Live Supervision Research Articles

Psychiatry Resident Outpatient Clinic Supervision: How Training Directors Are Balancing Patient Care, Education, and Reimbursement

Recent literature on psychiatry resident outpatient clinic supervision is sparse. In designing outpatient supervision, training directors must balance optimization of patient care, education, and reimbursement. The authors sought to describe current practices for supervision within psychiatry resident outpatient clinics. Directors of US psychiatric residency training programs were surveyed to examine methods used for supervision and billing in psychiatry resident outpatient clinics. Seventy of 183 (38%) training directors responded. Most programs utilize live supervision for medication management visits, but psychotherapy supervision is more varied. Billing practices are variable among programs. This report is intended to help training directors consider options for optimizing patient care and resident education in their outpatient clinics, while maintaining financial solvency. Ultimately, programs should have a way of ensuring all patient cases have some form of ongoing supervision, with possible modification based on training level, resident ability, patient acuity, and appointment type.

Authentically Engaged Learning Through Live Supervision: A Phenomenological Study

This phenomenological study explored the experiential learning of 5 master's‐level counseling students undergoing live supervision in a group techniques course. Multiple themes were identified to provide a textural‐structural description of how students authentically engaged in the learning process. Implications for counselor education and directions for future research are presented.

A qualitative case study on the process of Rhee Dongshick’s live supervision

A qualitative case study on the process of Rhee Dongshick’s live supervision

La thérapie familiale multidimensionnelle (MDFT) : quelles influences, quelles spécificités ?

Among illegal psycho-active drugs, cannabis is the most consumed by French adolescents. Multidimensional family therapy (MDFT) is a family-based outpatient therapy which has been developed for adolescents with drug and behavioral problems. MDFT has shown its effectiveness in adolescents with substance abuse disorders (notably cannabis abuse) not only in the United States but also in Europe (International Cannabis Need of Treatment project). MDFT is a multidisciplinary approach and an evidence-based treatment, at the crossroads of developmental psychology, ecological theories and family therapy. Its psychotherapeutic techniques find its roots in a variety of approaches which include systemic family therapy and cognitive therapy. The aims of this paper are: to describe all the backgrounds of MDFT by highlighting its characteristics; to explain how structural and strategy therapies have influenced this approach; to explore the links between MDFT, brief strategic family therapy and multi systemic family therapy; and to underline the specificities of this family therapy method. The multidimensional family therapy was created on the bases of 1) the integration of multiple therapeutic techniques stemming from various family therapy theories; and 2) studies which have shown family therapy efficiency. Several trials have shown a better efficiency of MDFT compared to group treatment, cognitive-behavioral therapy and home-based treatment. Studies have also highlighted that MDFT led to superior treatment outcomes, especially among young people with severe drug use and psychiatric co-morbidities. In the field of systemic family therapies, MDFT was influenced by: 1) the structural family therapy (S. Minuchin), 2) the strategic family theory (J. Haley), and 3) the intergenerational family therapy (Bowen and Boszormenyi-Nagy). MDFT has specific aspects: MDFT therapists think in a multidimensional perspective (because an adolescent's drug abuse is a multidimensional disorder), they work with the system and the subsystem, focusing on the emotional expression and the parental and adolescent enactment (a principle of change and intervention). MDFT includes four modules (adolescent, parent, family interaction, and extra-familial systems) in three steps (1) build the foundation, (2) prompt action and change by working the themes, and (3) seal the changes and exit). The supervision philosophy and methodology is also based on the principle of multidimensionality. Indeed, many different supervision methods are used in a coordinated way to produce the required adherence and clinical skill (written case conceptualizations, videotape presentation and live supervision). Family vulnerability and chronicity factors are a major challenge of modern research. MDFT questions the reciprocal adjustments that have to be made by the subject and his/her familial environment. It also helps to clarify the therapeutic interventions in order to enhance better adolescent development. For this purpose, MDFT offers a specific therapeutic frame, for it is a family therapy focused on adolescents with cannabis abuse problems. Its action and questioning on parental practices and adolescents lead to better psycho-educational support. It focuses the therapeutic process on emotions and family capacity for change.

Participant Supervision: Supervisor and Supervisee Experiences of Cotherapy

Participant supervision is a unique application of live supervision in which a supervisor and supervisee see clients conjointly. Although minimally discussed in the family therapy literature, it has notable advantages, chief among them being a shared clinical experience that increases attunement to supervisee skill and development, the modeling of skillful intervention, and a higher degree of collegiality. However, it is not without its challenges, including supervisee vulnerability and anxiety, diffusion of responsibility, and limited time for case discussion. This article highlights the experience of one supervisor and three doctoral-level supervisees engaging in participant supervision over the course of a 2-year period. Using illustrative examples, we discuss our experience of the advantages and challenges of participant supervision, and provide recommendations for establishing a collaborative relational context within which supervisory benefits can be maximized.

