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From CBT Therapist to CBT Supervisor

 Judith S. Beck and Daniella Cavenagh

How do you become a skilled CBT supervisor? Delivering effective CBT supervision requires a highly specialized, advanced set of competencies for which clinical acumen is essential but not sufficient. A growing body of literature indicates the importance of:

  • developing the relationship with supervisees, including eliciting and responding effectively to their feedback
  • setting goals with supervisees
  • accurately assessing supervisees’ strengths and weaknesses
  • developing effective individualized plans for supervision to implement within supervision sessions and across sessions
  • structuring supervision sessions (in a similar way to therapy sessions)
  • providing experiential exercises in and between supervision sessions (including having supervisees practice CBT conceptualization and treatment techniques on themselves)
  • regularly reviewing and providing feedback on therapy recordings and on the progress of the supervisee
  • teaching supervisees how to engage in effective self-reflection
  • using self-reflection yourself
  • engaging, on an ongoing basis, in activities to improve your own clinical and supervisory competence

When we train CBT supervisors, we first train them to be effective CBT therapists. Most of the competencies listed above have parallels in CBT treatment. Once therapists have developed a sufficient level of competence as a therapist, we provide training and supervision in CBT supervision, which includes reading the literature on CBT supervision, attending workshops on training and supervision, and receiving supervision on doing supervision (based on tape reviews of both client sessions and one’s own supervision sessions).

Judith S. Beck, PhD

Judith S. Beck, PhD

Self-reflection is also a crucial part of effective supervision. Supervisors need to objectively examine their knowledge and skill set and attitudes (about supervision, trainees, clients, and CBT in general). We first teach clinicians how to rate therapy sessions they conduct with their own clients (using the Cognitive Therapy Rating Scale), then how to rate the therapy sessions of their supervisees.

We also help them assess how they conducted the supervision session. For example, did they appropriately attend to the supervisee’s developmental stage? (In our experience, supervisees with relatively little CBT experience may benefit from a somewhat more directive approach than an experienced CBT supervisees for whom greater collaboration is effective). Did they use experiential learning strategies such as role plays? Did they competently handle any ethical issues? Were they attuned to cultural and diversity issues between the trainee and themselves, the trainee and the client, and indirectly, the client and themselves? Did they actively seek feedback and respond appropriately to it?

Finally, we teach supervisors (and supervisors-to-be) to reflect on the effectiveness of the supervision session as a whole. What did they do well? What might they need to improve upon? What can they do to increase their competency?

Providing CBT supervision is an incredibly rewarding experience when you see your supervisees becoming more competent and confident and their clients making good progress.  But a strong CBT clinician will not necessarily be a strong CBT supervisor. We encourage researchers to continue conducting studies to establish evidence-based CBT training and supervision competencies and practices — and we encourage clinicians who wish to become supervisors to seek out effective training.

Teaching and Supervising CBT: A 3-Day Workshop

When:    June 11-12, 2016
Where: Beck Institute, Suburban Philadelphia
Time:   8:15am – 4pm
Faculty: Donna Sudak, MD
Enrollment:  Limited to 42 participants
CE/CMEs:  12

 

 

 

Topics covered include:

  • Structuring and conducting CBT supervision
  • Measuring and evaluating therapist progress and competence
  • Adapting CBT supervision to the trainee’s level of development
  • Special issues in group supervision
  • Working effectively with a problematic trainee
  • Using measures to improve patient outcomes with informative feedback
  • Creating a comprehensive CBT curriculum based on core competencies necessary for practice
  • Teaching Socratic questioning and other specific competencies
  • Distance learning and use of technology
  • Advocating for CBT in training programs and competing for resources

Learn More

October 31 – November, 2011, Cognitive Behavior Therapy Workshop Level I: Depression and Anxiety

November 2011: Psychologists, psychiatrists, physicians, social workers, professors, counselors, nurses and other professionals from mental health, medical, and related fields traveled from 11 states and 5 countries (including Brazil, Singapore, Canada, India, and the Dominican Republic) to attend this month’s Cognitive Behavior Therapy Workshop Level I on Depression and Anxiety at Beck Institute.

Participants had the opportunity to gain professional training from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., and Amy Cunningham, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, observed and engaged in demonstration role-plays among other activities.

Cognitive Therapy Demonstration

Participants had the benefit of watching Dr. Aaron Beck conduct a live patient session, which was viewed via closed-circuit television. Following the patient interview Dr. Beck answered questions from participants in a case discussion (pictured above left), during which he explained what the next session should include. Dr. Beck explained agenda setting, beginning with a review of homework and went on to explain that he asks patients, “What problems do you want my help in solving today?” to guide them into naming the problems (as opposed to giving a full description at that moment), then prioritize the problems and let him know roughly about how much of the session they’d like to devote to each one. Participants noted some key techniques that Dr. Beck used which they found to be quite useful:

  • Normalizing patient’s emotions and beliefs
  • Providing patient with language with which they can describe and validate their thoughts
  • Instilling hope and reassuring successful treatment
  • Trying a variety of methods including imagery
  • Collaboration with the patient in terms of treatment model to prevent the patient from seeing the therapist as an authority figure
  • Finding some light anecdotes, humor can be a nice touch in sessions

Following the questions regarding the patient session, Dr. Beck answered participants’ questions on other subjects (video will be posted on our YouTube Channel).

