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How does supervision aid cognitive behaviour therapy skill development? Perspectives of CBT trainees: a thematic analysis

Published online by Cambridge University Press:  14 October 2020

Stephanie Murr
Affiliation:
University of Edinburgh, Edinburgh, UK
Leeanne Nicklas
Affiliation:
NHS Education Scotland, Edinburgh, UK
Sean Harper*
Affiliation:
South of Scotland PG Masters Training Programme in CBT, Royal Edinburgh Hospital, Edinburgh, UK
*
*Corresponding author. Email: [email protected]

Abstract

Eleven cognitive behaviour therapy (CBT) trainees in Scotland were interviewed regarding their experiences of clinical supervision and its impact on their skill development. Using thematic analysis, the authors developed four main themes: Linking Theory to Practice, Mirroring CBT in Supervision, The Expert Supervisor, and Trainees’ Reluctance to Give Negative Feedback. Clinical supervision was essential in helping trainees to link theory to practice; particularly through audio recordings, discussing formulations, and modelling and role-play. A CBT-specific approach to supervision and a CBT expert supervisor were also identified as valuable to learning. Trainees were reluctant to give negative feedback to supervisors, fearing negative consequences. The findings inform supervision practice.

Key learning aims

Readers of this paper will be able to:

  1. (1) Describe trainees’ most valued elements of CBT supervision.

  2. (2) Determine key learning methods in CBT supervision.

  3. (3) Explain the value of modality specific CBT supervision.

  4. (4) Articulate the context of supervision in CBT training and consider mutual feedback as a method to address identified challenges.

Type
Original Research
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Further reading

Milne, D. L. (2009). Evidence-Based Clinical Supervision: Principles and Practice. Hoboken, USA: John Wiley & Sons.Google Scholar
Milne, D. L. & Reiser, R. P. (2017). A Manual for Evidence Based CBT Supervision. John Wiley & Sons.CrossRefGoogle Scholar
Newman, C. F. (2010). Competency in conducting cognitive behavioural therapy: foundational, functional and supervisory aspects. Psychotherapy: Theory, Research, Practice, Training, 47, 1219. https://doi.org/10.1037/aoo18849 CrossRefGoogle ScholarPubMed

