Towards Multi-positioned Live Supervision in Family Therapy: Combining Treatment and Observation Teams with First- and Second-order Perspectives

This article describes a process of live supervision that has been designed to encourage trainees to experience competing theoretical perspectives. It involves the use of separate T (treatment) and O (observation) teams who conceptualise the same case from two broadly defined theoretical perspectives, variously called first and second order, modern and postmodern, or family systems and social constructionist. The process requires trainees to adopt multiple positions rather than identify with one perspective, and provides a basis for comparing and potentially integrating them. We provide examples of the approach, discuss important contextual issues for supervisors to consider when implementing it, and examine ways of adapting it to a wide range of training contexts.     

Gender and conversational behaviour in family therapy and live supervision

The association between supervisors' and therapists' gender and the conversational behaviour of four supervisors, nineteen trainee family therapists and twenty clients before, during and after eighty-eight live supervisory phone in events were examined in this study. Clients' co-operation was not directly related to the gender of therapists and supervisors. The quality of supervisors' collaborative behaviour was highest for events in systems where male supervisors were supervising male therapists and lowest for events in systems where male supervisors were supervising female therapists. In systems containing female supervisors and male therapists, therapists engaged in frequent collaborative behaviour and less frequent teaching behaviour with their clients. The quality of therapists' collaborative and supportive behaviour was highest in these systems. The unexpected results of this study suggest that the way supervisors interact with therapists and therapists interact with clients does not conform to gender stereotypic conversational behaviour in which males are directive and females affiliative. It may be that individuals whose conversational behaviour does not conform to gender stereotypes decide to become family therapists or that family therapy training helps people develop alternatives to gender-stereotypical conversational behaviour.     

“My big sister the town supervisor”: Family leadership training is not just for boys

This study investigates gender similarity in the effects of birth order upon political leadership. Town supervisors were the leaders studied as there are a considerable number of women who attain this level of leadership. Questionnaires about birth order and family size were gained from 66 women who were town supervisors in New York State in 1992, and compared to a randomly selected sample of 57 male town supervisors. It was found that women as well as men town supervisors were more likely to have been first born in their families. However, whereas gender does not apparently influence the relevance of birth order for leadership, it clearly does exert an influence on the level of political leadership attained. Women town supervisors gained their positions in towns that were considerably smaller than the towns led by the male supervisors. Discussion concerned the nature of family experiences that contribute to leadership training, including those that may be different for girls and boys. Further research is needed to clarify barriers to female assertion of political leadership at more senior levels, because as this study shows, female leadership is being trained in families.     

PYRAMIDAL STAFF TRAINING IN THE EXTENSION OF TREATMENT FOR SEVERE BEHAVIOR DISORDERS

We implemented a pyramidal training procedure for staff working with individuals who exhibited self-injurious behavior (SIB), aggression, and disruption. Two adults with developmental disabilities and their direct-care staff and supervisors participated. Following successful treatment by the experimenters, two types of baselines were conducted with the clients and their direct-care staff. During an initial baseline, the staff implemented preexisting procedures. Staff members then received instruction on the new treatment procedures using training methods common throughout the institution, and data were collected during this “post-in-service” baseline. Experimenters then taught unit supervisors to implement treatment, collect and interpret data, and provide similar instructions and feedback to the staff members. The supervisor training was implemented in a multiple baseline design across subjects (clients and direct-care staff). Results showed little change following in-service training but noticeable improvements in direct-care staff behaviors and corresponding decreases in the clients' inappropriate behavior following the pyramidal training intervention with supervisors. Six additional clients (along with their direct-care staff and supervisors) participated in pre- and posttreatment replication designs, and their results provided additional support for the efficacy of the supervisor training procedures.     

Qualitative undergraduate project supervision in psychology: current practices and support needs of supervisors across North East England and Scotland

The dissertation is a core component of a psychology undergraduate degree, though very little research has been conducted into supervision processes at undergraduate level. This study examined the accounts of supervisors of qualitative dissertations in order to identify current practices of supervision and possible resources that might support supervision. Seventeen supervisors from psychology departments in North East England and Scotland were interviewed, and three main themes were identified using thematic analysis: the quantitative culture in psychology teaching, supervisors’ expertise, and the supervision process. Supervisors noted that students were typically constrained in their choice of methodology due to limited qualitative methods teaching, lack of training and guidance for supervisors, and concerns about the risks of demanding qualitative projects. Supervisors therefore often reported staying within their comfort zone, electing where possible to supervise only the methods that they themselves use. Recommendations for practical resources are provided to help support students and supervisors in the process of undertaking qualitative psychology dissertations.     

