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Jan Prasko,1– 4 Ilona Krone,5 Julius Burkauskas,6 Jakub Vanek,1 Marija Abeltina,7 Alicja Juskiene,6 Tomas Sollar,2 Ieva Bite,7 Milos Slepecky,2 Marie Ociskova1,4 1Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic; 2Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic; 3Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, The Czech Republic; 4Jessenia Inc. - Rehabilitation Hospital Beroun, Akeso Holding, Beroun, The Czech Republic; 5Riga`s Stradins University, Riga, Latvia; 6Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania; 7University of Latvia, Latvian Association of CBT, Riga, LatviaCorrespondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, I. P. Pavlova 6, Olomouc, 77520, The Czech Republic, Tel +420 603 414 930, Email praskojan@seznam.czAbstract: 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.Keywords: supervision, cognitive behavioral therapy, homework, self-reflection

Objective: This article focuses on utilizing therapeutic letters within group schema therapy-an innovative therapeutic approach that integrates elements from various therapeutic disciplines. The primary aim is to explore how therapeutic letters can enhance the therapeutic process and support the treatment of patients., Methods: To achieve this objective, we conducted a narrative literature review centred on schema therapy and using therapeutic letters as a therapeutic strategy. We systematically searched databases (PubMed, PsycINFO, and Google Scholar) using the keywords "schema therapy," "therapy letters," "group," "therapeutic strategies," and "adult psychotherapy." Additionally, we gathered clinical insights from schema therapists through interviews to gain a practical perspective., Results: Group schema therapy primarily targets identifying and modifying early maladaptive schemas and maladaptive schema modes that originate during childhood and persist into adulthood. Within this context, therapeutic letters are an effective tool, allowing individuals to process intense emotions stemming from their formative years. Individuals complete these letters as homework assignments and then, divided into small groups, read them aloud while receiving emotional support and encouragement from their peers. This process enables individuals to explore their thoughts and feelings, potentially reframe their life narratives, seek forgiveness, and ultimately progress. Various types of therapeutic letters are discussed, including the "uncensored letter", "letter from the other shore", "letter to an adult child", "business card", and "letter from the future"., Discussion: The article provides an in-depth overview of the techniques and exercises employed in group schema work when using letters. It also addresses potential challenges, such as difficulties with visualization, resistance to change, and trust issues., Conclusion: Therapeutic letters emerge as a valuable tool in group schema therapy, enhancing the therapeutic process and supporting individual treatment. However, further research is necessary to comprehend and fully maximize their potential.

Drift is a phenomenon that can occur in cognitive-behavioral supervision, where core components of supervision are omitted, avoided, or deprioritized. This narrative review explores the signs, reasons, and impact of supervisory drift at the experiential, cognitive, and emotional levels for both the supervisor and the supervisee. Additionally, the article presents potential solutions for preventing and addressing supervisory drift, such as staying on track, anticipating problems before they arise, adapting supervision to the supervisee's needs, using active supervision methods to understand drift better, engaging in Supervision of Supervision (SoS), and using alliance measures. Through the use of case vignettes, we illustrate the potential solutions. We aim to provide a comprehensive understanding of supervisory drift and offer practical strategies for its prevention and management.

Aim: The paper describes the characteristics of relationship obsessive-compulsive disorder (R-OCD), including the types of obsessions and compulsions, the common triggers and the impact on psychological well-being and relationship functioning. It also offers basic cognitive-behavioural strategies to help patients change their attitudes towards obsessive thoughts and reduce compulsive behaviours., Methods: This article is a narrative review of the literature and case studies on R-OCD. To search for relevant sources, we used PubMed, PsycINFO and Web of Science databases with the keywords "relationship obsessive compulsive disorder", "R-OCD", "relationship OCD" and "partner-focused OCD". We included only studies published in English from January 1990 to June 2023. The paper provides examples of how basic cognitive-behavioural strategies help individuals with R-OCD., Results: People with R-OCD experience intrusive thoughts about whether they have the right feelings for their partner, whether their partner loves them, whether the relationship is suitable or whether their partner has flaws. These thoughts trigger the urge to perform various rituals to alleviate anxiety, such as repeated checking, reassurance or comparison. However, this behaviour leads to disruption of the relationship and long-term maintenance of the anxiety. Examples of basic cognitive-behavioural strategies can be applied in clinical practice to help individuals change their attitudes towards relational obsessive thoughts and reduce compulsive behaviours.

