COMPETENCY IN CONDUCTING COGNITIVE–BEHAVIORALTHERAPY: FOUNDATIONAL, FUNCTIONAL, AND

SUPERVISORY ASPECTS

CORY F. NEWMANUniversity of Pennsylvania

The delivery of cognitive–behavioraltherapy (CBT) is described in terms offoundational and functional competen-cies, with additional attention paid tohow these skills are applied in clinicalsupervision. Foundational competenciesinclude such qualities as ethical behav-ior, good interpersonal relational skills,a healthy capacity for self-awarenessand self-correction, cross-cultural sen-sitivity, and an appreciation for theempirical basis of clinical procedures.Functional competencies include theability to think like an empiricist and toteach clients to do the same, to concep-tualize cases in terms of maladaptivebeliefs and behavioral patterns, tostructure sessions in an organized andtime-effective manner, and to assignand review homework assignments.CBT supervisors have the multiple re-sponsibilities of serving as professionalrole models for their supervisees, nur-turing the latter’s professional develop-ment (although also being ready toidentify and remediate problems in thesupervisee’s performance), and engag-ing in ongoing self-improvement andeducation to function most effectively asclinical mentors. A brief, descriptivesupervisory vignette is presented.

Keywords: competence, supervision,empirically supported, cognitive–behavioral, techniques

Attaining and maintaining professional compe-tency is a core value in the field of psychology(American Psychological Association, 2002).Clinicians are expected to receive appropriateeducation and supervision, to strive to provide ahigh standard of care to clients, to be mindful oftheir responsibilities to society at large, and toengage in continuing education over the years.Competent psychotherapy requires an integrationof up-to-date knowledge of diagnostics, assess-ment methods, and interventions, interpersonalrelational and communication skills, sense of tim-ing, ethical judgment, self-awareness, acumen incollaborating with clients and colleagues alike,sensitivity toward diversity issues, and a respectfor scientific methods of inquiry, among otherqualities (Kaslow, 2004).

The “Cube” Model

A positive development in the conceptualiza-tion of psychotherapy competency has been theformulation of the “cube model” (Rodolfa, Bent,Eisman, Nelson, Rehm, & Ritchie, 2005), whichexamines expertise in conducting psychotherapyacross three dimensions. In brief, these dimen-sions include foundational competencies that cutacross all modalities of psychotherapy and com-prise the broad concept of “professionalism,”such as adherence to ethical standards, a willing-ness to self-reflect and self-correct, cross-culturalsensitivity as it pertains to interacting with clientsand supervisees, and interdisciplinary collabora-tion. The functional competencies have more todo with specific skills and knowledge, such asassessment and diagnosis, conducting supervi-sion, and (especially in the case of cognitive–behavioral therapy; CBT) the ability to structuresessions, teach clients to perform rational reeval-

Cory F. Newman, Center for Cognitive Therapy, Univer-sity of Pennsylvania.

Correspondence regarding this article should be addressedto Cory F. Newman, Center for Cognitive Therapy, Univer-sity of Pennsylvania, 3535 Market St., Second Floor, Phila-delphia, PA 19104. E-mail: psydoc@mail.upenn.edu

Psychotherapy Theory, Research, Practice, Training © 2010 American Psychological Association2010, Vol. 47, No. 1, 12–19 0033-3204/10/$12.00 DOI: 10.1037/a0018849

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uations exercises, conceptualize cases in terms ofdysfunctional beliefs and behavioral patterns, andassign and review homework assignments thathelp clients learn durable self-help skills. Thedevelopmental dimension of the cube pertains tothe practitioner’s stage of training and experi-ence. It has been argued that the measure of apsychotherapist’s competence should not be as-sessed solely at one point in time, as is often thecase when the licensing examination is the pri-mary benchmark (Lichtenberg et al., 2007).Rather, emphasis should be placed on assessingcompetency in such a way that it is both com-mensurate with the therapist’s experience level(e.g., graduate student or psychiatry resident,postdoctoral fellow, newly licensed practitioner,in practice for many years, in charge of the train-ing and supervision of other clinicians, etc.), andfacilitative of the value of lifelong learning(Kaslow, Rubin, Bebeau, et al., 2007).

