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High Intensity Handbook

For Assessment Cohort information, please see the following pages:

Programme and Module Descriptors

The HI IAPT Programme Descriptor can be found here: Programme Specification 2019

Module descriptors for the programme can be located on the following pages:

Handbook

Welcome to the University of Exeter’s PG Dip in High Intensity Psychological Therapy. We are really excited to be able to bring you this training programme which is the culmination of several years development. The training spearheads the exciting new Improving Access to Psychological Therapies service delivery model within which the High Intensity worker role is of fundamental importance.

The PG Dip is designed to increase participant’s knowledge and understanding of clinical theory and evidence-based practice of High Intensity Psychological Therapy for anxiety and depression. The programme is heavily rooted within the development of clinical skills associated with a patient-centred approach and on the skills required to support a range of evidence based High-intensity psychological therapies. The continued development of these skills is embedded within a strong focus on practice based supervision, which is a fundamental component of the training. As such your training should not just be seen as being the time you spend being taught within the University, but full time, based also around your clinical work undertaken within your work setting supplemented by your practice based supervision.

Successful completion of clinical and written assignments and appropriate participation in tutorials and workshops will lead to the awarding of a PG Diploma. We hope that graduates will be able to act as ‘product champions’ for CBT practice and to be available as teachers and consultants, in the various settings in which they work.

A major contributing resource to the programme is the knowledge and experiences that programme members bring with them. We intend to draw upon and honour this knowledge and experience in order to develop clinical skills and increase awareness and theoretical understanding. It is important, however, that understanding and use of theory is integrated with clinical application in a rigorous and constructively critical manner.

We hope you enjoy the training and look forward to meeting you over the coming months.

Diversity and Inclusivity

Respect for Diversity:

It is our intention that students from all diverse backgrounds and perspectives be well served by this course, that students’ learning needs be addressed both in and out of teaching sessions, and that the diversity that students bring to this cohort be viewed as a resource, strength and benefit. It is our intent to present materials and activities that are respectful of diversity: gender, sexuality, disability, age, socioeconomic status, ethnicity, race, and culture. Your suggestions are encouraged and appreciated. Please let us know ways to improve the effectiveness of the course for you personally or for other students or student groups. In addition, if any of our sessions conflict with your religious events, please let us know so that we can make arrangements for you.

(Adapted from a diversity statement from the University of Iowa College of Education)

Accessibility, Engagement, and Wellbeing:

We aim for this course to be inclusive and accessible to all. Please let the course team know if you are having difficulty engaging with any aspect of the course. Information regarding support related to accessibly can be found here: https://www.exeter.ac.uk/wellbeing/accessability/support/. A copy of the University’s accessibility statement for ELE is available here.

A personal tutor is assigned to all trainees on the course. The personal tutor will make contact with each trainee by email during the course and meet with each trainee once per term.

The university is committed to supporting trainees through their studies and recognises the importance of trainee wellbeing. As well as their personal tutor, trainees can contact hub staff or the Wellbeing service if they have questions or need support.

Course Team

Director of Portfolio for HI IAPT/CBT Programmes:

Dr Nicole Jamani - N.Jamani@exeter.ac.uk

HI IAPT Programme Leads:

Debbie Williams - D.Williams@exeter.ac.uk
Karen Tate - K.Tate@exeter.ac.uk

HI IAPT Clinical Leads:

Cohort 14:

Shane FitzGerald - S.J.Fitzgerald@exeter.ac.uk

Cohort 15:

Debbie Williams - D.Williams@exeter.ac.uk
Shane FitzGerald - S.J.Fitzgerald@exeter.ac.uk

HI IAPT Academic Leads:

Cohort 14:

Mike Sandercock - M.T.Sandercock@exeter.ac.uk

Cohort 15:

Karen Tate - K.Tate@exeter.ac.uk
Mike Sandercock - M.T.Sandercock@exeter.ac.uk

Depression Module Convenor:

Aims of the Programme

This programme is designed to prepare mental health workers employed as High Intensity trainees within the Improving Access to Psychological Therapies (IAPT) service delivery model. The course is BABCP level 2 Accredited. Successful completion of the course will provide programme members with all the necessary academic and training requirements to meet BABCP accreditation as a cognitive behavioural therapist.

