Live Supervision Research Articles

Does Live Supervision Make a Difference? A Multilevel Analysis

While the benefit of live supervision on clinical training is largely unquestioned, research that examines how live supervision affects the therapeutic process is lacking. Although marriage and family therapy has embraced this method of supervision, there is little empirical evidence suggesting it "works." This study uses hierarchical linear modeling to examine how therapy cases utilizing live supervision affect perceptions of progress on the problem. Findings indicated that live supervision does appear to make a difference for therapists' ratings of progress on the problem over the course of therapy; however, clients did not rate their progress as improving to the same degree. Implications for the use of live supervision as well as limitations of the study are discussed.

Towards Multi-positioned Live Supervision in Family Therapy: Combining Treatment and Observation Teams with First- and Second-order Perspectives

This article describes a process of live supervision that has been designed to encourage trainees to experience competing theoretical perspectives. It involves the use of separate T (treatment) and O (observation) teams who conceptualise the same case from two broadly defined theoretical perspectives, variously called first and second order, modern and postmodern, or family systems and social constructionist. The process requires trainees to adopt multiple positions rather than identify with one perspective, and provides a basis for comparing and potentially integrating them. We provide examples of the approach, discuss important contextual issues for supervisors to consider when implementing it, and examine ways of adapting it to a wide range of training contexts.

Reflections on Shared Practices in a Supervisory Lineage

Three members of a supervisory lineage (i.e., faculty supervisor, doctoral student supervisor/supervisee, and master's student counselor trainee) reflect on their practice during 15 weeks of counseling supervision. Supervisory collaboration and reciprocal learning were made possible by engaging in five shared activities: (1) utilizing a written supervision contract, (2) reviewing videotaped counseling and supervision sessions, (3) participating in live supervision, (4) maintaining written documentation, and (5) attending to here-and-now reflective conversations. Recommendations are provided for utilizing the supervisory relationship as the medium for mutual learning and professional development.

Supervision Challenges When Supervisors are Outside Supervisees' Agencies

Abstract Supervision may be provided by either insiders to the organizations from which supervisees come (employed by the agencies themselves), outsiders (privately contracted by supervisees to provide supervision) or embedded supervisors (outsiders to an agency with whom both supervisees and their agencies contract for supervision and training). While it is not uncommon for agencies to rely on supervision of their staff by nonagency personnel, outsider and embedded supervisors face challenges. These include the politics of clinical leadership; boundaries to professional practice; confidentiality; access to videotapes, audiotapes, and live supervision; and problems with routine logistics related to sustaining supervision over time. In this paper we explore these challenges and issues worth considering as supervisors and supervisees work to resolve them.

Providing Live Supervision Via Teleconferencing Improves Acquisition of Motivational Interviewing Skills After Workshop Attendance

Teleconferencing Supervision is a method for training community-based substance abuse clinicians in Motivational Interviewing (MI). Following a 2-day workshop, 13 clinicians received live supervision via telephone during 5 counseling sessions conducted at their community treatment facilities. Clinicians were assessed for skill level at post-workshop, at post-training, and 3 months later; learning was assessed using the MI Treatment Integrity instrument. All summary scores and therapist behavior frequency counts improved by post-training or by the 3 month follow-up, although some gains were not statistically significant. Teleconferencing Supervision may help facilitate the proficient use of MI community clinicians following workshop instruction.

Family Therapy for Adolescent Anorexia Nervosa: The Results of a Controlled Comparison of Two Family Interventions

This paper reports the results of a randomised treatment trial of two forms of outpatient family intervention for anorexia nervosa. Forty adolescent patients with anorexia nervosa were randomly assigned to “conjoint family therapy” (CFT) or to “separated family therapy” (SFT) using a stratified design controlling for levels of critical comments using the Expressed Emotion index. The design required therapists to undertake both forms of treatment and the distinctiveness of the two therapies was ensured by separate supervisors conducting live supervision of the treatments. Measures were undertaken on admission to the study, at 3 months, at 6 months and at the end of treatment. Considerable improvement in nutritional and psychological state occurred across both treatment groups. On global measure of outcome, the two forms of therapy were associated with equivalent end of treatment results. However, for those patients with high levels of maternal criticism towards the patient, the SFT was shown to be superior to the CFT. When individual status measures were explored, there were further differences between the treatments. Symptomatic change was more marked in the SFT whereas there was considerably more psychological change in the CFT group. There were significant changes in family measures of Expressed Emotion. Critical comments between parents and patient were significantly reduced and that between parents was also diminished. Warmth between parents increased.

Relational risk‐taking and the training of supervisors

Relational risk‐taking and the training of supervisors

Popcorn Moments

Feminist principles are rare in medical education and in the practice of medicine. The authors are feminist family therapists and feminist health communication scholars who are faculty in a department of family medicine. In this paper, they present their use of a feminist perspective and feminist methods in their teaching of family physicians in training. The use of a live supervision practicum, imported from marriage and family therapy training, is described as an example of how feminist family therapists can bring a much-needed but rarely taught perspective to medical education. This perspective represents a paradigm shift away from the traditional model in medicine, one that is based on objectivity and separateness, to a more empathic and connected stance which shifts power in the physician-patient relationship.