Using live supervision to deliver family intervention training

Using live supervision to deliver family intervention training

Standardizing the Pre-Licensure Supervision Process: A Commentary on Advocating for Direct Observation of Skills

The present paper advocates for standardized regulations and laws for supervision of pre-licensed counselors in the United States, particularly for direct observation of clinical skills. A review of regulations by the American Counseling Association's (ACA) Professional Affairs Division (2012) reveals that only two states (Arizona and North Carolina) specify requiring supervision interventions that include the use of reviewing audio or videotapes, or live supervision modalities, to help evaluate pre-licensed counselors competence. Literature on the current state of regulations as well as extant research in supervision practices, and effects on satisfaction with supervision and self-efficacy is presented and framed in terms of standardized policy.Keywords: pre-licensed counselors, regulations, laws, satisfaction with supervision, self-efficacy, direct observationA review of regulations by the American Counseling Association (ACA) Office of Professional Affairs (2012) reveals that all fifty states require the practice of counseling under supervision for two or more years after the completion of the master's degree prior to licensure. However, there are no unified national standards that govern post-master's degree supervision (e.g., ACA, 2012 Borders & Cashwell, 1992). Supervised counseling experience ranges from 1000 to 4500 hours (ACA Office of Professional Affairs), with the amount of face-to-face clinical supervision occurring either in an individual or group setting varying greatly (ACA, 2007). Furthermore, only two states (Arizona and North Carolina) specify requiring supervision interventions that include the use of reviewing audio or videotapes, or live supervision modalities to help evaluate pre-licensed counselor competence (ACA Professional Affairs Division). Some studies have investigated supervision in this counselor pre-licensure stage, including factors related to counselor effectiveness such as self-efficacy and satisfaction (e.g., Bernard & Goodyear, 2004; Fall & Sutton, 2004; Magnuson, Norem, & Wilcoxon, 2002). The use of direct observation of skills in supervision is noted to lead to more positive effects in terms of counseling performance and outcomes. Standardization of required direct observation of clinical skills is especially necessary. The literature indicates that observation of skills is crucial to counselor professional development and practice (Herbert & Trusty, 2006). Moreover, standardization of required direct observation of clinical skills is a key factor in licensure policy The following review calls for such standardization, with a summary of current regulations, extant research in counseling outcomes and supervision practice, and recommendations and advocacy for regulation.Supervision Background and StandardsACA, the Association for Counselor Education and Supervision (ACES), and the American Association of State Counseling Licensure Boards (AASCB) have all attempted to define best practices in counselor supervision. The ACA Code of Ethics standard F. 1 .a, discusses a primary obligation of supervisors in the role of monitoring services of counselors-Neal in-training. This monitoring consists of case notes, samples of clinical work or live observation of the trainee (Herlihy & Corey, 2006). In 1990, model legislation for licensed professional counselors was developed by the American Counseling Association to promote acceptable professional standards within the realm of counseling. This proposed licensure bill recommended state licensure boards consider what is the nature of the supervision co-therapy, direct observation, audio and/or videotaping (Bloom et al., p. 520). ACES also addressed this issue in two different documents. First, the Ethical Guidelines for Counseling Supervisors states that supervisors are responsible for actual work samples via audio or videotape or live observation... which should be reviewed by the supervisor as a regular part of the ongoing supervisory process (ACES, 1995, p. …

Training Methods in Cognitive Behavioral Therapy: Tradition and Invention.

Cognitive behavioral supervisors influence new generations of clients and clinicians. Accordingly, the task is meaningful, rewarding, challenging, and critically important. This article describes traditional and unconventional approaches to supervising clinicians in cognitive behavioral therapy (CBT). Traditional methods such as the use of the Cognitive Therapy Rating Scale, videotape/audiotape review, live supervision, and cotherapy are reviewed. Further, inventive procedures for teaching supervisees cognitive flexibility, empathy, tolerance for ambiguity, and remaining steadfast when faced with negative emotional arousal are explained. Popular media, improvisation and acting exercises, and working with professional actors as teaching methods are explained.

Internet-Based One-Way-Mirror Supervision for Advanced Psychotherapy Training

This article describes a technological setup and model for Internet-based one-way-mirror supervision, called Remote Live Supervision (RLS). RLS improves the availability of distance-based advanced psychotherapy training by permitting a supervisee to receive “live” supervision from a supervisor in a distant location, in real time during a psychotherapy session. The benefits and limitations of “cybersupervision” (Gilbert & Maxwell, 2011) are discussed, with special consideration given to supervision process, ethics, privacy, and security. Directions for future research are discussed.

