Using client feedback in psychotherapy training: An analysis of its influence on supervision and counselor self-efficacy.

Tracking client outcome and the therapeutic relationship across treatment (i.e., client feedback) has become a recommended practice for clinicians. This study investigated whether the utility of this practice would extend to trainees if the data gained from clients was provided to their supervisor for use within supervision. Trainees (N = 28) were assigned to a continuous feedback condition or no-feedback condition for 1 academic year. Results indicated that trainees in both conditions demonstrated better client outcomes at the end of their practicum training than at the beginning, but those in the feedback condition improved more. However, those in the feedback condition did not rate the supervisory alliance or satisfaction with the supervision process differently. The relationship between counselor self-efficacy and outcome was stronger for trainees in the feedback condition than for those in the no-feedback condition, perhaps indicating that feedback may facilitate a more accurate assessment of one’s skills. Implications of how counseling self-efficacy, the supervisory alliance, and satisfaction with supervision are related to effective supervision are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The supervisee experience of group supervision: Implications for research and practice.

Group supervision is commonly employed in graduate psychology training but has received insufficient attention in research. Supervisees' own perceptions and experiences in group supervision can provide valuable information in guiding our understanding and exploration of the benefits and uses of this form of training. This paper reviews 11 empirical studies exploring supervisee perceptions of group supervision experiences. Research, to date, appears to be largely in line with conceptual hypotheses regarding the benefits of group supervision experiences, and implications are discussed with regard to current practice. However, this review also points to the need for more in-depth and advanced research efforts in the area that can further explore supervisee experiences and identify means of optimizing this experience as a component of clinical training. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effects of a method of self-supervision for counselor trainees.

The authors tested the application of self-regulation and goal theory to self-supervision using a replicated, randomized multiple baseline (MBL) design. Specifically, 4 female novice counselor trainees were randomly assigned to 1 of 3 MBL conditions (self-supervision targeting the use of metaphor first and then empathy, self-supervision targeting empathy and then metaphor, or an attention placebo control) to test the effects of self-supervision on trainees' use of empathy and metaphor across counseling sessions. Although trainees significantly increased their use of metaphor after receiving self-supervision training, no significant effects were found for self-supervision targeting empathy. Tentative conclusions include that self-supervision appears viable with some limitations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concept mapping of the events supervisees find helpful in group supervision.

Although group supervision is ubiquitous in practicum training sites today, little research has examined its benefits. The authors identified 66 different helpful events, drawn from the free responses of 49 graduate students in psychology. Thirteen of these students then sorted the events by similarity; a concept map was created via cluster analysis and multidimensional scaling of the resulting similarity data. Helpful events fell into five clusters: Supervisor impact; Specific instruction; Self-understanding; Support and safety; and Peer impact. These clusters differed on two dimensions: Perceiving supervisor versus peer impact and Acquiring objective versus self knowledge. Research and practice implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in the ways that group trainees structure their knowledge of group members with training.

Multidimensional scaling (MDS) and Pathfinder were used to examine changes in the knowledge structures of 9 group therapy trainees, and to examine convergence in the trainees' knowledge structures with one experienced group leader. Participants (experienced group therapist and group therapy trainees) judged the similarity of each pair of group members in an ongoing interpersonal process group early and late in a semester of group therapy training. As in previous research, MDS and Pathfinder analyses of these similarity judgments were used to infer the cognitive structure of the trainees and of the experienced group leader. These analyses suggested that (a) the dimensions used by the trainees to conceptualize group members increased in complexity with training, and (b) trainees' knowledge structures became more similar to the experienced leader's knowledge structure with training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group process and learning: A grounded theory model of group supervision.

While there is a small but growing body of literature on group supervision, it has been limited to a handful of qualitative studies, and quantitative studies that have focused on specific aspects of the supervision process. Therefore, the purpose of this study was to develop a theoretical model of the process of group supervision and its relation to student learning. A grounded theory design with some features of consensual qualitative research was utilized to achieve this goal. Fifteen counseling psychology doctoral students and three supervisors comprising 13 supervision groups completed questionnaires following each group supervision session over the course of six semesters. Varying degrees of safety were reported by participants and group supervision was either facilitated by safety or inhibited by a lack of safety. However, when students reported feeling safe, a greater variety of learning occurred than when they reported they felt less safe. Also, within a supervision group, students experienced the group differently based on their ability to manage anxiety and develop supportive relationships with other peers in the group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group supervision practices at psychology predoctoral internship programs: 15 years later.

This national survey was conducted to answer several questions including: how predoctoral training sites practice group supervision, how these results compared to a similar survey sent in 1991 (Riva & Cornish, 1995), and whether group process and multicultural considerations are incorporated into group supervision practices. The original survey included 157 group supervisors from sites listed in the 1991-1992 APPIC Directory, while the current study's respondents included 162 group supervisors from sites in the 2006-2007 APPIC Directory. Several important similarities and differences were found between the two time periods. The results and implications related to how group supervision is conducted are presented. Recommendations based on these results are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hindering phenomena in group supervision: Implications for practice.

