Supervisión en la terapia cognitivo conductual enfocada en el trauma (TF-CBT) en PRACTICA: Marco basado en componentes, viñetas y consideraciones culturales
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Publicado
2025-12-30
Yahaira I. Márquez
Kristine Hodshon
Gilda Rodríguez-Díaz
https://orcid.org/0000-0001-9205-8012
Resumen
La supervisión en psicoterapia brinda un espacio profesional para que las personas supervisadas reflexionen sobre su trabajo, fortalezcan su práctica clínica y mejoren los servicios a clientes. La literatura ha documentado su rol esencial en la implementación y sostenibilidad de prácticas basadas en evidencia (PBE). La terapia cognitivo conductual enfocada en el trauma (TCC-ET) es una PBE bien establecida para la niñez impactada por el trauma y sus personas cuidadoras no ofensoras. Sin embargo, existe orientación limitada sobre la supervisión específica en este modelo. Las personas supervisoras enfrentan desafíos únicos: mantener la fidelidad al modelo, atender consideraciones culturales y contextuales, y guiar a los terapeutas en la metabolización del material clínico traumático. Proponemos un marco de supervisión de TCC-ET basado en componentes, informado por la literatura y por la experiencia clínica. Ofrecemos recomendaciones prácticas y viñetas que ilustran estrategias de supervisión alineadas con cada componente del modelo PRACTICA. Las viñetas buscan resaltar posibilidades y caminos de acompañamiento, más que prescribir guiones fijos. Nuestro objetivo es fortalecer la fidelidad clínica, apoyar la sostenibilidad de la implementación y promover la sensibilidad cultural en diversos contextos de práctica.
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Keywords
supervisión clínica, supervisión de TCC-ET, supervisión de PBE
References
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Alfonsson, S., Parling, T., Spännargård, Å., Andersson, G., & Lundgren, T. (2018). The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: A systematic review. Cognitive Behaviour Therapy, 47(3), 206–228. https://doi.org/10.1080/16506073.2017.1369559
Amaya-Jackson, L., Hagele, D., Sideris, J., Potter, D., Briggs, E. C., Keen, L., Murphy, R. A., Dorsey, S., Patchett, V., Ake, G. S., & Socolar, R. (2018). Pilot to policy: Statewide dissemination and implementation of evidence-based treatment for traumatized youth. BMC Health Services Research, 18(1), 589. https://doi.org/10.1186/s12913-018-3395-0
American Association for Marriage and Family Therapy. (2023). Approved supervision designation: Standards handbook. AAMFT.
American Psychological Association. (2014). Guidelines for clinical supervision in health service psychology. http://apa.org/about/policy/guidelines-supervision.pdf
Bernal, G., & Domenech Rodríguez, M. M. (2012). Cultural adaptation in context: Psychotherapy as a historical account of adaptations. In G. Bernal & M. M. Domenech Rodríguez (Eds.), Cultural adaptations: Tools for evidence-based practice with diverse populations (pp. 1–22). American Psychological Association. https://doi.org/10.1037/13752-001
Cohen, J. A., & Mannarino, A. P. (1993). A treatment model for sexually abused preschoolers. Journal of Interpersonal Violence, 8(1), 115-131. https://doi.org/10.1177/088626093008001009
Cohen, J. A., & Mannarino, A. P. (1996). A treatment outcome study for sexually abused preschool children: Initial findings. Journal of the American Academy of Child & Adolescent Psychiatry, 35(1), 42–50.
https://doi.org/10.1097/00004583-199601000-00011
Cohen, J. A., Deblinger, E., & Mannarino, A. P. (2018). Trauma-focused cognitive behavioral therapy for children and families. Psychotherapy Research, 28(1), 47–57. https://doi.org/10.1080/10503307.2016.1208375
Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 43(4), 393–402. https://doi.org/10.1097/00004583-200404000-00005
Cohen, J. A., Mannarino, A. P., & Kinnish, K. (2017). Trauma-focused cognitive behavioral therapy for commercially sexually exploited youth. Journal of Child and Adolescent Trauma, 10(2), 175–185. https://doi.org/10.1007/s40653-015-0073-9
Creed, T. A., Kuo, P. B., Oziel, R., Reich, D., Thomas, M., O’Connor, S., Imel, Z. E., Hirsch, T., Narayanan, S., & Atkins, D. C. (2022). Knowledge and attitudes toward an artificial intelligence-based fidelity measurement in community cognitive behavioral therapy supervision. Administration and Policy in Mental Health and Mental Health Services Research, 49(3), 343–356. https://doi.org/10.1007/s10488-021-01167-x
Cummings, J. A., Ballantyne, E. C., & Scallion, L. M. (2015). Essential processes for cognitive behavioral clinical supervision: Agenda setting, problem-solving, and formative feedback. Psychotherapy, 52(2), 158–163. https://doi.org/10.1037/a0038712
Deblinger, E., Lippmann, J., & Steer, R. A. (1996). Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Child Maltreatment, 1(4), 310–321. https://doi.org/10.1177/1077559596001004003
Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K., & Heflin, A. H. (2015). Brief TF-CBT Fidelity Checklist (App. F). In Child sexual abuse: A primer for treating children, adolescents, and their nonoffending parents (2nd ed., pp. 486–487). Oxford University Press.
