Michael Townend

CLINICAL SUPERVISION IN PRACTICE: A SURVEY OF UK COGNITIVE BEHAVIOURAL PSYCHOTHERAPISTS ACCREDITED BY THE BABCP

Clinical supervision is an integral aspect of training and is essential for accreditation as a cognitive behavioural psychotherapist. A questionnaire survey of a random sample of accredited British Association of Behavioural and Cognitive Psychotherapists ( n = 280) is reported, 61% ( N = 170) responded by describing their supervision practices in a number of areas. These included the organization of supervision, content, satisfaction, techniques, models, interdisciplinary working and supervision of others. The results indicate that satisfaction levels with supervision were high amongst accredited therapists and that the ratio of time spent in supervision to therapeutic contact is, on average, higher than recommended minimum levels. Supervision was less structured and active than therapy and little use was made of audio/video tapes of therapy sessions within supervision. The level of training for supervisors was highly variable with a substantial proportion having received no formal training in cognitive behavioural psychotherapy supervision. Dual role relationships were also common. Finally, recommendations for further research and practice are made.

Improving psychological adjustment following a first episode of psychosis: A randomised controlled trial of cognitive therapy to reduce post psychotic trauma symptoms

There are few evaluated psychological interventions or theoretical approaches which are specifically aimed at reducing problems related to adjustment and adaptation following a first episode of psychosis. The present study tests the efficacy of a form of CBT (Cognitive Recovery Intervention; CRI) in reducing trauma, depression and low self esteem following a first episode of psychosis, in a single-blind randomised controlled trial. A total of 66 patients who had recently experienced a first episode of psychosis were randomly assigned to CRI or treatment as usual (TAU) and followed up at 6 and 12 months. People receiving CRI tended to have lower levels of post-intervention trauma symptoms and demonstrated greater improvement than those receiving TAU alone. This was especially the case at 6 months for those with high pre-treatment levels of trauma. There was, however, no advantage for the CRI group with regards to reduced depression or improved self esteem. In conclusion, CRI appears to be an effective intervention to help young people adapt to the traumatic aspects of a first episode of psychosis although further evaluation in a larger study is warranted.

The experiences of reflective learning journals by cognitive behavioural psychotherapy students

Learning to reflect on practice is an important therapeutic skill for psychotherapists and counselors. This study examines the utility of a reflective learning journal within the context of postgraduate education to improve reflection amongst cognitive behavioural psychotherapy trainees. The methodology used was qualitative in order to understand the experiences and insights of the trainees. Focus groups were used to gather and begin the process of understanding experiences. The findings indicate that learning journals do seem to improve reflective learning but have also raised important ethical issues. There appears to be a place for learning journals in contemporary cognitive behavioural psychotherapy training. A number of tentative best practice recommendations are therefore made.

Mental health research-the value of user involvement

ISSN 0963-8237print/ISSN 1360-0567online/2002/020117-03

Quantitative Analysis of Qualitative Information From Interviews A Systematic Literature Review

Background: A systematic literature review was conducted on mixed methods area. Objectives: The overall aim was to explore how qualitative information from interviews has been analyzed using quantitative methods. Methods: A contemporary review was undertaken and based on a predefined protocol. The references were identified using inclusion and exclusion criteria and specific key terms in 11 search databases. Results: Evidence was synthesized from 14 references that included the methods used for quantifying qualitative information, analyzing it statistically and the rationale behind this. Gaps in the existing literature and recommendations for future research were identified. Conclusions: This review highlights the need for a new mixed method based on advanced statistical modeling method that will explore complex relationships arising from qualitative information.

Clinical supervision in cognitive behavioural psychotherapy: development of a model for mental health nursing through grounded theory

This study focuses on the development of a cognitive behavioural model of supervision for mental health nurses. The study utilized a grounded theory approach with cognitive behavioural psychotherapy training course directors. The aim was to more fully understand cognitive behavioural supervision from the perspective of expert supervisors, and develop a model of supervision for mental health nurses who are also cognitive behavioural psychotherapists. For this purpose, 16 course directors were interviewed in-depth, with data analysis taking place after each interview. Through a process of inductive reasoning, core categories were identified from the participants themselves. The relationships between the categories are described. The findings are discussed in terms of a new model that can be used to underpin cognitive behavioural psychotherapy supervision in mental health nursing.

CBT-Based Early Intervention to Prevent Panic Disorder: A Pilot Study

Panic disorder remains a major health problem associated with high levels of disability and medical care, compounded by difficulties accessing appropriate treatment. Despite significant advances in understanding and effective treatment with CBT, the scope for better recognition and early intervention to prevent panic disorder has been relatively neglected in the CBT literature. This pilot study utilized the prevalence of panic attacks presenting in emergency medical care to test deployment of CBT as a practical early intervention strategy for panic disorder in routine NHS conditions. Twenty-seven people attending two typical UK Accident & Emergency (A&E) Departments with recent onset panic attacks were given a single session of CBT-based intervention or assessment only, and followed-up over 3 months. Basic measures of panic symptoms showed an improving trend across the whole sample. The very limited experimental control did not permit firm conclusions about the role of the intervention but at follow-up nearly one-third reported persisting difficulties typical of panic disorder, which then improved with brief additional CBT. Implications are discussed in relation to the existing literature and regarding further research on panic disorder prevention.

Cognitive Therapy For Driving Phobia: Two Single Case Studies

Two single case studies are described of driving phobia treated with cognitive therapy. Assessment, formulation, risk and practical treatment of this common problem are reported. Self-report measures and a behavioural test evaluated results. Both cases improved significantly and reported that the treatment was acceptable. Recommendations for future research are also made.

An internet survey of psychiatrists who have a particular interest in cognitive behavioural therapy: what is the place for the cognitive behavioural model in their role as a psychiatrist?

A survey of psychiatrists with a special interest in CBT was conducted by email correspondence to answer two main questions: ‘What are the uses and the usefulness of the cognitive behavioural model within the day-to-day practice of psychiatrists?’ and ‘What are the most important roles of the consultant medical psychotherapist who has specialized in CBT?’ Despite the constraints of a low response rate the results still reflected the views of 46 psychiatrists who were particularly experienced in the area of CBT. They reported that the cognitive behavioural model was useful in general psychiatric settings, in particular in the engagement of patients, improving clients insight, adherence to medications, and for trainee supervision. The responders reaffirmed previously held views about the role of the consultant medical psychotherapist (CBT), in particular the roles of the assessment and management of complex cases, of taking responsibility for patients with a combination of medical and psychological issues and of teaching CBT to psychiatrists and other mental health professionals. The challenges of translating CBT competencies into generic non-CBT psychiatric settings are discussed, with the important potential role of the medical psychotherapist in this respect. The key skill of formulating cases in secondary care is emphasized.

A Case Study of Cognitive-Behavioral Psychotherapy With a Perpetrator of Domestic Abuse

This is a case study of a male perpetrator of domestic abuse who voluntarily sought help for abusive behavior toward his partner. The case is described, highlighting a 20-week treatment plan underpinned by an interacting cognitive subsystem-based conceptualization. Evaluation of the therapy is by self-report measures of aggression, assertiveness, and dysfunctional attitude that were administered pre- and posttherapy and at 9-month follow-up. The results are a reduction in aggressive behavior and improved assertiveness, whereas dysfunctional attitudes changed to a profile of greater psychological strengths. Implications for therapeutic intervention and development are also discussed.