Telephone Counseling: Are Offices Becoming Obsolete?

Reese, Conoley, and Brossart (2002) conducted research on the effectiveness of telephone and the quality of the relationship. Reese et al. stated that the purpose of the study was to investigate whether telephone as used in the field is effective for providing general mental health counseling (p. 234). They examined clients' self-reported satisfaction with telephone counseling's treatment of their problems, their self-reported improvement in specific areas of their life, and global improvement in emotional state. Furthermore, Reese and colleagues were interested in whether clients perceived that a therapeutic bond had been developed between themselves and the counselor. Research of this nature is critical for many reasons. First, more and more companies who have employee assistance programs are using some form of telephone to help them. Second, although telephone is used widely, little is known about its effectiveness compared with traditional face-to-face therapy. Reese and colleagues (2002) make an important contribution to the literature dealing with the effectiveness of such by comparing the results of their study with those from a large scale study of face-to-face therapy conducted by Consumer Reports (CR; Mental Health,1995). In this study, participants were 186 adult clients with various emotional difficulties. These clients were receiving services from a private telephone agency that serves as an employee assistance program for several large Fortune 500 companies. More than 2 million employees had access to the service. The participants were mostly women (73%), a majority were White (76%), and they were 18 to 60 years old. The clients presented with problems in a range of areas including depression, anxiety, substance abuse, eating disorders, work-related difficulties, and grief. The average number of sessions was 12, with a range of 1 to 99 sessions. These clients accessed the using a toll-free telephone number. There was a brief intake the phone, and then the client was given a time to call back to speak to a counselor. Sessions lasted an average of 30 minutes and were considered to be solution-focused therapy (SFT; De Jong, & Berg, 1998). All counselors were licensed and had a master's degree in counseling, psychology, marriage and family therapy, or social work. All counselors were trained in SFT and received live supervision. Three measures were used to determine therapeutic effectiveness. The Consumer Reports Questionnaire (CRAQ; Annual Questionnaire, 1994) was used so that comparisons could be made with the results of the CR study. Three subscales from the CRAQ--Specific Improvement, Satisfaction, and Global Improvement--were used. The Working Alliance Inventory-Bond Scale (WAI-B; Horvath & Greenberg, 1986) was used to assess the interpersonal aspect of the therapeutic alliance (Reese et al., 2002, p. 236). The final measure, Counselor Rating Form-Short Version (CRF-S; Corrigan & Schmidt, 1983), was used to measure the client's view of the counselor's influence. Reese et al. (2002) provided compelling evidence for the effectiveness of telephone counseling. The first question as to the client's perceptions of the effectiveness of telephone yielded very positive results. Over 80% of the participants felt that the specific problem that led them to had improved (Reese et al., 2002, p. 236). These mean scores were slightly, but significantly, lower than those for the CR face-to-face group. In terms of global improvement, most of the clients (53%) reported doing so-so (Reese et al., 2002, p. 237). These scores did not differ significantly from the CR face-to-face results. Regarding satisfaction, over two-thirds of the telephone sample (68%) reported being either 'very satisfied' or 'completely satisfied' with telephone counseling (Reese et al. …

Live Supervision: A Review of the Research

This article reviews research on live supervision published within the past 12 years. The focus of the research on live supervision can be conceptualized as addressing its prevalence and use, the impact of live supervision interventions, and perceptions of live supervision by supervisors, trainees, and clients. Implications for supervisors, practitioners, and future research are discussed.

Live Supervision: A Review of the Research

Live Supervision: A Review of the Research

A Survey of Clinical Supervision in Genetic Counseling.

Three hundred and thirty-five full members of the National Society of Genetic Counselors completed a survey concerning the nature of clinical supervision for genetic counseling students. Slightly over half (54.3%, n = 182) had provided clinical supervision within the past 5 years. Of those who supervised, 66.7% had 5 years or less supervision experience, and 55% had supervised 10 or fewer students. The majority became supervisors because they enjoy teaching and contributing to the profession. Common reasons for not supervising include no local graduate program, and had never been asked to supervise. Live supervision is the most prevalent student evaluation method: every supervisor reported providing one-on-one oral feedback, and 47.3% indicated that they always provide feedback immediately following a counseling session. The most frequent challenges involve students who lack technical knowledge and who fail to incorporate feedback. Training, policy, and research implications are discussed.

Computer‐Assisted Live Supervision in College Counseling Centers

The authors describe a computer‐based “bug‐in‐the‐eye” approach to counselor supervision that is well suited to college counseling centers. Hardware and software requirements, comparisons with other forms of supervision, support for and limitations of this approach, and recommendations are presented.