Deblinger, E., Mannarino, A. P., Cohen, J. A., & Steer, R. A. (2006). A follow-up study of a multisite, randomized, controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 45(12), 1474–1484. https://doi.org/10.1097/01.chi.0000240839.56114.bb
Deblinger, E., McLeer, S. V., & Henry, D. (1990). Cognitive behavioral treatment for sexually abused children suffering posttraumatic stress: Preliminary findings. Journal of the American Academy of Child & Adolescent Psychiatry, 29(5), 747–752. https://doi.org/10.1097/00004583-199009000-00012
Deblinger, E., Pollio, E., & Dorsey, S. (2015). Applying trauma-focused cognitive behavioral therapy in group format. Child Maltreatment, 21(1), 59–73. https://doi.org/10.1177/1077559515620668
Dorsey, S., Pullmann, M., Berliner, L., Koschmann, E. F., McKay, M., & Deblinger, E. (2014). Engaging foster parents in treatment: A randomized trial of supplementing trauma-focused cognitive behavioral therapy with evidence-based engagement strategies. Child Abuse & Neglect, 38(9), 1508–1520. https://doi.org/10.1016/j.chiabu.2014.03.020
Dorsey, S., Pullmann, M. D., Deblinger, E., Berliner, L., Kerns, S. E., Thompson, K., Unützer, J., Weisz, J. R., & Garland, A. F. (2013). Improving practice in community-based settings: A randomized trial of supervision—study protocol. Implementation Science, 8(1), 89. https://doi.org/10.1186/1748-5908-8-89
Friedberg, R. D. (2018). Best practices in supervising cognitive behavioral therapy with youth. World Journal of Clinical Pediatrics, 7(1), 1–8. https://doi.org/10.5409/wjcp.v7.i1.1
Lucid, L., Meza, R., Pullmann, M. D., Jungbluth, N., Deblinger, E., & Dorsey, S. (2018). Supervision in community mental health: Understanding intensity of EBT focus. Behavior Therapy, 49(4), 481–493. https://doi.org/10.1016/j.beth.2017.12.007
Márquez, Y. I., Deblinger, E., & Dovi, A. T. (2019). The value of trauma-focused cognitive behavioral therapy (TF-CBT) in addressing the therapeutic needs of trafficked youth: A case study. Cognitive and Behavioral Practice, 27(3), 253–269. https://doi.org/10.1016/j.cbpra.2019.10.001
Martin, P., Lizarondo, L., Kumar, S., & Snowdon, D. (2021). Impact of clinical supervision on healthcare organisational outcomes: A mixed methods systematic review. PLOS ONE, 16(11), e0260156. https://doi.org/10.1371/journal.pone.0260156
Metzger, I. W., Anderson, R. E., Are, F., & Ritchwood, T. (2021). Healing interpersonal and racial trauma: Integrating racial socialization into trauma-focused cognitive behavioral therapy for African American youth. Child maltreatment, 26(1), 17–27. https://doi.org/10.1177/1077559520921457
Meza, R. D., Alrasheed, R., Pullmann, M. D., & Dorsey, S. (2023). Clinical supervision approach predicts evidence-based trauma treatment delivery in children's mental health. Frontiers in Psychiatry, 13, 1072844. https://doi.org/10.3389/fpsyt.2022.1072844
Milne, D. (2008). CBT supervision: From reflexivity to specialization. Behavioural and Cognitive Psychotherapy, 36(6), 779–786. https://doi.org/10.1017/S1352465808004773
Milne, D., & Dunkerley, C. (2010). Towards evidence-based clinical supervision: The development and evaluation of four CBT guidelines. The Cognitive Behaviour Therapist, 3(2), 43–57. https://doi.org/10.1017/S1754470X10000048
Milne, D. L., & James, I. A. (2005). Clinical supervision: Ten tests of the tandem model. Clinical Psychology Forum, 151, 6–9 https://doi.org/10.53841/bpscpf.2005.1.151.6
Murray, L. K., Familiar, I., Skavenski, S., Jere, E., Cohen, J., Imasiku, M., Mayeya, J., Bass, J. K., & Bolton, P. (2013). An evaluation of trauma focused cognitive behavioral therapy for children in Zambia. Child Abuse & Neglect, 37(12), 1175–1185. https://doi.org/10.1016/j.chiabu.2013.04.017
