Teaching and Supervising Cognitive Behavioral Therapy

Donna M. Sudak, R. Trent Codd, III, John W. Ludgate, Leslie Sokol, Marci G. Fox, Robert P. Reiser, Derek L. Milne

• Publisher: Wiley
• Year: 2015
• Print ISBN: 9781118916087
• eBook ISBN: 9781119179788
• Edition: 1
• Topic: Psychology
• Subtopic: Cognitive Behavioral Therapy (CBT)
• Index: Psychology

A total CBT training solution, with practical strategies for improving educational outcomes.

Teaching and Supervising Cognitive Behavioral Therapy is the first comprehensive package to provide empirically-validated CBT training and supervisory techniques. Applicable to a variety of behavioral health care disciplines, this multi-modal guide provides educators with the information and tools that can help improve educational outcomes. An examination of CBT developments over the past twenty years leads into a discussion of practical applications for improving CBT education, while addressing the technological advances that facilitate dissemination and the specific challenges posed to confidentiality and patient care. The digital component contains additional audio and video content, plus downloadable worksheets that reinforce and expand upon the strategies presented.

Coverage includes advice geared specifically toward the most commonly-encountered problems, with video of training sessions that address issues like frustration with patients, disbelief in psychotherapy, dislike of the method, and lack of skills. Readers will gain insight into effective goal setting, and implement a structured approach to supervision.

• Examine existing literature and research on training, supervision, and evaluation
• Integrate theory with practical strategies to improve learning outcomes
• Customize training approaches to specifically suit different professional groups
• Fit the methods to the environment, including workshops, webinars, and podcasts

Mental health professionals who favor an empirically-based approach to therapy will appreciate the effectiveness of an empirically-based approach to pedagogy. Backed by over two decades of CBT research and the insight of leading CBT experts, Teaching and Supervising Cognitive Behavioral Therapy provides trainers with the tools and information they need to improve therapist educational outcomes.

Chapter 1
CBT Training and Supervision
An Overview

John Ludgate

To help readers understand the current recommendations for cognitive behavioral therapy (CBT) training and supervision, this chapter begins with a review of the historical roots and subsequent development of CBT training and supervision worldwide. In addition, the chapter describes the advantages and disadvantages of existing formats for training and briefly reviews the literature on the effectiveness and benefits of CBT training. Last, future directions regarding research and practice in the field of CBT training and supervision are outlined.

Historical Roots of CT Training and Supervision

The evolution of a cognitive model and the development of Beck's cognitive therapy has been described in several texts (Weishaar, 1993; Wills, 2009). The development of training in cognitive therapy (CT) is closely linked with the history of cognitive therapy itself. In the 1960s Aaron Beck, a psychiatrist in Philadelphia, now widely regarded as the father of cognitive behavioral therapy, became interested in determining the factors involved in the development and maintenance of depression. He formulated his initial cognitive model of depression in papers in 1963 and 1964 (Beck, 1963, 1964). The theory was elaborated in his book Depression: Clinical, Experimental, and Theoretical Aspects (1967).

Thereafter, along with the subsequent publication of Beck's Cognitive Therapy and the Emotional Disorders (1976), a number of case studies were conducted in single-case design in which therapy derived from the model was applied to depressed outpatients (Rush, Khatami, & Beck, 1975; Shaw, 1977).

John Rush, a psychiatry resident at University of Pennsylvania from 1972 to 1975, and other residents became interested in both the clinical and research applications of cognitive therapy for depression. Beck provided supervision to the residents at the Mood Clinic at Philadelphia General Hospital and, as well, taught a psychotherapy course (Weishaar, 1993). After the successful clinical outcome achieved in the single-case studies previously mentioned, a study was designed to test cognitive therapy in a randomized controlled trial compared with antidepressant medication, at that time considered the gold standard for treating depression. Beck and Rush were joined by Gary Emery, Marika Kovacs, and Steve Hollon in planning and conducting this study, which, according to Weishaar (1993), resulted in notes on each patient's progress and details on the effectiveness of techniques being used compiled initially into a twelve-page manual on conducting cognitive therapy. This manual eventually grew to two-hundred pages and evolved into the book Cognitive Therapy for Depression (Beck, Shaw, Rush, & Emery, 1979).

The earlier brief manual was used to guide research therapists; recruited subjects were randomly assigned to cognitive therapy or pharmacotherapy. The therapists were psychiatry residents who received weekly supervision from Beck based on audio recordings of actual therapy sessions, a highly influential, and unusual for the time, model of supervision that has continued to date. Beck's emphasis on supervision and feedback on actual therapy practice to ensure skill development, and experiential, active learning as part of initial training, are key contributions to psychotherapy education.

