Supporting our supervisors: a Summary and Discussion of the Special Issue on CBT supervision

Performance of a Supervisor Observational Coding System and an Audit and Feedback Intervention

Workplace-based clinical supervision is common in community based mental health care for youth and families and could be a leveraged to scale and improve the implementation of evidence-based treatment (EBTs). Accurate methods are needed to measure, monitor, and support supervisor performance with limited disruption to workflow. Audit and Feedback (A&F) interventions may offer some promise in this regard. The study-a randomized controlled trial with 60 clinical supervisors measured longitudinally for 7 months-had two parts: (1) psychometric evaluation of an observational coding system for measuring adherence and competence of EBT supervision and (2) evaluation of an experimental Supervisor Audit and Feedback (SAF) intervention on outcomes of supervisor adherence and competence. All supervisors recorded and uploaded weekly supervision sessions for 7 months, and those in the experimental condition were provided a single, monthly web-based feedback report. Psychometric performance was evaluated using measurement models based in Item Response Theory, and the effect of the SAF intervention was evaluated using mixed-effects regression models. The observational instrument performed well across psychometric indicators of dimensionality, rating scale functionality, and item fit; however, coder reliability was lower for competence than for adherence. Statistically significant A&F effects were largely in the expected directions and consistent with hypotheses. The observational coding system performed well, and a monthly electronic feedback report showed promise in maintaining or improving community-based clinical supervisors' adherence and, to a lesser extent, competence. Limitations discussed include unknown generalizability to the supervision of other EBTs.

Preventing harm related to CBT supervision: a theoretical review and preliminary framework

Like any treatment, cognitive behavioural therapy (CBT) may have negative as well as positive outcomes, and the same is true of CBT supervision. This is recognized in definitions of supervision, which prioritize helping supervisees to ‘do no harm’ to their patients. Client harm is associated with personal distress in supervisees (therapists), such as burnout, resulting in sub-standard therapy which causes harm to patients. Some supervisors have contributed to the supervisees’ distress, and consequently to patient harm. Harm may also arise from other staff members, or from situational factors that impact negatively on various aspects of the healthcare environment. At a more distal level, the host organization may create a context that allows such problems to go unchecked (e.g. a failure to train or support supervisors adequately). It follows that a large-scale framework is necessary to fully understand and address this multi-dimensional and systemic context for harm. Therefore, this theoretical review sketches out a preliminary ‘infidelity framework’ in order to classify ten types of problem behaviour that commonly contribute to harm that is linked to supervision. Drawing on related frameworks and neighbouring literatures, the infidelity framework also offers an understanding of the typical antecedents and consequences of each of these ten behaviours. This generic functional analysis leads to examples of evidence-based CBT supervision that might prevent or rectify harm.

A Descriptive Analysis of the Interactions During Clinical Supervision

This study intends to analyze some skills trained during supervision. In it we describe sets of interactions (based on the American Psychological Association [APA], 2006; competency domains) happened between the supervisor and the supervisee during the supervision process. Interactions from twelve supervisor-supervisee dyads during asynchronous and direct, and individual and group supervision sessions were video recorded for this purpose. The recordings helped to determine, classify, and define behavioral response classes in each dyad's interactions. Percentages of time spent in each behavior class were computed. A reliability of 95% CI [0.91, 0.95] among observers was obtained. The behavior classes in which more time was spent were assessment, intervention, and conceptualization skills. Behavior classes in which less time was spent were related to emotional and interpersonal processes. These findings are discussed by linking the evidence-based theory on supervision with the time spent in each behavior class.