Meta-competencies govern the application of more basic therapeutic competencies and allow CBT therapists to know when and why particular skills are needed. Meta-competencies are particularly important when responding to the needs of complex or atypical clinical cases. We explore CBT meta-competencies through therapist reflections on complex clinical scenarios and judgements about CBT skills. Three groups of therapists were compared in their responses to four complex clinical scenarios: trainees, recently qualified and experienced therapists. Participants reflected on how they would respond in each scenario and made ratings of the importance of different skills. There was a highly significant difference between trainees and experienced therapists in the number of reflective statements made, but no differences in the number of anticipated actions. There were no group differences in judgements about CBT skills. Reflective capacity is a meta-competency and higher-order skill that CBT therapists continue to develop several years post-qualification. Further studies are needed to replicate this finding and understand its impact on clinical practice.

1. (1) To learn about CBT meta-competencies when considering clinical complexity.

2. (2) To learn how to test meta-competencies in groups of therapists with differing levels of experience.

3. (3) To identify which meta-competencies are prioritised in clinically complex scenarios.

4. (4) To support the development of the scale which measures meta-competencies in therapists.