2 Saturdays ago we had a few of our internship sites in to talk about about our fieldwork portion of the program. One area discussed: the challenges of supervision. In preparation I read an article by Gary Freitas of U Maryland. He did an exam of 2 decades of research on the question of whether clinical supervision leads to improved client outcome.
The results? Not good. Most studies were fraught with serious methodological problems so can’t make good inferences. But He pointed out a couple of possible inferences from some of the studies he reviewed.
1. When supervision takes places just prior to the next session, it puts pressure on the counselor to perform more of what the supervisor suggests. The supervisor plays more of a consultant in planning the next session. Makes sense. But, counselors may use less of their own creativity and problem-solving skills and be less flexible and more wooden in such cases. More time between supervision (up to a point of course) may help more experienced counselors.
2. Therapist competence has a negative effect on outcome WHEN therapists are trying to adapt to a supervisor’s style of counseling. The more competent you are as a counselor, the harder it is to fit into someone else’s mold.
3. Live supervision leads to greater alliance between trainee and client.
4. Counselor empathy is positively related to clients’ ratings of feeling understood and client movement towards introspection. HOWEVER, counselor suggestions leads to higher client levels of passive dependence. Interestingly, counselor questions had no significant effect on outcome.
This last inference from Iberg (1991) is a good reminder that our helpful suggestions may not produce the results we are hoping for. Despite knowing this, I still have to fight not to become Mr. Fix-it. (I know, I’ll save that for my wife. I’m sure she’ll appreciate my sage advice!)
Freitas, G.J. (2002). The impact of psychotherapy supervision on client outcome: A critical examination of 2 decades of research. Psychotherapy: Theory/Research/Practice/Training, 39:4, 354-367.
Musings on Faith and Psychology 