supervision Dotaz Zobrazit nápovědu
OBJECTIVE: Supervision is a basic part of training and ongoing education in cognitive behavioural therapy. Self-reflection is an important part of supervision. The conscious understanding of one's own emotions, feelings, thoughts, and attitudes at the time of their occurrence, and the ability to continuously follow and recognize them are among the most important abilities of both therapists and supervisors. The objective of this article is to review aspects related to supervision in cognitive behavioural therapy and self-reflection in the literature. METHODS: This is a narrative review. A literature review was performed using the PubMed, SciVerse Scopus, and Web of Science databases; additional references were found through bibliography reviews of relevant articles published prior to July 2011. The databases were searched for articles containing the following keywords: cognitive behavioural therapy, self-reflection, therapeutic relationship, training, supervision, transference, and countertransference. The review also includes information from monographs referred to by other reviews. RESULTS: We discuss conceptual aspects related to supervision and the role of self-reflection. Self-reflection in therapy is a continuous process which is essential for the establishment of a therapeutic relationship, the professional growth of the therapist, and the ongoing development of therapeutic skills. Recognizing one's own emotions is a basic skill from which other skills necessary for both therapy and emotional self-control stem. Therapists who are skilled in understanding their inner emotions during their encounters with clients are better at making decisions, distinguishing their needs from their clients' needs, understanding transference and countertransference, and considering an optimal response at any time during a session. They know how to handle their feelings so that these correspond with the situation and their response is in the client's best interest. The ability to self-reflect increases the ability to perceive other people's inner emotions, kindles altruism, and increases attunement to subtle signals indicating what others need or want. Self-reflection may be practised by the therapists themselves using traditional cognitive behavioural therapy techniques, or it may be learned in the course of supervision. If therapists are unable to recognize their own thoughts and feelings, or the effects of their attitudes in a therapeutic situation, then they are helpless against these thoughts and feelings, which may control the therapist's behaviour to the disadvantage of the client and therapist alike. CONCLUSION: Training and supervision focused on self-reflection are beneficial to both supervisees and their clients. The more experienced the supervisor is, the more self-reflection used in therapy and supervision.
- MeSH
- kognitivně behaviorální terapie metody MeSH
- lidé MeSH
- organizace a řízení MeSH
- přenos (psychologie) MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
The homework aims to generalize the patient's knowledge and encourage practicing skills learned during therapy sessions. Encouraging and facilitating homework is an important part of supervisees in their supervision, and problems with using homework in therapy are a common supervision agenda. Supervisees are encouraged to conceptualize the patient's lack of homework and promote awareness of their own beliefs and responses to non-cooperation. The supervision focuses on homework twice - first as a part of the supervised therapy and second as a part of the supervision itself. Homework assigned in supervision usually deals with mapping problems, monitoring certain behaviors (mostly communication with the patient), or implementing new behaviors in therapy.
- Klíčová slova
- cognitive behavioral therapy, homework, self-reflection, supervision,
- Publikační typ
- časopisecké články MeSH
A graduate from a medical school who has obtained only, so called, adequate competence/ expertise must work under a supervision of a doctor who has the relevant specialised competence certification in order for the graduate to obtain this specialised competence as well. It is recommended to determine in writing which activities the doctor in training can perform alone during that time, which need to be supervised by the responsible doctor, and which treatment he is not yet prepared to perform at all. The head doctor or the head of the clinic is responsible for ensuring a full-time supervision of the doctor trainee by a certified specialist. If the trainee has obtained a certificate of completion of the basic level training of the relevant specialised module then he can serve during emergency hours under the condition that the presence of a specialised doctor is ensured to be within 20 minutes if needed. The head doctor, the head of the clinic or the specialised medical supervisor have no universal responsibility for any possible misconduct of the trainee. Everyone is responsible for his own conduct. The responsibility of the head doctor and the head of the clinic may be relevant if they did not fulfil the duties of being a supervising doctor. The responsibility may also be relevant if the supervising was neglected. Responsibility for the trainee may arise if he did not respect the orders from the supervisor or if the misconduct was such that it would be unacceptable even for a doctor without the relevant professional competence. If it is the case that the misconduct happens despite the supervising being absolutely correct, and under the conditions that the misconduct was unavoidable, the supervising attested professional doctor cannot be responsible for the consequences. Manual misconduct during a surgery is usually regarded to be accepted risk not violation of the rules of medical science.
