Clinical supervision in CBT training: what do participants view as effective?

Abstract

Literature pertaining to cognitive behavioural therapy (CBT) supervision is limited, particularly about CBT supervision during training. This exploratory study outlines the thoughts of supervisors and supervisees in a training context about which elements make supervision effective. Four supervisees and four experienced CBT supervisors (all from a CBT training programme and independent of one another) were interviewed and asked to consider what makes CBT supervision during training effective. Their responses were evaluated using thematic analysis (TA) and key themes identified. The fit with existing literature was considered via the use of an adapted Delphi poll. Two main themes, containing seven subthemes, were identified from the thematic analysis: ‘supervision as structured learning’ and ‘supervisory relations and process’. The adapted Delphi poll was divided into six categories denoting important characteristics of CBT supervision: (1) the supervisory relationship, (2) ethical factors, (3) generic supervisory skills, (4) mirroring the CBT approach, (5) the supervisor’s knowledge and (6) addressing difficulties. There was a good fit between the TA themes and the Delphi categories. For those engaging in CBT supervision, establishing a structure that mirrors a CBT session, alongside a supportive supervisory alliance, may promote effective CBT supervision during training. Key learning aims (1) To consider what might make CBT supervision during training a better experience for participants, such as alliance factors and structured learning. (2) To discover how supervisors’ and trainees’ perspectives fit with existing research on CBT supervision. (3) To consider some potential supervisory implications related to aspects of CBT supervision that participants find useful.

A qualitative examination of trainee perspectives on cognitive behavioural supervision

“…This finding is consistent with theory and research supporting the use of multiple teaching methods in promoting trainee satisfaction and better learning outcomes (e.g. Kelly and Hassett, 2021; Milne et al ., 2003; Murr et al ., 2020; Newman, 2013; Prasko et al ., 2012).…”

“…Some studies have reported strategies that trainees deem useful (e.g. Kelly and Hassett, 2021; Murr et al ., 2020), but research examining trainee perspectives remains inadequate, and no firm conclusions can be made about what trainees want from supervision (Callahan and Love, 2020; Kelly and Hassett, 2021). Therefore, this study aimed to further explore what trainees believe is most and least helpful following each supervision meeting, and to determine whether trainees’ perceptions of helpful supervision interventions align with what the expert consensus purports to be effective CBT supervision.…”

“…Milne, 2018;Milne and Reiser, 2017;Prasko et al, 2012;Sudak, 2016;Watkins and Milne, 2014), yet the topic remains critically under-studied (Alfonsson et al, 2018;Milne, 2018). Trainee perspectives have been especially neglected, particularly in settings working with pre-licensed trainees (Kelly and Hassett, 2021). Therefore, this paper aims to investigate trainees' perspectives on the most and least helpful aspects of CBS.…”

CBTsupervision behind closed doors: Supervisor and supervisee reflections on their expectations and use of clinical supervision

“…This is the first UK‐based IPA study that sought to capture the lived experiences of CBT supervisors and supervisees. Given the seismic effects that IAPT has had on CBT provision, training and culture since its inception (Kelly & Hassett, 2021; Liness et al, 2019; Liness & Muston, 2011; Turpin & Wheeler, 2011), the aim was to gauge CBT supervisor and supervisee experiences and explore how they made meaning of supervision (Smith et al, 2009). Previous research sampling the routine use of supervision took place pre‐IAPT (e.g., Townend et al, 2002) and had indicated that CBT practitioners rarely use active supervision methods.…”

“…At face value, CBT supervision shares many of the structural features of CBT treatment (Armstrong & Freeston, 2006; Kelly & Hassett, 2021; Prasko et al, 2012). For example, according to expert consensus within the field, it is recommended that supervision has an agreed agenda, specific task focus and review of learning, which mirrors the format of a therapy session (Gordon, 2012; Pretorius, 2006).…”