Repairing the ruptured supervisory alliance: Humility as a foundational virtue in clinical supervision

A practice-based study of relational virtues and alliance correspondence in psychodynamic psychotherapy

OBJECTIVE

Treatment outcome monitoring typically emphasizes pathology. In contrast, we responded to the need to establish psychodynamic psychotherapy as evidence-based by modeling changes in gratitude and forgiveness.

METHOD

We utilized a practice-based research design involving non-manualized outpatient treatment. We employed a longitudinal mixture modeling approach to evaluate treatment effectiveness. We did so by testing the theorized role for relational virtues (i.e., gratitude, forgiveness) as signs of progress in psychodynamic treatment, with relational virtues referring to the application of character strengths to specific situations. We modeled clients' self-reported level on the virtues as a joint process over five time points, and examined the influence of early treatment alliance correspondence on patterns of change using a sample of outpatient clients (N = 185; Mage = 40.12; 60% female; 74.1% White).

RESULTS

A 3-class solution best fit the data, with one class exhibiting growth in gratitude and forgiveness, improved symptoms, and a greater likelihood of symptom improvement relative to well-being gains. Alliance correspondence predicted the classes of change patterns, with greater similarity between clinicians' and clients' perceptions about the alliance predicting greater likelihood of belonging to the subgroup showing highest levels of virtues and well-being, lowest symptoms, and improved well-being.

CONCLUSION

Clinical implications involve monitoring gratitude and forgiveness as signs of progress and navigating the dialectic between implicit alliance processes and explicit virtue interventions. The former involves nurturing a strong alliance and repairing ruptures, whereas the latter involves direct in-session conversation and/or the practice of virtue interventions in and/or outside of session.

The Future of Evidence-Based Temperance Interventions

Positive psychology has accumulated a large and ever-growing body of scientific knowledge about human strengths and virtues. However, research on positive psychology interventions (PPIs) to develop such is still in its infancy. In this brief position paper, we summarize the status of PPIs in one of the positive psychology's most important virtues: temperance. Temperance refers to the capacity to manage habits and protect against excess and is composed of forgiveness, humility, and (we include) patience. Specifically, we examine the current state-of-the-science in the conceptualization of temperance, explore the efficacy of temperance interventions, and reflect upon what the future may hold in this research domain. In this paper, we first highlight the challenges and opportunities for expanding the theoretical conceptualization of temperance and reflect upon the challenges in temperance-related PPIs. For each aspect of temperance, we propose a specific research agenda. Second, we explore what is needed for PPIs to promote temperance and how growth in temperance intervention research can be fostered. Generally, while forgiveness interventions are well established, we recommended that both humility and patience interventions need more viable evidence-based research on existing and new interventions. Third, we advanced several recommendations regarding how to promote more research in new interventions. These recommendations included attracting more funders to the area, developing new interventions, and employing new technology. Because intervention research in temperance is in its infancy, the future looks rosy for PPI researchers as we move into a second generation of positive psychology research.