Specific Programme Aims

On completion of the programme we hope that members will be able to:

Evidence practical competency in Cognitive Behaviour Therapy for depression and anxiety and be familiar with the recognition and management of common co-morbid conditions.
Understand and work within an IAPT service model, understanding stepped care and the role of low intensity workers.
Evidence critical knowledge of the theoretical and research literature relating to CBT
Integrate theoretical understanding with their clinical practice in CBT practice
Be familiar with the classic CBT literature, its context and its relevance or otherwise to contemporary CBT practice.
Assess patients for CBT, to know when it is indicated and contra-indicated, and to have an awareness of other forms of potentially appropriate therapies.
Develop an ethical approach to the clinical practice of CBT practice, and an understanding of the issues of confidentiality and ethics in relation to CBT theory and practice.
Understand the social context in which CBT ideas developed and consider ways in which sexism, racism, sectarianism, ageism, and other forms of discrimination may affect practice of psychotherapy.
Engage in career-long reflective practice for the ongoing development of clinical skills.

CBT Competencies Framework

The University of Exeter High Intensity Training Programme has been designed in line with CBT Competencies Framework (Roth & Pilling, 2007) and the IAPT High Intensity Curriculum.

For further information on CBT Competencies, please visit: https://www.ucl.ac.uk/pals/research/cehp/research-groups/core/competence-frameworks/cognitive-and-behavioural-therapy.

IAPT disorder specific models are those referred to within the CBT competencies framework – references for these models are available by accessing this framework online (see link above).

On the Exeter University IAPT HI Course we ensure that we cover at least one of the approved models for each disorder.

The IAPT High Intensity Curriculum is available on the Health Education England website https://www.hee.nhs.uk/our-work/mental-health/improving-access-psychological-therapies

The evidence base for CBT is constantly being added to. In addition to the IAPT specific models, it is recognised that there are other evidenced based models that may be appropriate to use and so we may also teach the following models:

Disorder	Author
Specific Phobia	Kirk & Rouf
OCD	Salkovskis Rachman Whittal
GAD	Wells
PTSD	Brewin, Dalgeish and Joseph
Health Anxiety	Wells Salkovskis & Warwick

IAPT High Intensity curriculum mapping</h4 >

Download the document: CBT Competence Framework for Depression and Anxiety Disorders‌

Programme Structure

Programme structure 2020/21 - Cohort 14

Teaching Days
Term 1 - 5 Weeks: Mondays, Thursdays and Fridays: 28th June - 30th July. Term 2 - 12 weeks 6/9/21 – 3/12/21 (2 days per week, usually Mondays and Fridays, except for Thursday 16th September) (Half-term w/c 25/10/21) Term 3 - 10 weeks 17/1/22 – 1/4/22 (2 days per week, Mondays and Fridays) (Half-term w/c 21/2/22) Term 4 - 5 weeks 25/4/22 - 27/5/22 (2 days per week, Mondays and Fridays) - 5 weeks

Teaching Days

Term 1 - 5 Weeks:

Mondays, Thursdays and Fridays: 28th June - 30th July.

Term 2 - 12 weeks

6/9/21 – 3/12/21 (2 days per week, usually Mondays and Fridays, except for Thursday 16th September)

(Half-term w/c 25/10/21)

Term 3 - 10 weeks

17/1/22 – 1/4/22 (2 days per week, Mondays and Fridays)

(Half-term w/c 21/2/22)

Term 4 - 5 weeks

25/4/22 - 27/5/22 (2 days per week, Mondays and Fridays) - 5 weeks

The Structure and Timings of the days:

All university sessions will be delivered remotely. Lunch will be 12:30 - 1:30pm on all days.

Mondays: 9:30am - 4:30pm. Teaching hours = 5.5

Thursdays: 9:30am - 4:30pm. Teaching hours = 5.5 (Term 1 only)

