Cognitive Therapy Supervision Research Articles

A qualitative study exploring the perceived impact of supervision training on cognitive therapy supervisor practice

AbstractAlthough cognitive therapy (CT) has a large empirical base, research is lacking for CT supervision and supervision training, which presents an obstacle for evidence-based practice. A pilot CT supervision training programme, based on Milne's evidence-based supervision and Roth & Pilling's supervision competences was developed by the Northern Ireland Centre for Trauma and Transformation (NICTT), an organization specializing in CT therapy provision and training. This pilot study qualitatively explores CT supervisors’ perceptions of the impact the training had on their practice. Semi-structured interviews were conducted with seven participants, transcribed verbatim and analysed using Burnard's thematic content analysis. Findings illustrated that experienced CT supervisors perceived benefit from training and that the majority of supervisors had implemented contracts, used specific supervision models and paid more attention to supervisee learning as a result of the training. Obstacles to evaluating supervision included the lack of reliable user-friendly evaluation tools and supervisor consultancy structures. Recommendations are also made for future research to establish the long-term effects of supervision training and its effect on patient outcomes. Implications for future training based on adult learning principles are discussed.

Enhancing Self-Efficacy to Achieve Competence.

A primary goal of cognitive therapy supervision is to help the supervisee achieve greater competence in cognitive therapy. However, helping supervisees achieve competence rests in part on their judgments that they can use the skills they learned to help their clients feel and get better. Bandura referred to these judgments as self-efficacy, which he defined as an individual's perception that he is capable of accomplishing a certain level of performance (Bandura, 1977). Although it is understandable that most supervisees enter supervision with low self-efficacy, it can become an impediment to achieving competence if it persists. In this article, I define self-efficacy and describe four sources of information that influence self-efficacy: performance accomplishments, vicarious experiences, persuasion, and physiological states. I then describe how supervisors can use these sources to enhance the self-efficacy of supervisees to assist them in achieving actual competence.

Dissemination of Cognitive Therapy for Panic Disorder in Primary Care.

This study investigated whether brief training in cognitive therapy for panic disorder (Clark et al., 1994) can improve the outcomes that primary care therapists obtain with their patients. Seven primary care therapists treated 36 patients meeting DSM-IV (APA, 1994) criteria for panic disorder with or without agoraphobia in general practice surgeries. Outcomes for the cohort of patients whom the therapists treated with their usual methods (treatment-as-usual) before the training (N = 12) were compared with those obtained with similar patients treated by the same therapists after brief training and ongoing supervision in cognitive therapy (CT) for panic disorder (N = 24). Treatment-as-usual led to significant improvements in panic severity, general anxiety, and depression. However, only a small proportion (17% of the intent-to-treat sample) became panic free and there was no improvement in agoraphobic avoidance. Patients treated with CT achieved significantly better outcomes on all measures of panic attacks, including panic-free rate (54%, intent-to-treat), and showed significantly greater improvements in agoraphobic avoidance and patient-rated general anxiety. In conclusion, cognitive therapy for panic disorder can be successfully disseminated in primary care with a brief therapist training and supervision programme that leads to significant improvements in patient outcomes.

Some lessons from group supervision of cognitive therapy for depression

While much has been written on cognitive therapy of depression, we have found that our trainees have the same questions and difficulties year after year. This article reflects the questions and topics that have been asked most frequently during several years of group supervision led by the third author. We cover topics such as the specifics of the agenda, special uses of language, the pacing of therapy, and therapeutic alliance. We aim to address issues, such as guilt, self-blame, and vegetative symptoms, that arise with depressed patients. In addition, attributions of symptom change for patients concurrently taking antidepressant medications, as well as the special problems related to chronic depression, are covered in detail.

Cognitive therapy supervision as a framework for clinical supervision in nursing: using structure to guide discovery.

Cognitive therapy supervision as a framework for clinical supervision in nursing: using structure to guide discovery Cognitive therapy has an undisputed evidence base upon which its clinical application flourishes. This approach is now a well-recognized and widely adopted method used in the treatment of a diversity of psychological problems. More recently, prominent innovators of this psychotherapy have devised a framework to guide the clinical supervision of cognitive therapists. In keeping with its therapeutic application, the cognitive therapy framework for supervision is focused, structured, educational and collaborative. It serves to enhance the therapeutic proficiency of the cognitive therapist. In contrast, the supervision models reported in the recent nursing literature are less precise in their mission and when evaluated their contribution to nursing is shown to be dubious. Following an overview of the supervision models commonly cited in the nursing literature, a more focused comment on the evaluative research concerning Proctor's three-function interactive model will be offered. It is suggested that the unconvincing research findings may be related to the conceptual muddle surrounding clinical supervision, and the expectation for clinical supervision to deliver more than an opportunity for the progression of our therapeutic integrity. From this, a cognitive therapy supervision framework is described and suggested by the authors as a structure from which supervisors can guide discovery.

New Developments, Advances, and Possibilities in Cognitive Therapy Supervision

ABSTRACT Supervision in cognitive therapy is structured, focused, and supportive. It facilitates the acquisition and maintenance of therapeutic skills, while simultaneously attending to the personal development of the therapist. Some important refinements to cognitive therapy (regarding the therapeutic alliance and the case conceptualization) have occurred in the last decade. Therapists who do not regularly receive supervision are likely to miss these refinements and drift from the basics of cognitive therapy. This paper reviews developments in cognitive therapy supervision that aim to reduce therapist movement away from the theory and teach therapists about ongoing refinements to cognitive therapy.

Perspectives on supervision in cognitive therapy

Supervision is often a neglected clinical area. Frequently, supervisors view supervision as an epiphenomenon of clinical work rather than a central feature. This article emphasizes the importance of supervision in cognitive therapy. Teaching novice professionals to skillfully apply cognitive conceptualizations and interventions is a challenging and difficult task. It is argued that fostering a learning alliance in supervision forms the basis for acquisition of pivotal cognitive therapy competencies. Various impediments to productive learning alliances are discussed and ways to obviate these obstacles are suggested. Further, issues related to technical interventions, relationship processes, and case conceptualizations are discussed. Finally, ways to augment trainees' skills in these fundamental areas are delineated.

Cognitive Therapy Training in U.S. Psychiatry Residency Programs

Cognitive therapy (CT) is a relatively new mode of psychotherapy that is effective in the treatment of depression and other psychiatric disorders. The training directors of all U.S. general psychiatry residency programs were surveyed on the amount of time offered in teaching and supervision of CT and in other treatment modalities. Of the 127 responders, 91 % offer some classroom instruction in CT, 54% offer trainees supervised clinical experience, and 23% require such experience. The ranges of instructional time offered and number of patients treated per resident are broad. Thirty-seven percent of training directors consider graduating residents as qualified to practice CT, and 11% consider graduating residents as qualified to supervise others in CT. The authors conclude that little standardization exists in CT training, and they propose a minimum requirement.