---
name: cbt-clinical-evaluation
description: >-
  Provides clinical supervision protocols, real-time distortion detection rules,
  psychometric scoring rubrics, and post-session diagnostic report formatting.
---

# CBT Clinical Evaluation & Supervision Skill

Use this skill when refining the clinical analysis supervisor model prompts, tuning distortion detection thresholds, or formatting final session case reports.

---

## 1. Real-Time Turn-by-Turn Supervision Protocol

During a roleplay session, every completed user turn is evaluated out-of-band by an asynchronous clinical supervisor prompt.

### 1.1 Clinical Schema
```typescript
export interface AnalysisResult {
  analysis: {
    distortions: string[];       // Detected distortions (e.g. "Mind Reading", "Catastrophizing")
    isAdaptive: boolean;         // True if the response demonstrates cognitive restructuring
    evidence: string;            // Direct quote or behavioral evidence from user's response
  };
  rating: {
    score: number;               // 1-10 clinical effectiveness score
    reason: string;              // Clinical justification for the score
  };
  suggestions: {
    alternativeThought: string;  // Rational reframe of the user's statement
    behavioralStep: string;      // Actionable communication or behavioral adjustment
  };
}
```

---

## 2. Clinical Evaluation Rubric (1-10 Scoring Scale)

| Score Range | Clinical Category | Behavioral & Cognitive Characteristics |
|:---|:---|:---|
| **1 - 3** | **Maladaptive / Reactive** | User falls into cognitive distortions without awareness; demonstrates passive-aggressive, defensive, or submissive behavior; abdicates personal boundaries. |
| **4 - 6** | **Emerging Awareness / Partial Restructuring** | User attempts to challenge distortions or state boundaries, but tone remains emotionally reactive, apologetic, or hesitant. |
| **7 - 8** | **Adaptive / Effective Restructuring** | Clear cognitive restructuring; assertive, non-blaming boundary setting; validates other person's emotions while holding firm limits. |
| **9 - 10** | **Mastery / Radical Flexibility** | Demonstrates emotional regulation under high friction; employs sophisticated techniques (e.g., DEAR MAN, Gray Rock, Radical Acceptance); de-escalates without concession. |

---

## 3. Post-Session Comprehensive Case Report

At the end of a session, a final summary prompt generates a macro assessment:
1. **Primary Cognitive Distortions Identified**: Frequency and contexts of observed distortions.
2. **Techniques Successfully Applied**: Count and effectiveness of behavioral tools used.
3. **Core Cognitive Shifts**: Evolution of the user's responses across the dialogue arc.
4. **Targeted Clinical Homework**: 1-2 practical real-world exercises to reinforce learning.