Supervisory alliance as a moderator of the effects of behavioral rehearsal on TF-CBT fidelity: results from a randomized trial of supervision strategies

The present study examined relations between supervisory alliance and fidelity to the trauma narrative component of Trauma-Focused Cognitive Behavioral Therapy, as well as how supervisory alliance might moderate the effect of behavioral rehearsals (i.e., role plays) on fidelity. Forty-two supervisors and 124clinicians from 28 different community-based mental health offices across Washington State participated.Clinicians were randomized to receive one of two supervision conditions—symptom and fidelity monitoring or symptom and fidelity monitoring with behavioral rehearsal. Supervisory alliance alone did not predict adherence or extensiveness of the trauma narrative. One aspect of alliance, client focus, significantly altered the effect of supervision condition on adherence (p=0.05); however, this effect was only seen in 43.5% of clinicians. A second aspect of alliance, rapport, altered the effect of condition on trauma narrative extensiveness with moderate significance (p=0.09). Future research should investigate strategies to improve supervisory alliance or match supervision strategies to specific supervisor-clinician dyads.

Role reversal in remote peer supervision: Utilising tools commonly used in dramatherapy and family therapy to facilitate peer supervision

Peer supervision is a dynamic process which highlights constructive and supportive feedback among therapists while minimising feelings of being evaluated. Some of its benefits include decreased dependency on the expertise of a supervisor, freedom, and equality. In this article, we outline the benefits of peer supervision between a dramatherapist and a family therapist and how their common roots based on creativity and action-based approaches could be used remotely to enhance the goals of peer supervision. We discuss how we utilised such methods and more specifically role reversal in a virtual space during the first Covid-19 lockdown to facilitate the process of peer supervision and understand better the needs and perspective of the client. We propose that incorporating creative and spontaneous methods such as role reversal in a virtual peer supervision environment can potentially enhance the supervisory alliance and therapeutic practice.

Clinical supervision in CBT training: what do participants view as effective?

Literature pertaining to cognitive behavioural therapy (CBT) supervision is limited, particularly about CBT supervision during training. This exploratory study outlines the thoughts of supervisors and supervisees in a training context about which elements make supervision effective. Four supervisees and four experienced CBT supervisors (all from a CBT training programme and independent of one another) were interviewed and asked to consider what makes CBT supervision during training effective. Their responses were evaluated using thematic analysis (TA) and key themes identified. The fit with existing literature was considered via the use of an adapted Delphi poll. Two main themes, containing seven subthemes, were identified from the thematic analysis: ‘supervision as structured learning’ and ‘supervisory relations and process’. The adapted Delphi poll was divided into six categories denoting important characteristics of CBT supervision: (1) the supervisory relationship, (2) ethical factors, (3) generic supervisory skills, (4) mirroring the CBT approach, (5) the supervisor’s knowledge and (6) addressing difficulties. There was a good fit between the TA themes and the Delphi categories. For those engaging in CBT supervision, establishing a structure that mirrors a CBT session, alongside a supportive supervisory alliance, may promote effective CBT supervision during training. Key learning aims (1) To consider what might make CBT supervision during training a better experience for participants, such as alliance factors and structured learning. (2) To discover how supervisors’ and trainees’ perspectives fit with existing research on CBT supervision. (3) To consider some potential supervisory implications related to aspects of CBT supervision that participants find useful.

Training Healthcare Providers to Establish Therapeutic Alliances With Patients

This chapter discusses a variety of practices the healthcare education community can adopt from the psychotherapy literature regarding therapeutic alliance training when supervising trainees, and provides a series of recommendations, grounded in the extant literature, to bring these practices to life. In addition to describing how healthcare educators can translate Bordin's therapeutic alliance model to the medical and allied health communities, this chapter discusses aspects of therapeutic alliance facilitation and maintenance supervisors can address explicitly in supervision, including attunement to the developmental stage of trainees, using the supervisory alliance with trainees, addressing issues of diversity and multiculturalism, and increasing trainee self-awareness in the service of alliance maintenance. Specific strategies including role-play, alliance measurement, and use of video/audio recording are discussed. Supervisors can apply these nomothetic concepts to their scopes of practice and address idiographic concerns with trainees that emerge in their patient populations.