Behavioural and Cognitive Psychotherapy

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Behavioural and Cognitive Psychotherapy (2009), 37:207-219 Cambridge University Press
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2009

Research Article

Getting to the Heart of Clinical Supervision: A Theoretical Review of the Role of Emotions in Professional Development

Chiara Lombardoa1 c1, Derek Milnea1 and Rachael Proctora1

a1 Newcastle University, UK
Article author query
lombardo c [PubMed]  [Google Scholar]
milne d [PubMed]  [Google Scholar]
proctor r [PubMed]  [Google Scholar]


Background: The importance of supervision is increasingly recognized, yet it remains little understood, impairing research and practice. Specifically, the CBT supervision model provides a relatively “heartless” account of professional development, which may undermine its effectiveness. Method: A theoretical review of emotions in supervision and learning is provided, to summarize relevant theoretical and empirical literature. The objectives are to clarify the role of emotions in CBT supervision, and to use this understanding to outline an emotionally-attuned model, illustrating its application to two critical aspects of CBT supervision (the development of a learning alliance and enhancing professional competence). Conclusion: The reviewed literature (theory and research evidence) supports the explicit and systematic incorporation of emotions into CBT supervision. Conceptually, this can be achieved by integrating Lazarus's (1991) general theory of emotion with the CBT model. The illustrations of this augmented model indicate its value in understanding and managing both the “rupture-repair” cycle that can affect the supervisory alliance, and the “deskilling-development” pattern that appears to be necessary for the acquisition of competence. We propose that CBT supervision might usefully be guided by our expanded model, as this affords greater internal consistency and may be more effective educationally.

Keywords:Emotion; learning; clinical supervision; therapeutic alliance; training; professional development


c1 Reprint requests to Chiara Lombardo, School of Medical Education Development, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK. E-mail:

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