Fridays: 9:30am - 4:30pm. Teaching hours = 4.75

Programme structure 2021/22 - Cohort 15

Teaching Days 2021/22
Induction Days: 6^th and 7^th December 2021 Term 1 Week 1: Monday 10^th January – Thursday 13^th January 2022 Week 2: Monday 17^th January – Thursday 20^th January Week 3: Monday 24^th January – Tuesday 25^th January Week 4: Monday 31^st January – Tuesday 1^st February Week 5: Monday 7^th February – Tuesday 8^th February Week 6: Monday 14^th February – Tuesday 15^th February HALF TERM: Monday 21^st February – Friday 25^th February 2022 (Study Days) Week 7: Monday 28^th February – Tuesday 1^st March Week 8: Monday 7^th March – Tuesday 8^th March Week 9: Monday 14^th March – Tuesday 15^th March Week 10: Monday 21^st March – Tuesday 22^nd March Week 11: Monday 28^th March – Tuesday 29^th March EASTER BREAK: Wednesday 30^th March – Sunday 24^th April 2022 Term 2 Week 1: Monday 25^th April – Thursday 28^th April Week 2: Tuesday 3^rd May Week 3: Monday 9^th May – Tuesday 10^th May Week 4: Monday 16^th May – Tuesday 17^th May Week 5: Monday 23^rd May – Tuesday 24^th May HALF TERM: Monday 30^th May – Friday 3^rd June (Study Days) Week 6: Monday 6^th June – Tuesday 7^th June Week 7: Monday 13^th June – Tuesday 14^th June Week 8: Monday 20^th June – Tuesday 21^st June Week 9: Monday 27^th June – Tuesday 28^th June Week 10: Monday 4^th July – Tuesday 5^th July Week 11: Monday 11^th July – Tuesday 12^th July SUMMER HOLIDAY: Wednesday 13^th July – Sunday 4^th September 2022 Term 3 Week 1: Monday 5^th September – Thursday 8^th September Week 2: Monday 12^th September – Tuesday 13^th September Week 3: Monday 19^th September – Tuesday 20^th September Week 4: Monday 26^th September – Tuesday 27^th September Week 5: Tuesday 4^th October Week 6: Tuesday 11^th October Week 7: Tuesday 18^th October HALF TERM: Monday 24^th October – Friday 28^th October 2022 (Study Days) Week 8 – Week 11: Dates TBC

Teaching Days 2021/22

Induction Days: 6^th and 7^th December 2021

Term 1

Week 1: Monday 10^th January – Thursday 13^th January 2022

Week 2: Monday 17^th January – Thursday 20^th January

Week 3: Monday 24^th January – Tuesday 25^th January

Week 4: Monday 31^st January – Tuesday 1^st February

Week 5: Monday 7^th February – Tuesday 8^th February

Week 6: Monday 14^th February – Tuesday 15^th February

HALF TERM: Monday 21^st February – Friday 25^th February 2022 (Study Days)

Week 7: Monday 28^th February – Tuesday 1^st March

Week 8: Monday 7^th March – Tuesday 8^th March

Week 9: Monday 14^th March – Tuesday 15^th March

Week 10: Monday 21^st March – Tuesday 22^nd March

Week 11: Monday 28^th March – Tuesday 29^th March

EASTER BREAK: Wednesday 30^th March – Sunday 24^th April 2022

Term 2

Week 1: Monday 25^th April – Thursday 28^th April

Week 2: Tuesday 3^rd May

Week 3: Monday 9^th May – Tuesday 10^th May

Week 4: Monday 16^th May – Tuesday 17^th May

Week 5: Monday 23^rd May – Tuesday 24^th May

HALF TERM: Monday 30^th May – Friday 3^rd June (Study Days)

Week 6: Monday 6^th June – Tuesday 7^th June

Week 7: Monday 13^th June – Tuesday 14^th June

Week 8: Monday 20^th June – Tuesday 21^st June

Week 9: Monday 27^th June – Tuesday 28^th June

Week 10: Monday 4^th July – Tuesday 5^th July

Week 11: Monday 11^th July – Tuesday 12^th July

SUMMER HOLIDAY: Wednesday 13^th July – Sunday 4^th September 2022

Term 3

Week 1: Monday 5^th September – Thursday 8^th September

Week 2: Monday 12^th September – Tuesday 13^th September

Week 3: Monday 19^th September – Tuesday 20^th September

Week 4: Monday 26^th September – Tuesday 27^th September

Week 5: Tuesday 4^th October

Week 6: Tuesday 11^th October

Week 7: Tuesday 18^th October

HALF TERM: Monday 24^th October – Friday 28^th October 2022 (Study Days)

Week 8 – Week 11: Dates TBC

Study Time

Trainees are required by National Guidance to have a minimum of 28 days study time in addition to taught hours. We have timetabled in 6 days study time during the 3 half terms for Cohort 15, and 6-8 days during the summer and two half-terms for Cohort 14. It is recommended that the remaining 22 (or 20) days are spread throughout the year, either as a half day each week or an arrangement that works best for the programme member and their employer.

