Stockholm Oktober 2011 Center for Supervision (CS) · International Study of the Development of Psychotherapists Society for Psychotherapy Research (SPR)’s Collaborative Research

Center for Supervision (CS)

Birgit Bork Mathiesen Jan Nielsen Claus Haugaard Jacobsen

Associate Associate Professor Professor Professor

www.supervision.psy.ku.dk

Stockholm Oktober 2011

Centre for Supervision

Jan Nielsen Associate professor

University of Copenhagen &

Claus Haugaard Jacobsen Professor

University of Aalborg

Clinical supervision reflected in a Danish DPCCQ-sample

Foci and preliminary results

Abstract – point of departure

Supervision is vital to the development of psychotherapists (Bernard & Goodyear, 2009) and by novice therapists rated as the most important factor in their professional development (Orlinsky & Rønnestad, 2005).

Paradoxically, the standard version of the Development of Psychotherapists Common Core Questionnaire (DPCCQ) has only few questions on supervision.

Consequently, the Danish version of the DPCCQ has been supplemented by two new sections on supervision, one focusing on supervisees and another on super-visors.

This paper presents results from the supplementary questions on doing supervision (supervisors’ perspective) and being supervised (supervisees’ perspective).

Structure

1. Background 2. The international study 3. Methods: instruments, sampling, research strategies,

4. Results: a. Basics b. Supervisees c. Developmental factors (focus #1) d. Supervisors (focus #2)

5. Discussion: a. limitations; b. methods; c. validity; 6. Perspectives for supervision research

a. Novice therapists and the developmental triad (focus # 1) b. Supervisors development (focus # 2)

7. Conclusion a. Factors for development of professional identity (focus # 1) b. Training and experience: Development of competencies? (focus #2)

2. The international study

International Study of the Development of Psychotherapists

Society for Psychotherapy Research (SPR)’s Collaborative Research Network (CRN)

Orlinsky, D. E., Rønnestad, M. H.(eds) (2005). How psychotherapists develop: A study of therapeutic work and

professional growth.

Washington, DC: American Psychological Association.

3. Methods: instruments, sampling, research strategies,

DPCCQ-standard

SPR COLLABORATIVE RESEARCH NETWORK DEVELOPMENT OF PSYCHOTHERAPISTS

COMMON CORE QUESTIONNAIRE

THIS QUESTIONNAIRE was designed by a group of clinician-researchers from different countries as the basis of an international study of professional psychotherapists. (For simplicity, we use the term ‘therapist’ to refer generally to clinicians of all professional backgrounds and theoretical orientations, and the term ‘patient’ to refer generally to clients, analysands, etc.) MOST OF THE QUESTIONS can be answered quickly by checking or circling the response alternatives that most closely reflect your own experience. Please answer all the questions you can. If you find a question difficult to answer, give your best estimate and continue. The information you provide will be kept strictly confidential and will be used only for research purposes. Thanks!

1-1. Today’s date: month _____ year ________ 1-2. Date of Birth: month _____ year ________

1-3. Sex: Female _____ Male ______ 1-4. Country where you live: __________________________

Sections Items Themes – examples 1. Personal data 5 Date of birth, sex, …

2. Profession 23 Professional identification, qualifications, past and present supervision…

3. Therapeutic experience 21 Duration and type of clinical experience…

4. Career development 51 Retrospective estimate of the therapist´s overall career development…

5. Personal therapy 23 Type, intensity, duration …

6. Theoretical orientation 52 Current theoretical orientation …

7. Current development 36 The therapist´s sense of his/her current professional development …

8. Current praxis 43 Type and number of work settings, number and type of clients …

9. Difficulties 96 Various types of difficulties experienced by the therapist ...

10. Personal characteristics 42 Marital status, minority and immigration status …

11. Open questions 4 “Main factors leading you to become the therapist you are at present…”

Total 392

DPCCQ – standard

The Danish DPCCQ-2009 version

DPCCP-standard + Supplement I: On receiving (supervisee-section) 15 new items + Supplement II: On giving supervision (supervisor-section) 25 new items

3-1. In your career to date, how much formal case supervision have you received for your therapeutic work?

