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Supervision: Time for a New Way or to Dump the Practice Altogether?

January 10, 2020 By scottdm 3 Comments

what difference does it makeTherapists value supervision.  How do we know?  Research.

In their massive, long-term international study of therapist development, for example, Orlinsky and Rønnestad (2005) found, “practitioners at all experience levels, theoretical orientations, professions, and nationalities report that supervised client experience is highly important for their current and career development” (p. 188).

Regulatory boards deem supervision essential, in most jurisdictions requiring trainees have 3,000 hours –or nearly two years of full time work — before becoming licensed to practice independently.

Given such beliefs and requirements, one might reasonably thinking-womanconclude the evidence-base for clinical supervision is substantial.  And yet, a thorough search of the literature for studies investigating the relationship between the practice and treatment outcome turns up a mere handful of empirically sound investigations.  For these, the best that can be said is, the results are decidedly mixed (1, 2, 3, 4, 5).  It’s notable that a popular text on “evidence-based” supervision written by two leading researchers cites zero evidence that it leads to better results!

“Ultimately,” argue researchers Wrape and colleagues (2014), “the criteria by which to evaluate supervision’s efficacy … lie(s) in its power to bring about favorable client changes” p. (36).  Clearly, the assumption traditional supervision provides clinicians with the knowledge, skills, and capability necessary to provide safe and effective therapy is empirically questionable.  Perhaps the time has come to dump supervision altogether or at least consider new ways for helping clinicians deliver more effective services?

As already indicated, plenty of evidence indicates clinicians appreciate supervision.  Indeed, a near linear relationship exists between the number of hours received and levels of practitioner self-efficacy, job satisfaction, burnout, treatment knowledge, acquisition and use of particular treatment techniques and skills.  And therein lies the paradox: how, you might reasonably wonder, could such positive results not translate into improved outcomes for clients?

The answer?  Experience ([i.e., time in the field] of supervisors and therapists), self-rated efficacy, treatment knowledge, and competence in delivering particular treatment approaches are not, and have never been, related to outcome.  So, while regular contact with peers and mentors provides with critical emotional support for clinicians, something more and different is required for them to become more helpful to their clients.

Clues to what might replace traditional supervision can be found in a study by Goldberg et al. (2015) — the only study to date of a process resulting in continuous improvement in therapist effectiveness over time.  In it, practitioners engaged in five distinct activities: (1) formal and routine measurement of their client’s experience of progress and quality of the therapeutic relationship; (2) identification of performance shortfalls using the data generated by routine outcome monitoring; (3) ongoing clinical/supportive supervision to aimed at improving responsiveness in real time to the differences between individual clients; (4) coaching from an external expert; and (5) engagement in deliberate practice around basic therapeutic skills.

Clicking on the links above can provide you with ideas and resources to get started.  Participating in an intensive training is the next step.  Why not join us for the March intensives?  With the ICCE international faculty, you will get a thorough grounding in steps 1 through 3.  Click here for more information or to register.  Only a handful of spots remain.

OK, that’s it for now.  Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence
March 2020

 

Filed Under: deliberate practice, Feedback Informed Treatment - FIT, supervision Tagged With: psychotherapy supervision

Is Supervision Important to you?

June 20, 2014 By scottdm 1 Comment

ShowMeTheData-Howl-1

How valuable is clinical supervision to you?  In their massive, long-term international study of therapist development, researchers Orlinsky and Rønnestad (2005) found that “practitioners at all experience levels, theoretical orientations, professions, and nationalities report that supervised client experience is highly important for their current and career development” (p. 188).

Despite the value most of us place on the process, the latest review of the literature found no empirical evidence, “that psychotherapy supervision contributes to patient outcome” (Watkins, 2011).  Said another way, supervision does not produce more effective clinicians.  The result?  In the US, at least, opportunities for clinical supervision are in the decline, replaced by growing documentation requirements and administrative oversight–a trend destined to continue if the dearth of evidence persists.

What can be done?  Simply put, solicit formal feedback from clients regarding their experience of progress and the therapeutic relationship.  Such information, in turn, can be used to guide supervision, providing both a focus for the consultation and data supporting its effectiveness.  After all, multiple studies already document that the process improves outcomes while simultaneously decreasing drop out and deterioration rates (Miller, 2013 ).

Getting started is not difficult.  First, access two, free, easy-to-use scales for monitoring client progress and the relationship.   Second, join colleagues in the largest, online community of behavioral health professionals in the world.  It’s free–no hidden costs or secret levels of premium content.  On the ICCE, you can connect and consult with practitioners who are using feedback to improve the quality and outcome of treatment and supervision.  If you are new to feedback-informed work (FIT)–a SAMHSA certified evidence-based practice–you can get a thorough introduction at: www.whatispcoms.com .

Finally, get the  Feedback-Informed supervision manual and newly released, two-hour DVD.  Both provide step-by step instructions and examples of integrating feedback into supervision.  While you are at it, join us for our Feedback-Informed Supervision Intensive.  Last time around, it sold out months advance.  Registration is now open for our next training in March 2015.

Filed Under: Feedback Informed Treatment - FIT Tagged With: clinical supervision, feedback informed treatment, icce, international center for cliniclal excellence, Orlinsky, ors, outcome rating scale, PCOMS, psychotherapy supervision, Rønnestad, SAMHSA, session rating scale, srs

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