Timetables can be located on the HI IAPT ELE page.

Information sent to Workplace Service Leads, Clinical Leads & Supervisors

For more details about information sent to Workplace Service Leads, Clinical Leads and Supervisors, please see: Information for Leads and Supervisors - 2022‌

‌‌Tutorials

Academic tutorials:

Cohort 14: Fridays 9.30am – 12.30pm (Group 1) / 1.30pm - 4.30pm (Group 2)

Cohort 15: Tuesdays 10.00 - 13.00 (Group 1) / 14.00 - 17.00 (Group 2)

Purpose

Opportunity to reflect on any homework set
Opportunity to review literature
Opportunity to ask questions, give and receive feedback
Opportunity to address any queries around assessments

Skills based tutorials:

Cohort 14: Fridays 9.30am – 12.30pm (Group 1) / 1.30pm - 4.30pm (Group 2)

Cohort 15: Tuesdays 10.00 - 13.00 (Group 1) / 14.00 - 17.00 (Group 2)

Purpose

To facilitate the development of clinical skills and enable the trainee to acquire the clinical competencies required to become an effective CBT therapist.
To consolidate learning from workshops and enable the trainee to practise the key clinical competencies relating to a wide variety of relevant theoretical models that have been explored in workshops.
To provide a regular opportunity for further skills practice, with a primary focus on experiential exercises, problem based learning and case based discussion.
To provide the opportunity to use self-reflection, self-practise and enquiry to enhance clinical skills.

Individual tutorials:

1 x half hour tutorial per term

Purpose

Opportunity to review and reflect on your development and the course
Opportunity to give and receive feedback on assessed work.
Opportunity to give and receive feedback on the course.
To review your clinical portfolio.
A safe environment for addressing personal development.

NB: If trainees have any concerns or issues that may be impacting on their ability to participate fully in the training or causing them any distress or concern; trainees are strongly encouraged to notify either their tutor or any member of the course team as soon as possible, rather than wait for their 1:1 tutorial.

Preparation:

Trainees are required to prepare for their 1:1 tutorials each term by completing and bringing(hard copy or electronic) the relevant documents:

Tutorial preparation form (see below)
Clinical log
Supervision logs (university and workplace)
Teaching log
Any other portfolio documents completed or started. See clinical portfolio section for further guidance.

Attendance

We expect your attendance to be 100% because absences can affect the quality of the learning experiences of the course. As such we do not expect you to take holidays when teaching has been scheduled. Should exceptional circumstances for leave arise, then any requests for absence must be made in writing to the programme leads and agreed prior to leave being taken.

For HI IAPT training less than 100% attendance can result in failure to meet BABCP requirements for individual accreditation.

If a programme member is ill for a prolonged period of time or other unforeseen circumstances intervene to prevent attendance then the staff team will attempt to negotiate an alternative package of teaching attendance so that the programme member can still meet the requirements. Each programme member is required to keep a log of their attendance at teaching sessions and completion of feedback on these sessions. They need to bring this to their termly individual tutorial where it will be reviewed by their individual tutor.

A register to record the attendance of each programme member will be taken at the beginning of each teaching session which will reviewed by the programme leads. This register can be located at the reception area of the Washington Singer building or the room the teaching is taking place if outside of this building, or will be recorded online when sessions are delivered remotely.

This register will also cover any university directed study days/sessions. If you miss any of the teaching days (both within and outside of the university) it is your responsibility to inform both your employer and the relevant university staff members. If you are off work on sickness absence please let your 1:1 tutor or a programme lead know this. You should NOT attend university sessions if you are off work on sickness absence unless you, your service and the university all agree this is appropriate and there is a clear rationale for this. if any of our sessions conflict with your religious events, please let us know so that we can make arrangements for you.