[Include regular individual or group supervision during and after training.] _____ years _____ months

3-2. About how many hours of supervision have you received for all your cases in the last 12 months? _

____

0

_____ 1-10 _____ 11-20 _____ 21-30 _____ 31-40 _____ 41-60 _____ 61-90 _____ 90+

3-3. Are you currently receiving regular supervision for any of your therapy cases? ____

__

1. Yes. b. If yes, for how many cases? _________

______

2. No. c. [If no, describe why (then skip to 4-1): _____________________________________

_____________________________________________________________________________

Supplement I: Supervisee-section On receiving supervision – examples

Supplement II: Supervisor-section On giving supervision – examples

10-13. . Have you received formal training in supervision before you started as a supervisor? _____

_ yes ______ no

12-19. How many hours of supervision do you give in a typical month? ______ hours

10-21. How many therapists do you currently supervise? ______ therapists

10-18. To date, how many other therapists have you supervised in their psychotherapeutic work? [If ‘0’, skip to 11-36.]

____ 0 _____ 1-3 _____ 4-9 _____ 10-15 _____ 16-24 _____ 25-49 _____ 50-99 _____ 100+

Supplement II: Supervisor-section Supervisor training – examples

Regarding your supervisory training… 10-14. How long is it since you first received formal training in supervision? _____ years _____ months

10-15. Overall, how many hours of teaching in supervision theory have you received? _____ hours

10-16. Overall, how many hours of supervision on supervision have you received? _____ hours

Overall… 0=Not at all, 1= Slightly, 2= Somewhat, 3=Moderately, 4=Much, 5=Very much

10-17. How satisfactory was your supervisory training? 0 1 2 3 4 5

Sampling

8000 members

4000 1500

50% 37%

350 22%

clinicians DPSfP respondents

The Danish Psychological Association

4. Results

a. Basics b. Supervisees c. Developmental factors (focus #1) d. Supervisors (focus #2)

4. Results

a. Basics

Age of therapists

Sex of therapist

Experience in years n=347

Accreditations %

Dominant current orientation 4 or 5 on Likert-scala 0-5

4. Results

b. Supervisees

Currently in supervision / exp. %

Years of experience as therapist

Supervision last 12 mth. / exp.

0 1-10 11-20 21-30 31-40 41-60 61-90 90+

Experience

0-5 yrs

5-10 yrs

10-15 yrs

15-20 yrs

20-25 yrs

25-30 yrs

30+ yrs

Supervision last 12 mth. / exp. Exp./age => less supervision (neg. corr.)

Supervision last 12 mth. / exp.

Suphours 12 mth 31-40 21-30 21-30 21-30 21-30 21-30 21-30

4. Results

c. Developmental factors (focus #1)

Developmental factors

How much influence (positive and/or negative) do you feel each of the following has had on your overall development as a therapist?

5-1. Experience in therapy with patients ..................................... 5-2. Working with co-therapists ................................................. 5-3. Taking courses or seminars ................................................ 5-4. Getting formal supervision or consultation ………..…….. 5-5. Having informal case discussion with colleagues ….......... 5-6. The institutional conditions in which you practice.............. 5-7. Reading books or journals relevant to your practice........... 5-8. Observing therapists in workshops, films or on tape.......... 5-9. Getting personal therapy, analysis or counseling ...............

5-10. Giving formal supervision or consultation to others……...

5-11. Teaching courses or seminars...............................................

5-12. Doing research.....................................................................

International sample* Perceived Sources of Influence on Career Development (4-15.-4.28.)

items rank n M 4516 2.5 3966 2.3 3570 2.2

Courses or seminars 6 4514 1.8 Giving formal supervision 8 2382 1.6 Research 13 4506 0.7

*Orlinsky og Rønnestad, 2005, p. 137 / tab. 9.1.

International sample: 3 groups* Perceived Sources of Influence on Career Development (4-15.-4.28.)

items Novice <1,5 yrs

Experinced 7 yrs mean

Senior > 25 yrs

Working with patients 2 1 1 Personal therapy 3 2 2

1 3 4 Courses or seminars 5 4 3

*Orlinsky og Rønnestad, 2005, p. 155 / tab. 10.4

DPCCQ-DK 2009 Influence on delevopment as therapist

Most influental factors

Positive influence 0-3

Rank All Internal

N Mean Sd

4-15: Experience with clients (all) Novice (0-5 yrs) Novice (<1!yrs) Intro. post (’føl’ = praksiskandidat)

1 1 1 1

349 43 7 22

2,7 2,7 3,0 2.9

.520

.513 ----- .359

4-18: Getting formal supervision (all) Novice (0-5 yrs) Novice (<1!yrs) Intro. post (’føl’ = praksiskandidat)