Examining Pedagogical Practices in Family Systems Nursing

Teaching graduate family nursing students the important and delicate practice of entering into and mitigating families' illness suffering signifies an educational practice that is rigorous, intense, and contextual, yet not articulated as expounded knowledge. This study examined the pedagogical practices of the advanced practice of Family Systems Nursing (FSN) as taught to master's and doctoral nursing students at the Family Nursing Unit, University of Calgary, using observation of expert and novice clinical practice, live supervision, videotape review, presession hypothesizing, clinical documentation, and the writing of therapeutic letters to families. A triangulation of research methods and data collection strategies, interpretive ethnography, autoethnography, and hermeneutics, were used. Students reported an intensity of learning that had both useful and limiting consequences as they developed skills in therapeutic conversations with families experiencing illness. Faculty used an intentional pedagogical process to encourage growth in perceptual, conceptual, and executive knowledge and skills of working with families.

Peer live supervision in the familial cancer setting

At the Royal Melbourne Hospital, the Genetic Counsellors identified the desire to learn from each other, and engage in new forms of learning. Subsequently, a pilot project focusing on reflection, accountability, and experiential learning was developed. Live supervision with peers was identified as the model which fitted the learning objectives of the team. The aims of the project were to: 1. Develop a live peer supervision model relevant to Genetic Counselling practice applicable to both Board Eligible and Certified Genetic Counsellors working in Familial Cancer. 2. Develop guided post observation questions based on reflective practice. 3. Identify key learning points from the live peer supervision sessions. Seven Associate Genetic Counsellors/Genetic Counsellors participated in the project. The first phase involved collaborative brainstorming sessions to define the purpose of the project, gain knowledge and skills relevant to supervision, set the supervision contract, and develop post-observation questions. After each live supervision session, the discussions of the observer and observee were audio recorded. The second phase of the project involved analysing the recorded discussions and identifying key areas of learning, relevant to clinical practice. The observer and observee's self-reported areas of learning were also identified. This presentation will describe the process and outcomes from these two phases of the project. This pilot project provided the Genetic Counsellors with an opportunity to enhance clinical and supervision skills, harness the skills brought by each Genetic Counsellor, learn from one another's qualities, increase awareness of one's own style in clinical practice, and engage in the reflective process with immediacy. There were a number of learning areas unique to this model of supervision, including access to experiential and visual learning. Live-peer supervision may be a useful model to consider for both Associate and Certified Genetic Counsellors to engage in their continuing development and growth in clinical and supervision skills, ultimately improving patient care.

Training substance abuse clinicians in motivational interviewing using live supervision via teleconferencing.

Training through traditional workshops is relatively ineffective for changing counseling practices. Teleconferencing supervision (TCS) was developed to provide remote, live supervision for training motivational interviewing (MI). Ninety-seven drug treatment counselors completed a 2-day MI workshop and were randomized to live supervision via teleconferencing (TCS; n = 32), standard tape-based supervision (tape; n = 32), or workshop alone (workshop; n = 33). Supervision conditions received 5 weekly supervision sessions at their sites using actors as standard patients. Sessions with clients were rated for MI skill with the Motivational Interviewing Treatment Integrity (MITI) Coding System pre-workshop and 1, 8, and 20 weeks post-workshop. Mixed-effects linear models were used to test training condition on MI skill at 8 and 20 weeks. TCS scored better than workshop on the MITI for spirit (mean difference = 0.76; p < .0001; d = 1.01) and empathy (mean difference = 0.68; p < .001; d = 0.74). TCS was superior to workshop in reducing MI non-adherence and was superior to workshop and tape in increasing reflection to question ratio. Tape was superior to TCS in increasing complex reflections. Percentage of counselors meeting proficiency differed significantly between training conditions for the most stringent threshold (spirit and empathy scores ≥ 6). TCS shows promise for promoting new counseling behaviors following participation in workshop training. However, further work is needed to improve supervision methods to bring more clinicians to high levels of proficiency and facilitate dissemination of evidence-based practices.

Supplemental Material for Training Substance Abuse Clinicians in Motivational Interviewing Using Live Supervision Via Teleconferencing

Supplemental Material for Training Substance Abuse Clinicians in Motivational Interviewing Using Live Supervision Via Teleconferencing

"Old dogs" and new skills: how clinician characteristics relate to motivational interviewing skills before, during, and after training.

