Arundale, Carol Jean; (1993) Psychotherapy supervision: Impacts, practices and expectations. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The aim of the present thesis was to investigate psychotherapy supervision. Empirical data was collected from two types of studies, clinical trials and a major survey of the field. On the basis of a review of the field of psychotherapy research, it was concluded that there is sufficient evidence that all of the therapies are effective and that further research into their comparative value is less fruitful than investigation into 'process' features which are associated with good outcome. This line of research leads to the pre-eminance of therapist variables and the finding that some therapists are more effective than others, which ultimately points toward the importance of training and supervision. A selective review of the supervision literature revealed that in spite of the belief that it is crucial in producing good therapists and effective therapy, and its universal practice, there has been very little systematic research into supervision, either into its effectiveness or into that in which it consists. The first two studies featured clinical trials by NHS multiprofessionals who conducted supervised and unsupervised psychotherapy. In the first study, process and outcome data were collected over eight sessions of brief psychotherapy. There was evidence for greater improvement in the supervised condition, but because the design was quasi-experimental and therapist variables were not controlled, it could not be concluded that there was a supervision effect. In the second study, a two-way crossover experimental design with more difficult, longer term patients and more rigorous psychoanalytic psychotherapy input, a clear supervision effect was not obtained, indicating the need for more information about the nature and the practices of supervision in order to provide a basis for further research into its effect. The second series of studies reported the results of a supervision survey involving 196 supervisors from three professional groups, clinical psychologists, psychotherapists and counsellors. Content analysis of interviews with senior supervisors provided material for the development of a new questionnaire on supervision practices, which was sent to supervisors on 23 London-based training programmes, along with questionnaires on demographics, theoretical orientation, style and evaluation of a randomly-chosen supervisee. The supervisees provided data on expectations that were compared with supervisor provision. Significant differences in practice behaviours between the professions were found on the Supervision Questionnaire that were consistent with expectations, indicating questionnaire validity. When trainee expectations were compared to supervision provision in the whole sample, differences were found in three areas: the personal relationship, the laissez-faire climate, and the authoritative, didactic method of teaching, which were interpreted in terms of the novelty of the apprenticeship method. In a factor analysis of supervision style, distinctly different style factors were found for each of the three professional groups. Style data provided corroboration of expectations measured by the Supervision Questionnaire, particularly in regard to trainees' expectations of less laissez-faire, informal, non-challenging support and more guidance and teaching. There was a differential impact of expectation on evaluation, providing support for the hypothesis concerning the effect of unmet expectation. When high and low evaluated trainees were compared, significant differences emerged on seven dimensions: praise, supportiveness, reassurance, directiveness, goals of treatment, flexibility, and help with problems. Theoretical orientation factors were investigated in relation to style factors and the seven key variables. The results were discussed in the context of suggestions regarding a model of supervision and implications for further research.

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