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Lorona RT, Fergus TA, Valentiner DP, Miller LM, McGrath PB. Self-Stigma and Etiological Attributions About Symptoms Among Individuals Diagnosed With an Anxiety Disorder: Relations With Symptom Severity and Symptom Improvement Following CBT. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2018. [DOI: 10.1521/jscp.2018.37.7.536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nearly one-third of individuals in the U.S. will be diagnosed with an anxiety disorder during their lifetime. Receiving that label can evoke self-stigma, with self-stigma relating to greater symptom severity and negatively impacting treatment outcomes. A lesser-studied variable related to self-stigma is etiological attributions about symptoms, including biological and psychological attributions. The current study examined interrelations among self-stigma, etiological attributions, and symptom severity among 213 individuals diagnosed with an anxiety disorder who completed a cognitive-behavioral treatment (CBT) program. How self-stigma and etiological attributions related to symptom improvement following the program was examined in a subset of participants. Etiological attributions and self-stigma shared positive associations with symptom severity. Regression analyses indicated that, when controlling for overlap among self-stigma and etiological attributions, psychological attributions emerged as particularly relevant for understanding symptom severity. Changes in self-stigma and attributions were positively associated with changes in symptom severity following the CBT program. Study implications are discussed.
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Affiliation(s)
| | | | | | | | - Patrick B. McGrath
- OCD and Related Anxiety Disorders Program at Alexian Brothers Behavioral Health Hospital
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Friedberg RD. Best practices in supervising cognitive behavioral therapy with youth. World J Clin Pediatr 2018; 7:1-8. [PMID: 29456927 PMCID: PMC5803561 DOI: 10.5409/wjcp.v7.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/16/2017] [Accepted: 01/07/2018] [Indexed: 02/06/2023] Open
Abstract
Clinical supervision of cognitive behavioral therapy (CBT) with youth ensures better patient care and fosters trainees' professional development. However, often insufficient attention is directed toward disseminating best practices in supervision of CBT with youth. This Therapeutic Advances contribution aims to communicate the core content of supervision. Additionally, the key supervisory practices associated with CBT with youth are described. Supervisory outcomes are summarized and recommendations for supervisory practices are made.
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Affiliation(s)
- Robert D Friedberg
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, Palo Alto, CA 94304, United States
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Alfonsson S, Parling T, Spännargård Å, Andersson G, Lundgren T. The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review. Cogn Behav Ther 2017; 47:206-228. [PMID: 28929863 DOI: 10.1080/16506073.2017.1369559] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Clinical supervision is a central part of psychotherapist training but the empirical support for specific supervision theories or features is unclear. The aims of this study were to systematically review the empirical research literature regarding the effects of clinical supervision on therapists' competences and clinical outcomes within Cognitive Behavior Therapy (CBT). A comprehensive database search resulted in 4103 identified publications. Of these, 133 were scrutinized and in the end 5 studies were included in the review for data synthesis. The five studies were heterogeneous in scope and quality and only one provided firm empirical support for the positive effects of clinical supervision on therapists' competence. The remaining four studies suffered from methodological weaknesses, but provided some preliminary support that clinical supervision may be beneficiary for novice therapists. No study could show benefits from supervision for patients. The research literature suggests that clinical supervision may have some potential effects on novice therapists' competence compared to no supervision but the effects on clinical outcomes are still unclear. While bug-in-the-eye live supervision may be more effective than standard delayed supervision, the effects of specific supervision models or features are also unclear. There is a continued need for high-quality empirical studies on the effects of clinical supervision in psychotherapy.
