Journal of Contemporary Psychotherapy ( C  2006) DOI: 10.1007/s10879-005-9006-5 Community Implementation Successes and Challenges of a Cognitive-Behavior Therapy Group for Individuals with a First Episode of Psychosis Alicia Spidel, 1 Tania Lecomte, 2,4 and Claude Leclerc 3 CBT for psychosis has recently been called a best practice, suggesting that studies have demonstrated its efficacy with many populations. Community settings are encouraged to implement best practices such as CBT yet many factors can make the implementation of CBT challenging. Issues such as clinician resistance, setting, as well as client variables (refusal, denial of symptoms, etc.) come into play. Examples of successes and challenges of a community based study of CBT groups for first episodes will be described. The strategies used to overcome these challenges and the successes of the program will be presented. KEY WORDS: schizophrenia; CBT; first episodes; implementation. The past few years have seen major progress regarding the treatment of severe mental illness. Of these promis- ing treatments Cognitive Behavioral Therapy (CBT) has been recommended as a best practice for individuals with psychosis by the American Psychological Association’s Task Force on Severe Mental Illness (2004) as well as the American Psychiatric Association (Lehman et al., 2004). CBT for psychosis has been found to be effective with many types of individuals with psychosis, particularly with individual suffering from persistent psychotic symp- toms (Gould & Mueser, 2001; Pilling et al., 2002) but also with inpatients (Drury, Birchwood, Cochrane, and Macmillan 1996), first episodes of psychosis (Lecomte, Leclerc, Wykes, and Lecomte, 2003; Tarrier et al., 2004), and more geriatric populations (Granholm, McQuaid, McClure, Pedrelli, & Jeste, 2002). Though many ques- tions remain unanswered regarding the effective ingre- 1 Department of Psychology, University of British Columbia, Vancouver, BC, Canada. 2 Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada. 3 Department of Nursing, University of Quebec at Trois-Rivieres, Canada. 4 Address correspondence to Tania Lecomte, Ph.D., Assistant Profes- sor of Psychiatry, University of British Columbia, 828 West 10th Av- enue, Room 214, Vancouver, BC, V5Z 1L8, Canada; e-mail: lecomte@ interchange.ubc.ca. dients of this therapy and who benefits most from it (Lecomte & Lecomte, 2002), the existing studies all re- port positive results, either in terms of decreased positive symptoms, diminished distress, or improved social out- comes. As a result, the implementation of CBT in com- munity settings is greatly encouraged by leaders in the field. However, many reasons seem to explain why CBT for psychosis has yet to be implemented in many com- munity settings. For starters, many settings still do not offer most widely accepted evidenced based treatments, such as integrated dual disorder treatments, supported em- ployment programs, or assertive community treatments (Aarons, 2004; Hoagwood & Olin, 2002). There are many reasons for this, which includes local laws, administrative policies, funding priorities, advocates’ concerns and pro- gram staffing (Corrigan, Steiner, McCracken, Blaser, & Barr, 2001). Although many of these reasons are beyond the control of individual community settings, others –such as service providers’ resistance to implementation—can be targeted. It is these types of implementation issues that will be discussed here. This paper will describe the suc- cesses and challenges related to implementing CBT for psychosis in the community in order to facilitate a dia- logue about this issue, bridge the gap between research and practice, and provide health care providers with some insight regarding our experiences in implementing group 0022-0116/06 C  2006 Springer-Verlag