INFLUENCE OF THERAPIST SKILLS ON CLIENT PERCEPTIONS OF MARRIAGE AND FAMILY THERAPY OUTCOME: IMPLICATIONS FOR SUPERVISION

Clients seen in two marriage and family therapy training clinics were surveyed regarding treatment outcome. They rated their therapist's skill level on several therapist variables including "experience,""confident,""concerned," how well the treatment used seemed to "fit" their view of the problem and if the therapist seemed to "know how to deal" with their concerns. The variable of "fit" of treatment accounted for 35% of the variance in the client's perception of treatment outcome. "Concerned,""fit," and "knew how to deal" accounted for 36% of the variance in overall rating of the therapist. Suggestions for using these results in supervision of beginning therapists are given.     

IN DEFENSE OF CASE CONSULTATION: MAYBE "DEAD" SUPERVISION ISN'T DEAD AFTER ALL

Clinical supervision based on "raw data"—the supervisor having direct access to the therapy session via tape or live observation—has become a hallmark of family therapy training. Despite the many advantages of such an approach, it also has limitations. The case consultation approach to supervision provides a different perspective which complements raw data supervision and remedies some of the limitations of the raw data approach. This paper proposes four specific tasks that are best undertaken in case consultation sessions: understanding the "architecture" of therapy, helping trainees build theoretical models of change, understanding the clients'broader context, and understanding the student's broader context.     

Does Live Supervision Make a Difference? A Multilevel Analysis

While the benefit of live supervision on clinical training is largely unquestioned, research that examines how live supervision affects the therapeutic process is lacking. Although marriage and family therapy has embraced this method of supervision, there is little empirical evidence suggesting it "works." This study uses hierarchical linear modeling to examine how therapy cases utilizing live supervision affect perceptions of progress on the problem. Findings indicated that live supervision does appear to make a difference for therapists' ratings of progress on the problem over the course of therapy; however, clients did not rate their progress as improving to the same degree. Implications for the use of live supervision as well as limitations of the study are discussed.     

Clinical supervision: Its role in “Containing” countertransference responses to a filicidal patient

This paper illustrates the role of supervision in processing countertransference responses with might have disrupted the therapist's empathy with a patient who had killed her child. The clinical material demonstrates how the therapist's responses of initial denial and subsequent disgust and fear were dealt with in supervision. As a result, the treatment process led to genuine, albeit limited, therapeutic change in a patient with severe character pathology.This paper is developed from a presentation of the case of Mrs. Jay at Department of Psychiatry Grand Rounds, University of Cincinnati College of Medicine, on May 2, 1989.     

GROWTH BEHIND THE MIRROR:, THE FAMILY THERAPY CONSORTIUM'S GROUP PROCESS

An earlier paper (Wendorf, 1984) presented the pragmatic aspects and theoretical model of The Family Therapy Consortium, a group set up to provide supervision and continuing education in family therapy. The emphasis was on the development of each individual therapist's competency, the isomorphic relationship between the supervisor, group, therapist, and family levels of the therapeutic system, and the legitimacy of the term "peer supervision." Beginning under the leadership of an expert supervisor hired from outside the group, the Family Therapy Consortium has developed into a peer supervision group with a "floating," rather than fixed, supervisory hierarchy. The present paper charts this development and explores the peer supervision process as it currently works in the Consortium. The focus is on the growth of the individual behind the mirror as therapist, person, leader and group member, and on the growth of the group as a "mature sibling subsystem" no longer in need of outside supervision. Individual and group development are seen as complementary aspects of the same growth process.     

AN APPROACH TO SUPERVISION OF SYMBOLIC-EXPERIENTIAL PSYCHOTHERAPY

A model of experiential psychotherapy supervision is outlined and applied to a case study. Four stages of experiential supervision are identified with issues relevant to each stage presented. Various techniques for working with issues pertaining to the supervisory process are discussed and exemplified by case illustration.     

