Clinical Supervision in Cognitive Behavioural Psychotherapy

Cognitive Behavioural Psychotherapy

Cognitive behavioural psychotherapy arose as a result of the co-existence and subsequent integration of behavioural and cognitive approaches which shared common underpinning philosophies. Behavioural approaches, deriving initially from classical and operant conditioning perspectives, included Wolpe's early work on systematic desensitisation of fear (Wolpe, 1958), and the application of operant conditioning concepts to humans through ‘token economies’ (Ayllon and Azrin, 1968). Evaluation and elaboration of these approaches led to the development of exposure therapy for phobic conditions (Marks, 1969, 1981), and the development of a social reinforcement approach to operant conditioning. At the same time, Beck, Ellis and Meichenbaum were developing cognitive interventions based on the centrality of cognition in the maintenance of emotional disorders (Beck, 1976; Beck et al., 1979; Ellis, 1962; Meichenbaum, 1977). These theories proposed that emotional disturbance was mediated by the way in which the individual made sense of the world, and that effective therapeutic techniques would be those which identified, reality-tested and corrected distorted thinking, and the dysfunctional beliefs underpinning that thinking (Beck et al., 1979).

The behavioural and cognitive approaches shared many underpinnings, which led naturally to a closer association between the approaches. These included the following:

• that the therapy should be problem focused, and applied to a specified and agreed area of current dysfunction, rather than attempting to enhance general well-being;
• the importance of aiming to operationalise and make explicit procedures being utilised;
• the link between theory and practice, psychological research being given equal weight with the need for empirical evaluation of the developing techniques;
• the focus on detailed assessment of the individual, leading to a case formulation as the basis for individualised treatment;
• the active, educational and collaborative nature of the therapies.

Differences rested on the extent to which introspection, rather than behavioural observation should be central, and the claimed mechanisms underpinning emotional change in individuals (Haw ton et al., 1989; Rachman, 1997).

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