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Created by Jo Gledhill
almost 10 years ago
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Question | Answer |
How did Kavanagh et al., 2002 describe clinical supervision? | A working alliance between practitioners in which they aim to enhance clinical practice, fulfil the goals of the employing organization and meet the ethical, professional and best practice standards of the organization and the profession, while providing personal support and encouragement in relation to the professional practice. |
According to Kavanagh et al (2002), who has the highest stakes in supervision? | |
why is clinical supervision necessary? | A ‘working alliance’ – a positive relationship Support Encouragement Enhance therapeutic competence Assessment and therapy skills Link between theory & practice (esp. for trainees) Professional identity and obligations Ethics and conduct Professional standards Best practice Demands of the service Service standards Service demands Quality control To ‘oversee’ To meet minimum standards Reflective Practice, Case Discussion, Consultation, Support Groups (same or different profession) |
give some examples of issues taken to supervision? | Advice on formulation & therapy Reflecting on feelings experienced in sessions Discussing interactions with colleagues Ethical dilemmas Dual relationships |
What makes the ideal supervisor according to Kavanagh et al (2002)? | Empathy Respect Genuineness Easily understood Uses self disclosure Sense of humour |
What practical elements should be in place for effective supervision? | Regular times Clear and explicit goals Safe environment Uninterrupted |
Outline the different modes of supervision? | Individual, Group, Peer Observation Live Video Audio Reporting case material Role-play |
Describe CBT style supervision? | Congruent with structured, collaborative approach to therapy: Agenda setting Prioritisation Homework review & setting Summarising Supervisee feedback Encourage awareness of values and beliefs of supervisee and client Teaching specific techniques & specific behavioural tasks Direct instruction, guided discovery, Socratic questioning Discovering meaning and evidence for NATS & assumptions Supervisee as own agent of change Emphasis on empirical evaluation |
Describe the psychodynamic style of supervision? | Focus on the process of therapeutic sessions Detail of what happened and when Interest in how the work makes the supervisee feel (counter-transference) Focus on the supervisee-client relationship (transference) Focus on the supervisor-supervisee relationship Recognising Parallel Process – when the supervision relationship mirrors aspects of the therapeutic relationship Using the supervision relationship to model an analytic attitude Psychodynamic theories Defence mechanisms Internal conflicts The relationship – transference and counter-transference Resistance Can be useful even if not working within a psychodynamic framework In addition to personal therapy Different supervisor & therapist |
Describe Kolb’s experiential learning cycle (specific supervision model) | |
Outline issues with the CBT and psychodynamic models of supervision? | whilst there are some similarities between supervision and therapy, it can be argued that therapeutic models are too narrow to explain the complexity of supervision. As Supervision is essentially an educational process which facilitates the learning of a professional role – models of adult learning may be more useful. We learn by our experience and by being able to reflect on that experience; then linking experiences to theories to create new hypotheses on which to act. the absence of any one of these processes can hamper learning |
What did Feltham (2000) find regarding the effectiveness of supervision? | curiously little evidence, but much emotional rhetoric, supporting the value or clarifying the purposes of supervision |
who said that 'Effective supervision demands a causal link between supervisor interventions and client outcomes. This is a tall order'? | Scaife (2009) |
Give an overview of methodological criticisms of research on the effectiveness of supervision? | (paucity of) RCTs, Satisfaction Surveys, Systematic Reviews, Qualitative studies Small sample sizes Inadequate statistical power Lack of comparison groups Use of analogue situations & students Measures with poor reliability & validity Reliance on single sources of outcome information Difficult to compare therapist behaviours across clients Studies not testing theories of supervision |
What is defined as effectiveness? | Patient/client outcomes Supervisee outcomes (skills/behaviour/self-efficacy) Satisfaction ratings Service/organisational outcomes (e.g. governance) Difficult to measure and attribute to supervision (experience and additional learning outside supervision) |
what kind of supervision do inexperienced supervisees prefer? | more directive, structured supervision giving clear answers |
----- or ----- experience have not been shown to be important factors (evidence is mixed) | Gender Supervisor |