Although group supervision is practiced extensively, research on the subject remains scant. This study identified group supervision phenomena that hinder learning. Counseling and counseling psychology graduate students identified 61 group supervision experiences that they felt interfered with their learning. Then, 14 of the 49 original participants sorted the 61 phenomena on the basis of similarity. Hierarchical cluster analysis was used to identify 5 types of hindering phenomena: between-member problems, problems with supervisors, supervisee anxiety and other perceived negative affects, logistical constraints, and poor group time management. Implications for supervisors, supervisees, and training programs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between level of training, implicit bias, and multicultural competency among counselor trainees.

The assessment of attitudes toward diversity among counselor trainees has relied on self-report measures. Implicit measures might offer a valuable addition to self-report because they assess biased attitudes indirectly, do not rely on conscious introspection, and often demonstrate bias that contradicts self-reported attitudes. A sample (N = 105) of counselor trainees was assessed with measures of implicit bias toward African Americans and lesbians and gay men and a measure of self-reported multicultural competency. Implicit bias was present among counselor trainees despite high self-reported multicultural competency. In addition, self-reported multicultural competency varied by training level, but implicit bias did not. The results suggest that implicit bias can add to the understanding, assessment, and training of multicultural counselor competency. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of a feedback intervention on group process and outcome.

The effects of a feedback intervention directed at both members and leaders was examined in psychotherapy groups held in a university counseling center. Feedback consisted of group climate information using scores from the Group Climate Questionnaire, completed by members after each group session. The direct effects of the feedback intervention were assessed using scores on the Curative Climate Instrument as well as Group Climate Questionnaire subscales. These instruments were administered after each group session. Distal effects of the feedback intervention were examined using member symptom improvement (Outcome Questionnaire) and group attendance. Members and leaders in the experimental condition were given weekly written and graphical feedback and contrasted against comparable groups receiving no feedback. Results indicate the feedback intervention had little impact on the therapeutic factors and outcome. However, for members who reported that the group was high in conflict, the feedback intervention had a significant negative effect on outcome. Implications and directions for future research are examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Describing and facilitating effective supervision behavior in counseling trainees.

Counseling trainees often do not receive formal assistance in assuming the role of supervisee. What constitutes effective trainee behavior within the context of supervision, as opposed to the clinical context, also has received little empirical attention. A national sample of 176 participants (145 supervisees, 31 supervisors) affiliated with counseling psychology or counseling center internship programs rated the importance of 52 behaviors/characteristics (Supervision Utilization Rating Form; SURF) to the effective use of supervision at specific developmental training levels. Supervisors and supervisees applied ratings from important to extremely important to all items. Statistically significant differences between supervisor and supervisee ratings were noted on 6 items. The development of the SURF and its potential uses in supervisee role induction are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Arab and Israeli counseling trainees: A comparison of ethnically homogeneous and heterogeneous groups.

The study compared Arab and Jewish trainees in ethnically homogeneous and heterogeneous groups, in 1 counselor training program in Israel. The 60 participants were divided into 4 conditions: Jewish trainees in homogeneous and heterogeneous groups (n=15 in each), and Arab trainees in homogeneous and heterogeneous groups (n=15 in each). Functioning in the group was measured through group climate (engagement, conflict, and avoidance), group intimacy, self-disclosure, and regret of disclosure. Results indicated cultural differences only on self-disclosure, with Arabs scoring lower than Jews on several dimensions. Group composition differences were mainly indicated on the climate measure, with higher scores in the heterogeneous group on conflict and avoidance, and lower scores on regret of feeling exposure. Culture-by-group interactions were found for engagement, self-disclosure, and regret after disclosure about self, with Arabs in heterogeneous groups scoring higher on the first 2 and lower on the third. These results recommend placing Arab trainees in heterogeneous groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The supervision genogram: A tool for preparing supervisors-in-training.

The purpose of this article is to introduce the supervision genogram as a training tool that can be implemented in supervisor training. The supervision genogram is a unique training tool that may be used to enhance supervisors'-in-training self-awareness and understanding of the supervisory process. Psychological trainers who are responsible for training supervisors may also find that the supervision genogram can aid them in assessing the needs of supervisors-in-training and in creating corresponding supervisory environments and experiences. A detailed account of how to develop and process the supervision genogram is given. An overview of supervision genogram symbols and a completed supervision genogram are also provided. Implications for training, such as flexibility of application, ethical and professional issues, and developmental considerations for using this tool are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-critiques of audiotaped therapy sessions: A motivational procedure for facilitating feedback during supervision.

Although supervision is an important mechanism for developing clinical competencies, trainees sometimes find it difficult to accept critical feedback. The procedure of using written self-critiques of audiotaped therapy sessions, based on motivational interviewing (MI) principles, was used to facilitate acceptance of feedback for doctoral clinical psychology students. MI techniques have been shown to decrease resistance and enhance motivation to change. The self-critiques were evaluated very positively by trainees as helping them accept critical feedback and allowing them to provide suggestions for their own clinical skill development. The use of self-critiques based on MI techniques is a promising adjunctive supervisory procedure that warrants additional evaluation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing supervisee reflectivity in clinical supervision: A case study illustration.