Cognitive Behavior Therapy for Depression

Dr. Judith Beck (pictured left) spoke about cognitive behavior therapy with depressed patients and their automatic thoughts.  She emphasized psychoeducation, treatment planning, goal setting, and activity scheduling with patients.

Cognitive Behavior Therapy for Anxiety

Dr. Amy Cunningham (pictured below) spoke about the need for anxiety and the need to learn how to cope with it.  She emphasized the use of teaching problem-solving skills and building self-efficacy.

We are so pleased that so many professionals from all over the world were able to come to the Beck Institute for such an exciting workshop!

More event highlights:

What research is Dr. Beck presently involved in? (Students Ask Dr. Beck – Part SEVEN)

This is the seventh question from the Q&A portion of Beck Institute’s 3-Day CBT Workshop on Depression and Anxiety for students and post-doctoral fellows, held on August 15 – 17, 2011. In this video Dr. Aaron Beck discusses research he is presently involved in and/or leading at the University of Pennsylvania. Dr. Beck explains the work being done by three different teams within his unit; including clinical trials with suicidal patients, groundbreaking research on CBT treatment for schizophrenia, and a community mental health center project involving dissemination of cognitive behavior therapy.

CBT Interventions: The SPIRIT Training Course

Recently, due to important policy changes, there has been a significant increase in the demand for psychologists specializing in CBT in the United Kingdom.   As a result, specialists have been stressing the importance of various teaching approaches in CBT, such as workbooks or courses, to enable more professionals to practice CBT. In a recent study, the Structured Psychosocial InteRventions in Teams (SPIRIT) course, which is a university accredited program consisting of 38.5 hours of workshops and 5 hours of clinical supervision, was utilized to train professionals in CBT.

17 Mental Health Teams, consisting of 267 professionals from mental health fields in Glasgow were recruited to participate in this study.  These clinicians completed the SPIRIT course, in which they learned how to build relationships with their patients and modify the distorted thinking of their patients through various problem solving activities. Participants were given a subjective skill test, subjective knowledge test, and objective skill test three separate times: before the intervention, immediately following the intervention, and 3 months after the intervention.

The results demonstrated that the SPIRIT course was effective in teaching professionals CBT. The baseline scores on the subjective skill test, subjective knowledge test, and objective skill test all significantly increased after the SPIRIT training program.  In addition, the scores on each test after the intervention and the scores on each test 3 months after the intervention remained constant. This implies that the participants were still able to utilize the knowledge they had learned from the intervention 3 months after their training. Future research is still necessary to investigate whether patients are benefiting in therapy sessions from techniques learned in the SPIRIT course.

Williams, C., Martinez, R., Dafters, R., Ronald, L., & Garland, A. (2011). Training the wider workforce in cognitive behavioural self-help: The SPIRIT (structured psychosocial inteRventions in teams) training course. Behavioural and Cognitive Psychotherapy.

May 23 – 25, 2011, Cognitive Behavior Therapy Workshop Level I: Depression and Anxiety

May 2011: Psychologists, psychiatrists, physicians, social workers, professors, counselors, nurses and other professionals from mental health, medical, and related fields traveled from 16 states and 8 countries (including Brazil, Cayman  Islands, Denmark, Peru, Romania, Sweden, Switzerland, and Turkey) to attend this month’s Cognitive Behavior Therapy Workshop Level I on Depression and Anxiety at Beck Institute.

Participants had the opportunity to gain professional training from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, observed and engaged in demonstration role-plays among other activities.

Cognitive Therapy Demonstration

Participants had the benefit of watching Dr. Aaron Beck conduct a live patient session, which was viewed via closed-circuit television. Following the patient interview Dr. Beck answered questions from participants in a case discussion (pictured above left), during which he explained what the next session should include. Dr. Beck explained agenda setting, beginning with a review of homework and went on to explain that he asks patients, “What problems do you want my help in solving today?” to guide them into naming the problems (as opposed to giving a full description at that moment), then prioritize the problems and let him know roughly about how much of the session they’d like to devote to each one. Participants noted some key techniques that Dr. Beck used which they found to be quite useful:

  • Normalizing patient’s emotions and beliefs
  • Providing patient with language with which they can describe and validate their thoughts
  • Instilling hope and reassuring successful treatment
  • Trying a variety of methods including imagery
  • Collaboration with the patient in terms of treatment model to prevent the patient from seeing the therapist as an authority figure
  • Finding some light anecdotes, humor can be a nice touch in sessions

Following the questions regarding the patient session, Dr. Beck answered participants’ questions on other subjects, such as Positive Psychology and CBT, and CBT with depressed patients in chronic pain. Dr. Judith Beck (pictured right) spoke about cognitive behavior therapy with depressed patients and their automatic thoughts.  She emphasized psychoeducation, treatment planning, goal setting, and activity scheduling with patients.  Dr. Leslie Sokol (pictured below) spoke about the need for anxiety and the need to learn how to control it, rather than mask it with medication.  She emphasized the use of Socratic questioning and interoseptive exposure experiments in treatment.  Dr. Norman Cotterell (pictured below) spoke about suicidality.

