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Supervising Cognitive-Behavioral Psychotherapy: Pressing Needs, Impressing Possibilities

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Abstract

While accounts of the practice of cognitive behavioral therapy (CBT) supervision have been available over the past 15 years and have demonstrated consistency in terms of an overall model specifying the structure, process and content of supervision sessions, a number of gaps can be identified in the literature on the clinical supervision of CBT. Comprehensive consensus statements of the competencies underlying clinical supervision have been developed both in the United States (Falender et al., J Clin Psychol, 60, 771–785, 2004) and in the United Kingdom (Roth and Pilling, IAPT supervision competencies framework, University College London, 1992), but there has been a lack of attention to relevant theory and to procedural detail. As a consequence, the literature on CBT supervision has only recently begun to assimilate concepts from the wider supervision field (e.g. developmental models), and there is as yet no manual that would allow supervisors to make explicit determinations of competency. Furthermore, supervision in general continues to suffer both from the absence of compelling empirical support demonstrating its effectiveness in improving clinical outcomes, and there is a lack of explicitly-defined supervisory procedures that can be reliably observed and measured. Unfortunately, this combination of factors hampers the development of CBT supervision (e.g. it complicates efforts to provide a standardized framework for training in supervision). As an important starting point in ‘treating’ the underdeveloped state of CBT supervision, we outline a formulation of its current condition, then suggest some promising interventions.

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References

  • American Psychological Association (APA). (2002). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. Washington, DC: Author.

  • American Psychological Association. (2007). Assessment of competency benchmarks work group: A developmental model for the defining and measuring competence in professional psychology. Washington DC: Author.

  • Armstrong, P. V., & Freeston, M. H. (2006). Conceptualising and formulating cognitive therapy supervision. In N. Tarrier (Ed.), Case formulation in cognitive behaviour therapy: The treatment of challenging and complex clinical cases. London: Routledge.

  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.

    Google Scholar 

  • Beck, J., Sarnat, J. E., & Barenstein, V. (2008). Psychotherapy- based approaches to supervision. In C. Falender & E. Shafranske (Eds.), Casebook for clinical supervision—a competency based approach. Washington, DC: American Psychological Association.

    Google Scholar 

  • Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice, 17, 1–30.

    Article  Google Scholar 

  • Bellg, A. J., Borrelli, B., Resnick, B., Hecht, J., Minicucci, D. S., Ory, M., et al. (2004). Enhancing treatment fidelity in health behavior change studies: Best practices and recommendations from the NIH Behavior Change Consortium. Health Psychology, 23, 443–451.

    Article  PubMed  Google Scholar 

  • Bennett-Levy, J. (2006). Therapist skills: A cognitive model of their acquisition and refinement. Behavioural and Cognitive Psychotherapy, 34, 57–78.

    Article  Google Scholar 

  • Bennett-Levy, J., McManus, F., Westling, B. E., & Fennell, M. (2009). Acquiring and refining CBT skills and competencies: Which training methods are perceived to be most effective? Behavioural and Cognitive Psychotherapy, 37, 571–583.

    Article  PubMed  Google Scholar 

  • Blackburn, I. M., James, I. A., Milne, D. L., Baker, C., Standart, S., Garland, A., et al. (2001). The Revised Cognitive Therapy Scale (CTS-R): Psychometric properties. Behavioural and Cognitive Psychotherapy, 29(4), 431–447.

    Article  Google Scholar 

  • British Psychological Society. (2009). Directory for applied psychology practice supervisors. Leicester: BPS.

    Google Scholar 

  • Brosan, L., Reynolds, S., & Moore, R. G. (2006). Factors associated with competence in cognitive therapists. Behavioural and Cognitive Psychotherapy, 35, 179–190.

    Article  Google Scholar 

  • Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17–31.

    Article  PubMed  Google Scholar 

  • Clark, D. M., Layard, R., Smithies, R., Richards, D. A., Suckling, R., & Wright, B. (2009). Improving access to psychological therapy: Initial evaluation of two UK demonstration sites. Behaviour Research and Therapy, 47, 910–920.

    Article  PubMed  Google Scholar 

  • Culloty, T., Milne, D. L., & Sheikh, A. I. (2010). Evaluating the training of clinical supervisors: A pilot study using the fidelity framework. The Cognitive Behaviour Therapist, 3, 132–144.

    Article  Google Scholar 

  • Ellis, M. V., & Ladany, N. (1997). Inferences concerning supervisees and clients in clinical supervision: An integrative review. In C. E. Watkins (Ed.), Handbook of psychotherapy supervision (pp. 447–507). Chichester: Wiley.

    Google Scholar 

  • Falender, C., Cornish, J. A. E., Goodyear, R., Hatcher, R., Kaslow, N. J., Leventhal, G., et al. (2004). Defining competencies in psychology supervision: A consensus statement. Journal of Clinical Psychology, 60, 771–785.