Newman, C. F. (2013). Training cognitive behavioral therapy supervisors: Didactics, simulated practice, and meta-supervision. Journal of Cognitive Psychotherapy, 27(1), 5–18. https://doi.org/10.1891/0889-8391.27.1.5
Pullmann, M. D., Lucid, L., Harrison, J. P., Martin, P., Deblinger, E., Benjamin, K. S., & Dorsey, S. (2018). Implementation climate and time predict intensity of supervision content related to evidence-based treatment. Frontiers in Public Health, 6, 280. https://doi.org/10.3389/fpubh.2018.00280
Roscoe, J., Taylor, J., Harrington, R., & Wilbraham, S. (2022). CBT supervision behind closed doors: Supervisor and supervisee reflections on their expectations and use of clinical supervision. Counselling and Psychotherapy Research, 22(4), 1056–1067. https://doi.org/10.1002/capr.12572
Spännargård, Å., Fagernäs, S., & Alfonsson, S. (2024). Discrepancies between guidelines, preferences and actual activities in psychotherapy supervision. Counselling and Psychotherapy Research, 25(1), e12824. https://doi.org/10.1002/capr.12824
Sudak, D. M., & Reiser, R. P. (2021). Training cognitive behavioral therapy supervisors. In A. Wenzel (Ed.), Handbook of cognitive behavioral therapy: Applications (pp. 669–696). American Psychological Association. https://doi.org/10.1037/0000219-021
Terjesen, M. D., & Del Vecchio, T. (Eds.). (2023). Handbook of training and supervision in cognitive behavioral therapy. Springer International Publishing. https://doi.org/10.1007/978-3-031-33735-2
Warfield, J. R. (2013). Supervising culturally informed modified trauma-focused cognitive behavioral therapy. Journal of Cognitive Psychotherapy, 27(1), 51–60. https://doi.org/10.1891/0889-8391.27.1.51
Weck, F., Jakob, M., Neng, J. M. B., Höfling, V., Grikscheit, F., & Bohus, M. (2016). The effects of bug-in-the-eye supervision on therapeutic alliance and therapist competence in cognitive behavioural therapy: A randomized controlled trial. Clinical Psychology & Psychotherapy, 23(5), 386–396. https://doi.org/10.1002/cpp.1968
Alfonsson, S., Parling, T., Spännargård, Å., Andersson, G., & Lundgren, T. (2018). The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: A systematic review. Cognitive Behaviour Therapy, 47(3), 206–228. https://doi.org/10.1080/16506073.2017.1369559
Amaya-Jackson, L., Hagele, D., Sideris, J., Potter, D., Briggs, E. C., Keen, L., Murphy, R. A., Dorsey, S., Patchett, V., Ake, G. S., & Socolar, R. (2018). Pilot to policy: Statewide dissemination and implementation of evidence-based treatment for traumatized youth. BMC Health Services Research, 18(1), 589. https://doi.org/10.1186/s12913-018-3395-0
American Association for Marriage and Family Therapy. (2023). Approved supervision designation: Standards handbook. AAMFT.
American Psychological Association. (2014). Guidelines for clinical supervision in health service psychology. http://apa.org/about/policy/guidelines-supervision.pdf
Bernal, G., & Domenech Rodríguez, M. M. (2012). Cultural adaptation in context: Psychotherapy as a historical account of adaptations. In G. Bernal & M. M. Domenech Rodríguez (Eds.), Cultural adaptations: Tools for evidence-based practice with diverse populations (pp. 1–22). American Psychological Association. https://doi.org/10.1037/13752-001
Cohen, J. A., & Mannarino, A. P. (1993). A treatment model for sexually abused preschoolers. Journal of Interpersonal Violence, 8(1), 115-131. https://doi.org/10.1177/088626093008001009
Cohen, J. A., & Mannarino, A. P. (1996). A treatment outcome study for sexually abused preschool children: Initial findings. Journal of the American Academy of Child & Adolescent Psychiatry, 35(1), 42–50.
