Professional Effectiveness – Supervision, Clinical Audit and Continuing Professional Development

Professional Effectiveness – Supervision, Clinical Audit and Continuing Professional Development

In order to practise CBT to a professional standard, and to monitor and develop this over time, therapists need to draw on a range of strategies to improve their own clinical practice.

Three key elements in this are clinical supervision, clinical audit and continuing professional development (CPD).

Professional Effectiveness – Supervision, Clinical Audit and Continuing Professional Development

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Supervision

It is important to choose a clinical supervisor who is qualified and experienced in both the relevant modality (i.e. CBT) and in supervision.

Preparing for supervision helps the therapist to gain maximum benefit from this. It can be helpful to use individual client case formulations as the basis for discussions in CBT supervision, sharing these with the supervisor as the core structure on which to hang exploration/evaluation of each client case in supervision.

CBT supervision is important in a number of respects in the CBT context:

  • helping the therapist to design and implement an appropriate treatment plan, including specific techniques and interventions (especially if the therapist has been previously trained in a non-directive approach, e.g. person-centred therapy, which can make it challenging to become accustomed to the need to be more directive in CBT work)
  • supporting the therapeutic relationship and process, helping to identify where the therapist’s process may interact with the client’s process, and so spotting possible transference, countertransference and parallel process
  • discussing any possible onward referrals, e.g. of severe or complex mental health problems
  • checking on the therapist’s wellbeing, competency and efficacy – especially when working with clients with difficult material
  • ensuring that the therapist is practising thorough and effective self-care.

Just as CBT seeks to encourage clients to become their own CBT therapist, so therapists can develop their own internal supervisor, which provides continual feedback on the quality of my CBT work during and between client sessions. This cannot and should not ever replace – but serves as a valuable addition to – formal clinical supervision.

Other forms of supervision include peer supervision and group supervision, both of which may be combined with individual supervision to meet ethical-body requirements.

Clinical Audit

There are various clinical audit tools that can be used in CBT; these tend to use a questionnaire format to assess the client’s thoughts, feelings and behaviours over recent times (often the last two weeks). Examples of such tools include PHQ-9, GAD-7, Beck’s Depression Inventory, CORE-10, CORE-34 and WEMWBS.

Professional Effectiveness – Supervision, Clinical Audit and Continuing Professional Development - Audit

The fact that clinical audit tools (such as those mentioned above) provide quantitative cores means they are highly appropriate for using in large-scale research such as randomised controlled trials (RCTs – which the National Institute for Health and Care Excellence recognises as producing the most reliable evidence).

Different organisations have different requirements regarding which audit tools their counsellors use; many counselling agencies use CORE IMS tools (which are designed by counsellors specifically for the counselling context), but it can be argued that mental-health measures used more widely by doctors and other healthcare professionals (such as PHQ-9 and GAD-7) fit well with the CBT model, being more closely allied to psychopathology.

A particular advantage of these is that they are internationally recognised as robust measures of anxiety and depression respectively.

The completion of clinical audit tools is often seen as a tick-box exercise and is explained away to clients as relating only to the need to collect before-and-after data for organisational purposes.

However, it is helpful to integrate these into the therapeutic process to the benefit of clients. Indeed, their use can be viewed not as an administrative task but as a clinical skill, offering two key benefits: enabling the therapist to collect a lot of information quickly and efficiently; and helping clients to articulate a wide range of their current experience.

Agencies vary too in how often they want their counsellors to use audit tools, though there may be some scope for professional autonomy in deciding this too. Whenever this is done, it is important to explain to clients the measures, and why and how we use them, in order to help build trust in the therapeutic bond (otherwise, the questionnaires could look frightening and mysterious to them).

Clients can be given the choice of whether to fill the measurement questionnaires in themselves (ideally in the therapy room) or to work through them together with the therapist. Either way, the therapist can encourage the client to ask any questions and talk about their answers as they go along, if they so wish.

Looking at the results enables the therapist to get an overview of any patterns, and explore areas in which they have scored more highly. This can support assessment and also offers an opportunity to demonstrate the core conditions in the therapist’s responses to their answers.

CPD

The Ethical Framework for the Counselling Professions (BACP, 2018: 14) requires that ‘we will keep skills and knowledge up to date by … regular continuing professional development to update knowledge and skills’.

Along with clinical supervision and professional indemnity insurance, 30 hours’ CPD per year is one of the requirements of being a registered member of the British Association for Counselling and Psychotherapy (BACP).

Professional Effectiveness – Supervision, Clinical Audit and Continuing Professional Development - CPD

It is also a required part of the professional accreditation process offered by bodies such as the BACP. For example, among the written pieces to be submitted when applying for BACP accreditation is a requirement to describe a recent CPD activity, provide reasons for choosing the activity with reference to practice, and show how the activity has influenced your practice.

The BACP website (undated: unnumbered) defines CPD as ‘any learning experience that can be used for the systematic maintenance, improvement and broadening of competence, knowledge and skills to ensure that the practitioner has the capacity to practise safely, effectively and legally within their evolving scope of practice. It may include both personal and professional development.’

Identifying our CPD needs helps ensure client safety through maintaining and enhancing our knowledge and skills. In particular, it is important to keep abreast of new research evidence, guidelines and effective approaches in order to make sure we offer our clients the best possible service.

The BACP sees CPD as a cyclical process, generally beginning with reflecting and identifying learning needs, then planning and prioritising, followed by acting, and finally by evaluating.

It provides a template that registered members must complete with their CPD reflections and planning, looking what the therapist needs to learn, how the learning is relevant to their practice, what they might do in order to achieve this, the success criteria, and target dates for review/completion.

In developing an individual programme for CPD for the next 12 months, the therapist can usefully draw on reflections and conversations with their clinical and managerial supervisors.

Other Activities Contributing to Professional Effectiveness

Personal therapy can be really valuable in enhancing self-awareness, which is itself key to offering a high-quality CBT service to others. This supports both professional and personal development for therapists. Personal support networks and good self-care are also important ingredients.

Professional networks can also be a highly valuable source of professional support – for example through colleagues in counselling work and peers on counselling courses (always respecting contracted client confidentiality).

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Professional Effectiveness – Supervision, Clinical Audit and Continuing Professional Development

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References

BACP (2018) Ethical Framework for the Counselling Professions, BACP: https://www.bacp.co.uk/media/3103/bacp-ethical-framework-for-the-counselling-professions-2018.pdf