Did you learn CBT through the tradition of “See one, do one, teach one?” Were your instructors and supervisors clinicians who had never learned the principles of adult learning? Did they instead teach or supervise you in the way they themselves had been taught or supervised?
Dissemination and training of quality CBT therapists has become a recent focus for CBT programs throughout the world. There is a renewed focus in the field of CBT and on the skills needed to effectively teach and supervise. In fact, CBT supervision skills have independently been recognized as a competency in recent years.
Perhaps surprisingly, little research exists on CBT training. What constitutes sufficient training? What does “competence” in CBT actually mean? How should therapist “drift” be monitored and assessed? Sudak et al (2015) summarizes the current research in training and supervision.
Training is defined as the effective transfer of knowledge about and practice of the key skills of CBT. It represents both knowing that and knowing how. Most skills are taught both in training and supervision. Therapists or students first learn the rationale for a skill; they watch experts, and model what they have learned in practice with roleplayed “clients” of varying degrees of difficulty (with corrective and confirming feedback). Once trainees have the necessary skills, they can then be supervised with actual clients in a setting of “real world complexity.”
CBT supervision is most effective and efficient when the supervisor uses processes that parallel CBT therapy. The supervisory alliance is critical to effective work in supervision. The relationship needs to be safe enough for the supervisee to tell the truth and to be able to hear and incorporate constructive feedback. Supervisors should do a needs assessment with supervisees and then collaboratively set goals which form the “road-map” for supervision. Good supervision uses a session structure similar to that employed with clients in psychotherapy (Liese and Beck, 1997). By so doing, the model is reinforced and the supervisee can have an experience akin to self-practice.
Several other important parallels exist between effective supervision and therapy. These include using Socratic questions to stimulate learning and reflection, action plans between sessions and eliciting and giving feedback. Tapes of client sessions must be used to assess progress, rated by both the supervisee and supervisor with a validated instrument to determine fidelity and integrity, such as the Cognitive Therapy Rating Scale and client symptom rating scales provide data to determine if care is adequate and safe.
Supervision also requires conceptualization – both of the client and the supervisee. We are more effective supervisors if we develop a tailored educational plan based on the educational needs of the trainee and his or her capacities as therapist. The cultural competence and the cultural background of supervisees and clients should also be considered as a part of the conceptualization.
Supervisees should be encouraged to use thought records regarding their reactions to clients and expectations of themselves as therapists. This practice helps them to learn more effectively and inculcates the self-reflection that encourages expertise. Bennett-Levy (2003) has published extensively regarding this core process in CBT training. Active engagement and thoughtful implementation of several learning methods, as described by Milne and Dunkerley (2010), heightens curiosity and interest in supervisees.
Making our supervision and training more effective is also more engaging and fun for the teacher, so everyone benefits from this effort to improve our work.
Sudak, D.M., Codd, R.T., Ludgate, J., Reiser, R.J., Milne, D., Sokol, L., Fox, M. Teaching and Supervising Cognitive Behavioral Therapy. (2015) Hoboken: John Wiley and Sons.
Bennett-Levy, J. Lee., N., Travers, K., Pohlman, S., & Hammernick, (2003). Cognitive therapy from the inside: Enhancing therapist’s skills through practicing what we preach. Behavioural and Cognitive Psychotherapy, 31, 145–163.
Liese, B.S., & Beck, J. S. (1997). Cognitive therapy supervision. In E. Watkins (Ed.), Handbook of psychotherapy supervision. New York, NY: Wiley
Milne, D.L., & Dunkerley, C. (2010). Towards evidence-based clinical supervision: The development and evaluation of four CBT guidelines. Cognitive Behaviour Therapist, 3, 43–57.
One of our psychologists, Robert Hindman, Ph.D., has been involved in a research study on how to effectively train an organization in CBT. The lead investigator is Cara Lewis, Ph.D., a former Beck Institute Scholar and Professor of Psychology at Indiana University where she has a dissemination and implementation science lab. Dissemination and implementation science studies the best ways to take practices which research shows are effective, train clinicians to use them properly, and keep clinicians using the best practices after the training is over.
