Clinical supervision is recognized as essential for CBT therapists, both during training and in subsequent practice, and there has been a rapidly growing demand for accredited therapists to become supervisors. However, this can be a daunting prospect. Supervision is a highly complex activity with several overlapping purposes, in which the supervisor must enact multiple roles and use varied modes of activity. Research on the process has been limited, but a consensus on good practice and evidence-based procedures is beginning to emerge. Against this backdrop, a sequence of steps to be taken within any CBT supervision session is presented here. The structure is applicable across all levels of expertise. The purpose is to give clear and accessible guidance to supervisors to ensure they adhere to best practice and manage sessions in an efficient, helpful and well-focused style.

Evidence clearly suggests that the therapeutic relationship is important to successful outcomes in psychotherapy. It is less clear as to why this might be the case. Throughout the literature, various factors such as warmth, empathy, compassion, unconditional positive regard, and openness are identified as key. The way in which factors such as warmth and empathy bring about an amelioration of psychological distress, however, is not entirely obvious. We suggest that one possible mechanism through which these factors become important is by helping to create an environment where clients can examine their problems freely. Furthermore, we propose that when the therapeutic relationship is therapeutic, clients feel comfortable to consider whatever comes into their mind; with any filtering or evaluating happening after the ideas have been expressed, and not before. Psychological processes identified as maintaining psychological distress (e.g. thought suppression, avoidance, rumination) block this capacity. Our suggestion is that as internal experiences are being examined, the client has an opportunity to become aware of facets of the problem that were previously unattended to; and to continue this process outside therapy. Through this awareness-raising process the client's problem can be reorganized via intrinsic learning processes to achieve a more contented state of mind.

To contribute to a model of CBT supervision, we interpreted supervisees' understanding of the processes involved in their receipt of supervision. Second, we assessed the utility of a Grounded Theory Methodology (GTM) to study supervision. Supervisees were interviewed about their experiences of supervision, within a cross-sectional, qualitative design. In-depth, face-to-face individual interviews were conducted with seven trainee clinical psychologists. Their perceptions of supervision were analysed by means of a constructivist revision of GTM. A conceptual model is presented, to show the learning process from the perspective of the supervisees. This suggests that the receipt of supervision was experienced against a developmental backdrop involving a progression along two continua: competency and awareness. A set of core processes (Reflection, Socratic Information Exchange, Scaffolding, Supervisory Alliance) were thought to interact, enabling appropriate learning across developmental stages. This was thought to facilitate movement through individualized Zones of Proximal Development (ZPD). The fidelity construct of ‘receipt’ is complex and does not lend itself to quantification and measurement using a positivistic approach. By contrast, GTM was a useful methodology to use in this context. Further research using a similar methodology may further contribute to a model of CBT supervision.

Parkinson's disease (PD) is associated with significant symptoms of depression. Cognitive behaviour therapy (CBT) has been shown to be effective for depression in PD. However, much of the previous research focuses on working with younger adults in the earlier stages of the disease, despite evidence for greater risk of depression when PD symptoms are more severe. This paper provides a case illustration of using CBT for depression with an 84-year-old man with advanced PD. The results of an assessment are described and a psychological formulation is presented. The specific adaptations made to the therapy and illustrations of the content of therapy are discussed. This intervention resulted in improvements in global mental health and moderate reductions in depression. However, there was no effect on anxiety. This case highlights the complexity of conducting CBT with this population, and further research is needed to determine the modifications necessary to make such interventions effective.

This study performed a systematic literature review to examine existing and recommended CBT support for staff working within mental healthcare, who experienced occupational traumatization. The following questions were posed: (1) What are the effects of differing levels of occupational trauma on the individual and/or organization? (2) Are there any current CBT-specific models, or treatment pathways, aimed at supporting those experiencing the effects of occupational trauma? Conclusions showed the effects of occupational trauma are significant, varied and predominantly negative to both employees, and the organizations where they work. There were no CBT-specific models or pathways sourced to address occupational trauma; however, interventions were highlighted which may form parts of a larger pathway. Reviewed evidence suggests that development of a stepped CBT pathway for occupational trauma will be beneficial.

