efficient Use of Time

Part II. CONCEPTUALIZATION, STRATEGY, AND TECHNIQUE

______ 7. Guided Discovery

______ 8. Focusing on Key Cognitions or Behaviors

______ 9. Strategy for Change

______ 10. Application of Cognitive-Behavioral Techniques

______ 11. Homework

________ TOTAL SCORE

Beck Institute for Cognitive Behavior Therapy

One Belmont Avenue, Suite 700
Bala Cynwyd, PA 19004
610-664-3020
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