Principles of supervision in cognitive behavioural therapy

Abstract

Background. Psychotherapy requires clinical supervision. This is systematic guidance of a therapist by a supervisor. Inevitably, there is a question of training new high-quality therapists. This is related to supervision of their basic training. Later, it is important to provide an opportunity for lifelong supervision throughout the entire psychotherapeutic practice. Method. PUBMED data base was searched for articles using the key words "supervision in CBT", "therapeutic relations", "transference", "countertransference", "schema therapy", "dialectical behavioral therapy". The search was repeated by changing the key word. No language or time constraints were applied. The lists of references of articles detected by this computer data base search were examined manually to find additional articles. We also used the original texts of A. T. Beck, J. Beck, M. Linehan, R. Leahy, J. Young and others. Basically this is a review with conclusions about supervision in cognitive behavioral therapy. Results. The task of supervision is obvious -to increase the value of the therapeutic process in the client's best interest. At the same time, supervision is an educational process in the truest sense of the word, including an opportunity to select one's own supervisor. This is a very important procedural aspect since the therapist identifies with his/her supervisor, either consciously or unconsciously. Establishing the supervisor-supervisee relationship is based on principles similar to those in the therapeutic relationship. There is an important parallel reflecting the therapist-client relationship. This is because any changes in the supervisory process are analogically transferred onto the therapist-client relationship. Additionally, supervision is oriented towards increasing the therapist's competencies. The CBT therapist's basic skills involve good theoretical knowledge, professional behaviour towards clients, ability to use specific therapeutic strategies for maintaining the therapeutic relationship, sensitivity to parallel processes and accomplishment of changes, and adherence to ethical norms. Given the fact that during supervision, the supervisee may be in any stage of his/ her training, supervision must take into consideration where the therapist is in his/her training and development and what he/she has or has not learnt. Conclusions. Both the literature and our experience underscore the importance of careful supervision of cognitive behavioral therapy. The supervisory relationship is similar to a therapeutic relationship and the supervisee also needs security, acceptance and appreciation for his/her professional growth. However, there is more freedom in the relationship. Supervision may only lead to the supervisee's professional growth if it supports his/her individuality and helps him/her to discover things. Therefore, numerous approaches are used in supervision which are associated with the abilities to self-reflect and to realize transference and countertransference mechanisms.

Self-reflection in cognitive behavioural therapy and supervision

“…In the course of supervision, however, supervisees usually get used to the process and ignore the camera after several recordings are made. If supervision is safe, encouraging, and respectful, recording causes no problems after a short period of time 13 .…”

“…Realizing one's own inner experiences is an essential skill, from which other skills, knowledge, and attitudes necessary for therapy may stem. These include the recognition of one's role as a therapist, acknowledgement of transference and countertransference, emotional self-control, and continuous development of therapeutic competencies 12,13 . In his Declarative-Procedural-Reflective (DPR) model, Bennett-Levy 14 provided a useful model for conceptualizing therapist skill development.…”

“…One option is to record automatic thoughts regularly after sessions, when therapists have enough time to consider what was happening and what they actually want, as well as why they react emotionally and behave in a particular manner. Another possibility is to use the downward arrow technique to analyse the therapist's own schemata for a better understanding of the attitudes that give rise to particular thoughts, emotions, and behaviour 13 . It is also possible to make notes about one's thoughts during therapy sessions or when reviewing recordings of one's sessions with the patient 40 .…”

“…Self-reflection may be practised by the therapist using traditional cognitive behavioural therapy techniques or may be learned in the course of supervision 39 . When practising self-reflection, a vicious circle may be used to map one's own reactions to the patient 13 . One option is to record automatic thoughts regularly after sessions, when therapists have enough time to consider what was happening and what they actually want, as well as why they react emotionally and behave in a particular manner.…”

“…They know how to handle their feelings so that these correspond with the situation and their response is in the client's best interest. Self-reflecting therapists continuously recognize their own cognitive and emotional functioning, and their emotional expressions are cultivated 13 . Knowing one's own reactions becomes a basis for independence, awareness of limitations, and mood control.…”