The subsequent paper (Rush, Beck, Kovacs, & Hollon, 1977) was the first to show the efficacy of cognitive therapy, and a follow-up study of this patient cohort (Kovacs, Rush, Beck, & Hollon, 1981) showed that cognitive therapy was as effective as medication in the short term and fared better at one-year follow-up, findings that have been confirmed in numerous subsequent studies. As well as the training and supervision of therapists for this outcome study, another seminal event was the development of the Cognitive Therapy Rating Scale (CTS; Young & Beck, 1980) to ensure fidelity, which has become a key measure of competence for training and supervision, and, in addition, an Index of Cognitive Therapy Fidelity in outcome studies. Chapter 4 illustrates the use of the rating scale and other methods of evaluating competency in trainees.

In 1979 the National Institute of Mental Health (NIMH) elected to conduct a multicenter outcome study comparing cognitive therapy, interpersonal psychotherapy (Klerman, Weisman, Rounsaville, & Chevron, 1984), and medication for unipolar depression. Cognitive therapists were trained by the Philadelphia group at a number of sites to participate in the study. By the study design, only three months of training was provided to these novice therapists because the NIMH stipulated that it should represent the therapy provided by the “average practitioner,” who presumably would have received only short-term training.

According to Weishaar (1993), therapists' ratings indicated that the majority failed to reach the established competency criteria for cognitive therapists. Beck, apparently, strongly suggested that it would take one year of training and supervision to produce adequately trained cognitive therapists. The somewhat poorer outcome for cognitive therapy with severe depression found in this study (Elkin et al., 1989) relative to interpersonal psychotherapy and medication may have been due to inadequate training. Even in these early days in the evolution of cognitive therapy and CT training, an essential for effective training was thought to be an adequate dosage of training and the provision of supervision over a significant time period, which has been validated by subsequent research. This idea is discussed in greater detail in chapter 10.

Another important contribution to training and dissemination in cognitive therapy was the development of a one-year postdoctoral fellowship in cognitive therapy at the University of Pennsylvania in 1979. The objective was to provide intensive training and supervision in CT. Trainees also provided therapy to a range of clients at the Center for Cognitive Therapy, an outpatient clinic under the University of Pennsylvania's Department of Psychiatry. As the program grew, approximately six to seven full-time fellows were accepted into this program per year, including some key figures in the development of CBT.

Although this program is no longer in existence in its original form, the model of training has endured, and fellowships in CBT are currently offered at several centers, including the Beck Institute for Cognitive Behavior Therapy, the Cognitive-Behavioral Institute of Albuquerque, Harbor-UCLA, and the Depression and Anxiety Specialty Clinic in Chicago. An extramural training program started at the Center for Cognitive Therapy in Philadelphia to allow clinicians who were employed to travel to the center for didactic training several times a year and to also receive case supervision, often by telephone, when geographical location made this more feasible than face-to-face supervision, a model that has been continued by the Beck Institute for Cognitive Behavior Therapy.

As CBT training evolved, the Center for Cognitive Therapy and the Beck Institute offered visiting professionals brief or longer trainings customized and designed for their particular needs. Individuals who had spent time training in Philadelphia returned to their home countries or home locations within the United States and started training, therapy, or research programs in the field of CBT.

For example, seve...

Table of contents

• Cover
• Title Page
• Copyright
• Acknowledgments
• Foreword
• About the Authors
• Chapter 1: CBT Training and Supervision: An Overview
• Chapter 2: Core Competencies in Cognitive Behavioral Therapy Training
• Chapter 3: Empirically Supported Educational Methods
• Chapter 4: Measures of Competence in Cognitive Behavioral Therapy
• Chapter 5: Feedback in Cognitive Behavioral Therapy Training
• Chapter 6: Teaching CBT for Specific Disorders
• Chapter 7: Technology in CBT Training and Supervision
• Chapter 8: Graduate Training
• Chapter 9: CBT in Psychiatry Residency Training
• Chapter 10: Continuing Education for Therapists in Practice
• Chapter 11: Training and Supervising Nontraditional Care Providers
• Chapter 12: Evidence-Based Supervisory Practices in CBT
• Chapter 13: Training CBT Supervisors
• Chapter 14: Self-Management in CBT Training and Supervision
• Index
• About the Companion Website
• End User License Agreement