Competency and Cognitive-BehavioralTherapy

Inherent in the quest to deliver CBT compe-tently is the priority given to conducting clinicalprocedures that have been shown to be empiri-cally efficacious, or at least are promising enoughto be in the process of being evaluated as such.Examples of such methods include behavioralactivation (e.g., Dimidjian, Martell, Addis, &Herman-Dunn, 2008) and rational reevaluation(e.g., Strunk, DeRubeis, Chiu, & Alvarez, 2007;Tang, Beberman, DeRubeis, & Pham, 2005) fordepressed clients, graded anti-avoidance exer-cises and interoceptive exposures for clients withpanic disorder (e.g., Addis et al., 2006), exposureand response prevention for the rituals ofobsessive– compulsive disorder (Wilhelm &Steketee, 2006), repeated processing of traumamemories combined with rational reevaluationfor posttraumatic stress clients (e.g., Resick,Monson, & Rizvi, 2008), and an extensive list ofothers. These CBT procedures are most compe-tently delivered when therapists collect clinicaldata as a routine part of treatment, conductwell-organized and time-effective therapy ses-sions, teach clients self-monitoring and copingskills both in session and via homework assign-ments, offer empathy and support while em-powering the clients via the transfer of skills,and explicitly aim to help clients maintain their

gains long after therapy has concluded (New-man & Beck, 2009).

A wealth of outcome data on a wide range ofcognitive–behavioral treatments paints an ex-tremely promising picture (Butler, Chapman,Forman, & Beck, 2006), though much work stillneeds to be done to find ways to help clients whoare “nonresponders” to otherwise empiricallysupported treatments (Coffman, Martell, Dimid-jian, Gallop, & Hollon, 2007). The fact that thereare so many applications of CBT designed spe-cifically for so many clinical problems and clientpopulations (see Butler et al., 2006), along withthe clinical reality that some clients are difficultto help sufficiently or to retain in treatment, be-gins to shed some light on the difficulties indefining competence in CBT. It is nearly impos-sible even for seasoned clinicians (much lesstherapists-in-training) to master literally dozensof separate (though related) treatment protocols(Dobson & Dobson, 2009). Further, though com-petency in doing CBT has been found to bepositively related to client responsivity (Kuyken& Tsivrikos, 2009; Trepka, Rees, Shapiro, Hardy,& Barkham, 2004), client characteristics still ac-count for a significant proportion of the variancein outcome (Garfield, 1994). Nonetheless, thereare identifiable benchmarks of competence in thedelivery of CBT that make it more likely thatclients will get the maximum benefits of theapproach, the likes of which will be reviewedbelow.

Foundational Competency in CBT

The following is a brief, nonexhaustive sum-mary of some of the key foundational competen-cies of conducting CBT. Although such compe-tencies typically cut across all modalities ofpsychotherapy, it is useful to illustrate their ap-plication within a specific orientation such asCBT.

Respecting and Understanding the ScientificUnderpinnings of the Treatment

Competent CBT practitioners have a fund ofknowledge regarding the scientific foundations ofcognitive theory of psychological disorders,while at the same time being aware of the limitsof the knowledge base in the field (Clark, Beck,& Alford, 1999). They familiarize themselvesand keep up-to-date with studies on CBT meth-

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ods and outcomes for a range of clinical prob-lems, and stay abreast of empirical developmentson concepts such as cognitive styles, selectiveattention and recall, and schemas, among others.The competent CBT therapist brings a healthyskepticism to bear on his or her own work, beingever mindful of the need to test hypotheses in themanner of a skilled social scientist.

Skill in Managing the Therapeutic Relationship

Although CBT has garnered a stellar reputa-tion as providing a plethora of useful therapeutictechniques, it is also true that the therapeuticrelationship is of central importance in CBT (Gil-bert & Leahy, 2007). There is recent evidencethat the foundational competencies involved inbuilding the therapeutic alliance and the func-tional competencies of CBT case formulation andinterventions interact in compelling and unex-pected ways. For example, in an outcome studyof CBT for clients with avoidant personalitydisorder and obsessive–compulsive personalitydisorder, the most favorable outcomes tended tooccur in clients who experienced significant alli-ance strains with their therapists but then re-solved them favorably and completed the treat-ment protocol (Strauss et al., 2006). In addition,there is evidence that clients who are depressedand who learn the specific skills of CBT and thenuse them to gain some symptomatic relief oftenfind that their therapeutic relationship improvesas a result (DeRubeis, Brotman, & Gibbons,2005; Feeley, DeRubeis, & Gelfand, 1999). Theendeavors involved in the technical skills of CBTand the maintenance of a positive therapeuticrelationship seem to act in a positive feedbackloop (Newman, 2007).

