The prevalence of mental health conditions is high for autistic adults. Yet, the IAPT manual states that referral rates into NHS Talking Therapies Services (NHS-TTS) do not reflect this nationally. Non-adapted treatment has been identified as a key barrier to accessing these services. It is therefore imperative that clinicians adapt to the needs of autistic individuals to make treatment accessible and effective. However, there is limited research in the field, especially for low-intensity cognitive behavioural therapy (LICBT). This service evaluation explores adapted LICBT for autistic adults within Plymouth’s NHS-TTS and Autism Service. It investigated clinical outcomes of adapted group and one-to-one LICBT with 84 participants. It hypothesised that psychometric measures for anxiety and depression would be lowered on treatment completion, whilst exploring whether either intervention showed a greater reduction. Additionally, semi-structured interviews were conducted with six participants from the sample to gather perspectives on what aspects of treatment were favourable or require improvement. A factorial ANOVA revealed that psychometric measures reduced on completion across both interventions, with a greater decrease for one-to-one treatment and the anxiety measure. In addition, four themes and nine subthemes emerged following a thematic analysis, which focus on different aspects of treatment, such as content, structure, interaction, and barriers to engagement. Findings indicated that adapted LICBT was associated with lower anxiety and depression for autistic adults. This consequently has implications for improving the current LICBT provisions being offered to autistic adults within the NHS-TTS.

1. (1) To understand some of the barriers autistic people face accessing an NHS Talking Therapies Service (NHS-TTS) and cognitive behavioural therapy (CBT).

2. (2) To reflect on the importance of adapting practice and CBT for autistic people.

3. (3) To present potential adaptations to low-intensity CBT for autistic adults with anxiety and depression.

Little is known about dialectical behaviour therapists’ (DBT) own experiences of mental health issues or being experts by experience. Quantitative exploratory methodology surveyed DBT therapists about their own experiences of mental health issues. Questionnaires were varied and far-reaching including collection of data on demographics as well as mental health experiences and disclosures of difficulties, Adverse childhood experiences, quality of life, attitudes towards people with borderline personality disorder (BPD), and a measure of internalised stigma and stigma resistance for people who endorsed a formal mental health diagnosis. Ninety-four people responded, 92 of whom identified as a practising DBT; 80 endorsed a history of or current mental health difficulties. This exploratory research, based on responses from 94 DBT therapists, expands knowledge on the relevance of ‘wounded healer/impaired practitioner’ concepts for practitioners of DBT and raises issues related to consultation team and a duty of care towards DBT therapists. Low response rate makes it difficult to generalise these findings. Respondents were predominantly white, female, heterosexual therapists earning well above the median and mean incomes in the UK. Additionally, respondents were not asked to define the functions and modes of their DBT practice.

1. (1) Readers will learn about the treatment relationship within a DBT context.

2. (2) Readers will learn about the concepts of wounded healer and impaired practitioner as well as the related issue of stigma.

3. (3) Readers will learn about the experiences of mental health issues of 94 DBT therapists.

Only a few instruments can monitor the quality of individual supervision sessions. Therefore, the first objective was to develop a brief Quality of Supervision Questionnaire (QSQ). The second objective was to examine person and context variables associated with more effective supervision sessions. Two online samples of n=374 psychotherapy trainees and n=136 supervisors were used to develop the QSQ using exploratory factor analysis, validity and reliability analyses, and tests for measurement invariance. In addition, correlations between the QSQ and person and context variables were examined. The final QSQ included 12 items and three factors (Effectiveness, Procedural Knowledge, Relationship). The supervisee version had good reliability (α=.83 to .88) and correlated moderately to strongly with convergent measures (r=.37 to .68). The supervisor version was partially invariant to the supervisee version, displayed weak to good convergent validity (r=.27 to .51) and mixed reliabilities (α=.67 to .81). Regarding person variables, higher session quality was positively associated with supervisee self-efficacy (r=.16) and being a supervisor (vs supervisee, d=0.33 to 0.56). Regarding context variables, there were significant effects for supervisors in cognitive behaviour therapy (vs psychodynamic therapy; in terms of Procedural Knowledge, d=0.86) and for competence feedback (vs no feedback; d=0.47 to 0.68), but not for individual (vs group-based) sessions. Overall, the QSQ is a valid and reliable self-report questionnaire. We discuss the conceptual overlap between supervision scales.

As a result of reading this paper, readers will:

1. (1) Be aware of the Quality of Supervision Questionnaire (QSQ), which is a brief self-report scale assessing the quality of individual supervision sessions with 12 items and three subscales: Effectiveness, Procedural Knowledge, and Relationship.

2. (2) Learn that there are no significant differences in the quality of supervision between sessions in individual and group formats. Compared with psychodynamic supervisors, supervisors in cognitive behaviour therapy report more procedural knowledge (i.e. what exactly to do and how to do it) in their sessions.

3. (3) Understand that supervisees evaluate sessions that included competence feedback as qualitatively better than supervisees who did not receive competence feedback.