(PS10-96) Enhancing CBT Competency with the Application of the Cognitive Therapy Rating Scale-Revised in a Telehealth Training Environment

Abstract Text: Empirically-based supervision methods are essential to training student therapists to implement CBT with fidelity and competency. Direct observation either through live supervision or the review of video/audio recordings is recognized as a best practice in assessing trainee performance. Furthermore, the use of an adherence rating scale has been found to be an effective tool for providing structured feedback to trainees during observation. One of the most widely used adherence scales is the Cognitive Therapy Scale by Beck and Young (1980). A recent revision of the measure, the Cognitive Rating Scale-Revised (CTRS-R; Miller, 2022) has addressed subjectivity in scoring by providing clearer behavioral anchors for the 11 core components of CBT that should be performed in each session: action plan, agenda, application of CBT techniques, collaboration, feedback, focus on key cognitions, guided discovery, interpersonal effectiveness, pacing and efficient use of time, strategy for change and understanding. The CTRS-R total score ranges from 0 to 33 with a score of 22 indicating “moderate skill,” the minimum requirement for competency.

The purpose of this study was to evaluate the viability of providing live observation using the CTRS-R to masters-level marriage and family therapy students in their first year of training in an HMO counseling practicum clinic. The supervisor was a licensed marriage and family therapist with 3 years of supervisory experience who had completed a continuing education workshop in the use of CTRS-R at the Beck Institute. Four trainees were observed and rated in real-time by the supervisor while conducting CBT with adult patients via telehealth over the 12-month practicum period. The most common diagnoses treated were depressive and anxiety disorders. Trainees were given verbal feedback on in-session skills immediately after the video visit as well as detailed written and visual feedback in weekly one-hour individual supervision meetings. The feedback included graphs of CTRS-R item and summary scores accompanied by coaching on competencies mutually identified by the trainee and supervisor as needing improvement. Trainees also participated in weekly small group supervision meetings and weekly group didactic instruction on CBT theory and strategies as part of the clinic’s standard practicum curriculum. This study will report on trainees’ individual CTRS-R summary scores over time demonstrating competency gains; qualitative feedback from trainees on the supervisory process, and issues related to the implementation of this new supervisory method in our training clinic.