Missed Sessions

If trainees miss any teaching sessions (including Clinical Skills Tutorials) they should take the following actions:

Inform the programme leads (Karen Tate and Debbie Williams) and programme administrator as well as your employer
Read the teaching materials on ELE for the missed session(s)
Speak to peers about any practical/experiential exercises and ideally complete these in own time
Complete a 200-500 word reflection on learning points for each missed session, which will need to be included in the clinical portfolio in the 'Teaching Log' section
Please also send the reflection/s to your 1:1 Tutor within 4 weeks of the missed teaching. This will be reviewed and discussed in your next 1:1 tutorial
For cohort 15 trainees onwards, please evidence that you have taken all necessary steps using the 'HI IAPT Missed University Sessions Catch-Up Form' which is on the forms page of the handbook

Timekeeping

We expect your timekeeping on the programme to be rigorous. Timekeeping will be monitored and your employer will be informed of any recurrent lapses, either at the start or end of the day or returning from breaks. We maintain vigilance around this aspect out of consideration for the member of staff delivering the teaching session and for fellow programme members.

Programme Member Support

We recognise that the training course is likely to be stressful at specific points in the programme, due to course deadlines and/or personal circumstances. University attendance, clinical practice and independent study may at times be difficult to balance, and students may also have personal life events which may at times impact on stress levels and the ability to balance the demands of the course with other areas of their lives.

Within the training programme we hope to promote a mutually supportive atmosphere in which students feel able to share concerns and issues with one another, with the programme team and with their clinical supervisors. However, we recognise that the programme team and supervisors cannot necessarily provide all the support that may be required, and other sources of support may at times need to be accessed.

Students are encouraged to make use of the following support whilst on the course:

Programme Leads (Debbie Williams & Karen Tate): You are welcome to talk to the Programme Leads in the case of any difficulties you may experience, in relation to the course and/or any personal circumstances for which you will need support and which may impact on your ability to study. At times it may be useful for them to liaise with you workplace manager or clinical supervisor to discuss a supportive way forward.
1:1 Tutor: You can talk with your 1:1 tutor, either at your 1:1 tutorial or at any other time, if you begin to experience difficulties. In the event of significant difficulties that may impede your ability to study, your tutor may need to discuss this with the Programme Leads and with your workplace manager/clinical supervisor to discuss a supportive way forward.
Wellbeing Services: All students can access support through the University Wellbeing Services. More information can be found on the University wellbeing services web pages
Reed Mews Wellbeing Centre: There is also a University Wellbeing Centre that is free and confidential and available to all students. Appointments are available during term time by emailing wellbeing@exeter.ac.uk and a reduced service is offered during the vacation (tel 01392 264381).
Email Counselling: A professional online counselling is available to all students during term time. Students can get in touch by following this link: e-counselling@exeter.ac.uk. More details on how the service works are then forwarded to anyone expressing an interest. This facility can be particularly helpful for students who can't easily attend sessions in person or don't want face-to-face counselling.

University Buddy System

Your buddy is a previous trainee (so someone who has been through their IAPT training at Exeter University and might know something about what you are experiencing at what stages of the training); they will be familiar with the various aspects of the trainee role and be familiar with the roles of the workplace and university staff. They are a point of contact and may be able to offer some guidance/advice or signpost you to the appropriate person who might help you. They are someone who can comprehend the high and low points of being a trainee. A buddy may be someone who you contact once or twice a term, or not at all. They are not a substitute or alternative to support arrangements that are in place, but can be a good sounding board. The university 1:1 tutor is the main point of contact for difficulties with training and tutors are there to help and support, please do not hesitate to contact your tutor where this would be helpful.

Reading Lists

Books and articles:

*Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.

Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective. Basic Books.

*Beck, J. S. (2020). Cognitive therapy: Basics and beyond (3rd Ed.). Guilford Press.

Beck, J. (2005). Cognitive therapy for challenging problems: What to do when the basics don’t work. Guilford Press.

*Bennett-Levy, J., Butler, G., Fennell, M., Hackmann, A., Mueller, M., & Westbrook, D. (2004). Oxford guide to behavioural experiments in cognitive therapy. Oxford University Press.

Bennett-Levy, J., Thwaites, R., Haarhoff, B., & Perry, H. (2015). Experiencing CBT from the inside out: A self-practice/self-reflection workbook for therapists. Guilford Press.

Bream, V., Challacombe, F., Palmer, A., & Salkovskis, P. (2017). Cognitive behaviour therapy for OCD. Oxford University Press.

Butler, G., Fennell, M., & Hackmann, A. (2008). Cognitive behavioural therapy for anxiety disorders: Mastering clinical challenges. Guilford Press.