- MeSH
- klinické kompetence * MeSH
- lidé MeSH
- organizace a řízení normy MeSH
- právní odpovědnost MeSH
- specializace MeSH
- studium lékařství specializační postgraduální MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Computer Tomography (CT) is an imaging procedure that combines many X-ray measurements taken from different angles. The segmentation of areas in the CT images provides a valuable aid to physicians and radiologists in order to better provide a patient diagnose. The CT scans of a body torso usually include different neighboring internal body organs. Deep learning has become the state-of-the-art in medical image segmentation. For such techniques, in order to perform a successful segmentation, it is of great importance that the network learns to focus on the organ of interest and surrounding structures and also that the network can detect target regions of different sizes. In this paper, we propose the extension of a popular deep learning methodology, Convolutional Neural Networks (CNN), by including deep supervision and attention gates. Our experimental evaluation shows that the inclusion of attention and deep supervision results in consistent improvement of the tumor prediction accuracy across the different datasets and training sizes while adding minimal computational overhead.
- Klíčová slova
- CNN, UNet, VNet, attention gates, deep supervision, medical image segmentation, organ segmentation, tumor segmentation,
- Publikační typ
- časopisecké články MeSH
Dysfunctional patterns, beliefs, and assumptions that affect a patient's perception of other people often affect their perceptions and behaviours towards the therapist. This tendency has been traditionally called transference for its psychoanalytical roots and presents an important factor to monitor and process. In supervision, it is important to put the patient's transference in the context of the conceptualization of the case. Countertransference occurs when the therapist responds complementary to the patient's transference based on their own dysfunctional beliefs or assumptions. Transference and countertransference provide useful insights into the inner world of the patient, therapist, and supervisor. Guided discovery is one of the most common approaches used by a supervisor and a supervisee to map all types and directions of transference and countertransference. Other options to map transference and countertransference are imagery and role-playing techniques.
- Klíčová slova
- cognitive behavioral therapy, countertransference, supervision, supervisory relationship, therapeutic relationship, transference,
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: The project aimed to assess compliance with evidence-based criteria regarding the use of clinical supervision amongst district nurses and to improve knowledge and engagement in clinical supervision activities within the workplace. INTRODUCTION: It is important to provide clinical support to all healthcare workers that provide opportunities to develop and be listened to in a supervised environment. Clinical supervision is seen as a key element to provide this support. It provides a professional working relationship between two or more members of staff where the reflection of practice and personal emotion can be discussed, which is outlined in many policies and guidelines. METHODS: A baseline audit was carried out using the JBI Practical Application of Clinical Evidence System program involving 16 participants in one district nursing team in South Wales. The first step involved the development of the project and generating the evidence. Following this, a baseline audit was conducted, and educational training on clinical supervision was undertaken followed by clinical supervision sessions. A postimplementation re-audit was conducted following implementation. RESULTS: A total of 16 participants enrolled on the project. Receiving basic training and participating in clinical supervision was much higher than the baseline audit with both increasing to 100% compliance. Furthermore, 94% of participants were aware of clinical supervision activities and 88% knew of existing records on clinical supervision. The project results show a large increase in compliance with all of the criteria. CONCLUSION: Overall the implementation project achieved an improvement in evidence-based practice regarding clinical supervision in primary care.
- MeSH
- lékařská praxe založená na důkazech * MeSH
- lidé MeSH
- odborný výcvik * MeSH
- zdravotnický personál MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Psychotherapy requires clinical supervision. This is systematic guidance of a therapist by a supervisor. Inevitably, there is a question of training new high-quality therapists. This is related to supervision of their basic training. Later, it is important to provide an opportunity for lifelong supervision throughout the entire psychotherapeutic practice. METHOD: PUBMED data base was searched for articles using the key words "supervision in CBT", "therapeutic relations", "transference", "countertransference", "schema therapy", "dialectical behavioral therapy". The search was repeated by changing the key word. No language or time constraints were applied. The lists of references of articles detected by this computer data base search were examined manually to find additional articles. We also used the original texts of A. T. Beck, J. Beck, M. Linehan, R. Leahy, J. Young and others. Basically this is a review with conclusions about supervision in cognitive behavioral therapy. RESULTS: The task of supervision is obvious - to increase the value of the therapeutic process in the client's best interest. At the same time, supervision is an educational process in the truest sense of the word, including an opportunity to select one's own supervisor. This is a very important procedural aspect since the therapist identifies with his/her supervisor, either consciously or unconsciously. Establishing the supervisor-supervisee relationship is based on principles similar to those in the therapeutic relationship. There is an important parallel reflecting the therapist-client relationship. This is because any changes in the supervisory process are analogically transferred onto the therapist-client relationship. Additionally, supervision is oriented towards increasing the therapist's competencies. The CBT therapist's basic skills involve good theoretical knowledge, professional behaviour towards clients, ability to use specific therapeutic strategies for maintaining the therapeutic relationship, sensitivity to parallel processes and accomplishment of changes, and adherence to ethical norms. Given the fact that during supervision, the supervisee may be in any stage of his/ her training, supervision must take into consideration where the therapist is in his/her training and development and what he/she has or has not learnt. CONCLUSIONS: Both the literature and our experience underscore the importance of careful supervision of cognitive behavioral therapy. The supervisory relationship is similar to a therapeutic relationship and the supervisee also needs security, acceptance and appreciation for his/her professional growth. However, there is more freedom in the relationship. Supervision may only lead to the supervisee's professional growth if it supports his/her individuality and helps him/her to discover things. Therefore, numerous approaches are used in supervision which are associated with the abilities to self-reflect and to realize transference and countertransference mechanisms.