https://doi.org/10.1097/00004583-199601000-00011
Cohen, J. A., Deblinger, E., & Mannarino, A. P. (2018). Trauma-focused cognitive behavioral therapy for children and families. Psychotherapy Research, 28(1), 47–57. https://doi.org/10.1080/10503307.2016.1208375
Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 43(4), 393–402. https://doi.org/10.1097/00004583-200404000-00005
Cohen, J. A., Mannarino, A. P., & Kinnish, K. (2017). Trauma-focused cognitive behavioral therapy for commercially sexually exploited youth. Journal of Child and Adolescent Trauma, 10(2), 175–185. https://doi.org/10.1007/s40653-015-0073-9
Creed, T. A., Kuo, P. B., Oziel, R., Reich, D., Thomas, M., O’Connor, S., Imel, Z. E., Hirsch, T., Narayanan, S., & Atkins, D. C. (2022). Knowledge and attitudes toward an artificial intelligence-based fidelity measurement in community cognitive behavioral therapy supervision. Administration and Policy in Mental Health and Mental Health Services Research, 49(3), 343–356. https://doi.org/10.1007/s10488-021-01167-x
Cummings, J. A., Ballantyne, E. C., & Scallion, L. M. (2015). Essential processes for cognitive behavioral clinical supervision: Agenda setting, problem-solving, and formative feedback. Psychotherapy, 52(2), 158–163. https://doi.org/10.1037/a0038712
Deblinger, E., Lippmann, J., & Steer, R. A. (1996). Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Child Maltreatment, 1(4), 310–321. https://doi.org/10.1177/1077559596001004003
Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K., & Heflin, A. H. (2015). Brief TF-CBT Fidelity Checklist (App. F). In Child sexual abuse: A primer for treating children, adolescents, and their nonoffending parents (2nd ed., pp. 486–487). Oxford University Press.
Deblinger, E., Mannarino, A. P., Cohen, J. A., & Steer, R. A. (2006). A follow-up study of a multisite, randomized, controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 45(12), 1474–1484. https://doi.org/10.1097/01.chi.0000240839.56114.bb
Deblinger, E., McLeer, S. V., & Henry, D. (1990). Cognitive behavioral treatment for sexually abused children suffering posttraumatic stress: Preliminary findings. Journal of the American Academy of Child & Adolescent Psychiatry, 29(5), 747–752. https://doi.org/10.1097/00004583-199009000-00012
Deblinger, E., Pollio, E., & Dorsey, S. (2015). Applying trauma-focused cognitive behavioral therapy in group format. Child Maltreatment, 21(1), 59–73. https://doi.org/10.1177/1077559515620668
Dorsey, S., Pullmann, M., Berliner, L., Koschmann, E. F., McKay, M., & Deblinger, E. (2014). Engaging foster parents in treatment: A randomized trial of supplementing trauma-focused cognitive behavioral therapy with evidence-based engagement strategies. Child Abuse & Neglect, 38(9), 1508–1520. https://doi.org/10.1016/j.chiabu.2014.03.020
Dorsey, S., Pullmann, M. D., Deblinger, E., Berliner, L., Kerns, S. E., Thompson, K., Unützer, J., Weisz, J. R., & Garland, A. F. (2013). Improving practice in community-based settings: A randomized trial of supervision—study protocol. Implementation Science, 8(1), 89. https://doi.org/10.1186/1748-5908-8-89
Friedberg, R. D. (2018). Best practices in supervising cognitive behavioral therapy with youth. World Journal of Clinical Pediatrics, 7(1), 1–8. https://doi.org/10.5409/wjcp.v7.i1.1
Lucid, L., Meza, R., Pullmann, M. D., Jungbluth, N., Deblinger, E., & Dorsey, S. (2018). Supervision in community mental health: Understanding intensity of EBT focus. Behavior Therapy, 49(4), 481–493. https://doi.org/10.1016/j.beth.2017.12.007
Márquez, Y. I., Deblinger, E., & Dovi, A. T. (2019). The value of trauma-focused cognitive behavioral therapy (TF-CBT) in addressing the therapeutic needs of trafficked youth: A case study. Cognitive and Behavioral Practice, 27(3), 253–269. https://doi.org/10.1016/j.cbpra.2019.10.001
Martin, P., Lizarondo, L., Kumar, S., & Snowdon, D. (2021). Impact of clinical supervision on healthcare organisational outcomes: A mixed methods systematic review. PLOS ONE, 16(11), e0260156. https://doi.org/10.1371/journal.pone.0260156