Clark, D. A., Beck, A. T., & Alford, B. A. (1999). Scientific foundations of cognitive theory and therapy of depression. Wiley.

Clark, D. A. (2019). Cognitive behavioural therapy for OCD and its subtypes. Guilford Press.

Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461-470.

*Clark, D. M. (1999). Anxiety disorders: Why they persist and how to treat them. Behaviour Research and Therapy, 37, 5-27.

Clark, D. M., & Fairburn, C. G. (Eds.). (1997). Science and practice of cognitive-behaviour therapy. Oxford University Press.

Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., . . . Jacobson, N. S. (2006). Randomized trial of behavioural activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658-670.

Ehlers, A., & Clark, D. M. (2000). A cognitive model of post-traumatic stress disorder. Behaviour Research and Therapy, 38, 319-45.

Gilbert, P. (2000). Overcoming depression: A self-help guide using cognitive-behavioural techniques (2nd Ed.). Robinson.

Gilbert, P, & Leahy, R. L. (Eds.). (2007). The therapeutic relationship in the cognitive behavioural psychotherapies. Routledge.

Haarhoff, B., & Thwaites, R. (Eds.) (2016). Reflection in CBT. Sage.

*Hawton, K., Salkovskis, P. M., Kirk, J., & Clark, D. M. (Eds.). (1989). Cognitive-behaviour therapy for psychiatric problems. Oxford University Press.

Heimberg, R. G., Liebowitz, M. R., Hope, D. A., & Schneier, F. (Eds.). (1995). Social phobia: Diagnosis, assessment and treatment. Guilford Press.

Kazantzis, N., Deane, F. P., Ronan, K. R., & L’Abate, L. (2005). Using homework assignments in cognitive behavior therapy. Routledge

*Kennerley, H., Kirk, J., & Westbrook, D. (2017). An introduction to cognitive behaviour therapy: Skills and applications (3rd Ed.). Sage

Leahy, R. L. (Ed.). (2003). Overcoming resistance in cognitive therapy. Guilford.

Leahy, R. L. (Ed.). (2006). Contemporary cognitive therapy. Guilford.

Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). Depression in context: Strategies for guided action. Norton.

Martell, C.R., Dimidjian, S., & Herman-Dunn, R. (2010). Behavioral Activation for depression: A clinician’s guide. Guilford Press.

Milne, D. (2008). Discovering CBT supervision. Wiley, Blackwell.

Moore, R. G., & Garland, A. (2003). Cognitive therapy for chronic and persistent depression. Wiley.

Roth, A., & Fonagy, P. (2005). What works for whom: A critical review of psychotherapy research (2nd Ed.). Guilford Press.

Tarrier, N. (Ed.). (2006). Case formulation in cognitive behaviour therapy: The treatment of challenging and complex cases. Routledge.

Safran, J. D., & Muran, J. (2000). Negotiating the therapeutic alliance: A relational treatment guide. Guilford.

*Salkovskis, P. M. (Ed.). (1996). Frontiers of cognitive therapy. Guilford Press.

Short, N., Grant, A., Mills, J., & Mulhern, R. (2004). Working with people who are anxious. In A. Grant, J. Mills, R. Mulhern & N.Short (Eds.). Cognitive behavioural therapy in mental health care. Sage.

*Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Wiley.

*Whittington, A., & Grey, N. (Eds.) (2014). How to become a more effective CBT therapist: Mastering metacompetence in clinical practice. John Wiley & Sons Ltd.

Whisman, M. A. (Ed.). (2008). Adapting cognitive therapy for depression: Managing complexity and co-morbidity. Guilford Press.

Williams, J. M. G. (1992). The psychological treatment of depression: A guide to the theory and practice of cognitive behaviour therapy (2nd ed.). Routledge.

Wills, F., & Sanders, D. (1997). Cognitive therapy: Transforming the image. Sage.

Useful websites and links

Supervision

Throughout the course trainees receive supervision from course supervisors within the university and from their workplace based supervisors. Please see separate Supervision Guide for details of supervision and link to Using Supervision Competences. Should there be any difficulties that arise within your supervisory relationship, in the first instance please try to work with your supervisor to address these. If difficulties continue, please discuss this with your 1:1 tutor, Clinical Lead or Programme Lead.

