Academic journal article Journal of Cognitive Psychotherapy

Cognitive Behavioral Therapy Supervision in a University-Based Training Clinic: A Case Study in Bridging the Gap between Rigor and Relevance

Academic journal article Journal of Cognitive Psychotherapy

Cognitive Behavioral Therapy Supervision in a University-Based Training Clinic: A Case Study in Bridging the Gap between Rigor and Relevance

Article excerpt

Principles and procedures for supervising cognitive behavioral therapy (CBT) were broadly defined in 2 early seminal texts almost 15 years ago (Liese & Beck, 1997; Padesky, 1996) and updated more recently (Beck, Sarnat, & Barenstein, 2008; Newman, 2010). However, the actual practice of CBT supervision often shows poor fidelity to this model (Townend, Iannetta, & Freeston, 2002) with notable deficiencies in the use of direct observation, standardized observational rating systems, and experiential methods in supervision (Milne, 2008). The advent of more specific competency statements on CBT supervision has been a significant leap forward (Falender et al., 2004; Roth & Pilling, 2008) but poses some practical challenges to clinical supervisors in terms of transferring broad competency statements into actual supervisory practice. We address the need for more rigor in CBT supervision within a university training clinic setting and outline some promising ingredients for this specification drawing on competencies, metacognition, and experiential learning theory.

Keywords: training; supervision; competence; cognitive behavioral therapy

In-house teaching clinics have been described as the preferred model for providing clinical practicum experiences, optimally helping students acquire the basic knowledge, skills, and attitudes required to integrate academic preparation with clinical practice (Binder & Wechsler, 2010). In theory, this approach allows for very high levels of control over supervised experiences and clinical problems, which maximizes consistency between coursework and clinical training and provides the fullest possible integration between science and clinical practice. Therefore, one of the major challenges of basic practicum training is to bridge the gap between classroom didactics and real-world clinical practice. This mirrors the well-recognized science-practice gap in which the divergent traditions of "pure" clinical science (with its basis in the positivist tradition and emphasis on rigor: high levels of internal validity) can be sharply contrasted with the "roughness" (Schon, 1983) of clinical practice (i.e., relevance: high external validity). Schon (1983) describes the "swampy lowland" of clinical practice where problems are often "confusing messes" incapable of technical solution, and contrasts this with the "high, hard ground" of research-based theory and technique, noting, ironically: "in the swamp are problems of greatest human concern" (p. 42).

In discussing how we attempt to bridge this rigor-relevance gap in relation to clinical supervision, we will next outline the clinic setting, then detail some promising approaches to being more rigorous about the CBT supervision model, before providing a series of examples (critical incidents) designed to illustrate how our approach can be applied within this setting. The Kurt and Barbara Gronowski Psychology Training Clinic at Palo Alto University is a community-based psychology training clinic that provides mental health services to low income, ethnically diverse, and primarily uninsured (58% of our current clients) adults, older adults, families, and children. Clients typically present with very complex quality of life problems, high levels of comorbidity, and a significant percentage of clients fall into the category of severe and persistent mental illness. The clinic provides an important access point to clients needing outpatient mental health care and has an explicit mission that incorporates responding to the uninsured by providing mental health services to low-income adults, older adults, families, and children with serious mental illnesses who are unable to access care through the local public or the private fee for service health care system.

All students at Palo Alto University are required to begin their initial clinical practicum experiences at the clinic after an initial year of classroom and didactic training. Consistent with the National Council of Schools and Programs of Professional Psychology (NCSPP) model, efforts are made to closely integrate classroom and academic learning activities with clinical training (Ducheny, 2009). …

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