Background: Ethics is an inherent part of psychotherapy that protects the interests and rights of all parties engaged in the therapeutic relationship. This article focuses on ethical issues and dilemmas that may arise when using schema therapy., Method: We created a narrative review by searching the databases PubMed, Web of Science, and Scopus with the keywords "psychotherapy", "schema therapy", "therapeutic relationship", "ethics", "ethical questions", and "ethical dilemmas". In addition, we focused on the clinical experience of therapists, training instructors, and supervisors., Results: Ethical psychotherapy requires adherence to ethical codes and standards. Among the most important ethical principles are confidentiality, informed consent, boundaries of the therapeutic relationship, and dual relationships. Understanding transference, countertransference, and one's modes and schemas is essential to ethical reflection in schema therapy. The article presents examples of ethical dilemmas in schema therapy and suggests possible solutions. At the same time, we point out the need for further research in this field., Conclusion: Similarly to other psychotherapeutic approaches, one of the schema therapist's core competencies is following the profession's ethical principles and productively finding solutions to the occasional ethical dilemmas. Ethics is a prominent part of all psychotherapeutic sessions. Still, it becomes even more central when working with challenging issues such as personality disorders that schema therapy routinely treats. More research on the topic is needed.

The purpose of supervision is to ensure that clients' needs are met and to monitor the effectiveness of therapeutic interventions and the therapeutic relationship. Cognitive behavioural therapy (CBT) supervision is the systematic cooperation of the supervisee with the supervisor, which aims at increasing the therapists' competencies when working with specific clients. The advantage of supervision is the possibility to shape and develop the therapist's practical skills through specific techniques. This paper aims to review currently available CBT supervision strategies that boost the development of therapists' skills and provide possible examples. Various techniques are discussed, including behavioural, cognitive, imagery and psychodrama methods that facilitate supervisors in enhancing therapists' skills. In addition, complementary approaches are discussed, such as role-playing, modelling, chaining, or imitation to present at a particular moment of the therapy, increase the insight into the client's perspective or the treatment itself, and search for an alternative approach to improve the therapeutic outcomes for the client. Overall, the article describes the supervisor's need to have a flexible variety of skills and know which learning methods might be most effective for boosting the supervisee's skill level and needs with a particular client.

Introduction: The parallel process is a psychosocial phenomenon where the relationship dynamics between the therapist and the client are repeated in the supervisory relationship between the therapist and the supervisor. The concept of the parallel process can be a useful tool for understanding and solving problems in therapy. However, it can induce supervision drift or block the supervision process., Objective: This article aims to familiarize the reader with parallel processes in cognitive-behavioural therapy (CBT) and schema therapy supervision and discuss how to manage this phenomenon in supervision., Method: This article is a narrative review with illustrations of supervision interviews in which the parallel process unfolds. The text provides an overview of theoretical constructions and empirical studies related to the parallel process. We searched PubMed, PsycINFO, Web of Science, and Google Scholar for relevant resources using the keywords "parallel process," "cognitive behavioural therapy," "schema therapy," "transference," and "countertransference." Case vignettes were collected from trainees, training leaders and supervisors to provide real-life examples of how self-reflection and self-experience can enhance CBT and schema therapy training, practice, and supervision.