An Instrument for Person-of-the-Therapist Supervision

This article introduces a tool that serves as a guide for building an effective bridge between the personal and technical aspects of therapy in supervision. The instrument is based on a model of clinical supervision that emphasizes the purposeful utilization of self—in the moment, with both flaws and strengths—in the therapeutic relationship in combination with the technical interventions with clients. The article also offers some aid to promote a personal integration of the philosophy underlying this supervisory model into a therapist's clinical thinking and practice .     

Clinical supervision for psychiatric nurses

Supervision does not represent merely the acquisition of facts. It is an emotionally charged process that touches on therapists' affective problems, interpersonal conflicts, problems in being helped, and problems in helping (Ekstein). As such, it is a process similar to, but not the same as, psychotherapy. Supervision is necessary for continued professional growth, no matter how skilled the nurse may be. Other mental health disciplines have long accepted supervision as an essential component of professional work. A number of methods can be used to review the therapist's work, including case material discussion, conjoint interviewing, direct observation, and review of mechanical recordings. This can be done individually, in groups, or among peers. A supervisor can be a senior clinician from any of the mental health disciplines. The nurse should not be limited to receiving supervision only from other nurses. Periodic evaluations of the supervisory relationship as well as the therapist's skills are recommended. Supervision is a valuable tool that the nurse therapist should use fully to develop the professional self.     

THE INVISIBLE MIRROR: IN-HOME FAMILY THERAPY AND SUPERVISION

Home-based family therapy intervention programs, designed as a preventive strategy for multi-problem, at-risk families, are a rapidly growing phenomenon in mental health agencies. However, a review of the literature reveals little information on clinical supervision, which is a major component of home-based family intervention. The purpose of this article is to provide an alternative supervisory approach, in-home supervision, for training therapists who do home-based intervention.     

Using live supervision to teach counselling skills to social work students

This article reports on a research project which explored how anxiety can be managed when social work students receive live supervision as they are learning counselling skills. Eight social work students volunteered to participate in an eight session project in which they role played counselling sessions and received live supervision of their work. Their subjective experience of live supervision was elicited via survey reported surveys over the course of the project. They also submitted pre-and post-project recordings of their counselling role plays which were evaluated for changes in skill level. The participants’ survey results showed that, over the course of the project, each participant became less anxious about live supervision and came to find it a valuable learning experience. Their recorded role plays all showed improvements in skill level across a range of domains. The authors contend the establishment and maintenance of positive and trusting relationships between participants and between participants and the supervisor was crucial to the success of this project, as was attention to power dynamics and differences in learning styles. These results suggest that, under the right conditions, live supervision can be a valuable addition to counselling skills teaching strategies with social work students.     

FOCUSED SUPERVISION SEEN THROUGH A RECURSIVE FRAME ANALYSIS*

The last decade has seen a dramatic increase in the literature addressing family therapy training and supervision (Liddle, Breunlin, & Schwartz, 1988; Morris & Chenail, 1995; Selekman & Todd, 1995; Thomas, 1994). Most of this literature, however, focuses on theory rather than prctice. This paper presents a study of solution-focused therapy's model of supervision, which we have labeled focused supervision. This supervisory process is conceptualized as a conversation during which supervisor and supervisee engage in a dialogue that mutually shapes the meaning of the experience. This study attends to the actual words spoken and utilizes recursive frame analysis to get closer to the talk of a focused supervisory session.     

TEENAGE RISKY BEHAVIOR AND PARENTAL SUPERVISION: THE UNINTENDED CONSEQUENCES OF MULTIPLE SHIFTS SCHOOL SYSTEMS

We study the relationship between attending high school at night and the probability of engaging in risky behavior, such as having unsafe sex or consuming substances. To address potential endogeneity concerns we take advantage of a random assignment of high school students to daytime and night shifts in the city of Buenos Aires. Using an original survey on students attending their last year of high school, we find that girls attending high school in the evening start having sex at an earlier age and present a higher probability of getting an abortion. We find no significant differences for substance use. Our experimental approach suggests that the link between high school shift and risky behavior is causal. Results hold when we use an alternative sample of alumni. Finally, we report evidence that the lack of parental supervision is the mechanism underlying our results. (JEL I12, I25, J13)     