More experienced practitioners also prefer more directive supervision approach if...? | learning new skills or dealing with new situations |
Direct instructional methods are associated with? | greater supervisee competence |
What did Beck, 1986 find regarding supervisee effects? | Ongoing supervision prevented deterioration of CBT skills following an intensive 3-month training programme |
High quality supervision may enhance? | therapist self-efficacy |
--- of supervision (not ---) may enhance job satisfaction and prevent burnout | quality quantity |
What did Spence et al (2001) find about supervision? | Overall limited evidence, providing tentative support for positive effects of supervision. |
Intensive, directive ---- can be effective in teaching new clinical skills and enhancing client outcomes. Evidence for --- is less robust, and in some cases what is found? | Training Supervision no relationship between amount of supervision and client outcomes was found. However clients attended more often when more supervision was available (Steinhelber et al., 1984). |
What did Bambling et al., 2006 find regarding client outcomes? | Supervision aided the therapeutic alliance and reduced depression scores |
WHat did Beinhart & Clohessy (2009) find? | Client attendance related to amount of supervision Client improvement related to congruence of supervisor/supervisee theoretical model Direct feedback related to trainee effectiveness & client outcome (rated by supervisor) |
What did Kavanagh et al (2002) find in their review of supervision for drug and alcohol services? | Sessions can degenerate into unstructured socialization: aims and objectives are important The potential complexities of roles and objectives in supervision means that a structured agreement is an important part of a successful supervision relationship |
who said that the literature on the effectiveness of supervision is heavy on opinion, theory and reccomendations, and light on good evidence? | Kavanagh et al (2002) |
what do surveys of practitioners typically find regarding access to supervision? | problems with access are posed by competing high priority work demands and by a lack of appropriate and available supervisors Kavanagh et al (2002) |
what review found that supervisors typically receive little in supervision methods? | Spence et al (2001) |
Outline the study of Milne and James (2002) | The present study analysed the impact and relative effectiveness of routine training (consultancy) versus routine training plus feedback on clinical supervision. Design. The behaviours of one supervisor and six supervisees were observed longitudinally, and comparisons made between a baseline condition and two subsequent experimental training conditions (with and without feedback) and a maintenance period. Method. An observational instrument was used to code N = 1387 interactions between the supervisor and the supervisees. Supervisees' satisfaction with supervision was also recorded longitudinally. Results. The inter-observer reliability was very good initially (K ≥ 0.81) and did not ‘drift’. Supervision improved during the experimental phase, but most markedly during the maintenance phase. The results appear to reflect a lag effect for the interventions, which can be most readily explained in terms of a socialization period during which both supervisor and supervisee adapted their styles of interaction. Conclusion. Competence in supervision appears to require training. |
Outline the method of Bambling et al (2006) | This study evaluated the impact of clinical supervision on client working alliance and symptom reduction in the brief treatment of major depression. The authors randomly assigned 127 clients with a diagnosis of major depression to 127 supervised or unsupervised therapists to receive eight sessions of problems-solving treatment. Supervised therapists were randomly assigned to either alliance skill– or alliance process–focused supervision and received eight supervision sessions. Before beginning treatment, therapists received one supervision session for brief training in the working alliance supervision approach and in specific characteristics of each case. Standard measures of therapeutic alliance and symptom change were used as dependent variables. |
What did Bambling et al (2006) find? | Client-rated Working Alliance scores were significantly superior for participants in supervised groups compared with those in the unsupervised group, providing qualified support for Hypothesis 1. Hypothesis 2 was supported because clients receiving supervised therapy achieved a significantly greater reduction in BDI scores than those receiving unsupervised therapy. Hypothesis 3 was supported because supervision had a significant effect on client treatment satisfaction. Clients treated by supervised therapists were more satisfied than those treated by unsupervised therapists. Client satisfaction might be regarded not only as an indication of treatment success but also as an independent measure of treatment effect |
Outline the 7 eyed process model by Hawkins & Shohet, 2006 (part two) | |
Outline the 7 eyed process model by Hawkins & Shohet, 2006 (part two) |
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