Schema therapy is an integrative approach to treat patients with personality disorders and other complex psychological problems. Group schema therapy has been developed to enhance the effectiveness and efficiency of schema therapy by providing a supportive and stimulating environment for change. This article introduces the River of Life Method, a novel technique for facilitating group schema therapy, based on the metaphor of a river of life. The method helps patients to identify and modify their maladaptive schemas and modes in a nurturing process in the group. The article describes the theoretical background, the practical steps, and the clinical applications of the method. It also presents the patients' experience with the method, based on their feedback and self-reports. The results showed that the method was well received by both patients and therapists, and that it had positive effects on schema modes, psychological distress, and coping with adversities and hope for the future.

This article emphasizes the critical role of self-care in the professional lives of cognitive behavioural therapy (CBT) therapists and supervisors. It delves into the importance of self-care, elucidating its significance in maintaining therapists' mental health and effectiveness. The article presents a range of practical strategies that promote self-care, providing therapists and supervisors with specific steps to incorporate self-care into their daily routines. Moreover, the article explores common challenges and barriers to self-care, such as a lack of time, feelings of guilt associated with prioritizing one's needs, and a lack of available resources for self-care. The article aims to deepen our understanding of the complexities of practising self-care by shedding light on possible obstacles. In addition, the article includes case vignettes that demonstrate tangible examples of the positive impact of self-care on therapists' mental health and effectiveness. The overarching goal of this article is to encourage ongoing discussion and research on self-care. It advocates a greater emphasis on self-care in CBT and CBT supervision (CBTS), intending to promote the health and well-being of those who dedicate their lives to caring for others. The insights and strategies presented in this article serve as a resource for therapists and supervisors striving to achieve a balanced lifestyle while effectively catering to the needs of their clients.

Purpose: Self-awareness can be characterised as impartial, non-judgmental thoughtful attention towards the self. Self-reflection in therapy is when a therapist reviews their experiences, thoughts, and behaviours concerning therapy and changes them as needed to enhance the therapeutic process. Therapists with good quality self-reflection can make more effective and ethical decisions, differentiate their own needs from clients', understand transference and countertransference, and consider the optimal response during a session. Practising the CBT approach and reflecting on one's own experiences can be essential for successful therapeutic development. Furthermore, self-reflection forms the basis of a fruitful therapeutic relationship and the therapist's self-confidence and sense of competence.

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.

Ethical reflection is a process that comes from the deeper attitudes and values of the therapist and supervisor. The capability to recognize one's perspectives and ethical dimensions and how they affect own practice is one of the crucial tasks of a responsible therapist. Attitudes and values of an individual or a group may significantly influence the therapeutic process and a choice of strategies and behaviour towards the patient, often working at an unconscious, unreflected levels. Ethics is closely connected with psychotherapeutic treatment. Basic principles, such as expediency, honesty, integrity, justice, and respect, apply to all people equally, including psychologists, psychiatrists, psychotherapists, and supervisors. The goal of supervision is to cultivate the therapeutic process in the client's best interest. The supervisor-supervisee relationship is then grounded on principles similar to those in the therapeutic relationship.

The study aimed to test the validity of the burnout subtypes hierarchic model operationalized by the 'Burnout Clinical Subtypes Questionnaire' (BCSQ-36) and its applicability in other cultures. To that aim psychometric properties, factorial and convergent validity regarding the Maslach Burnout Inventory - General Survey (MBI-GS), and correlation with demographic factors were reviewed. A voluntary internet-based approach was used on a multi-occupational sample of adult Latvians (n = 394). The results of the internal consistency of the Latvian version of the BCSQ-36 exceeded .89 for all three subtypes. The CFA was used to test a hierarchical factorial model, and the analysis revealed an acceptable fit of the model to the data. Correlation analysis showed results as expected, similarly to the original sample - Underchallenged and Worn-out subtypes correlated with all MBI-GS scales, while Frenetic subtype did not correlate with the MBI-GS Cynicism scale. Besides, demographic data showed some correlation only on the subscale level. Overall research results provide support of the validity of the burnout subtypes hierarchical model and applicability in another culture.