References

Barnfield, T. V., Mathieson, F. M., & Beaumont, G. R. (2007). Assessing the development of competence during postgraduate cognitive-behavioral therapy training. Journal of Cognitive Psychotherapy, 21, 140147.CrossRefGoogle Scholar
Bagnall, G., Sloan, G., Platz, S., & Murphy, S. (2011) Generic supervision competencies for psychological therapies. Mental Health Practice, 21, 140147. https://www.researchgate.net/publication/271763420 Google Scholar
Baum, B. E., & Gray, J. J. (1992). Expert modeling, self-observation using videotape, and acquisition of basic therapy skills. Professional Psychology: Research and Practice, 23, 220225.CrossRefGoogle Scholar
Bazeley, P., & Jackson, K. (2013). Qualitative Data Analysis with NVivo. Thousand Oaks, CA, USA: Sage Publications Limited.Google Scholar
Bearman, S. K., Weisz, J. R., Chorpita, B. F., Hoagwood, K., Ward, A., Ugueto, A. M., … & Research Network on Youth Mental Health (2013). More practice, less preach? The role of supervision processes and therapist characteristics in EBP implementation. Administration and Policy in Mental Health and Mental Health Services Research, 40, 518529.CrossRefGoogle ScholarPubMed
Beck, J. S. (2008). Supervision in cognitive therapy. In Falender, C.A., & Shafranske, E.P. (eds), Casebook for Clinical Supervision: A Competency Based Approach (pp. 5769). Washington, USA: American Psychological Association.CrossRefGoogle 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, 571583.CrossRefGoogle ScholarPubMed
Bennett-Levy, J., & Padesky, C. A. (2014). Use it or lose it: post-workshop reflection enhances learning and utilization of CBT skills. Cognitive and Behavioral Practice, 21, 1219.CrossRefGoogle Scholar
Blackburn, I. M., James, I. A., Milne, D. L., Baker, C., Standart, S., Garland, A., & Reichelt, F. K. (2001). The revised cognitive therapy scale (CTS-R): psychometric properties. Behavioural and Cognitive Psychotherapy, 29, 431446.CrossRefGoogle Scholar
Braun, V., & Clarke, V. (2013). Successful Qualitative Research: A Practical Guide for Beginners. London, UK: Sage.Google Scholar
British Psychological Society (2014). DCP Policy on Supervision. London, UK: British Psychological Society.Google Scholar
Buetow, S. (2010). Thematic analysis and its reconceptualization as ‘saliency analysis’. Journal of Health Services Research & Policy, 15, 123125.CrossRefGoogle ScholarPubMed
De Stefano, J., D’Iuso, N., Blake, E., Fitzpatrick, M., Drapeau, M., & Chamodraka, M. (2007). Trainees’ experiences of impasses in counselling and the impact of group supervision on their resolution: a pilot study. Counselling and Psychotherapy Research, 7, 4247.CrossRefGoogle Scholar
Department of Health (2008). Improving Access to Psychological Therapies implementation plan: National guidelines for regional delivery (286387). Available at: http://www.iapt.nhs.uk Google Scholar
Falender, C. A., & Shafranske, E. P. (2004). Clinical Supervision: A Competency-Based Approach. Washington, USA: American Psychological Association.CrossRefGoogle Scholar
Ferguson, S., Harper, S., Platz, S., Sloan, G., Smith, K. (2016). Developing specialist CBT supervision training in Scotland using blended learning: challenges and opportunities. The Cognitive Behaviour Therapist. doi: 10.1017/S1754470X15000732 CrossRefGoogle Scholar
Fleming, I., & Steen, L. (eds). (2013). Supervision and Clinical Psychology: Theory, Practice and Perspectives. Hove, UK: Routledge.CrossRefGoogle Scholar
Folkes-Skinner, J., Elliott, R., & Wheeler, S. (2010). ‘A baptism of fire’: a qualitative investigation of a trainee counsellor’s experience at the start of training. Counselling and Psychotherapy Research, 10, 8392.CrossRefGoogle Scholar
Forrester, M. A. (ed). (2010). Doing Qualitative Research in Psychology: A Practical Guide. London, UK: Sage.Google Scholar
Franklin, M. E., Abramowitz, J. S., Furr, J. M., Kalsy, S., & Riggs, D. S. (2003). A naturalistic examination of therapist experience and outcome of exposure and ritual prevention for OCD. Psychotherapy Research, 13, 153167.CrossRefGoogle Scholar
Gray, L. A., Ladany, N., Walker, J. A., & Ancis, J. R. (2001). Psychotherapy trainees’ experience of counterproductive events in supervision. Journal of Counselling Psychology, 48, 371.CrossRefGoogle Scholar
Ladany, N., Mori, Y., & Mehr, K. E. (2013). Effective and ineffective supervision. The Counseling Psychologist, 41, 2847.CrossRefGoogle Scholar