2 2 1 2

347 42 7 21

2,4 2,6 2.7 2.3

.747

.633 ------ .956

4-23: Getting personal therapy (all) Novice (0-5 yrs) Novice (<1!yrs) Intro. post (’føl’ = praksiskandidat)

3 3 3 2

345 42 7 22

2,2 1,7 0.8 2.3

.949 1.097 ------ 1.077

The triade: Formation and development

of professional identity

clients

supervision personal therapy

International sample* Perceived Sources of Influence on Career Development (4-15.-4.28.)

rank items n M DK-rank 1.! Working with patients 4516 2.5 1

2.! Getting formal supervision 3966 2.3 2 3. Personal therapy 3570 2.2 3

6.! Courses or seminars 4514 1.8 4

13.! Research 4506 0.7 14

*Orlinsky og Rønnestad, 2005, p. 137 / tab. 9.1.

4. Results

d. Supervisors (focus #2)

Hypothesis testing

Supervisors own perception of the value of their training for their current competencies as supervisors ?

Sr Sd / T Cl

Variable: training => supervisor competencies ?

DPCCQ-DK 2009-10

Supervisor training

Overall… 0=Not at all, 1= Slightly, 2= Somewhat, 3=Moderately, 4=Much, 5=Very much

10-17. How satisfactory was your supervisory training?

0 1 2 3 4 5

h. How well are you able to detect and deal with your supervisees’ emotional reactions to you?

j. How much precision, subtlety and finesse have you attained in your supervision work?

k. How much discomfort do you experience when your supervisees expose flaws in professional function?

a. How effective are you at engaging supervisees in a working alliance? Likert: 0 1 2 3 4 5

b. How ‘natural’ (authentically personal) do you feel while working with supervisees?

c. How empathic are you in relating to supervisees with whom you had relatively little in common?

d. How well do you understand what happens moment-by-moment during supervision sessions?

e. How effective are you in communicating problems in the professional function of your supervisees to them? f. How effective are you in communicating your understanding and concern to your supervisees?

g. How much mastery do you have of the techniques and strategies involved in practicing supervision?

DPCCQ-DK 2009-10 Operationalization: competencies

Compentencies / skills

a. = alliance; b. = ’natural’ / authentic; c. = empathic; d. = moment by moment; e. = effective communicate problems; f. = effective communicating understanding and concern ; g. = mastery in technique and strategy; h. = detect and deal with supervisees’ emotional reactions ; i. = detect own emotional reactions; j. = precision, subtlety and finesse; k = discomfort.

Competencies / training value

Relation between training and competencies Little 0-1 Some 2-3 Much 4-5 One-way ANOVA (bt. groups)

Items # 1 2 3 F Sig. 11-25 a 3,75 3,93 4,13 4,042 0.019* 11-26 b 4,03 3,88 4,17 2,475 0.087 11-27 c 3,15 3,36 3,47 1,676 0.190 11-28 d 2,94 3,24 3,57 7,248 0.001** 11-29 e 2,77 3,05 3,39 6,566 0.002** 11-30 f 3,61 3,71 4,09 7,134 0.001** 11-31 g 2,42 3,24 3,83 37,578 0.000* 11-32 h 2,84 3,20 3,47 5,683 0.004** 11-33 i 3,09 3,22 3,47 3,371 0.036 11-34 j 2,36 2,96 3,49 20,143 0.000** 11-35 k 2,88 2,39 2,35 2,655 0.73

Hypothesis testing: Is experience enough ?

Bernard & Goodyear 2009: ’Supervisors do not get more competent as they gain experience’. (p. 100).

Worthington 1987: ’Unwilling as we might be to accept it, most supervisors simply might not improve with experience.’ (p. 206).

DPCCQ-DK 2009-10

Development of supervisor competencies

Training, numbers of supervisees, or

years as supervisor?

items Training (0-5) Sig. Cor. Rank

Number supervisees (0-100+) Sig. Cor. Rank

Supervised years (0-40) Sig. Cor. Rank

11-25. .015 .170* 1 .053 .130 2 .074 .122 3 11-26. .214 .088 3 .050 .132 2 .012 .172* 1 11-27. .104 .115 1 .568 .039 3 .124 .106 2 11-28. .001 .229** 1 .003 .198** 2 .178 .093 3 11-29. .001 .223** 1 .001 .220** 2 .002 .207** 3 11-30. .000 .267** 1 .059 .127 3 .000 .246** 2 11-31. .000 .526** 1 .000 .387** 2 .000 .279** 3 11-32. .000 .262** 1 .000 .387** 2 .022 .158* 3 11-33. .008 .184** 3 .002 .210** 2 .001 .234** 1 11-34. .000 .416** 1 .000 .378** 2 .000 .321** 3 11-35. .230 -.085 3 .186 .089 2 .048 .136* 1 Sum 17 24 25

