The cognitive behavior supervisory model allows working with patients on two distinct elements – their cognition and behavior. They learn how to identify a problem and develop a strategy for addressing it. Cognitive-behavioral therapy (CBT) became one of the most commonly used forms of supervision in psychotherapy. This approach allows discussing an agenda, prioritizing a goal, agreeing on homework, and discussing the outcomes in the next sessions. This paper will examine the supervisory model of cognitive behavior, provide a rationale for choosing it, and explain the main limitations of the model.
CBT is typically carried out in a structured manner developed by a variety of researchers and practitioners. Bernard and Goodyear (2019) state that the session begins with a check-in and agenda-setting, following a bridge from a previous session and discussion of previously supervised therapy. After the homework from the previous session is reviewed, the supervisor and the supervisee work on prioritizing an agenda item and work on the problem. Here, several options are available, for example, role-playing, direct instruction, or problem-solving, depending on the specifics of the case (Bernard & Goodyear, 2019).
Alternatively, in instances where the supervisor is unsure of the approach that should be taken in a particular scenario, they can work on guiding the supervisee towards the next steps. After this, the supervisee is assigned homework and can share feedback about the session. Therefore, the structure of CBT implies that they supervise to engage in collaborative and individual work when attending therapy sessions and to complete homework assignments.
With CBT in particular, it is essential to establish a safe environment to enable productive work. Among the key principles of cognitive behavior supervision and CBT is the employment of learning theory principles (Bernard & Goodyear, 2019). As a result, unhelpful thoughts provoking unhelpful behaviors can be replaced with better ones. Hayes and Hofman (2017) describe it as “the application of learning principles to wellāevaluated methods designed to change overt behavior” (p. 245).
After the 1970s, the focus of CBT practitioners shifter towards maladaptive thinking and the use of various methods for detecting and addressing them. Further developments of CBT and its evolution introduced “mindfulness, emotions, acceptance, the relationship, values, goals, and metaācognition” as a way of resolving problems (Hayes & Hofman, 2017, p. 245). Therefore, CBT has evolved and changed over the years, with different concepts and methods being added to the theory, however, the focus on behavior and cognition remains unchanged.
I chose this model because I specialize in trauma and often use cognitive processing therapy (CPT), which is another type of behavioral supervision, apart from CBT. This approach incorporates some elements of CBT and manualized therapy, and I have seen the effectiveness of using it in clinical practice. The advantages of this model include its focus on changing unhealthy behaviors and addressing destructive thoughts that can affect both actions and emotions of the supervisee.
The limitations of this model are described by David et al. (2018) as problems with research on CBT. Mainly, the authors cite issues with methodology used in many articles that explain empirical studies of CBT. David et al. (2018) cite having weak comparisons, such as waitlist control conditions, as the main problem that undermines the reliability and validity of many CBT studies. However, there is research on CBT that uses valid methodology and comaprissons such as psychological placebo, making the conclusions of this researches trustworthy.
Mainly, the cognitive and behavioral therapies differ since the former aims to modify observable behavior and leverage models of learning. At the same time, the latter is focused on cognition, usually the client’s self-talk. CBT is the most widely used model, which can be characterized as a widely applied method of supervision due to its versatility.
The basic structure of CBT implies having both in-session work and homework for the client to complete. When working on a specific goal with a client, the supervisor aids in correcting the dysfunctional thinking that adversely impacts the emotions and behaviors of the patient.
As was mentioned, the CBT model is used for addressing a plethora of mental health issues and problems that require supervision. In their article, David et al. (2018) discuss why CBT is currently considered the gold standard of psychotherapy, mainly because it is the most well-researched form of psychotherapy and because it consistently allows achieving positive results, despite the issues with a methodology that were discussed.
Hence, CBT is currently the best practice in the field, although more research and development is necessary to improve it. However, as shown by the evolution of this approach, new methods and strategies for changing cognition and behavior may be developed in the following years.
Overall, the cognitive behavior supervisory model is based on the learning abilities of the supervisee. The goal is to enable the process of identifying a problem and developing a solution. The most commonly used form of cognitive behavior supervisory is CBT, which is the current gold standard in the field. The approach has a clearly defined structure according to which the supervised and supervisee work on a defined plan, and the latter receives homework for individual work.
References
Bernard, J.M. & Goodyear, R.K. (2019). Fundamentals of clinical supervision (6th ed.). Boston, MA: Pearson.
David, D., Cristea, I., & Hofmann, S. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers In Psychiatry, 9, 1-10.
Hayes, S. C., & Hofmann, S. G. (2017). The third wave of cognitive behavioral therapy and the rise of process-based care. World psychiatry: Official Journal of the World Psychiatric Association (WPA), 16(3), 245ā246.