Family therapist comfort with and willingness to discuss client sexuality

Limited empirical information exists on whether or not marriage and family therapists are having sexuality-related discussions with their clients. When helping professionals ignore client sexuality, the potential for unintended negative outcomes increases. The researchers surveyed 175 clinical members of the American Association for Marriage and Family Therapy to assess how their clinical training and education, their perceived sexual knowledge, and their comfort with sexual material influenced their willingness to engage in sexuality-related discussions with their clients. The results indicate that sexuality education and supervision experiences are the cornerstone for a therapist's base level of comfort. It is through sexuality education and supervision that sex knowledge is acquired and comfort levels are increased. Once comfort with sexual discussions increases, then therapists are more likely to engage in sexuality discussions with their clients.     

A TOOL FOR TRAINING SUPERVISORS: USING THE SUPERVISION FEEDBACK FORM (SFF)

As the field of supervision and training has evolved, there has been a growing recognition of and appreciation for the skills required to be an effective supervisor or trainer (Liddle, Breunlin, & Schwartz, 1988). This new awareness has pointed to the need for effective methods and tools for training family therapy supervisors. One of the tools I developed to improve my supervision complete to give me feedback on my supervision. This article describes how developing and using an SFF was valuable to me in my training as a supervisor. Based on my experience, I believe the SFF could be a useful tool in training other supervisors.     

A SELF-MANAGEMENT MODEL FOR SUPERVISION

The authors present a management-of-self model of supervision that is currently being used in the graduate training program in marriage and family therapy at Virginia Polytechnic Institute and State University. The major proposition of the model is that as the supervisee comes to understand how family of origin and family constellation patterns learned in the past are reenacted within the therapeutic context, he/she can then interrupt those patterns of interaction that tend to inhibit his/her therapeutic effectiveness.     

EXAMINING THE MULTIFACETED NOTION OF ISOMORPHISM IN MARRIAGE AND FAMILY THERAPY SUPERVISION: A QUEST FOR CONCEPTUAL CLARITY

The notion of isomorphism has been recommended as a comceptual framework to guide the practice of marrige and family therapy (MFT) supervision. The term is frequently cited in the MFT training literature but is often used in different ways. A panel of MFT supervirors rated the impotance and relevance to both therapy and supervision of a large pool of variables. The majority of variables were found to be a equally relevant or isomorphic to the domains of MFT and MFT supervisoin. A qualitative interview with a small subset of the panelists suggested that the concept, to varying degrees, has influenced their work as supervisors. The implications of the results for theory development, research, and supervisory practices are discussed.     

Crisis management during "live" supervision: clinical and instructional matters

In this article, we illustrate two examples of "live" supervision with marriage and family therapy trainees whose clients presented in the therapy room in immediate crisis. The case examples, one a client with suicidal thoughts and the other a parent who had struck her child, demonstrate how the university-based therapy team managed the recursive clinical and supervision processes that unfolded during the sessions. We present the case examples from the perspective of both supervisees and supervisor, discussing how our different experiences of the supervision unfolded in real time. Case discussion and reflections later in the article illustrate the need for an open, transparent, dialogical process throughout supervision. A case is made for supervisory participants to create alternative formats in which multiple supervisory voices can be heard.     

Live supervision in the same room

Following a brief explanation of live supervision, its advantages as a practice teaching method are outlined. The main part of the article focusses on detailed and practical suggestions for the preparation and conduct of live supervision sessions. Discussion then centres around some of the pitfalls and ethical issues which need to be considered. The article concludes by advocating that live supervision can make an important contribution to the current drive to improve practice competence in social work.     

Social Work Intellectuals in the Twenty‐First Century: Critical Social Theory,Critical Social Work and Public Engagement

Frequently, observation of social work students in ‘live’ work is absent or haphazard. An overview of the key literature examines the need for observation of students during training, explores the strengths and challenges of live supervision and describes a planned process for conducting live supervision. This approach incorporates four phases: collaborative preparation for a session of direct practice; observation of the student's work by a field educator; debriefing and feedback; and the development of a plan for further learning steps. Brief vignettes are used to illustrate the process. The article is enriched by the inclusion of student comments from the evaluations undertaken after live supervision activities.