Supervising Cognitive Behavioral Therapy Practitioners in Urban Brazil
Bakos, Daniela Schneider, Kristensen, Christian Haag, Journal of Cognitive Psychotherapy
There is growing interest in the study of supervision as a core aspect of cognitive behavioral therapy (CBT) learning and practice. Standard models of CBT supervision generally contain some components of the following structure: teaching therapist conceptualization skills, interpersonal processes to build a collaborative therapeutic relationship, clinical procedures, and treatment protocols presenting specific procedures for particular problems. As is true for CBT practice, supervision is affected by the cultural context, including macrostructures (e.g., social and economic aspects) and microstructures (e.g., the institution where training is provided). The main goals of this article are (a) to review some of the key elements in clinical supervision of CBT practitioners, (b) to postulate sources of cultural variation that may affect CBT supervision in Brazil, and (c) to illustrate differences between CBT supervision models proposed in the literature and the practice of supervision carried out in Brazil.
Keywords: CBT; clinical supervision; cultural context; professional practice; training
Since its inception and throughout its evolution, cognitive behavioral therapy (CBT) has prioritized scientific, evidence-based practice. The cognitive-behavioral model of psychotherapy, built on the empirical knowledge base of psychology, has undergone rapid and constant development. In light of the strong scientific tradition of CBT, it is surprising that evidence-based practice has not been extended to the teaching of these therapies and training of CBT practitioners.
The absence of evidence-based models of CBT supervision has been progressively noted in the specific literature (Falender et al., 2004; Milne, 2008; Milne et al., 2010). This occurs because, despite the well-established importance of supervision to the practice of psychology, there is still no formal guideline to support this activity and provide guidance on therapeutic conduct and patient management. Because of this lack of consensus on the competences required for supervisory activities and training methods, professionals engaged in supervision eventually conduct their supervisory practice based on their own experience as supervisees (Milne, 2008).
Many CBT researchers and practitioners seek to bridge this gap with outcome-oriented, scientific supervision practices. On the basis of systematic reviews of the literature and original empirical research, some important elements of clinical supervision of CBT have been proposed, as well as specific models for the practice of supervision (Falender et al., 2004; Friedberg, Gorman, & Beidel, 2009; Lombardo, Milne, & Procter, 2009; Milne, 2008; Milne & Dunkerley, 2010; Milne et al., 2010).
In addition to practitioner demand for a standard model of clinical supervision, the relevant literature addresses other equally important elements that should be taken into account. One concerns the influence of culture on clinical supervision activities. On this topic, it is important to discuss the distinct ways of managing supervision depending on the cultural context in which it takes place. This is because both understanding and operationalization of any theoretical construct depends on individual subjectivity, which, in turn, is closely tied to one's cultural surroundings.
The aim of this article is to present a clinical supervision model used in two distinct university settings in Southern Brazil. Therefore, we conducted a review of the literature about clinical supervision in CBT. In addition, we postulated sources of cultural variation that may affect CBT supervision in Brazil.
CliniCal SuperviSion of Cognitive Behavioral therapy
According to Padesky (1994), supervisees would benefit from the same processes and methods used in cognitive therapy-an approach rooted in the training of behavioral therapists (Bootzin & Ruggill, 1988). This method gives therapists in training the opportunity of actually experiencing, during supervision, the lessons they will later translate into practice. …