Cultural Competency

The concept of cultural competency is beingincreasingly recognized as a critical skill for psy-chotherapists to appreciate and develop (seeTseng & Streltzer, 2004). For example, culturallycompetent Anglo American CBT therapists mayunderstand that it is not necessarily a sign ofexcessive dependency for a man of East Asianethnicity in his 20s to live with his parents.Rather, he may be fulfilling an important culturalrole—that of filial piety. Thus, the CBT therapistwill not jump to the conclusion that the client’sbelief that “I must be close to my parents and take

care of them” is necessarily dysfunctional. Thissame therapist may ascertain that the use of So-cratic questioning with logical conclusions (awell-known feature of CBT) may miss the markwith this client, as an East Asian man may bemore receptive to a less linear discussion of thecontradictions that are inherent in one’s inner andouter life (see Nisbett, 2003).

Intercollegial, Interdisciplinary Collaboration,and Consultation

Yet another related area of foundational com-petence has to do with the knowledge and facilityto interact in a collegial, synergistic manner withhealth care professionals from other disciplines(Kaslow, Dunn, & Smith, 2008). For psycholo-gists, this can mean consulting in a constructiveand mutually enlightening manner with the pre-scribing psychiatrist on a shared case, coordinat-ing with nursing staff in the logistics of a grouptherapy session on an inpatient ward, and brain-storming with social work professionals in theproper disposition of cases, including referrals toadjunctive services and treatments.

There is a growing trend toward applying theempirically supported methods of CBT in closecoordination with primary care physicians andsettings (DiTomasso, Golden, & Morris, 2010).This represents a promising use of the field’sknowledge of the “mind–body connection” at thelevel of professional systems, with the promise ofcompetent use of CBT principles to assist physi-cians with patients who evince unhealthy life-styles, addictions, underlying mood disorders,nonadherence to medical advice, and other rele-vant problems in primary health care.

Functional Competencies of CBT

An overarching aspect of becoming an effec-tive, competent CBT therapist is learning how tothink like an empiricist. Collecting clinical datavia reliable, valid means, generating and testinghypotheses, and devising sensible interventionsbased on these hypotheses are central features ofbeing an empirically sophisticated clinician. Inaddition, one of the hallmarks of CBT is teachingthe clients themselves to think more empirically.For example, the competent CBT therapist helpsclients learn to make important distinctions be-tween subjective impressions and objective evi-dence, to self-monitor relevant aspects of their

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own functioning, to reduce the tendency to drawcausal inferences from correlational circum-stances, and to devise hypotheses that can betested systematically via behavioral experimentsand other appropriate means.

One of the clearest examples of clinical empir-icism is the clinician’s formulation of a caseconceptualization as a set of hypotheses (Kuyken,Padesky, & Dudley, 2009) that are subject totesting and revision as new information is soughtand attained. Similarly, the empirically mindedCBT therapist does not jump to the conclusionthat his or her CBT techniques (as summarizedbelow) are in fact helping the clients withoutconsidering alternative hypotheses, and withoutusing measures of progress that are suitably reli-able, valid, or otherwise corroborated.

Core Techniques

In CBT, there are some core techniques thattherapists need to practice and master to teachthem to their clients, including:

● Self-monitoring (to take data on their mostsalient situations, thoughts, behaviors, emo-tions, and outcomes).

● Asking “guided discovery” questions to ratio-nally reevaluate the automatic thoughts thatproduce unwarranted distress.

● Practicing new ways of functioning via role-playing in session and designing homeworkassignments such as behavioral experiments.

● Scheduling activities that have a reasonablechance to stimulate enjoyment and/or a senseof accomplishment.

● Relaxation and controlled breathing exercisesto reduce hyperarousal (as in cases of excessiveanxiety, fear, or anger), sometimes in the con-text of exposure to avoided situations or expe-riences, either in vivo or via guided imagery.

● Practicing and reviewing old skills and oldhomework assignments in novel situations toincrease the chances of therapeutic mainte-nance.

Similarly, CBT therapists need to be able toreflect on their own skills regarding the above,and to keep them fresh so as to be of maximalfluency when it comes time to impart them toclients (Bennett-Levy, 2006). In keeping with thecollaborative philosophy of CBT, therapistsshould be able to be directive through asking

guided discovery questions and by humbly pos-ing hypotheses, rather than being too passive atthe one extreme, or too authoritarian at the other.