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Affiliation(s)
- Sven Alfonsson
- a Department of Clinical Neuroscience, Centre for Psychiatry Research , Karolinska Institutet & Stockholm Health Care Services , Stockholm , Sweden.,b Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Thomas Parling
- a Department of Clinical Neuroscience, Centre for Psychiatry Research , Karolinska Institutet & Stockholm Health Care Services , Stockholm , Sweden
| | - Åsa Spännargård
- a Department of Clinical Neuroscience, Centre for Psychiatry Research , Karolinska Institutet & Stockholm Health Care Services , Stockholm , Sweden
| | - Gerhard Andersson
- a Department of Clinical Neuroscience, Centre for Psychiatry Research , Karolinska Institutet & Stockholm Health Care Services , Stockholm , Sweden.,c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Tobias Lundgren
- a Department of Clinical Neuroscience, Centre for Psychiatry Research , Karolinska Institutet & Stockholm Health Care Services , Stockholm , Sweden
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Alfonsson S, Spännargård Å, Parling T, Andersson G, Lundgren T. The effects of clinical supervision on supervisees and patients in cognitive-behavioral therapy: a study protocol for a systematic review. Syst Rev 2017; 6:94. [PMID: 28490376 PMCID: PMC5425973 DOI: 10.1186/s13643-017-0486-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical supervision by a senior therapist is a very common practice in psychotherapist training and psychiatric care settings. Though clinical supervision is advocated by most educational and governing institutions, the effects of clinical supervision on the supervisees' competence, e.g., attitudes, behaviors, and skills, as well as on treatment outcomes and other patient variables are debated and largely unknown. Evidence-based practice is advocated in clinical settings but has not yet been fully implemented in educational or clinical training settings. The aim of this systematic review is to synthesize and present the empirical literature regarding effects of clinical supervision in cognitive-behavioral therapy. METHODS This study will include a systematic review of the literature to identify studies that have empirically investigated the effects of supervision on supervised psychotherapists and/or the supervisees' patients. A comprehensive search strategy will be conducted to identify published controlled studies indexed in the MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases. Data on supervision outcomes in both psychotherapists and their patients will be extracted, synthesized, and reported. Risk of bias and quality of the included studies will be assessed systematically. DISCUSSION This systematic review will rigorously follow established guidelines for systematic reviews in order to summarize and present the evidence base for clinical supervision in cognitive-behavioral therapy and may aid further research and discussion in this area. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016046834.
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Affiliation(s)
- Sven Alfonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet and Stockholm Health Care Services, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden. .,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Åsa Spännargård
- Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet and Stockholm Health Care Services, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden
| | - Thomas Parling
- Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet and Stockholm Health Care Services, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden
| | - Gerhard Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet and Stockholm Health Care Services, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet and Stockholm Health Care Services, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden
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The challenge of training supervisors to use direct assessments of clinical competence in CBT consistently: a systematic review and exploratory training study. COGNITIVE BEHAVIOUR THERAPIST 2016. [DOI: 10.1017/s1754470x15000288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractEvaluating and enhancing supervisee competence is a key function of supervision and can be aided by the use of direct assessments of clinical competence, e.g. the Cognitive Therapy Scale – Revised (CTS-R). We aimed to review the literature regarding inter-rater reliability and training on the CTS and CTS-R to present exploratory data on training raters to use this measure. We employed a systematic review. An exploratory study evaluated the outcomes of a CTS-R supervisor training workshop (n = 34), including self-reported familiarity with and confidence in using the tool, and inter-rater consistency on three CTS-R subscales, pre- and post-training. CTS and CTS-R inter-rater reliability was variable, with evidence of rater training enhancing reliability, although the form, duration and frequency of such training is unclear. The exploratory study found that supervisors rated themselves as more familiar with and confident in using the CTS-R at the end of training compared to at the beginning. However, inter-rater reliability was poor at the beginning and end of the training. Rating competence requires supervisors to make qualitative judgements, which is inherently variable. Training raters has been shown to improve rater reliability, although this was not demonstrated in the exploratory study. Practice implications and future research priorities are identified.
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Waltman SH. Model-Consistent Cognitive Behavioral Therapy Supervision: A Case Study of a Psychotherapy-Based Approach. J Cogn Psychother 2016; 30:120-130. [PMID: 32755911 DOI: 10.1891/0889-8391.30.2.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is a great need for training in cognitive behavioral therapy (CBT) for community clinicians who work in public mental health systems where resources are low and demands are high. Researchers have found that simply attending intensive CBT workshops will not result in adherent or competent CBT being delivered, rather ongoing CBT supervision/consultation has been found to be associated with the best training outcomes. Psychotherapy-based approaches to supervision have recently received some attention for their value in providing experiential learning. What follows is a case example of a community clinician who had little previous training in CBT and following an intensive training and 16 weeks of CBT supervision had substantial gains in her CBT adherence and competency ratings. Recommendations such as the value of experiential learning are discussed.
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Affiliation(s)
- Scott H Waltman
- Beck Initiative, Aaron T. Beck Psychopathology Research Center, University of Pennsylvania
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Friedberg RD, Brelsford GM. Training Methods in Cognitive Behavioral Therapy: Tradition and Invention. J Cogn Psychother 2013; 27:19-29. [DOI: 10.1891/0889-8391.27.1.19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
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.