- MeSH
- klinické kompetence MeSH
- kognitivně behaviorální terapie výchova MeSH
- lidé MeSH
- vyučování * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVE: This article describes the role of imagery in supervision which is a part of the work of both the supervisee and the supervisor. Imagination bears outstanding importance in psychotherapy and supervision. METHOD: The relevant texts for this narrative review were identified through the Web of Science and PubMed databases, within the period 1990-2019. The search terms included: Supervision, Cognitive behavioural therapy, Imagination, Imagery, Imagery rescripting, Therapeutic relationship, Supervisory relationship. The report also includes information from the books referred to by the articles. The supervisory experiences of the authors were also incorporated. The theoretical part is supplemented with case vignettes of strategies using imagination in CBT supervision. RESULTS: Working with imagery can be used in transformative experiential learning. It can help to better map the situation with the patient, including its emotional components and basic psychological needs, to realise how the therapeutic relationship is set up, as well as to rework own therapist attitudes, schemas and emotional - behavioural responses, and plan future steps in the therapy. Many therapy steps could be learned during imagery exercises. Imagery also helps to understand and regulate the supervisory relationship. CONCLUSION: It is useful to integrate imagery to the supervision. Using imagery can help to understand the patient, the therapeutic relationship better, and to plan optimal therapeutic strategies, as well as reflect/self-reflect and train difficult skills which promote professional and personal growth.
Role-play helps the supervisor present a moment of therapy, and reflect on what has happened to the therapist to the patient and further model the therapeutic skills. Usually, the supervisor or other supervisees (in group supervision) play the patient, and the therapist plays a significant moment in the psychotherapeutic session. Supervisors or supervisees in group supervision can play the patient in different situations, and can also reverse roles when the therapist plays their patient, and the supervisor plays the therapist. Before role-playing, there is a need to set a specific goal. Playing roles in supervision can focus on (a) conceptualizing the case; (b) assessing and optimizing therapeutic strategies; (c) a better understanding of the therapeutic relationship. A specific goal needs to be set before role-playing. The technique can focus on (a) case conceptualization; (b) assessment and optimization therapeutic strategies; (c) a better understanding of the therapeutic relationship. A variety of approaches can be used for role-playings, such as pattern learning, modelling, chaining, encouragement and feedback, or psychodrama techniques such as monologue, an empty chair, role change, alter-ego, using multiple chairs or toys.
BACKGROUND: Postgraduate medical trainees experience high rates of burnout, but evidence regarding psychiatric trainees is missing. We aim to determine burnout rates among psychiatric trainees, and identify individual, educational and work-related factors associated with severe burnout. METHODS: In an online survey psychiatric trainees from 22 countries were asked to complete the Maslach Burnout Inventory (MBI-GS) and provide information on individual, educational and work-related parameters. Linear mixed models were used to predict the MBI-GS scores, and a generalized linear mixed model to predict severe burnout. RESULTS: This is the largest study on burnout and training conditions among psychiatric trainees to date. Complete data were obtained from 1980 out of 7625 approached trainees (26%; range 17.8-65.6%). Participants were 31.9 (SD 5.3) years old with 2.8 (SD 1.9) years of training. Severe burnout was found in 726 (36.7%) trainees. The risk was higher for trainees who were younger (P<0.001), without children (P=0.010), and had not opted for psychiatry as a first career choice (P=0.043). After adjustment for socio-demographic characteristics, years in training and country differences in burnout, severe burnout remained associated with long working hours (P<0.001), lack of supervision (P<0.001), and not having regular time to rest (P=0.001). Main findings were replicated in a sensitivity analysis with countries with response rate above 50%. CONCLUSIONS: Besides previously described risk factors such as working hours and younger age, this is the first evidence of negative influence of lack of supervision and not opting for psychiatry as a first career choice on trainees' burnout.
- Klíčová slova
- Burnout, Psychiatry, Risk factors, Supervision, Training,
- MeSH
- demografie MeSH
- dospělí MeSH
- kontinuální vzdělávání lékařů metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- osobnostní dotazník MeSH
- profesionální vyhoření * diagnóza epidemiologie etiologie MeSH
- průzkumy a dotazníky MeSH
- psychiatrie statistika a číselné údaje MeSH
- rizikové faktory MeSH
- služby péče o duševní zdraví organizace a řízení MeSH
- socioekonomické faktory MeSH
- vliv směnného provozu na zdraví psychologie MeSH
- volba povolání MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