Reflectivity has been described as the cyclical process whereby individuals engage in a critical evaluation of their affective, cognitive, and behavioral experiences to produce insight and fundamental shifts in their original beliefs. Developing reflectivity in supervisees is one of the most challenging, yet important, responsibilities of clinical supervisors, given its link to such skills as critical thinking, ethical decision making, and problem solving. This paper advances the literature by presenting a case example that demonstrates how reflectivity can be emphasized in clinical supervision, highlighting the barriers to reflectivity, and providing strategies that supervisors can utilize to encourage reflectivity within clinical supervision. The strategies and information discussed may be flexibly applied to supervisees of all developmental levels within the context of individual supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Directed self-reflection protocols in supervision.

Directed self reflection is an ancillary supervisory method that an experienced therapist can use to prepare a novice therapist for clinical work with an unfamiliar patient population, modality, or setting. First, the supervisor generates a list of questions that address issues known to be problematic for many trainees in a specific clinical site. Prior to contact with patients, the supervisee reflects upon the questions and privately writes answers as a means of priming him or her for potential challenges and further discussion. An example of a self-reflection protocol is discussed, and suggestions are given for constructing protocols for specific clinical settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A transtheoretical model of clinical supervision.

The purpose of this article is to introduce a transtheoretical model of clinical supervision for professional psychology. The various stages and processes of change inherent in the transtheoretical psychotherapy model (Prochaska & DiClemente, 1982, 1984, 1986; Prochaska & Norcross, 2007) are assessed and applied to clinical supervision. Specifically, relevant literature is examined; supervisee stages of change (SSC) and supervisor processes of change (SPC) are introduced and discussed; and existent models of supervision are contextually compared to the proposed transtheoretical model. Strategies and recommendations for implementing and researching a transtheoretical approach to clinical supervision are also provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

General and multicultural case conceptualization skills: A cross-sectional analysis of psychotherapy trainees.

The general and multicultural case conceptualization skills of 91 psychotherapy trainees were evaluated for complexity and expertness across 3 case scenarios. The cases varied in the extent to which culture was presented in the demographic information and presenting concerns. Whereas general case conceptualization skills were found to relate to clinical training, multicultural case conceptualization skills were found to relate to multicultural training. Across cases, advanced trainees demonstrated significantly greater complexity and expertness than beginners. Trainees consistently included more culturally relevant ideas when culture was explicitly stated in the case as a presenting problem, versus when culture was implied. Last, consistently significant differences in the case conceptualizations of White trainees and trainees of color were not found. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Divergence, convergence, openness, and specificity in training and supervision.

Reviews the books, Supervision and training: Models, dilemmas and challenges edited by F. W. Kaslow (1986); Handbook of family therapy training and supervision edited by H. A. Liddle, D. C. Breunlin, and R. C. Schwartz (see record 1988-98390-000); and Family therapy education and supervision edited by F. P. Piercy (1986). Kaslow's book uniformly addresses the subject of supervision with some comment on training formats as well. The volume succeeds admirably in realizing the editor's intention of presenting a multiplicity of viable models, and her summary chapter draws common threads together into a patchwork of issues and themes. Liddle, Breunlin, and Schwartz's book is thoughtful and concise, with a nice blend of conceptual and practical material. The book offers the most current overview and bibliography available, useful specific recommendations, and thoughtful organization of its articles. It is praiseworthy in its attention to research, theory, and context and stage-of-training factors in relation to supervision and training. Piercy's book contains chapters which are well presented and offer valuable concrete guidelines; however, overall the material is unfocused, scattered across too many areas, and works best in journal form. All three of the volumes considered in this review serve as compendiums, and in some cases updates, of models for the delivery of training and supervision. There is very little overlap of content among the three, and taken together, they offer intra- and interdisciplinary contrasts of training and supervision that may serve as the starting place for program planning, or for hypothesizing data collection, and theorizing about these two important endeavors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Retrospectives from three counseling psychology predoctoral interns: How navigating the challenges of graduate school in the face of death and debilitating illness influenced the development of clinical practice.

Death and debilitating illness can have a significant impact on one's understanding of self, others, and society. When a counseling or clinical psychology graduate student experiences such hardships during the course of his or her clinical training, there can be several potential implications. The stressors of graduate school may exacerbate the emotional responses to an already painful situation. Additionally, clinical skill development can be negatively affected if the student has difficulty acknowledging how hardship influences his or her capacity to be an effective therapist. However, the same tribulations can also help new therapists to realize their inner strength, develop beneficial coping skills, and apply this knowledge when working with clients. Highlighted in this article are three cases of loss and hardship that underscore the importance of supportive clinical supervision, psychological hardiness, humor, and optimism during times of personal crises. (PsycINFO Database Record (c) 2010 APA, all rights reserved)