Conceptualising and managing supervisory drift

Maladaptive therapist schemas in CBT practice, training and supervision: A scoping review

BACKGROUND

Maladaptive therapist schemas are hypothesized to generate difficulties within cognitive behavioural therapy (CBT) practice, training and supervision. Without adequate identification and management, they negatively affect the cognitions and emotions of the therapist, leading them to behave in ways that risk ruptures or therapy and supervision being delivered in a suboptimal fashion. Consequently, there is a need to synthesize the research that has been undertaken to date on the content, prevalence, identification and management of maladaptive therapist schemas.

METHOD

A scoping review was undertaken of studies that have been published since 2001 on the impact of maladaptive therapist schemas (also referred to interchangeably as beliefs or cognitions) in CBT practice, training and supervision. Thirteen studies were identified in a literature search from four electronic databases, a reference list search of identified articles and hand searches.

RESULTS

Three overall themes were identified in the research: (1) prevalence of therapist schemas, (2) specific therapist beliefs and (3) therapist characteristics associated with the delivery of suboptimal CBT or supervision. While there is little empirical support for therapist schemas, therapist resistance and beliefs relating to the fear of using exposure therapy were identified. Therapist intolerance of uncertainty and self-esteem were recurrent factors.

CONCLUSION

There is no consensus on how to define, identify, formulate or respond to maladaptive therapist beliefs or schemas in clinical practice, training or supervision. Further research is needed to better understand their origins, maintaining factors and appropriate management of their impact.

‘It was like the unicorn of the therapeutic world’: CBT trainee experiences of acquiring skills in guided discovery

Training as a cognitive behavioural therapist involves a considerable role transition for mental health professionals where they are expected to demonstrate competence in a range of new skills that emphasise collaboration and Socratic dialogue. This can be in stark contrast to the more didactic style that trainees are familiar with prior to embarking on their training. Guided discovery (GD) is an integral part of formulation and treatment, yet little is known at present about the experiences of cognitive behavioural therapy (CBT) trainees when learning this new skill; specifically, how they assimilate this with existing ways of working and the challenges this might involve. This research is a preliminary attempt to understand factors that help and hinder GD skill acquisition. Eighteen trainee CBT practitioners completed an online questionnaire with the subsequent data analysed using a grounded theory methodology. Three themes were identified: ‘Competing Selves’, ‘Style’ and ‘Active Engagement and Learning’. These themes were used to develop a preliminary model of factors that enable or inhibit skills in GD. The impact of previous professional roles appears to influence the acquisition of confidence and skill in GD. This paper discusses the implications of the findings for CBT trainers, supervisors and trainees.

Key learning aims

As a result of reading this paper, readers should: (1)