There are a multitude of additional CBT tech-niques that can be creatively derived from thecore techniques mentioned above. A review ofsuch techniques goes beyond the scope of thispaper, but the reader is referred to recent worksthat extensively explicate the full range of clini-cal strategies in the CBT repertory (e.g., Bennett-Levy et al., 2004; Freeman, Felgoise, Nezu,Nezu, & Reinecke, 2005; Leahy & Holland,2000; O’Donohue, Fisher, & Hayes, 2008). Ther-apists who become facile in the appropriate andtimely delivery of these techniques will be well-positioned to do highly competent CBT, if per-formed within the context of a collaborative ther-apeutic relationship and an accurate caseconceptualization (Newman & Beck, 2009).

Attaining and Maintaining FunctionalCompetency in CBT

The importance of quantity of practice shouldnot be overlooked. Good CBT therapists shouldendeavor to practice their methods as much aspossible. Having a large, active caseload is oneway to achieve this goal over time, but it is just asplausible to improve competency via extensiverole-playing (e.g., in supervision), and via theself-application of CBT techniques.

Even among experienced CBT therapists,straying from the active procedures occurs all toofrequently, a phenomenon known as therapist“drift.” In describing this problem, Waller (2009)hypothesizes that CBT therapists sometimes en-gage in “safety behaviors,” as they reason that theclient needs to feel better in the short term as thetop priority, and that the rigorous activities ofCBT are prohibitively stressful despite the longterm benefits. Although this may be true at givenmoments in a session, it sometimes mistakenlybecomes a therapist’s general rule. The belief thatthe clients will not be able to handle or cope withCBT techniques leads therapists to revert mostlyto supportive, nondirective methods, with the re-sult that CBT is watered down. This will riskreducing the effectiveness of the treatment (in-cluding attenuating long-term maintenance ofgains), as well as risking that the therapist will get“out of shape” in doing the more challengingactivities of CBT such as exposure exercises,cognitive restructuring, relaxation and guided im-

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agery, graded tasks assignments, and the assign-ing of homework. To develop and maintain ex-pertise in a complicated task, whether it issurgery, sports, the performing arts, or CBT,there is no substitute for regular practice (Levitin,2006).

According to a comprehensive report compiledby Roth and Pilling (2007) for the Department ofHealth in the United Kingdom, a competent ther-apist is respectful of the theory, rationale, struc-ture, and procedures of a CBT manual for a givendisorder and/or population, but is not restrictedby a sense of rigid mandate to conduct a “one sizefits all” treatment. As the authors noted

most of our competence lists for problem-specific interven-tions include an important metacompetence—the ability tointroduce and implement the components of a program in amanner which is flexible and which is responsive to the issuesthe client raises, but which also ensures that all relevantcomponents are included. (p. 19)

Competencies in the CBT SupervisoryProcess

Supervisors have multiple responsibilities, asthey must be mindful of the well-being of theclients, while simultaneously assisting their su-pervisees (the therapists of these clients) in learn-ing the skills to become independent practitionerswho can deliver competent care. These are chal-lenging concurrent tasks, and yet the field ofpsychotherapy has been slow to formalize thetraining of supervisory skills (Falender &Shafranske, 2007).

Foundational Competencies in CBT Supervision

Even a short overview of some of the founda-tional skills required of psychotherapy supervi-sors demonstrates the high level of professionalfunctioning that is required. In the area of culturalcompetence, supervisors need to be aware notonly of the special considerations for (and clini-cal implications of) treating clients of varyingethnic backgrounds, but also how these samefactors may affect the supervisory relationship.At a minimum, supervisors need to be prepared toinitiate discussions about diversity in supervision,as this modest step alone has been shown toimprove the supervisory relationship (Falender &Shafranske, 2007). Supervisors also must bemindful of the power they wield in the lives oftheir trainees, in that their summative evaluations

of the novice therapists’ performance may have asignificant impact on the trajectory of the latter’scareer (Kaslow, Rubin, Bebeau, et al., 2007).Thus, supervisors must rise to the occasion interms of creating, communicating, and sustaininga safe, growth-enhancing climate in which theirsupervisees can learn optimally to conduct ther-apy more and more competently. At the sametime, supervisors have a very real responsibilityto spot serious problems and deficits in theirsupervisees’ performance, to address themovertly toward the goal of remediation, and toserve as professional gatekeepers to protect thepublic in the event that the supervisee is unable orunwilling to make the necessary improvements intheir professional behavior (Kaslow, Rubin, For-rest, et al., 2007).

