Table 1.

Barriers to uptake of new psychological treatments

Barriers	Rank	Frequency	Percent	Examples
Clinician attitudes
Question efficacy in general	7	115	4.1	Being convinced that they are worth the effort to learn and have measurable positive outcomes
				I need proof that it has been tried and is successful
Belief that psychotherapy is more than a set of techniques	21	26	0.9	I do not need techniques, they are not significant, the process is!
				My belief that the most important curative aspect of treatment is the client/therapist relationship
Belief that what one is currently doing is sufficient/effective	8	95	3.4	I am very comfortable with what I do and believe that it provides me the foundation I need to do effective therapy
				I have enough in my armamentarium and I do not find the need to add any
Belief that treatment must be compatible with therapist style/viewpoint	16.5	33	1.1	Finding ones that are compatible with the way I am comfortable practicing
				It has to feel natural for me and consistent with my training and experience
Belief that treatment must be easily integrated with current approach	14	37	1.3	Difficulty integrating the new techniques/skills into my current approach in a systematic and meaningful way
				How to integrate it into who I am, what I do
Lack of interest or energy/inertia/boredom	11	67	2.4	Boredom/burnout
				My own energy and enthusiasm
Late age/stage in professional development	16.5	33	1.1	Do not want to learn complicated systems at this stage of my career
				I am old and have been trained up the wazoo
Client attitudes/characteristics
Client’s resistance	12	57	2.0	Engaging the client to try something new and outside their comfort zone
				Getting the client to be open to the new technique
Question efficacy or applicability for particular client population	9	75	2.6	An impoverished public mental health clientele whose lives are often in chaos and who need much practical assistance on an ongoing basis
				Sufficient client base with relevant issues/interest to justify time and expense
Contextual or institutional factors
Institutional restrictions/lack of institutional support	6	116	4.1	Agency practices from a specific theoretical perspective so techniques must be consistent with that.
				Limited time with clients, and the amount of non-therapy tasks that also have to be addressed
Insurance restrictions	10	69	2.4	Insurance demands on time and “accepted” models of treatment.
				Number of sessions allowed by insurance companies
Acceptance or support by other outside influences (e.g., colleagues)	15	36	1.3	Attitudes of other clinicians
				Professional associations not endorsing or not accepting these as valid without empirical research
Training issues
Insufficient time	1	795	28.1	Getting the training. It is expensive and time consuming and it is difficult to get away from my practice. Time away is time without pay, and the pay is low enough as it is!
High cost of training	2	430	15.2	A lack of training opportunities that are affordable
				Financial support for training and supervision
Lack of accessible (local) training opportunities	5	201	7.1	Lack of available training in my area
				Lack of convenient training opportunities
Insufficient or lack of training/supervision for refining skills	3	249	8.8	Lack of ongoing support for skill building
				Lack of opportunity to practice them under sufficient supervision
Lack of experience, confidence, comfort or proficiency in using technique	4	204	7.2	Developing enough proficiency in a new area to feel comfortable in using the new techniques
				Learning the new techniques successfully and completely, so these will come as naturally as the ones I already use
Lack of tools to assist learning	24	13	0.5	Finding the resources that lay out practical, usable curricula that can be easily adapted for different needs
				Lack of good video demonstrations of exactly how to do a particular therapy
Awareness or exposure to new techniques and knowing which one to choose from	22	25	0.9	Determining which of the myriad of available techniques would be the most relevant and useful to my work
				Discerning the most useful training
Other
Implementation requires meeting certain special requirements	19	30	1.1	Becoming certified
				Lack of physical space needed for some techniques
Insufficient number of clients	23	20	0.7	Availability of clients
				Not enough clients
Ethical and legal concerns	20	27	1.0	Potential for litigation
				The test of time to insure they are not harmful
Isolation	18	31	1.1	Lacking peer professional support to keep update on new research findings
				Having colleagues to interact with that are doing the same techniques (within a 60 miles radius)
Other	13	46	1.6	Transcending my own internal biases and assumptions.
				Tedium or complexity of the approach
Total		2830	100.0