Academic journal article
By Ng, Roger M. K.
Hong Kong Journal of Psychiatry , Vol. 15, No. 4
Behavioral Medicine--Social Aspects
Medical Research--Social Aspects
Mental Disorders--Care and Treatment
Mental Disorders--Social Aspects
Objective: To investigate the effect of cognitive therapy supervision on the enhancement of supervisee competence and improvement in the clinical outcome of patients under cognitive therapy conducted by the supervisee.
Patients and Methods: This pilot study included 1 supervisor, 5 supervisees, and 8 patients. Trainee supervisees provided cognitive therapy to the patients individually during audiotaped sessions. After reviewing the tape-recorded therapy sessions, the supervisor conducted supervisory sessions with the supervisees. Supervisees' competence was measured by the Cognitive Therapy Rating Scale, while patients' overall symptom severity was measured using the Beck Depression Inventory-II, Beck Anxiety Inventory, and Beck Hopelessness Scale.
Results: A significant improvement was observed in supervisee competence with progression of supervision. There was a parallel significant improvement in the clinical outcome of the patients under therapy conducted by supervisees.
Conclusion: This pilot study highlights the importance of supervision in the improvement of supervisee competence and hence clinical outcome.
Key words: Cognitive therapy, Psychotherapy, Teaching, Treatment outcome
Clinical supervision is an intensive relationship focussed on interpersonal interactions in which one person, the supervisor, facilitates the development of therapeutic competence in the supervisee. (1) The purpose of supervision is to facilitate experiential learning (formulating case conceptualisation, technical expertise, and relationship qualities), thereby establishing the fitness of the supervisee to practice (accreditation) while maintaining professional competence standards and promoting professional development. (2) The fundamental purpose is to guide the supervisee in order that he/she may provide safe and effective therapy to patients. (3) Supervision, therefore, is exceptionally important in professional practice. Despite the importance of supervision, there is a dearth of research on the impact of clinical supervision on patient outcome. (4)
Cognitive therapy is an effective psychological treatment for a variety of disorders. Outcome studies have demonstrated its efficacy for the treatment of depression, (5) panic disorder, (6,7) generalised anxiety disorder, (8) social phobia, (9,10) substance abuse, (11) post-traumatic stress disorder, (12) and eating disorders. (13,14) Recent studies have confirmed its efficacy in the treatment of other difficult psychiatric problems, including treatment-resistant psychosis (15) and personality disorders. (16) Cognitive therapy places primary emphasis on cognitive processes, including the identification and modification of core beliefs, conditional assumptions, and automatic thoughts. (17) A basic assumption is that the manner in which individuals process information influences their emotions, behaviour, and physiology in a predictable way. Cognitive formulations have been available for many major psychiatric disorders. Various cognitive and behavioural strategies have been developed specifically for different psychiatric disorders. This highlights the importance of cognitive therapy supervision in ensuring therapist competence. There is increasing data to support the notion that the degree of adherence of therapists to cognitive therapy (18) and cognitive therapist competence have a long-term impact on clinical outcomes in case of neurotic disorders (19) and prevention of self-harm. (20) More critically, Tang and DeRubeis have demonstrated that in a therapy course, the session with the lowest rating with regard to therapist competence may be the most robust predictor of clinical outcome. (21)
This was a single-centre, non-randomised, longitudinal study that investigated the impact of cognitive therapy supervision on clinical outcome. This study was conducted as a service research in a realistic clinical setting in the psychiatric unit of a general hospital in Hong Kong. …