Electronic Communication in Supervisory Relationships: A Mixed Data Survey

Much has been written about online communication between therapists and clients, particularly regarding the feasibility, ethics, and frequency of such practices. Little, however, has been published with regard to electronic communication patterns between therapists and their supervisors. The purpose of this study was to understand if and how electronic communication is used between marriage and family therapy (MFT) supervisees and supervisors. To accomplish this, we administered a mixed data survey to MFT supervisors and supervisees across the United States regarding frequency of interaction via electronic methods. We also assessed comfort level with online supervision, how supervisory participants make determinations when to use online supervision, and when online communication is believed to be most appropriate within MFT supervision. We report both qualitative and quantitative findings regarding the use of online technologies in supervision. Implications for research, training, and supervision are discussed.     

Clinical supervisor training in Australia: A review of current problems and possible solutions

Clinical supervision cuts to the heart of professional psychology training. It is the most expensive single investment of staff time in the training of the psychology practitioner, and it appears to be the single most important contributor to training effectiveness, repaying that investment. Now there are changes afoot internationally which may change its pivotal role. For example, the Psychology Board of Australia has recently proposed that supervisors undergo approved supervisor training; in the USA, a competence‐based emphasis is gaining ground; while in the UK, supervisors within the Improving Access to Psychological Therapies initiative are receiving unprecedented training and support. It is therefore timely to clarify the need for such training and to consider promising options for its effective delivery. Following a summary of the changes within Australia, we next address these emergent problems and promising solutions by examining the available scientific evidence and by considering professional consensus statements.     

Impact of Co-Therapy Teams on Client Outcomes and Therapist Training in Marriage and Family Therapy

This study of 33 student therapists, 402 client systems, and three supervisors tested the efficacy of using student co-therapy teams as an aspect of clinical training in a marriage and family therapy program. This study utilizes both quantitative and qualitative methodology. Two research questions were addressed: “Do different pairings of co-therapists affect client outcomes?” and “Is co-therapy a viable option for a training program?” The results indicate that client outcomes using co-therapy are at least as effective as treatment using one therapist and in some circumstances produce more positive outcomes for both clients and student therapists.     

Raids upon the random in family therapy training: Discovering what becomes significant

How do you provide family therapy training in a primarily rural state with limited resources? A model for training therapists and supervisors that well may offer guidance to other states that face such a challenge is described here. A meta supervision approach over long distance was used in the three-year project that is described in this paper. Self-reports from the 31 participants who completed the program reveal some interesting positive reactions.     

Evaluating Training Needs for Home-Based Family Therapy: A Focus Group Approach

Therapists and supervisors engaged in the delivery of home-based services participated in two rounds of focus groups. Participants discussed the challenges they face doing home-based therapy, and how an accredited family therapy program could modify its curriculum to better prepare trainees to meet these demands. Eight topic areas considered necessary for home-based practice were identified and the implications for training reviewed. The focus group methodology is described in detail and is recommended as a useful tool to assess training needs and as a way of promoting improved collaboration among training sites.     

TRAINING RESIDENTIAL SUPERVISORS TO PROVIDE FEEDBACK FOR MAINTAINING STAFF TEACHING SKILLS WITH PEOPLE WHO HAVE SEVERE DISABILITIES

We evaluated procedures for training supervisors in a residential setting to provide feedback for maintaining direct-service staff members' teaching skills with people who have severe disabilities. Using classroom-based instruction and on-the-job observation and feedback, 10 supervisors were initially trained to implement teaching programs themselves. The training improved supervisors' teaching skills but was insufficient to improve the quality of feedback they provided to direct-service staff regarding the staff members' teaching skills. Subsequently, classroom-based instruction and on-the-job observation and feedback that targeted supervisors' feedback skills were provided. Following training in provision of feedback, all supervisors met criterion for providing feedback to their staff. Results also indicated that maintenance of teaching skills was greater for direct-service staff whose supervisors had received training in providing feedback relative to staff whose supervisors had not received such training. The need for analysis of other variables that affect maintenance of staff performance, as well as variables that affect other important areas of supervisor performance, is discussed.     

Experiences related to expert supervisors' views of ideal therapeutic practice

Aims: This study examines the relationship between expert supervisors' professional experiences and their views about the importance of different psychotherapy techniques. Method: Thirty psychodynamic‐interpersonal (PI) supervisors and 13 cognitive‐behavioural (CB) supervisors (N=43) were instructed to rate 20 therapeutic techniques according to how characteristic each technique is of an ideally‐conducted session within their theoretical orientation. The measure used for this assessment was the Comparative Psychotherapy Process Scale. Results: Findings demonstrated that supervisors' beliefs about ideal therapeutic techniques are related to their number of years in post‐graduate clinical practice, training, and supervising trainees, as well as to the number of publications they have authored. Further, experience within a given orientation tends to lead to a greater endorsement of techniques within that orientation, although this finding is more uniform for CB supervisors than PI supervisors. Finally, differential types of experience lead to differential focusing on specific techniques. Discussion: The clinical importance of these findings is explored.     