Additional foundational competencies thatclinical supervisors must demonstrate include(but are not limited to) being role models forethical decision making, engaging in ongoingself-education about developments in the field,maintaining boundaries so that supervision doesnot morph into the personal therapy of the super-visee, and being adept at interdisciplinary collab-oration and consultation (such as when the super-visor and supervisee both are psychologists, butthe client is also seeing a pharmacotherapistwhose input is needed). The supervisor also mustpossess a facile knowledge of diagnostics andrelated assessment, maintain records of supervi-sion, assume responsibility for the care beingreceived by the clients, and keep up-to-date inproviding supervisees with evaluative feedbackon their performance and progress.

Functional Competencies in CBT Supervision

In terms of CBT-specific functional skills, su-pervisors have to teach their trainees how toconceptualize cases in CBT terms (Kuyken et al.,2009), to direct the trainees toward resources(literature, videos, conferences) that will intro-duce them to a full range of technical skills, andto provide them with opportunities to practicesuch skills (e.g., role-playing in supervision ses-sions, participation in special training sessionsand/or treatment studies).

Supervisors periodically listen to their super-visees’ recorded sessions with their clients so asto provide the supervisees with highly specificfeedback that potentially has maximum instruc-tional value (Beck, Sarnat, & Barenstein, 2008;

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Newman & Beck, 2008). To give their supervis-ees quantitative and qualitative ratings, supervi-sors often use the Cognitive Therapy Scale (CTS:Young & Beck, 1980), which captures the essen-tial “required elements” of a typical cognitivetherapy session, along with the therapist’s profi-ciency (on a well-described, well-anchored scaleof 0–6) in implementing each of these elements.Items include setting an agenda, collaboration,focusing on key cognitions and behaviors, under-standing, strategy for change, eliciting feedback,reviewing and assigning homework, and others.It should be noted that the criterion of setting anagenda is particularly important as a means bywhich to assess how well the session is struc-tured. The CTS has had a major, longstandinginfluence on how CBT therapists have beentrained, and no other extant measure has been assuccessfully validated against clinical outcomes(Trepka et al., 2004).

Sample CBT Supervision in Action

The following, brief dialogue between a super-visor and supervisee serves as an illustration,with parenthetical commentary in italics beloweach statement to explicate the competencies thatare being addressed in the supervision session.

Therapist: My client, Mr. B., typically fails to do his home-work. He says things such as, “I know I should do it, but I justnever follow through. Why do I do that?” It’s as if he isputting the burden on me to explain his noncompliance. I feelstuck, and frustrated with this case. (The therapist is assigninghomework—a functional competency in CBT—but feels sty-mied in managing the client’s avoidance of the homework).

Supervisor: I totally understand. You are working hard to helpthis client, spending time devising well-conceptualized home-work assignments that fit his needs, and giving Mr. B. goodinstructions and a rationale, yet he habitually fails to do thework and instead behaves in a helpless manner time aftertime. No wonder you feel frustrated. (The supervisor exer-cises the foundational skill of being supportive of the trainee,giving positive feedback regarding the various ways in whichthe trainee is successfully utilizing functional competencies,and being empathic about the unexpected difficulties).

Therapist: Sometimes I seriously wonder if I should just giveup on trying to give him homework altogether. (The therapistfeels safe enough in the supervisory relationship to reveal herpessimism about continuing with an important part of thetreatment plan).

Supervisor: Instead of stopping the homework, let’s try toconceptualize what is going on with Mr. B. by hypothesizingthe schemas that may underlie his therapy-interfering behav-iors. (The supervisor nicely recommends an alternative strat-egy that requires the therapist to use conceptual skills, a

functional competency with special reference to the schema-focus of CBT case formulation).

Therapist: I have already tried to offer hypotheses to Mr. B.,such as saying that maybe the thought of trying to do hishomework activates his sense of incompetency, but when Iask for his feedback on the matter he just says, “I don’t know,you’re the expert.” (The therapist has tried to take a concep-tual approach to understand the client’s nonadherence, butstill feels blocked).

Supervisor: I think you and I can brainstorm some ways to getpast this roadblock. Anecdotal experience tells us that whenwe ask highly avoidant clients difficult, probing questions,their modal answer is “I don’t know.” The question is, “Whatcan we do with this?” If we can find ways to encourage andreinforce your client to do more of the work in therapy, wemay find that not only will his avoidance diminish, but hisdepression may remit as well. (The supervisor continues toapply the foundational skills of bolstering hope and facilitat-ing the supervisory relationship, and by extension the train-ee’s alliance with her client. The supervisor also utilizes theCBT functional skill of remaining structured, on task, andgoal-directed).