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Role Transition from Mental Health Nurse to IAPT High Intensity Psychological Therapist. Behav Cogn Psychother 2011; 40:351-66. [DOI: 10.1017/s1352465811000683] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: The Improving Access to Psychological Therapies (IAPT) initiative has depended on the training of a new NHS mental health workforce. At step 3 of the stepped care model, capacity building has required the recruitment of a wide range of mental health professionals into high intensity therapists training posts. This shift naturally entails role transition on the part of trainees into delivering cognitive behavioural psychotherapy (CBP), but no previous research has examined the experience of such transitions. Aim: To describe the lived experience of transition from mental health nurse to IAPT high intensity therapist and to identify possible factors which moderate effective role conversions. Method: Six qualified high intensity therapists were interviewed using a semi-structured interview and the subsequent interviews transcribed. Thematic content analysis (TCA) was used to analyze personal accounts of role transition. All participants had previously been mental health nurses and attended the same IAPT high intensity therapist (HIT) training programme. Results: Six key themes were apparent from the TCA. Three interconnected themes concerning supervision (style, impact of approach and historical context) and three additional themes of the challenge of learning a new clinical approach, high need for support, and forming a new psychotherapist identity. Conclusions: Findings suggest supervision is the most important factor in supporting complex psychotherapy role transitions. Clinical supervisors may need to incorporate dedicated time on role and identity shift during CBP training to ensure effective assimilation and transition. Methodological short-comings are identified and discussed.
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Fitch JC, Pistole MC, Gunn JE. The Bonds of Development: An Attachment-Caregiving Model of Supervision. CLINICAL SUPERVISOR 2010. [DOI: 10.1080/07325221003730319] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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NIMH Multisite HIV/STD Prevention Trial for African American Couples Group. Supervision of facilitators in a multisite study: goals, process, and outcomes. J Acquir Immune Defic Syndr 2008; 49 Suppl 1:S59-67. [PMID: 18724192 PMCID: PMC2875787 DOI: 10.1097/qai.0b013e3181844807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe the aims, implementation, and desired outcomes of facilitator supervision for both interventions (treatment and control) in Project Eban and to present the Eban Theoretical Framework for Supervision that guided the facilitators' supervision. The qualifications and training of supervisors and facilitators are also described. DESIGN This article provides a detailed description of supervision in a multisite behavioral intervention trial. The Eban Theoretical Framework for Supervision is guided by 3 theories: cognitive behavior therapy, the Model of Life-Long Supervision, and the empowerment model of culturally responsive supervision. METHODS Supervision is based on the Eban Theoretical Framework for Supervision, which provides guidelines for implementing both interventions using goals, process, and outcomes. RESULTS Because of effective supervision, the interventions were implemented with fidelity to the protocol and were standard across the multiple sites. CONCLUSIONS Supervision of facilitators is a crucial aspect of multisite intervention research quality assurance. It provides them with expert advice, optimizes the effectiveness of facilitators, and increases adherence to the protocol across multiple sites. Based on the experience in this trial, some of the challenges that arise when conducting a multisite randomized control trial and how they can be handled by implementing the Eban Theoretical Framework for Supervision are described.
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Kindsvatter A, Granello DH, Duba J. Cognitive Techniques as a Means for Facilitating Supervisee Development. COUNSELOR EDUCATION AND SUPERVISION 2008. [DOI: 10.1002/j.1556-6978.2008.tb00048.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gonsalvez CJ, Oades LG, Freestone J. The objectives approach to clinical supervision: Towards integration and empirical evaluation. AUSTRALIAN PSYCHOLOGIST 2006. [DOI: 10.1080/00050060210001706706] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Craig J. Gonsalvez
- University of Wollongong
- Department of Psychology, University of Wollongong, NSW, 2522, Australia
| | - Lindsay G. Oades
- University of Wollongong
- Department of Psychology, University of Wollongong, NSW, 2522, Australia
| | - John Freestone
- University of Wollongong
- Department of Psychology, University of Wollongong, NSW, 2522, Australia
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Abstract
With the face of health care changing at a blistering pace due to shrinking resources, advanced technology, and growing consumer demands, organizations, for-profit and nonprofit alike, have responded by flattening organizational hierarchies. Consequently, it is not an uncommon practice to promote "successful technical experts" to clinical administrator positions. Ill-prepared, rookie clinical administrators are often left struggling to manage an organization with little experience and training. Fortunately, there is help. This article will identify and apply internal and external tools that newly promoted clinical administrators can use to hurdle potential pitfalls.
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RONEN TAMMIE. CLIENT SELF-ASSESSMENT OF THERAPY PROCESS IN THE TREATMENT OF ANOREXIA. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2003. [DOI: 10.1080/10720530390117858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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