Competences Document - Ability to make use of Supervision

If you are a Cohort 14 trainee, please see the Supervision Guide 2021.

As part of the programme you will receive two hours of university-based group supervision a week, which will be held either at 10.30am - 12.30pm on Tuesday mornings or at 2.30pm – 4.30pm on Tuesday afternoons in Terms 1 & 2 and on Tuesday morning 11am - 1pm or Tuesday afternoon 3 - 5pm in Term 3. You will also receive regular individual supervision from your workplace supervisor. Over the course of the year you need to have received a minimum of 70 hours of supervision and 200 hours of supervised CBT practice.

Please note that when calculating your supervision hours for your Clinical Portfolio, it is recognised that time spent in group supervision offers greater value than simply calculating the time spent on an individual’s case, and dividing the overall time spent in the group by the number of participants.

The BABCP recommends using the following two calculations:

1: Time spent discussing a particular case in group supervision is multiplied by two.
For example, if there are three participants in a two-hour group, 30 minutes might be spent discussing each case.

30 minutes x 2 = 60 minutes’ equivalent case supervision time.

This calculation should be used for the ‘Client Summary Sheet’ and also on the ‘Overall Summary Sheet’. (see Clinical Portfolio webpages).

2: Overall group clinical supervision equivalent time is calculated in the following way:

The time spent in the group is divided by the number of participants in the group, and this time is then doubled.
For example, if there are 3 participants in the group, and the group meets for two hours; the formula would be

2 hours divided by 3 people = 40 minutes x 2 = 1 hour 20mins equivalent group supervision time.

This calculation should be used for the ‘Supervision Log’. (see Clinical Portfolio webpages).

By the end of the course, you need to have seen at least 8 completed cases (seen for 5 sessions or more from start to completion/termination of treatment) and have received 5 hours minimum of supervision, from a supervisor who is a BABCP accredited therapist, on each of these cases. The University will provide the supervision for up to 3 of these cases and there should be a focus on one client per term.

3 of these 8 cases must be closely supervised. This means they will need to have been formally assessed using video or live practice observation of your clinical sessions and assessed by the university to be to a reasonable standard of CBT competency in accordance with the Cognitive Therapy Scale – Revised (CTS-R). There will be a Formative CTS-R assessment of your CBT competencies in Assessment & Formulation skills at the end of term 1. There will a Summative CTS-R assessment of a full therapy session demonstrating CBT competencies at the end of Term 2, the middle of Term 3 and at the end of Term 3. 1 of the 3 closely supervised cases must be a client with PTSD.

Your Supervisors

University - there will be a rotation of University Supervisors so that you will have one supervisor for Term 1 and another Supervisor for the duration of Terms 2 & 3. Your University Supervisor will provide you with intensive skills-based supervision, helping to develop your CBT competencies. They will supervise up to 3 clients over the year.

Workplace - your workplace based supervision will involve skills-based and caseload supervision. The workplace supervisor will hold an overview of all your clinical cases. They will also support you in applying CBT theory to your cases and will be able to support you in working in your clinical setting and dealing with clinical issues such as risk.

Both University and Workplace supervisors will be providing a dual function in their role as supervisor. They will facilitate your development as Cognitive Behavioural Therapists through skills-based supervision. They will also assess your competency as a CBT therapist via CTS-R assessment and provide Supervisor Reports at the end of each term (see Supervisor Report for details of competencies being assessed). They will be offered training in the requirements of supervision and the clinical assessment associated with the programme and will also be offered ongoing continued professional development (CPD) in CBT supervision.

Both your Workplace and University based clinical supervisors will liaise about your progress at least once per term. They are requested to attend the Leads and Supervisors Meeting held at the university each term and may liaise again around the time of preparing your Supervisor Reports.

We have provided a supervision contract for you and both your supervisors to work through during your initial meetings to help you discuss and agree the nature and content of your supervision (see Supervision Contract). This will form the Supervision Contract between yourself, University Supervisor and Workplace Supervisor. You are responsible for ensuring the contract is completed, signed and presented in your clinical portfolio.

Supervision Feedback

We have provided the Helpful Aspects of Supervision Questionnaire (HASQ, Milne 2008) supervisee feedback form on supervision which can be a useful tool to help you review supervision with your supervisor. During each term we ask you to provide feedback to your supervisor by using the Supervisory Relationship Questionnaire (SRQ, Palomo et al 2010). At the end of each term, we ask you to provide feedback on your experience of supervision for that term on Accelerate. If you have any concerns about your cases or supervision please do raise these with your supervisors in the first instance.