________________________Non-parametric test (Spearman) ________________________

Train-value # Sd-total #Sd -current Superv. yrs. Suptranyrs items Sig Corr Rank Sig Corr Rank Sig Corr Rank Sig Corr Rank Sig Corr Rank

11-25 015 .170 1 .053 .130 2 .391 .059 5 .074 .122 3 109 .117 4 -26 214 .088 4 .050 .132 3 .463 .051 5 .012 .172* 1 .043 .149* 2 -27 104 .115 1 .568 .039 4 .601 -.036 5 .124 .106 3 .124. 114 2 -28 .001 .229** 1 .003 .198** 3 .277 .076 5 .178 .093 4 002. .222** 2 -29 .001 .223** 1 .001 .220** 2 .045 .139* 5 .002 .207** 3 .020 .170* 4 -30 .000 .267** 1 .059 .127 4 .931 -.006 5 000 .246** 2 005. .203** 3 -31 .000 .526** 1 .000 .387** 2 .000 .297** 3 .000 .279** 4 .000 .274** 5 -32 .000 .262** 1 .003 .197** 2 .783 .019 5 .022 .158* 4 .018 .173* 3 -33 .008 .184** 4 .002 .210** 3 .330 .067 5 .001 .234** 1 .001 .232** 2 -34 000 .416** 1 .000 .378** 2 .000 .250** 5 .000 .321** 3 .000 .280** 4 -35 230 -.085 3? .186 .089 2 .050 -.136* 1? .048 .136* 1 .673 .031 4

Sum 1 19 2 29 5 49 3 31 4 35

Training (0-5)

17= 1

Number supervisees (0-100+)

24 = 2

Supervised years (0-40)

25 = 3

Train-value

19 = 1

# Sd-total

29 = 2

Superv. Yrs. 31 = 3

Suptranyrs

35 = 4

#Sd –current 49 = 5

Training (skills) vs. experience

Items Training Supervised

years 11-25. Alliance 1 skills/technique 3 11-26. Authentic 3 1 personal 11-28. Moment by moment 3 11-29. Effective communicate problems 1 skills/technique 3 11-31. Mastery in technique and strategy 1 skills/technique 3

11-32. Detect and deal with supervisees emotional reactions

1 skills/technique 3

11-33. Detect own emotional reactions 3 1 personal 11-34. Precision, subtlety and finesse 1 skills/technique 3

11-35. Discomfort 3 1 personal

5. Discussion

a. limitations; b. methods; c. validity;

Limitations

•! Cross-sectional designs •! Retrospective •! Subjective / self-reporting = experiences •! Many different measures •! Validity DK: No data to compare with = generalization?

6. Perspectives for supervision research

a. Novice therapists and the developmental triad (focus # 1)

b. Supervisors development (focus # 2)

The triade and novices Formation and development of professional identity

Clients 2

Personal therapy

3

On supervisor development

”…no new models have been developed in the past decade. It is easy to speculate that this lack of activity is related to the lack of any new interest in counselor [supervisor] stage developmental models.”

(Bernard & Goodyear 2009, p. 297)

New directions

Defining Competencies in Psychology Supervision: A Consensus Statement: Falender et al. (2004):

”Expand the description of developmental levels of supervisors … (p. 772)

Carol Falender

Skills for supervisors – examples:

•! Ability to build relationship and alliance •! Ability to provide effective and summative feedback •! Ability to promote growth and self-assessment in the trainee •! Ability to conduct own self-assessment process •! Ability to assess the learning needs and developmental level of the supervisee •! Ability to encourage and use evaluative feedback from the trainee

Falender et al. (2004): Defining Competensies in Psychology Supervision: A Consensus Statement (p. 778) Journal of Clinical Psychology, vol. 60 (7): 771-785.

7. Conclusion

Novices: Factors for development of professional identity

Focus 1

Supervisor training and experience: Development of competencies?

Focus 2

Supervision – Novices Focus 1

•! Central and critical for novice therapists.

•! Negative experiences in supervision => negative professional identity.

•! Negative experiences in supervision => double traumatization. (under pressure in both therapy and supervision; O&R, 2009)

•! The triad: supervision, clients and personal therapy.