    Article  PubMed  Google Scholar 

  • Falender, C. A., & Shafranske, E. P. (2004). Clinical supervision: A competency-based approach. Washington, DC: American Psychological Association.

    Book  Google Scholar 

  • Falender, C., & Shafranske, E. (2010). Psychotherapy-based supervision models in an emerging competency-based era: A commentary. Psychotherapy Theory, Research, Practice, Training, 47, 45–50.

    Google Scholar 

  • Fixsen, D.L., Naoom, S.F., Blasé, K.A., Friedman, R.M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).

  • Fleming, I. (2004). Training clinical psychologists as supervisors. In I. Fleming & L. Steen (Eds.), Supervision and clinical psychology: Theory, practice and perspectives. New York: Brunner-Routledge.

    Google Scholar 

  • Fouad, N. A., Grus, C. L., Hatcher, R. L., Kaslow, N. J., Hutchings, P. S., Madson, M., et al. (2009). Competency benchmarks: A model for the understanding and measuring of competence in professional psychology across training levels. Training and Education in Professional Psychology, 3, S–S26.

    Article  Google Scholar 

  • Freitas, G. J. (2002). The impact of psychotherapy supervision on client outcome: A critical examination of two decades of research. Psychotherapy: Theory/Research/Practice/Training, 39, 354–367.

    Article  Google Scholar 

  • Hadjistavropoulos, H., Kehler, M., & Hadjistavropoulos, T. (2010). Training graduate students to be clinical supervisors: A survey of Canadian professional psychology programs. Canadian Psychology, 51(3), 206–212.

    Article  Google Scholar 

  • IAPT Education and Training Group (2011). Guidance for Commissioning IAPT Supervisor Training (Revised 2011). Retrieved from IAPT website: http://www.iapt.nhs.uk/silo/files/guidance-for-commissioning-iapt-supervisor-training-revised-2011.pdf.

  • Kaslow, N. J., Borden, K. A., Collins, F. L., Jr., Forrest, L., Illfelder-Kaye, J., & Nelson, P. D. (2004). Competencies conference: Future directions in education and credentialing in professional psychology. Journal of Clinical Psychology, Special Issue, 60, 699–712.

    Google Scholar 

  • Kolb, D. A. (1984). Experiential learning. Englewood-Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  • Lambert, M. J., & Ogles, B. M. (2004). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change. New York: Wiley.

  • Liese, B. S., & Beck, J. S. (1997). Cognitive therapy supervision. In C. E. Watkins (Ed.), Handbook of psychotherapy supervision (pp. 114–133). Chichester: Wiley.

    Google Scholar 

  • McHugh, R. K., & Barlow, D. H. (2010). The dissemination and implementation of evidence-based psychological treatments: A review of current efforts. American Psychologist, 65, 73–84.

    Article  PubMed  Google Scholar 

  • Miller, W. R., & Mount, K. A. (2001). A small study of training in motivational interviewing: does one workshop change clinician and client behavior? Behavioural and Cognitive Psychotherapy, 29, 457–471.

    Article  Google Scholar 

  • Miller, W. R., Yahne, C. E., Moyers, T. B., Martinez, J., & Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology, 72(6), 1050–1062.

    Article  PubMed  Google Scholar 

  • Milne, D. L. (2008). CBT supervision: From reflexivity to specialization. Behavioural and Cognitive Psychotherapy, 36, 779–786.

    Article  Google Scholar 

  • Milne, D. L. (2009). Evidence-based clinical supervision. Chichester: BPS Blackwell.

    Google Scholar 

  • Milne, D. L. (2010). Can we enhance the training of clinical supervisors? A national pilot study of an evidence-based approach. Clinical Psychology and Psychotherapy, 17, 321–328.

    PubMed  Google Scholar 

  • Milne, D. L., & Dunkerley, C. (2010). Towards evidence-based clinical supervision: The development and evaluation of four CBT guidelines. The Cognitive Behaviour Therapist, 3, 43–57.

    Article  Google Scholar 

  • Milne, D. L., & James, I. A. (2000). A systematic review of effective cognitive-behavioural supervision. British Journal of Clinical Psychology, 39, 111–127.

    Article  PubMed  Google Scholar 

  • Milne, D. L., James, I. A., Keegan, D., & Dudley, M. (2002). Teacher’s PETS: A new observational measure of experiential training interactions. Clinical Psychology and Psychotherapy, 9, 187–199.

    Article  Google Scholar 

  • Milne, D. L. & Reiser, R. (2008). Supervision: Adherence and guidance evaluation (SAGE). Unpublished instrument, available from the first author.

  • Milne, D. L., & Reiser, R. (in press). A rationale for evidence-based clinical supervision. Journal of Contemporary Psychotherapy.

  • Milne, D. L., Reiser, R., Aylott, H., Dunkerley, C., Fitzpatrick, H., & Wharton, S. (2010). The systematic review as an empirical approach to improving CBT supervision. International Journal of Cognitive Therapy, 3, 278–294.

    Article  Google Scholar 

  • Milne, D.L., Scaife, J., & Cliffe,T. (2009). How should we train effective supervisors? A British consensus on facilitating experiential learning. Clinical Psychology Forum, 203.

  • Newman, C. F. (2010). Competency in conducting cognitive–behavioral therapy: Foundational, functional, and supervisory aspects. Professional Psychology: Research and Practice, 47(1), 12–19.

    Google Scholar 

  • Padesky, C. A. (1996). Developing cognitive therapist competency: Teaching and supervision models. In P. M. Salkovskis (Ed.), Frontiers of cognitive therapy. London: Guilford Press.

    Google Scholar 

  • Rakovshik, S. G., & McManus, F. (2010). Establishing evidence-based training in cognitive behavioral therapy: A review of current empirical findings and theoretical guidance. Clinical Psychology Review, 30, 496–516.

    Article  PubMed  Google Scholar 

  • Reiser, R.., & Milne, D. L. (2009, November). Assessing competence in CBT supervision. Clinical roundtable presented at the annual meeting of Association of Behavioural and Cognitive Therapies, New York, NY.

  • Rings, J. A., Genuchi, M. C., Hall, M. D., Angelo, M., & Erickson Cornich, J. A. (2009). Is there consensus among predoctoral internship training directors regarding clinical supervision competencies? A descriptive analysis. Training and Education in Professional Psychology, 3, 140–147.

    Article  Google Scholar 

  • Rodolfa, E., Bent, R., Eisman, E., Nelson, P., Rehm, L., & Ritchie, P. (2005). A cube model for competency development: Implications for psychology educators and regulators. Professional Psychology: Research and Practice, 36(4), 347–354.

    Article  Google Scholar 

  • Roth, A., & Pilling, S. (1992). IAPT supervision competencies framework. Retrieved from University College London. http://www.ucl.ac.uk/clinical-psychology/CORE/supervision_framework.htm.

  • Roth, A., & Pilling, S. (2008). A competence framework for the supervision of psychological therapies. Retrieved March 30, 2009, from http://www.ucl.ac.uk/clinical-psychology/CORE/supervision_framework.htm.

  • Roth, A., Pilling, S., & Turner, J. (2010). Therapist training and supervision in CBT in major trials for depression and anxiety. Behavioral and Cognitive Psychotherapy, 38(3), 291–302.

    Article  Google Scholar 

  • Simons, A. D. et al. (2010). Training and dissemination of cognitive behavior therapy for depression in adults: A preliminary examination of therapist competence and client outcomes. Journal of Consulting and Clinical Psychology, 78(5), 751–756.

    Google Scholar 

  • Shanfield, S. B., Mohl, P. C., Mathews, K. L., & Hetherly, V. (1992). Quantitative assessment of the behavior of supervisors. American Journal of Psychiatry, 149(3), 352–357.

    PubMed  CAS  Google Scholar 

  • Sholomskas, D. E., Syracuse-Siewert, G., Rounsaville, B. J., Ball, S. A., Nuro, K. F., & Carroll, K. M. (2005). We don’t train in vain: A dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 73, 106–115.

    Article  PubMed  Google Scholar 

  • Townend, M., Iannetta, L., & Freeston, M. H. (2002). Clinical supervision in practice: A survey of UK cognitive-behavioural psychotherapists accredited by the BABCP. Behavioural and Cognitive Psychotherapy, 30, 485–500.

    Google Scholar 

  • Townend, M., Iannetta, L., Freeston, M. & Hayes, J. (2007). Supervision practices of UK cognitive-behavioural psychotherapists, 2001 and 2006. Paper presented at the 5th World Congress of Behavioural and Cognitive Therapies, Barcelona, 11–14 July.

  • Watkins, C. E. (Ed.). (1997). The handbook of psychotherapy supervision. Chichester: Wiley.

    Google Scholar 

  • Wheeler, S., & Richards, K. (2007). The impact of clinical supervision on counselors and therapists, their practice and their clients. A Systematic review of the literature. Counselling and Psychotherapy Research, 7(1), 54–65.

    Article  Google Scholar 

  • Young, J. & Beck, A.T. (1988) The cognitive therapy rating scale manual (revised). Philadelphia, PA: Center for Cognitive Therapy, University of Pennsylvania.

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Reiser, R.P., Milne, D. Supervising Cognitive-Behavioral Psychotherapy: Pressing Needs, Impressing Possibilities. J Contemp Psychother 42, 161–171 (2012). https://doi.org/10.1007/s10879-011-9200-6

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