The relationships between the occupational, educational, and verbal-cognitive characteristics of health care professionals and their motivational interviewing (MI) skills before, during, and after training were investigated. Fifty-eight community-based addiction clinicians (M = 42.1 years, SD = 10.0; 66% Female) were assessed prior to enrolling in a 2-day MI training workshop and being randomized to one of three post-workshop supervision programs: live supervision via tele-conferencing (TCS), standard tape-based supervision (Tape), or workshop training alone. Audiotaped sessions with clients were rated for MI skillfulness with the Motivational Interviewing Treatment Integrity (MITI) coding system v 2.0 at pre-workshop and 1, 8, and 20 weeks post-workshop. Correlation coefficients and generalized linear models were used to test the relationships between clinician characteristics and MI skill at each assessment point. Baseline MI skill levels were the most robust predictors of pre- and post-supervision performances. Clinician characteristics were associated with MI Spirit and reflective listening skill throughout training and moderated the effect of post-workshop supervision method on MI skill. TCS, which provided immediate feedback during practice sessions, was most effective for increasing MI Spirit and reflective listening among clinicians with no graduate degree and stronger vocabulary performances. Tape supervision was more effective for increasing these skills among clinicians with a graduate degree. Further, TCS and Tape were most likely to enhance MI Spirit among clinicians with low average to average verbal and abstract reasoning performances. Clinician attributes influence the effectiveness of methods used to promote the acquisition of evidence-based practices among community-based practitioners.

The Evolution of Family Process: Contexts and Transformations1,2

The Evolution of Family Process: Contexts and Transformations1,2

Live Supervision of Students in Field Placement: More than Just Watching

Frequently, observation of social work students in ‘live’ work is absent or haphazard. An overview of the key literature examines the need for observation of students during training, explores the strengths and challenges of live supervision and describes a planned process for conducting live supervision. This approach incorporates four phases: collaborative preparation for a session of direct practice; observation of the student's work by a field educator; debriefing and feedback; and the development of a plan for further learning steps. Brief vignettes are used to illustrate the process. The article is enriched by the inclusion of student comments from the evaluations undertaken after live supervision activities.

The effects of meeting a family therapy supervision team on client satisfaction in an initial session

Despite the wide use of live supervision in marriage and family therapy training, there have been no randomized trials comparing different variations of the practice. This randomized trial of 86 clients was designed to measure client satisfaction after an initial therapy session under two conditions: meeting the supervision team behind the observation mirror or not meeting the team. A mixed linear model analysis of covariance was used to examine the relationship between ‘meeting the team’ versus ‘not meeting the team’ and client satisfaction. There were no statistically significant differences in client satisfaction based on whether clients met the team or not. There was a trend toward greater satisfaction with the therapy session among clients who did not meet the supervision team.

Working interactively using a systemic sex therapy model for common sexual problems within a modern health service setting

Summary Sexual and Relationship Couples Psychotherapy is a specialist form of psychotherapy and counselling within which different theoretical perspectives may be employed by clinical staff. These include psychodynamic, family-of-origin, cognitive behavioural and systemic therapies. Systemic therapy has developed from a family systems background for the management of couples with relationship difficulties and in certain instances for couples with both relationship and sexual difficulties. The history and development of systemic therapy is described followed by a more specific review and outline of systemic therapy in the management of sexual problems. We go on to describe the specific training experience of a member of staff in systemic therapy to build upon the existing clinical framework employed within the service. Inherent for systemic therapy, there is a need for a team of observers, which in our clinic incorporates both staff and our postgraduate trainees. The experience of the member of staff learning specific skills in systemic sex therapy and live supervision of the team of her work during development of her skill set is explored and discussed. Issues around clinical outcomes and clinical governance are further described as our service is provided within a national health system service where these are considered mandatory.

Using Live Supervision in Field Education: Preparing Social Work Students for Clinical Practice

This article presents a qualitative study exploring respondents’ perceptions of live supervision as the primary field instruction method for MSW students participating in an internship that emphasized family therapy. Participants were specifically asked in what ways live supervision supported and facilitated learning clinical practice. Identifying live supervision as important for bridging the pedagogical gap between teaching theory and practice learning stood out as an important metatheme of the study, not previously discussed in the literature. Important emergent categories included learning-in-action pedagogy, feedback loop for integrative learning, the safety net in parallel observation, transparency in the supervision process, and building capacity for entering the workforce. Incorporating the principles of adult learning theory, live supervision offers an important contribution to social work field education.

Tuning the Ear: Listening in Narrative Therapy

In this article the authors adopt “tuning the ear” as a metaphor for listening within narrative work. The distinction between listening as an intentional event, influenced by personal, theoretical, and political intentions is discussed. A central idea involves distinguishing between “listening to” and “listening for,” which suggests that therapists select events to be heard or not heard. The authors suggest that intentional listening can lead to therapeutic conversations that bring forward aspects of the lives of both clients and the therapists that would not have been predicted by the problem story. A map around intentional listening is presented, the Tuning the Ear Map, which includes four levels: tuning in, intentions, consequences, and action. The map is illustrated with excerpts from a conversation within a live supervision group.1