Metzger, I. W., Anderson, R. E., Are, F., & Ritchwood, T. (2021). Healing interpersonal and racial trauma: Integrating racial socialization into trauma-focused cognitive behavioral therapy for African American youth. Child maltreatment, 26(1), 17–27. https://doi.org/10.1177/1077559520921457
Meza, R. D., Alrasheed, R., Pullmann, M. D., & Dorsey, S. (2023). Clinical supervision approach predicts evidence-based trauma treatment delivery in children's mental health. Frontiers in Psychiatry, 13, 1072844. https://doi.org/10.3389/fpsyt.2022.1072844
Milne, D. (2008). CBT supervision: From reflexivity to specialization. Behavioural and Cognitive Psychotherapy, 36(6), 779–786. https://doi.org/10.1017/S1352465808004773
Milne, D., & Dunkerley, C. (2010). Towards evidence-based clinical supervision: The development and evaluation of four CBT guidelines. The Cognitive Behaviour Therapist, 3(2), 43–57. https://doi.org/10.1017/S1754470X10000048
Milne, D. L., & James, I. A. (2005). Clinical supervision: Ten tests of the tandem model. Clinical Psychology Forum, 151, 6–9 https://doi.org/10.53841/bpscpf.2005.1.151.6
Murray, L. K., Familiar, I., Skavenski, S., Jere, E., Cohen, J., Imasiku, M., Mayeya, J., Bass, J. K., & Bolton, P. (2013). An evaluation of trauma focused cognitive behavioral therapy for children in Zambia. Child Abuse & Neglect, 37(12), 1175–1185. https://doi.org/10.1016/j.chiabu.2013.04.017
Newman, C. F. (2013). Training cognitive behavioral therapy supervisors: Didactics, simulated practice, and meta-supervision. Journal of Cognitive Psychotherapy, 27(1), 5–18. https://doi.org/10.1891/0889-8391.27.1.5
Pullmann, M. D., Lucid, L., Harrison, J. P., Martin, P., Deblinger, E., Benjamin, K. S., & Dorsey, S. (2018). Implementation climate and time predict intensity of supervision content related to evidence-based treatment. Frontiers in Public Health, 6, 280. https://doi.org/10.3389/fpubh.2018.00280
Roscoe, J., Taylor, J., Harrington, R., & Wilbraham, S. (2022). CBT supervision behind closed doors: Supervisor and supervisee reflections on their expectations and use of clinical supervision. Counselling and Psychotherapy Research, 22(4), 1056–1067. https://doi.org/10.1002/capr.12572
Spännargård, Å., Fagernäs, S., & Alfonsson, S. (2024). Discrepancies between guidelines, preferences and actual activities in psychotherapy supervision. Counselling and Psychotherapy Research, 25(1), e12824. https://doi.org/10.1002/capr.12824
Sudak, D. M., & Reiser, R. P. (2021). Training cognitive behavioral therapy supervisors. In A. Wenzel (Ed.), Handbook of cognitive behavioral therapy: Applications (pp. 669–696). American Psychological Association. https://doi.org/10.1037/0000219-021
Terjesen, M. D., & Del Vecchio, T. (Eds.). (2023). Handbook of training and supervision in cognitive behavioral therapy. Springer International Publishing. https://doi.org/10.1007/978-3-031-33735-2
Warfield, J. R. (2013). Supervising culturally informed modified trauma-focused cognitive behavioral therapy. Journal of Cognitive Psychotherapy, 27(1), 51–60. https://doi.org/10.1891/0889-8391.27.1.51
Weck, F., Jakob, M., Neng, J. M. B., Höfling, V., Grikscheit, F., & Bohus, M. (2016). The effects of bug-in-the-eye supervision on therapeutic alliance and therapist competence in cognitive behavioural therapy: A randomized controlled trial. Clinical Psychology & Psychotherapy, 23(5), 386–396. https://doi.org/10.1002/cpp.1968
Cómo citar
Supervisión en la terapia cognitivo conductual enfocada en el trauma (TF-CBT) en PRACTICA: Marco basado en componentes, viñetas y consideraciones culturales. (2025). Revista Puertorriqueña De Psicologia, 36(3), 420-433. https://doi.org/10.55611/reps.3603.06
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Artículo de investigación
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Cómo citar
Supervisión en la terapia cognitivo conductual enfocada en el trauma (TF-CBT) en PRACTICA: Marco basado en componentes, viñetas y consideraciones culturales. (2025). Revista Puertorriqueña De Psicologia, 36(3), 420-433. https://doi.org/10.55611/reps.3603.06