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Featured Therapist Interview
Stephen Swallow received his Ph.D. in clinical psychology from the University of Western Ontario in 1990 and went on to work as staff psychologist with Zindel Segal on the Cognitive Behaviour Therapy Unit at Toronto’s Clarke Institute of Psychiatry (now the Centre for Addiction and Mental Health). In his position at the Clarke, Dr. Swallow conducted research on social comparison processes in depression and social anxiety, supervised psychology interns and psychiatry residents in CBT, and carried his own caseload of patients. Aware that his first love was clinical work, Dr. Swallow left the Clarke to open a private CBT practice in Oakville Ontario, a small town 30 km west of Toronto. The practice gradually evolved into the Oakville Centre for Cognitive Therapy, a dedicated CBT treatment facility currently employing eight psychologists and serving adults, adolescents, children, couples, and families with a range of presenting problems. Dr. Swallow’s clinical interests focus on CBT for depression, anxiety, and health-related difficulties. Over the years he has particularly valued the opportunity to contribute to the training of a number of young psychologists who have gone on to distinguished careers in both academic and clinical settings.
An active member for 20 years, Dr. Swallow considers ABCT his professional home. He particularly credits the Annual Convention and the journal Cognitive and Behavioral Practice for helping him to stay current with developments in the field of CBT.
First, we would like to know a little about your practice.
When did you begin your practice?
I began my private practice in 1994 on a part-time basis because I was working full-time and then transitioned into full-time private practice by 1996.
Do you have a specialty?
My three areas of primary practice focus are CBT for depression, anxiety, and health concerns. I’m a health psychologist as well as a clinical psychologist. I apply CBT to health concerns, such as chronic pain conditions, people suffering from MS, fibromyalgia, and other chronic medical conditions.
What are your personal strengths as a practitioner?
What I try to do is combine three considerations: a value on empiricism and empirically supported treatment, rigor in terms of clinical formulation of presenting problems so that interventions are strategic and targeted, and strong compassion for my clients.
What is one method you use to promote your practice?
I’ve never said “no” to opportunities to give talks in the community. I’ve presented information to family doctors, psychiatrists, community and advocacy groups, and others. It gives me the opportunity to inform them about CBT and will often result in referrals to our practice. Websites and brochures are helpful as well.
However, the best and most important way to promote your practice is to do excellent work with clients who then tell others.
How important are board certifications and/or credentialing programs to your practice?
In our practice what’s important is registration with our provincial licensing body.
Each province regulates its practicing psychologists, and all of our clinicians are either registered or in the process of becoming registered. Board certifications are not as critical.
What tips can you offer to colleagues just opening a practice?
There are a few. One of the things that I found extremely helpful when I was beginning my practice was a course on the practical aspects of a psychology practice, which covered issues like choosing office equipment, bookkeeping, leasing, etc. These things weren’t taught in graduate school and were very useful.
It’s also important to be confident in your training. I find that psychology graduates sometimes lack professional self-esteem and that graduate school may leave students acutely aware of their limitations. Believing in the quality of your training and the value that you bring to the table is crucial. If you strive for excellence in everything you do, most everything else will take care of itself.
Hire a good assistant or coordinator as soon as you can. Having a really good person to take care of administrative issues builds your practice and allows you to focus on clinical and other aspects of your practice.
What sorts of literature do you make available in your waiting room that describes evidence-based therapy?
Our clinic operates as a book seller as well so we have a fully stocked bookstore of self-help material that we have vetted beforehand to make sure we are promoting empirically supported self-help materials. People will often spend time while they’re waiting looking through the materials. We also have brochures on CBT and our practice available in the waiting area.
What self-help books do you suggest to your clients?
It really depends on the nature of the problem, but for depressed patients I will often recommend The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness by Williams, Teasdale, Segal, and Kabat-Zinn; Overcoming Depression One Step at a Time: The New Behavioral Activation Approach to Getting Your Life Back by Addis and Martell; and Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy by Hayes.
There are dozens and dozens of books we use and can recommend based on the presenting issues. I think it’s a good idea for practitioners to stock up on an array of self-help resources to promote follow-through when they suggest the titles to clients. Then we know they have it when they leave the office.
What one book do you recommend as a “must read” to improve your practice?
If I had to pick one book that really influenced my thinking about CBT it would be Cognitive Therapy in Practice: A Case Formulation Approach by Jackie Persons, which really emphasizes how absolutely critical solid case formulation is in CBT practice.
Are you involved in other types of professional activities in addition to your private practice?
I teach a course at a theological seminary in Toronto on basic interviewing and counseling skills for students who are mostly planning to become clergy.