Therapist: I hope we can brainstorm some ways to encourageMr. B. to be more active and participatory, but I have to admitthat I have some doubts about myself. I often get impatientwith Mr. B., and I have a tendency to answer my ownquestions when he gets into “helplessness mode.” I “rescue”him, and then I resent him, and then I start doubting my abilityto help him, and I know that all of that can’t be helpful! (Thetherapist reveals some of the countertherapeutic patterns shehas noticed in her interactions with her client, thus showingthe foundational competency of self-assessment).

Supervisor: Nice self-assessment—I’m very impressed! Let’suse that skill and take it further. What are some rationalresponses you would give yourself in order to reduce yourself-doubts, and maybe even to reduce your resentment to-ward the client? I think you have the proper attitude to do thiswell. (The supervisor’s foundational skills of relationship-building dovetail with the functional skills of positively rein-forcing the trainee’s growth-enhancing willingness to moni-tor herself. The supervisor suggests that the trainee couldpractice the functional CBT skill of cognitive restructuring tobegin to remediate her problems with clients such as Mr. B.).

Therapist: I guess I can remind myself that “it’s all data,” asyou always say (laughs). I can tell myself to turn a probleminto a chance to do some problem solving, rather than rumi-nating about what isn’t going well. (Therapist responds to thesupervisor’s support by mobilizing her functional skill ofrational responding, and applying it to herself).

Supervisor: I would be happy to listen to one of your record-ings of your sessions with Mr. B. so I can give you morespecific feedback. If you’re okay with this, just make sure thatMr. B. is given informed consent about the use of the record-ing, and then feel free to give me the CD. (Supervisor volun-teers to monitor and supervise the therapist’s work moredirectly, showing a commitment to the teaching process, whilemodeling the foundational competency of the ethical principleof informed consent for clients).

The competent supervisor identifies the train-ees’ personal strengths and encourages them to

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use these capabilities in the service of the treat-ment (e.g., appropriate humor), rather than mak-ing them subservient to a monolithic method.Likewise, the competent supervisor identifies ar-eas of weakness and is able to address themdirectly and tactfully so that the supervisees willbe able to improve on these lacunae in function-ing as CBT therapists, without feeling undulydiscouraged. Good supervisors teach their train-ees to use the methods of CBT on themselves tobecome more adept at teaching the methods totheir clients (Bennett-Levy, 2006). At the sametime, supervisors know where to draw the linebetween supervision and therapy, advising trou-bled supervisees to seek their own counseling,while keeping supervision focused squarely onthe wellness of the clients, and the professionaldevelopment of the supervisee.

Conclusions

The field of psychotherapy has mobilized toaddress the pressing matter of what comprises“competency” in conducting psychotherapy, andhow that concept develops over the course of anindividual’s training and career. Practitioners ofCBT must strive to achieve and to demonstrategrowth in the high levels of foundational compe-tence that cut across different modalities of psy-chotherapy, such as maintaining ethical attitudesand behaviors, learning about (and thereforepracticing with sensitivity to) diversity issues,demonstrating warmth and genuineness in thetherapeutic relationship, and exercising profes-sional humility and collaborative communicationin consultation with professional peers, amongother skills. They must also invest time and en-ergy to repeatedly practice the core functionalcompetencies, which include formulating cogni-tive case conceptualizations, teaching clients toself-monitor and rationally respond to their dys-functional thinking, helping clients become morebehaviorally active, using guided discovery ques-tions, and assigning and reviewing homework,among other methods.

Good supervision is necessary to help traineesturn raw skills into refined skills, and to learn tointegrate the foundational and functional compe-tencies of CBT so as to deliver empirically sup-ported treatments in the manner in which theywere conceptualized and intended. Unfortu-nately, insufficient attention has been paid to thetraining of the supervisors themselves, a situation

that needs to change, but that also suffers fromthe same (if not greater) difficulties as in defining,promoting, and measuring competencies amongCBT therapists. This paper has presented a briefsample of expert CBT supervision that facilitatesthe performance of the therapist while promotingthe competent care of the client. As such, itserves as a good model for the mentoring ofpractitioners who are trying to master the meth-ods of CBT.

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Special Section: Competency in Conducting CBT

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