Supervisors Focus 2

•! Experience is not enough.

•! Training is vital to develop as supervisor.

•! Training is especially central for supervisors to experience themselves as competent.

Thanks !

Birgit Bork Mathiesen Jan Nielsen Claus Haugaard Jacobsen

Associate Associate Professor Professor Professor

www.supervision.psy.ku.dk

The troublesome question

Does supervision work ?

Client Therapist / Supervisee Supervisor

And how to approach this?

”What supervisory intervention, by what supervisor, is most effective for a particular therapist, with a specific supervisory need, under which set of circumstances will offer the type of treatment, by the aforementioned therapist, that would be most effective for a specific client, with a specific problem, under which set of circumstances?

(Paul 1967; IN Rønnestad & Ladany 2006, p. 263).

Kind of an answer - or more troublesome questions ?

Reframing this debate, a more rigorous and relevant question would be to determinate whether a therapist has acquired relevant and specific competencies in the course of his/her training or experiences, and whether this process of acquisition is linked to better therapeutic outcomes.

An even more challenging question is whether training enhances therapists´ capacity to generalise their learning…to apply their knowledge to novel clinical situations …? (Roth & Fonagy, 2005, p. 456)

Wampold (2006)

”… one realizes that having a good therapist is much more important than what type of therapy is delivered.”

(IN Rønnestad, 2008).

The supervisory alliance: dialogue and reflection 8

Factors develop competencies: a. Training; b. Supervised therapist; c. Supervised years ?

a: Training (10-17.) b: No. supervisees (10-18.) c: Years as supervisor (10-9.)

items 0-5 cat. / nCAT(1-3) 0-5 cat. / nCAT (1-3) 0-40yrs / nCAT (1-3)

11-25. .063 / 0.019 .645 / .509 .867 / .043 11-26. .054 / 0.087 .307 / .274 .599 / .010 11-27. .312 / 0.190 .986 / .325 .714 / .438 11-28. .006 / 0.001 .676 / .050 .031 / .681 11-29. .018 / 0.002 .155 / .188 .209 / .009 11-30. .001 / 0.001 .824 / .189 .273 / .008 11-31. .000 / 0.000 .071 / .000 .002 / .002 11-32. .006 / 0.004 .763 / .042 .147 / .221 11-33. .146 / 0.036 .610 / .021 .095 / .005 11-34. .000 / 0.000 .193 / .000 .000 / .000 11-35. .179 / 0.73 .367 / .357 .756 / .067

Sig. 6 / 7 0 / 3 3 / 7

___________________________One-way ANOVA (bt. groups)_________________________________

Factors develop competencies: a. Training; b. Supervised therapist; c. Supervised years ?

Training No. supervisees Years as supervisor

items 0-5 cat / nCAT(1-3) 0-5 cat. / nCAT (1-3) 0-40yrs / nCAT (1-3)

11-25. Working alliance .063 / 0.019 .645 / .509 .867 / .043

11-26. ’Natural’ .054 / 0.087 .307 / .274 .599 / .010

11-27. Empathic .312 / 0.190 .986 / .325 .714 / .438

11-28. Step by step .006 / 0.001 .676 / .050 .031 / .681

11-29. Problems .018 / 0.002 .155 / .188 .209 / .009

11-30. Concern .001 / 0.001 .824 / .189 .273 / .008

11-31. Techniques .000 / 0.000 .071 / .000 .002 / .002

11-32. Emot. react. .006 / 0.004 .763 / .042 .147 / .221

11-33. Pers. react .146 / 0.036 .610 / .021 .095 / .005

11-34. Precision .000 / 0.000 .193 / .000 .000 / .000

11-35. Discomfort .179 / 0.73 .367 / .357 .756 / .067

_____________________One-way ANOVA (bt. groups)_______________________

items Training (0-5) Sig Corr Rank

No. supervisees (0-8) Sig Corr Rank

supervised years Sig Corr Rank

11-25. .005 1 006 2 039 3 11-26. .106 2 003 1 027 3 11-27. .036 1 375 3 087 2 11-28. .000 1 001 1 126 2 11-29. .001 1 000 1 003 2 11-30. .000 1 017 2 000 1 11-31. .000 1 000 1 000 1 11-32. .000 1 002 2 009 3 11-33. .010 2 001 1 000 1 11-34. .000 1 000 1 000 1 11-35. .122 1 284 3 046 2

________________________Non-parametric test (Pearson) ________________________