Training Methods in Cognitive Behavioral Therapy: Tradition and Invention

Article excerpt

Cognitive behavioral supervisors influence new generations of clients and clinicians. Accordingly, the task is meaningful, rewarding, challenging, and critically important. This article describes traditional and unconventional approaches to supervising clinicians in cognitive behavioral therapy (CBT). Traditional methods such as the use of the Cognitive Therapy Rating Scale, videotape/audiotape review, live supervision, and cotherapy are reviewed. Further, inventive procedures for teaching supervisees cognitive flexibility, empathy, tolerance for ambiguity, and remaining steadfast when faced with negative emotional arousal are explained. Popular media, improvisation and acting exercises, and working with professional actors as teaching methods are explained.

Keywords: training; supervision; cognitive behavioral therapy; clinical education

In an early work on cognitive behavioral therapy (CBT) supervision, Perris (1993) defined supervision as "an interpersonal process in which two or more persons almost always with quite a different level of professional competence, participate actively" (p. 30). Supervision is more than an experienced clinician imparting wisdom to a relative novice. Rather, it is a comprehensive process that requires each person's full interpersonal engagement. Supervisory activity assumes many forms; supervisors work to improve supervisees' declarative knowledge, procedural understanding, technical skills, and self-reflection. In addition, supervisors review trainees' progress notes, assessment reports, case conceptualization write-ups, and other paperwork. Ledley, Marx, and Heimberg (2010) noted that supervisors not only teach trainees technical and conceptual skills but also coach them to become clinicians. In short, supervision is the way trainees' raw skills become refined (Newman, 2010). This article presents various conventional as well as uncommon methods for teaching beginning clinicians how to do cognitive therapy.

Bennett-Levy (2006) conceptualized clinical training along three interrelated dimensions: declarative, procedural, and self-reflective knowledge. According to Bennett-Levy, declarative knowledge refers to acquisition of factual knowledge. Procedural knowledge depends on factual knowledge but transcends this understanding by putting information into practice. Procedural knowledge incorporates actionable rules, strategies, and skills. Self-reflection is a "meta-cognitive skill that accompanies the observation, interpretation, and evaluation of one's own thoughts, emotions, actions, and outcomes" (Bennett-Levy, 2006, p. 60). Bennett-Levy stated that self-reflective knowledge builds clinical wisdom.

Binder (1999) noted that declarative knowledge that remains unapplied is essentially inert data. Boswell and Castonguay (2007) remarked that typically, trainees find applying cognitive interventions quite straight forward in a classroom setting. However, once they are confronted with a real client in a therapy office, they discover the genuine complexity associated with clinical care. Accordingly, Rosenbaum and Ronen (1998) argued that a complex skill such as psychotherapy must be taught experientially. They employed the analogy of learning to swim. Although a person could study the mechanics of swimming and the art of difficult strokes, their knowledge must be put into action in water. An abstract, intellectualized grasp of the process does not suffice. Similarly, cognitive behavioral psychotherapy must be practiced in order for supervisees to learn.

Ladany (2007) complained that criteria for admittance to graduate school are not linked to factors that predict competence in psychotherapy. Friedberg, Gorman, and Beidel (2009) argued that training in important but nonspecific factors such as genuineness, empathy, and warmth is misguided. Indeed, training a student in genuineness seems oxymoronic. Rather, training should focus on teachable knowledge, skills, and attitudes. …