Next, we are interested in your continuing education activities.
How do you stay current with new research or advances in the field as applied to your practice?
This is where ABCT is especially important to me. I try to attend the annual conference every year or another one of the major cognitive therapy conferences. It’s easy to become complacent when you’ve been practicing for a while. I also read two journals regularly, the Journal of Consulting and Clinical Psychology and Cognitive and Behavioral Practice.
In our clinic we also conduct rounds every month where we get together and discuss a recent paper or a workshop that someone has attended.
Where do you earn your continuing education credits?
We don’t have continuing education credit requirements. The College of Psychologists of Ontario requires us to submit a learning plan and how we’re planning to reach our learning goals every two years, and, within that, we provide evidence of ongoing training. I typically get my ongoing training through the ABCT conference and pre-conference workshops.
We would also like to know a little about you personally.
Who was your mentor?
There are two people in particular who come to mind. My thesis advisor was Nick Kuiper at the University of Western Ontario who was a role model in terms of displaying a strong work ethic and being a non-procrastinator.
I also worked with Zindel Segal for six years and consider him to be a great science-practitioner. I’ve been really impressed with his ability to apply theory and data to clinical practice, and he’s a compassionate and astute clinician.
What is the last book you read?
This is kind of embarrassing. I am an avid golfer and tend to find illustrative material for my practice in golf as it’s such a mental game and so many principles can apply to other areas of life.
I’ve been reading Extraordinary Golf: The Art of the Possible by Fred Shoemaker. It addresses the application of mindfulness to golf and the importance of being in the moment. I’ve also recently read Michael Murphy’s Golf in the Kingdom about the nexus between golf and spirituality and the mental game of golf.
How do you avoid burnout?
Golf. I find that it’s one activity that I can get completely absorbed in and I never think about my practice. I take regular vacations. It’s easy when you’re in private practice and self-employed to work all the time but important to discipline yourself to take regular vacations and spend time with your family.
When not practicing CBT, what do you do for fun?
Besides golf? I enjoy back country canoe trips in Algonquin Park in Ontario, about three hours north of Toronto. You can go out and not see another soul for the entire time you’re out there.
Do you have any other “talents?”
I do like music. I play the guitar and piano and I have a home music studio where I write and record music. However, I confine my singing to the studio in the basement.
We are also interested in some of your views of CBT.
What do you think is the single most important thing CBT can do for your clients?
My experience is that CBT empowers clients by equipping them with skills and tools for living their lives in a way that’s consistent with their values. It frees them to live life in accordance with their own personalities.
Where do you see the field of cognitive and behavioral therapies going over the next 3 to 5 years?
In some ways I see two possibly competing trajectories.
On the one hand, there seems to be some fragmentation of CBT into disorder-specific protocols or sub-protocols. Specifically in the UK and Australia we’re seeing the mass dissemination of CBT, which necessarily involves a degree of simplification and technique-y stuff that you’re teaching people.
On the other hand, we’re seeing the development of a broader-based, formulated approach like David Barlow’s unified protocol for emotional disorders, which is where I hope it goes.
How do you use the local media to educate your community on the benefits of CBT?
A few years ago the local newspaper, the Oakville Beaver, contacted me about advertising with them. I suggested instead that they do an article on the Centre so they sent over a reporter and a photographer and they did a full-page story about us with a good description of CBT. It was a great opportunity to educate the public about CBT and let them know what it’s about.
Finally, we would like to know your opinions about ABCT.
How long have you been a member of ABCT?
About 20 years.
How has ABCT helped you professionally?
Mostly through attending the annual conference regularly, reading the journal, and also in terms of maintaining contact with colleagues. The conference is sometimes the one time I get to re-connect and network with colleagues. It gives you a sense of community, which is a great feeling; like you aren’t the only one out there doing what you’re doing.
What services do you consider the most valuable from ABCT?
The annual conference and the journal.
What service(s) are missing from ABCT in your role as a practitioner?
As a Canadian, ABCT may be a little more focused on practice issues in the U.S. than elsewhere, although the conference has been and will be in Toronto. There is a Canadian Association of Cognitive and Behavior Therapy, but it does not have any impact on my ties with ABCT as my primary professional home.
How do you see the future of ABCT?
I think the future is really bright. Whenever I go to the conferences I see a lot of excellent graduate students and newly minted psychologists who are doing interesting research and work. It’s also nice to see people from other professions (physicians, social workers, etc.) and expanding the professions involved in ABCT is a promising direction as every discipline brings its unique aspects.
Thank you very much for taking the time to answer our questions!