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Preventing harm related to CBT supervision: a theoretical review and preliminary framework

Published online by Cambridge University Press:  23 November 2020

Derek Milne
Derek Milne*
Affiliation:
Private scholar, Northumberland, UK
*
*Corresponding author. Email: derekmilne2017@outlook.com
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Abstract

Like any treatment, cognitive behavioural therapy (CBT) may have negative as well as positive outcomes, and the same is true of CBT supervision. This is recognized in definitions of supervision, which prioritize helping supervisees to ‘do no harm’ to their patients. Client harm is associated with personal distress in supervisees (therapists), such as burnout, resulting in sub-standard therapy which causes harm to patients. Some supervisors have contributed to the supervisees’ distress, and consequently to patient harm. Harm may also arise from other staff members, or from situational factors that impact negatively on various aspects of the healthcare environment. At a more distal level, the host organization may create a context that allows such problems to go unchecked (e.g. a failure to train or support supervisors adequately). It follows that a large-scale framework is necessary to fully understand and address this multi-dimensional and systemic context for harm. Therefore, this theoretical review sketches out a preliminary ‘infidelity framework’ in order to classify ten types of problem behaviour that commonly contribute to harm that is linked to supervision. Drawing on related frameworks and neighbouring literatures, the infidelity framework also offers an understanding of the typical antecedents and consequences of each of these ten behaviours. This generic functional analysis leads to examples of evidence-based CBT supervision that might prevent or rectify harm.

Type
Review Paper
Information
the Cognitive Behaviour Therapist , Volume 13 , 2020 , e54
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Further reading

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