Drs. Lewis and Hindman began the project in 2012 with an organization in Michigan, Wolverine Human Services (WHS), which provides treatment to adolescents who need residential treatment services. WHS contacted the Beck Institute to provide their clients with evidenced based CBT. Before the training began, Drs. Hindman and Lewis met with the administrators, clinicians, and staff at all levels of the Wolverine organization to identify any factors or barriers that could get in the way of successful implementation of CBT. They developed a plan to address the potential obstacles, and worked with Wolverine to make the necessary changes.
So far, Drs. Hindman and Lewis have conducted two trainings at Wolverine Human Services and are scheduled for their next visit this month. They also work with Wolverine between visits; Dr. Lewis helps them successfully complete the implementation plan, and Dr. Hindman provides supervision to their clinicians and supervisors in CBT. At their March visit, Drs. Hindman and Lewis will begin training the supervising clinicians on how to supervise their staff in CBT, so that after the 5-year training program is over, Wolverine can continue to provide high quality CBT to its clients.
This is a fantastic training opportunity for pediatricians who want to use cognitive behavior therapy to supplement medication management. [My supervisor] has been enthusiastic and patient and is a wealth of knowledge. It has added a wonderful dimension to my practice and I would recommend this for any practioneer who deals with behavior issues in kids.
The supervision was far more than I could have known to expect. [My supervisor’s] teaching was very helpful; she always had lots of recommendations for literature and her supervision was strengths-based. I learned something new every session and I looked forward to our sessions every week! [She] was collaborative and asked for feedback each session, and our working together evolved to fit my specific needs as time went on. It was truly woth the time, cost, and commitment! I learned so much!
[My supervisor] was helpful in so many ways… [he was] always pinpointing which therapeutic interventions were most helpful for the patient, and which were less effective, always in a very constructive way, and providing me a rationale of his feedback. [He] was not only interested in helping me with my therapeutic skills, but he provided me with book references, articles — any and all information that could empower my knowledge in cognitive therapy… and he showed remarkable attention towards my concerns and questions. His clinical supervision was a very important element in the improvement of my clinical skills. I truly recommend [this program]. Thank you!
[My supervisor was] a fabulous teacher – dynamic and energetic. Covered any type of client or issue we wanted to discuss. Thank you!
I cannot thank you, and Drs. Judy and Aaron Beck, enough for the fantastic experience that this past year has been. It is without doubt one of the highligths of my career to date. I have valued enormously your thoughtful, clear, and clinically rich supervision. The latter focus on [supervision of] supervision was also rewarding for me. It can be easy to work in isolation from other cognitive therapists when working in a busy early intervention in-service, so to have the time to revisit first principles of CBT has been immensely helpful.
Being a psychologist is a second career for me. Previously, I was a business person and recognized the need for continuous improvement in order to stay competitive. The Beck Institute’s Supervision Program has allowed me to pursue continuous improvement in my clinical skills. The training they provide is world-class AND a great value. Week after week, in case after case, my supervisor provided me with actionable feedback on how to deliver more effective Cognitive Therapy. One reason they can do this is because they really listen to the work samples you provide. This hands on approach is an ideal often touted but rarely achieved in practice. My participation in The Beck Institute’s Supervision Program has allowed me to help my patients develop the skills they need to solve problems more effectively and manage their emotional well-being through the use of cognitive-behavioral skills. I recommend this training to every mental health professional.
Thank you so much for all of your assistance over the past year. It has been a remarkable experience for me. I found that the supervision experience was essential in truly learning Cognitive Therapy Techniques and I am proud to say that I am now certified as a Cognitive Therapist! This past year has taught me more than I have learned in the last 10 years! [My supervisor] is a wonderful teacher and an asset to your supervision program.
Beck Institute for Cognitive Behavior Therapy is a leading international source for training, therapy, and resources in CBT.
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