We are so pleased that so many professionals from all over the world were able to come to the Beck Institute for such an exciting workshop!

More event highlights:

April 4 – 6, 2011, Cognitive Behavior Therapy Workshop Level I

April 2011: Psychologists, psychiatrists, physicians, social workers, professors, counselors, and other professionals from mental health, medical, and related fields traveled from 18 states and 8 countries, including Australia, Brazil, Canada, France, Ireland, New Zealand, Peru, and United Arab Emirates. Pictured above-left, Dr. Aaron T. Beck conducts a roleplay with Ricardo Luiz Malina Losso, a psychiatrist from Brazil, to demonstrate useful techniques to use for challenging problems when working with patients. Dr. Beck also conducted a live patient session that was viewed (via closed-circuit television) by participants in the April 4 – 6, 2011, Cognitive Behavior Therapy Workshop Level I at Beck Institute.

Cognitive Behavioral Therapy Treatment Plan

Following the patient interview Dr. Beck answered questions from participants in a case discussion (pictured below), during which he explained what the next session should include (see video clip here). Dr. Beck explained agenda setting, beginning with a review of homework and went on to explain that he asks patients, “What problems do you want my help in solving today?” to guide them into naming the problems (as opposed to giving a full description at that moment), then prioritize the problems and let him know roughly about how much of the session they’d like to devote to each one.

(Right) Dr. Judith Beck conducts a roleplay with David Black, a psychologist from Missouri.  Dr. Beck discussed how to differentiate between practical and psychological problems, and how to use a cognitive framework to understand why psychological problems arise. Participants received professional training in Cognitive Behavior Therapy from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, observed

and engaged in demonstration roleplays among other activities. More event highlights:

Level I Cognitive Behavior Therapy Workshop for Professionals at Beck Institute: February 7 – 9, 2011

February 2011: Psychologists, psychiatrists, physicians, social workers, professors, counselors, nurse practitioners, and other professionals from mental health, medical, and related fields traveled from 15 states and 4 countries, including Brazil, Canada, Japan, and Turkey. Pictured above-left, Aaron T. Beck, M.D. answers questions after conducting a live patient session that was viewed (via closed-circuit television) by participants in the Cognitive Behavior Therapy workshop at Beck Institute. (Below/right) Judith S. Beck, Ph.D. and Julie Hergenrather, Ph.D., announce upcoming Level II Cognitive Behavior Therapy Workshops at Beck Institute and answer questions on our Beck Supervision Program – a distance learning program that provides intensive, one-on-one supervision from your home state or country.  Level II CBT Workshops are designed for experienced professionals who have already received at least some basic training in CBT and seek to enhance their ability to deliver CBT efficiently and effectively to clients who pose a challenge in treatment. Participants received professional training in Cognitive Behavior Therapy from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, and observed demonstration roleplays among other activities. More event highlights:

Cognitive Behavior Therapist – How to Find One

Two days ago, we received a great comment that said, “This is *not* what I experienced when I saw a cognitive-behavioral therapist… I wish cognitive-behavioral therapy as described on this site was available. Too many CBT therapists are not well-trained and refuse to think!” (you can read Sam’s full comments about the kind of ‘CBT’ that he and his friend received on this post – his is the fourth comment down).

We thought it was important to highlight his experience because we think many consumers may not know about the vast differences in training and approach among people who call themselves Cognitive Therapists or Cognitive Behavior Therapists. Read more

Cognitive Therapy for Schizophrenia

Here’s what Kevin Benbow emailed to us about his experience supervising a clinician with her first schizophrenia patient:

As a clinical supervisor for a small, rural mental health clinic in Arizona I get the opportunity to supervise and train behavioral health technicians.  Such individuals have a wide range of experience and education levels and are allowed to practice under Arizona State law if they receive supervision from a licensed Behavioral Health Professional.

One of these clinicians has been particularly receptive to the cognitive model and has been helping many of her clients identify their automatic thoughts and subsequently test them.  Recently she assessed a client who was subsequently diagnosed with schizophrenia.  She had only weeks before experienced her first psychotic episode.  Read more

Roleplaying with Aaron Beck

At our Extramural Workshop last week, we had about 40 trainees from around the world participate in a two-day Cognitive Therapy training focused on Anxiety and Panic Disorders (the trainees are mental health professionals enrolled in the Beck Institute’s Cognitive Therapy supervision program – they send tapes/CDs or transcripts of therapy sessions to their Beck Institute supervisor for review and feedback, and also participate in our on-site training workshops).

 

 

 

 

 

 

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