Creative Moments in Supervision

Abstract Marriage and family therapy educators and supervisors offer students the opportunity to put theory into action by facilitating live clinical training. Creativity is both a process and a goal of this supervised experience with the supervisors' task being threefold: (1) to facilitate a dialogue among the clinical team of observers as each session unfolds, (2) to streamline the dialogue or conversation into helpful and concise directives to share with the co-therapy teams, and (3) to identify and discuss common themes during group supervision discussions that follow. Live supervision provides supervisors and trainees with a series of “windows” through which to view training, therapist development and clients' struggles and gains. A case study serves as a reminder that the views through these various widows are often more similar than different.

Therapists' “Brightest” Moments

Abstract This article discusses a humorous situation that occurred during live supervision with a therapist intern in training.

A Qualitative Investigation of Student and Supervisor Perceptions of Live Supervision in Genetic Counseling.

Live supervision of genetic counseling students is critical for ensuring quality client care and student clinical skill development. However, no research has investigated students' and supervisors' experience of this primary supervision method. In this study, separate focus groups of students and supervisors discussed their perceptions of the nature and impact of live supervision. A modified Consensual Qualitative Research method (Hill et al. (1997) Couns Psychol 25:517-572) was used to analyze the data. Results suggest that live supervision is an essential and effective method that promotes student skill development and professional development for both students and supervisors. There is a lack of formal training regarding supervision; most learning is trial and error. Students worry about being evaluated, and supervisors wonder if they are providing supervision effectively. Both samples emphasized that client care should not be compromised. Participant recommendations for improving live supervision are described, and suggestions are made for future research.

Gender and conversational behaviour in family therapy and live supervision

The association between supervisors’ and therapists’ gender and the conversational behaviour of four supervisors, nineteen trainee family therapists and twenty clients before, during and after eighty‐eight live supervisory phone in events were examined in this study. Clients’ co‐operation was not directly related to the gender of therapists and supervisors. The quality of supervisors’ collaborative behaviour was highest for events in systems where male supervisors were supervising male therapists and lowest for events in systems where male supervisors were supervising female therapists. In systems containing female supervisors and male therapists, therapists engaged in frequent collaborative behaviour and less frequent teaching behaviour with their clients. The quality of therapists’ collaborative and supportive behaviour was highest in these systems. The unexpected results of this study suggest that the way supervisors interact with therapists and therapists interact with clients does not conform to gender stereotypic conversational behaviour in which males are directive and females affiliative. It may be that individuals whose conversational behaviour does not conform to gender stereotypes decide to become family therapists or that family therapy training helps people develop alternatives to gender‐stereotypical conversational behaviour.

Comparing the Effects of Live Supervision Interventions on Novice Trainee Anxiety and Anger

To assess the effects of supervision upon the anxiety and anger of novice counselors-in-training, sixty-five participants received traditional delayed, phone-in, or bug-in-the-ear supervision while counseling a role-play client for the first time. Doubly multivariate analysis of covariance procedures were used to analyze the data from repeated measures of the State-Trait Anxiety Inventory and State-Trait Anger Expression Inventory. Findings revealed significant differences in state anxiety and anger due to CIT trait anxiety and anger, but no significant differences due to supervision method. CIT scores for state and trait anxiety were well below published norms. The discussion of the findings includes the possibility of a response set, CIT reluctance or inability to report anxiety or anger, and implications for the supervision of novice CITs.

Clients' views of live supervision and satisfaction with therapy.

In this study we examined clients' perceptions of live supervision and their satisfaction with therapy in a university-based training clinic for marriage and family therapists. A total of 108 clients completed the Client Satisfaction Questionnaire-8 and a modified version of the Purdue Live Observation Satisfaction Scale. Clients' comments on the advantages and disadvantages of live supervision were also solicited through short-answer questions. Results indicated that clients were generally satisfied with therapy and found the live-supervision process satisfactory as long as the perceived helpfulness of live supervision outweighed its perceived intrusiveness. The challenge for training clinics is striking a balance between helpfulness and intrusiveness in an effort to both train competent therapists and provide quality treatment.

Family Therapy for Adolescent Anorexia Nervosa: The Results of a Controlled Comparison of Two Family Interventions

This paper reports the results of a randomised treatment trial of two forms of outpatient family intervention for anorexia nervosa. Forty adolescent patients with anorexia nervosa were randomly assigned to "conjoint family therapy" (CFT) or to "separated family therapy" (SFT) using a stratified design controlling for levels of critical comments using the Expressed Emotion index. The design required therapists to undertake both forms of treatment and the distinctiveness of the two therapies was ensured by separate supervisors conducting live supervision of the treatments. Measures were undertaken on admission to the study, at 3 months, at 6 months and at the end of treatment. Considerable improvement in nutritional and psychological state occurred across both treatment groups. On global measure of outcome, the two forms of therapy were associated with equivalent end of treatment results. However, for those patients with high levels of maternal criticism towards the patient, the SFT was shown to be superior to the CFT. When individual status measures were explored, there were further differences between the treatments. Symptomatic change was more marked in the SFT whereas there was considerably more psychological change in the CFT group. There were significant changes in family measures of Expressed Emotion. Critical comments between parents and patient were significantly reduced and that between parents was also diminished. Warmth between parents increased.