Your Role as Supervisee

In addition to filling in the clinical and supervision logs and reports, you will also need to think about your role as a supervisee. This will include coming prepared for your supervision (see Supervision preparation form and Supervision template); preparing a Supervision Question; reviewing recordings of sessions in advance and locating the section of the recording that relates to the Supervision Question, supervision goal/CBT skill you are wanting to develop; keeping notes on discussions in supervision and carrying through jointly agreed action points (see Record of supervision). In addition to preparation time during the week, you will have 1 hour dedicated to supervision preparation prior to your supervision session each week, from either 9.30 - 10.30am for morning supervision groups and 1.30 – 2.30pm for afternoon supervision groups (10 - 11am and 2-3pm in Term 3). Consent to record forms for clinical and supervision sessions are included below.

In order to develop a reflective approach to the work you carry out and link theory, practice and supervision, a Reflective Practice log can be used to aid you in this process. Additionally, this may help you when writing your Case Reports and CTS-R Reflections (see course handbook) as you will have ongoing records of learning experiences from teaching, SP/SR blogs, your clinical work and your discussions/experience in supervision.

Assessment of Clinical Practice & Supervision Reports

Supervision Reports

At the end of terms 1 and 2 both university and workplace supervisors will complete formative supervisor’s reports. You will need to submit these at the end of terms 1 and 2. You must submit your supervisor reports via PDF document via Turnitin. Please note that all supervisors reports must be hand-signed and you should keep the original copies of your reports.

Clinical Portfolio

At the end of the course each programme member is required to submit a clinical portfolio which will include: your supervision contract, Summative University and Workplace Supervisors' Reports and Supervision Logs.

Formative Supervision Reports - Terms 1 and 2

To assist with assessment of your ability to use supervision and your competence, strengths and areas for improvement, the adapted Dreyfus scale (1989), as used with the CTS-R (2001), will be used as a guide to facilitate feedback on competency.

Incompetent: The therapist commits errors and displays poor and unacceptable behaviour, leading to negative therapeutic consequences.
Novice: At this level the therapist displays a rigid adherence to taught rules and is unable to take account of situational factors. He/she is not yet showing any discretionary judgement.
Advanced Beginner: The therapist treats all aspects of the task separately and gives equal importance to them. There is evidence of situational perspective and discretionary judgement.
Competent: The therapist is able to see the tasks linked within a conceptual framework. He/she makes plans within this framework and uses standardised and routinised procedures.
Proficient: The therapist sees the patient's problems holistically, prioritises tasks and is able to make quick decisions. The therapist is clearly skilled and able.
Expert: The therapist no longer uses rules, guidelines or maxims. He/she has deep tacit understanding of the issues and is able to use novel problem solving techniques. The skills are demonstrated even in the face of difficulties (e.g. excessive avoidance).

Guidance on the use of Supervision

In order to ensure that you make the most effective use of supervision we suggest you read this guide and the criteria included within the supervisors’ reports. In addition we have included below some suggested content of supervision and supervision methods and topics. Please also see the suggested plan for supervision sessions over the course above.

Content of supervision

Content of supervision will focus on acquisition of knowledge, conceptualisation and clinical skills within a cognitive behavioural model(s)
Associated issues will also be discussed when it is relevant to do so e.g. medication, hospitalisation, case management
Identification (and collaborative change of these if appropriate) of supervisee thoughts, attitudes, beliefs and values and the impact of these on therapeutic and professional behaviour
Discussion and working through relationship and process aspects of supervision

Supervision methods and topics

Discussion of therapeutic relationship and engagement issues
Case conceptualisation/formulation
Rehearsal of therapeutic techniques e.g. simulation, role-play
Discussion about therapeutic strategies
Case Presentations
Homework
Review of video recordings
Direct observation of practice
Identification of supervisee thoughts, attitudes, beliefs with exploration of the impact of these on therapeutic and professional behaviour
Review of risk and therapist/service user safety
Review of clinical guidelines/manuals/protocols
Review of psychoeducational material
Experiential exercises
Reflective practice
Other strategies as agreed