Liese, B. S., & Beck, J. S. (1997). Cognitive therapy supervision. In C.E. Watkins Jr (ed), Handbook of Psychotherapy Supervision (pp. 114133). New York, USA: Wiley.Google Scholar
McClain, T., O’Sullivan, P. S., & Clardy, J. A. (2004). Biopsychosocial formulation: recognizing educational shortcomings. Academic Psychiatry, 28, 8894.CrossRefGoogle ScholarPubMed
Milne, D. L. (2009). Evidence-Based Clinical Supervision: Principles and Practice. Hoboken, USA: John Wiley & Sons.Google Scholar
Milne, D. L., & Reiser, R. P. (2014). SAGE: a scale for rating competence in CBT supervision. The Wiley International Handbook of Clinical Supervision, pp. 403415.Google Scholar
Newman, C. F. (2010). Competency in conducting cognitive-behavioral therapy: foundational, functional, and supervisory aspects. Psychotherapy: Theory, Research, Practice, Training, 47, 12.CrossRefGoogle ScholarPubMed
NICE (2009). Depression in adults: recognition and management. Clinical Guideline CG90. London, UK: National Institute for Health and Clinical Excellence.Google Scholar
NICE (2011). Generalised anxiety disorder and panic disorder in adults: management. Clinical Guideline CG113. London, UK: National Institute for Health and Clinical Excellence.Google Scholar
NICE (2014). Psychosis and schizophrenia in adults: prevention and management. Clinical Guideline CG178. London, UK: National Institute for Health and Clinical Excellence.Google Scholar
Öst, L.-G., Karlstedt, A., & Widén, S. (2012). The effects of cognitive behavior therapy delivered by students in a psychologist training program: an effectiveness study. Behavior Therapy, 43, 160173.CrossRefGoogle 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, 496516.CrossRefGoogle ScholarPubMed
Rakovshik, S. G., & McManus, F. (2013). An anatomy of CBT training: trainees’ endorsements of elements, sources and modalities of learning during a postgraduate CBT training course. The Cognitive Behaviour Therapist, 6, 112.CrossRefGoogle Scholar
Rakovshik, S. G., McManus, F., Vazquez-Montes, M., Muse, K., & Ougrin, D. (2016). Is supervision necessary? Examining the effects of internet-based CBT training with and without supervision. Journal of Consulting and Clinical Psychology, 84, 191.CrossRefGoogle ScholarPubMed
Reichelt, S., & Skjerve, J. (2001). Supervision of inexperienced therapists: a qualitative analysis. The Clinical Supervisor, 19, 2543.CrossRefGoogle Scholar
Roth, A. D., & Pilling, S. (2008). Using an evidence-based methodology to identify the competences required to deliver effective cognitive and behavioural therapy for depression and anxiety disorders. Behavioural and Cognitive Psychotherapy, 36, 129147.CrossRefGoogle Scholar
Roth, A. D., & Pilling, S. (2009). A competence framework for the supervision of psychological therapies. Available at: www.ucl.ac.uk/clinical-psychology/CORE/supervision_framework.htm Google Scholar
Schoenwald, S. K., Sheidow, A. J., & Chapman, J. E. (2009). Clinical supervision in treatment transport: effects on adherence and outcomes. Journal of Consulting and Clinical Psychology, 77, 410.CrossRefGoogle ScholarPubMed
Scottish Government (2008). Mental Health in Scotland. A Guide to Delivering Evidence Based Psychological Therapies in Scotland ‘The Matrix’. Edinburgh, UK: Scottish Government.Google Scholar
Sudak, D. M., Codd III, R. T., Ludgate, J. W., Sokol, L., Fox, M. G., Reiser, R. P., & Milne, D. L. (2015). Teaching and Supervising Cognitive Behavioral Therapy. Hoboken, USA: John Wiley & Sons.CrossRefGoogle Scholar
Watkins, C. E. (2012). Contemporary visions of psychotherapy supervision: sharing perspective, identifying need, and charting possibility. Journal of Contemporary Psychotherapy, 42, 125127.CrossRefGoogle Scholar
Westbrook, D., Sedgwick-Taylor, A., Bennett-Levy, J., Butler, G., & McManus, F. (2008). A pilot evaluation of a brief CBT training course: impact on trainees’ satisfaction, clinical skills and patient outcomes. Behavioural and Cognitive Psychotherapy, 36, 569579.CrossRefGoogle Scholar
Wilson, H., Davies, J. S., & Weatherhead, S. (2016). Trainee therapists’ experiences of supervision during training: a meta-synthesis. Clinical Psychology & Psychotherapy, 23, 340351.CrossRefGoogle ScholarPubMed
Wheeler, S., & Richards, K. (2007). The impact of clinical supervision on counsellors and therapists, their practice and their clients. A systematic review of the literature. Counselling and Psychotherapy Research: Linking Research with Practice, 7, 5465.CrossRefGoogle Scholar
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