Clinical supervision is key to the delivery and governance of effective psychological work. We place increasing emphasis on the evidence base in our clinical decision making, and yet there is no comparable body of information to inform our supervisory practice. This is a serious problem for psychological therapists; there is an urgent need for theoretically driven and empirically evaluated approaches to supervision, and the training of such skills. This preliminary evaluation examined the impact of a 5-day training designed for Improving Access to Psychological Therapies (IAPT) supervisors new to the role. A within-subject, repeated-measures design was used to compare self-assessed supervision competencies over the course of training. Twenty-eight IAPT supervisors completed 5 days’ training based on the Supervision Competencies Framework and IAPT Supervision Guidance. Significant improvements were found in ratings of generic, specific, applied and meta-supervision competencies, as well as overall competency. This evaluation gives preliminary support for the impact of training on supervisory competencies. There are clear limitations, particularly the lack of objective measures and comparison training. Nevertheless, in the context of a very limited evidence base to date, the study contributes to a more robust approach to developing supervisory competence in clinical practice.

Mindfulness meditation is developing momentum as a mental health promoting activity in clinical and non-clinical settings. Our Early Intervention in Psychosis (EIP) service wished to determine its acceptability and utility among a mixed group of participants. All clinical team members, their patients and their carers were offered an 8-week Mindfulness group. Participants rated acceptability before and after. They prospectively identified, then monitored, distress associated with areas of their lives they hoped might improve. Nineteen participants provided a mean attendance of 11.25 per group. The group was overwhelmingly positively perceived and distress associated with participants’ items significantly improved. Findings support further implementation. The goal of inclusion was achieved with some reservation about staff preparation.

A 35-year-old Middle Eastern woman, experiencing moderate depression compounded by animal phobia was referred to an Improving Access to Psychological Therapies (IAPT) service. Shared understandings were gradually developed using written functional analyses translated in session. Activity scheduling was integrated with graded exposure to increase access to positive reinforcement. Questionnaires and subjective data indicated a reduction in phobic avoidance and functioning increased. Despite the complexity of working as a triad, a positive therapeutic relationship was achieved with increased mutual cultural understanding. Indirect communication led to difficulties maintaining guided discovery and focus. There is limited evidence to support CBT when delivered through an interpreter. IAPT recommendations suggest staff reflect the community; the North East has one of the lowest foreign-born populations in the UK indicating that IAPT services may be ill prepared to work with ethnic minorities. Learning points for the therapist were: maintain simplicity, take time to formulate incorporation of cultural difference, and use transcultural interventions. The interpreter brought advantages; providing means of communication and understanding of cultural differences. Disadvantages were the potential for bias or lost information, increased time and complexity of delivering therapy. This case indicates a deficit in high intensity training and lack of literature to support therapists.

Despite a strong evidence base for cognitive behavioural therapy (CBT) for obsessive compulsive disorder (OCD), there is limited evidence regarding the effectiveness of group therapy compared to individual therapy. As services struggle to manage high demands, CBT for OCD is often offered in group format. This paper examines the current evidence base for group CBT for OCD considering both clinical outcomes and cost, and describes a group CBT intervention for people with OCD. A CBT group was set up, consistent with NICE guidelines, but slightly adapted from standard group protocols, in line with recommendations from experts in the field. It was evaluated as part of an audit of the service. Statistical analyses demonstrated significant improvements in both measures of depression and the impact of difficulties, and on specific measures of OCD, in clients who attended group CBT (n = 17). The analyses also demonstrated improved effectiveness of therapist hours for group therapy compared to individual therapy. It is concluded that group therapy for OCD should be considered as an alternative to individual therapy when there are significant demands on the service. Recommendations regarding specific adaptations to the standard group CBT format are made.

In a previous paper auditing individual therapy in the STEPS team, we demonstrated a significant problem with attrition for both CBT and person-centred therapy. We argued that a root-and-branch change to the referral process was needed. This paper looks at the system which replaced it. ‘Callback’ allows self-referral with service users able to leave a phone message at any time. Clinicians call back and carry out a protocol-driven assessment, arranging, where appropriate, services at the end of the call. Reporting on the first 2500 calls, 92% of callers were successfully called back. Individuals were, on average, called back in 8.4 hours. Eighty-six percent of callers were offered an intervention within the STEPS service. They entered these STEPS services, on average, 9.4 days after the initial phone call. Of all callers 15.6% were offered individual therapy. Of these, 93% attended the first appointment and 82% completed a course of treatment. The results suggest that Callback is a significant improvement on the GP-referral system it replaced and provide evidence supporting the utility of ‘multi-level, multi-purpose’ services in primary care.