Counselors' Evaluation of Rogers-Perls-Ellis's Relationship Skills

Twenty-two participants (12 employment counselors and 10 counselor supervisors) attended a three-week workshop on enhancing relationship skills, after which each participant evaluated the Rogers, Perls, and Ellis film, Three Approaches to Psychotherapy, on 15 skills. Results indicate that there was general agreement between the counselors and the supervisors when judging levels of therapist functioning by the relationship skills. However, they also show that within each group there is wide divergence of judgment. Neither counselors nor supervisors agree among themselves on their evaluation of the relationship skills of Rogers, Ellis, and Perls. Implications are drawn for the use of the film as a training/evaluation aid for employment counselors and supervisors.     

Behind the (Virtual) Mirror: Online Live Supervision in Couple and Family Therapy

Online therapy and supervision, a rapidly rising practice in couple and family therapy, has been the subject of a growing body of literature. From its early days, family therapy training has included live supervision, which has typically been conducted by a supervisor and a team of trainees situated on the other side of a one-way mirror. With the outbreak of the COVID-19 global pandemic, we—the staff of supervisors at the Barcai Institute in Tel Aviv, Israel—were compelled to find solutions to continue meeting with clients and to provide supervision for family therapy trainees. To this end, we have shifted our live supervision courses (“practicums”) to the virtual arena, adapting the popular application “Zoom” into what we call “PractiZoom.” Based on over 100 PractiZoom sessions conducted between March and May 2020, involving 14 supervisors and 28 therapists-in-training and their clients, the article reflects on this pioneering online practicum for the online live supervision of therapists with geographically distributed participants. In this article, we outline our operational methods and adaptations for conducting live behind-the-mirror supervision online. Following a short theoretical background, we outline the process of online live supervision, discuss our reflections and those of our trainees on the challenges and possibilities it poses, and offer a number of preliminary conclusions and recommendations.     

The Development and Evaluation of a Statewide Training Center for Home Visitors and Supervisors

This paper informs practice in community‐based home visiting workforce development by describing the development and evaluation of a university‐based training certificate program for home visitors and supervisors. The Interactive Systems Framework for Dissemination and Implementation (ISF; Wandersman et al., 2008) guides our conceptualization and paper organization. The ISF describes the components involved in translating research findings into effective implementation of prevention programs. We describe implementation and lessons learned from seven development activities: (a) review of the literature, (b) survey of other training initiatives across the country, (c) focus groups with home visitors and supervisors, (d) consultation with individual home visitors, (e) creation of a state advisory board of home visiting providers and stakeholders, (f) evaluation of two pilot trainings, and (g) video development. We then present evaluation data from 49 home visitors and 23 supervisors who completed the training certificate program after the pilot trainings. Both home visitors and supervisors rated training satisfaction highly, reported significant increases in self‐efficacy related to the training topics, and reported extensive use of motivational communication techniques, which are the foundational skills of the training content. These and other favorable results reflect the benefits of building on advances in theory and science‐based practice and of involving providers and stakeholders repeatedly throughout the development process.     

Within‐session supervision communication in the training of clinical psychologists

There is little research evaluating within‐session supervision communication in the training of clinical psychologists. This study evaluated the perception of 37 interns and 49 patients regarding communication between supervisor and intern during the therapy session. Most supervisors used such communication infrequently. While some interns and patients viewed call‐ins or walk‐ins as intrusive and unhelpful, the majority did not. Indeed, some valued the feedback. No association was found between the use of call‐ins or walk‐ins and patient reports of therapist behaviours or intern reports of supervisory style. It is concluded that within‐session communication is not deemed as necessary by most supervisors, who should remain cautious in their use of such communication, unless patient care is compromised.     

The Soul of Supervision: Counselor Spirituality

Because spirituality training for counselors and supervisors is vital to counselor development, the authors examined the relationships between purpose in life, the integration of spirituality into supervision, and the supervisory working alliance among a sample of supervisors and trainees. Supervisors reported a greater sense of purpose and spiritual discussion during supervision than trainees. Trainees' personal sense of purpose was positively related to spiritual discussions with a supervisor and to an emphasis on client issues in supervision.     

Learning and Living Systemic: Exploring the Personal Effects of Family Therapy Training

Despite growing recognition that systemic family therapists need to be adept at personal reflection and managing the therapeutic relationship, little research has explored the effects of training beyond the development of skills. This article provides a report on a qualitative study focussed on the personal effects of family therapy training, with particular reference to the aspects of training that foster personal reflection and growth. Twenty three trainees from three training institutions were interviewed, utilizing the practices of grounded theory. Trainees reported a deepening relational awareness, which applied to both personal and professional domains and included shifts in perspectives on relationships with loved ones. