Cognitive-Behavioral Supervision
Presenters: Gabri, MHC, Jacky, MA, Shannon, MA
References
We made it!
Beck, A. T., & Young, J. E. (1980). Cognitive therapy scale rating [PDF document]. Retrieved from www.beckinstitute.org
Gordman, P. K. (2012). Ten steps to cognitive behavioural supervision. The Cognitive Behaviour Therapist, 5, 71-82.
Newman, C. F. (2013). Training cognitive behavioral therapy supervisors: Didactics, simulated practicie, and "meta-supervision." Journal of Cognitive Psychotherapy, 27(1), 5-18.
Pretorius, W. M. (2006). Cognitive behavioural therapy supervision: Recommended practice. Behavioural and Cognitive Psychotherapy, 34, 413-420.
UCL. (2015). Cognitive and behavior therapy [PDF document]. Retrieved from https://www.ucl.ac.uk/pals/research/cehp/research-groups/core/competence-frameworks/cognitive-and-behavioural-therapy
Watkins, C. E., & Milne, D. L. (2014). The Wiley international handbook of clinical supervision. New York: Wiley.
Debriefing
- Questions
- Comments
- Useful Features
- Blind Spots
Interactive Experience
Patient Information
Therapeutic Progress
Carly is a 26-year-old Caucasian woman who resides in Manhattan with her fiancé and works as a receptionist at a non-profit organization. Carly sought psychological services to assist with her depression, reporting symptoms of fatigue, poor concentration, hypersomnia, isolation, weight loss, feelings of emptiness, and a loss of interest in pleasurable activities.
Within the first four sessions, the therapist and client have used cognitive therapy to uncover core beliefs. With the help of guided discovery and specific examination of the belief “I am worthless,” the client has come to recognize her core beliefs stem from early experiences after being told she was not capable of accomplishing tasks the way her parents wanted her to. The core belief, “Nothing I do is good enough,” has caused the client to avoid work tasks as well as previous pleasurable activities for fear of failure, which in turn reinforces her assumptions that she is not capable. Using Socratic questioning, the client has come to understand that her assumptions about how she “should” be engaging in tasks interferes with her ability to explore what it means for her to engage in activites at her own pace without gaining approval from others. Moreover, by identifying the sources of the high standards that the client places on herself, the client has come to understand that she is capable of creating her own standards.
Apart from cognitive interventions, the therapist has noticed Carly’s lack of motivation to engage in homework. This observation has led to the therapist's own reservations in assigning therapeutic homework. After receiving guidance from his supervisor, the therapist’s personal homework was to use a thought record to examine his automatic thoughts that arise during the homework assignment process. Aside from troubleshooting resistance, the therapist was instructed to introduce behavioral interventions (e.g., behavioral activation) in session.
Supervisee Information
Todd is a level 1 therapist who recently began his second year in a counseling psychology PhD program. He currently holds a student-therapist externship position at an outpatient clinic, which trains and supervisors using a cognitive-behavioral framework.
Areas of Therapeutic Strength:
- Knowledge & understanding of mental health problems
- Multicultural competence & assessment of personal biases
- Knowledge of basic prinicples of CBT & rationale for tx
- Ability to detect, examine, & help client test ATs
Areas of Therapeutic Weakness:
- Does not acknowledge client’s affective responses
- Difficulty using case formulation as guide in session
- Inability to adhere to an agenda
- Difficulty assigning homework
Supervision Encounter
Cognitive Therapy Scale Rating
Part I: General Therapeutic Skills
- Agenda: 0
- Feedback: 2
- Understanding: 2
- Interpersonal Effectiveness: 3
- Collaboration: 3
- Pacing & Efficient Use of Time: 3
Part II: Conceptualization, Strategy, & Techniques
- Guided Discovery: 2
- Focusing on Key Cognitions of Behaviors: 4 (Bx); 2 (Cog)
- Strategy for Change: 3
- Application of Cognitive-Behavioral Techniques: 2
- Homework: 2
Explanation of Techniques
- Uses therapy techniques to teach and experience interventions
- Socratic Questioning
- Guided Discovery
- Educational Role-Play
- Behavior Rehearsal
- Behavioral Activation
- Behavioral Experiments
- Modeling
- Corrective Feedback
CBT Therapeutic Competencies
Structure of Supervisory Sessions
- The Structure of a Supervisory Session:
- Check-in
- Setting the agenda
- Bridging from Previous session
- Inquiring about previously discussed cases
- Review Homework
- Prioritize agenda items
- An individual case (video/audio)*
- Use of direct instruction (e.g., technique or skill), guided discovery or Socratic method
- Standardized supervision instruments
- Assigning new HW
- Summarizing and eliciting feedback from supervisee
Methods
- Cognitive-Behavioral
- Humanistic
- Psychoanalytic
- Psychodynamic
Functions
- Fitness for practice
- Normative, Formative, Restorative
- Fitness for purpose
- Enhancing wisdom
- Fitness for profession
- Building self-esteem
- Fitness for award
- Evaluate
Purpose
- Safe and effective therapy
- Secure and enhance client welfare
Outcomes
- Fitness for practice
- Knowledge, Skills, Attitudes
- Fitness for purpose
- Independent capability
- Fitness for profession
- Professional identity
- Fitness for award
- Professional qualification
Signs of Supervision Drift
Fundamental Supervision Competencies
Session Structure
- Check-in
- Prioritization and discussion of supervision agenda
- Bridge from previous session
- Review of assigned homework
- Supervisor
- provides capsule summaries
- assigns new homework
- elicits feedback from therapist
- Unstructured supervision sessions
- No well-defined learning agenda
- Excessive reliance on case discussion
- Low levels of active experiential learning
- Limited use of homework
- Lack of direct observation
Setting the Agenda
Uniqueness of CBT Supervision
Key Elements of CBT Supervision
Session Content
- Discuss cognitive therapy individual case formulation
- Focus on structuring of therapy sessions
- Teach specific cognitive and behavioral techniques
- Make use of audio- or videotapes
- Use standardized supervision instruments
- Address ethical Dilemmas
- Highly structured
- Agenda-driven
- Emphasizes direct observation
- Reviews audio or video recordings of sessions
- Utilizes standardized instruments
- Assesses supervisee competence
Session Process
- Take an empirical stance with therapist
- Utilize guided discovery and Socratic questioning
- Utilize experiential exercises and learning experiments
- Take a collaborative approach
- Address difficulties of therapist:
- interpersonal issues in supervision
- personal issues and maladaptive beliefs interfering with therapy
- Fundamental Supervision Competencies
- CBT Therapeutic Competencies
- Uniqueness of CBT Supervision & Role of Supervisor
- Key Elements & Outline of CBT Supervision
- Explanation of Techniques
Role of CBT Supervisor
- Primary Goal: Adopting CBT philosophy and approach for changing cognitions, emotions and behaviors
- Secondary Goal: Teach specific skills or techniques
- Clinical Teachers
- Encouragement to support independent thinking
- Professional forthrightness
- Take notes on supervision sessions and supervisee's patients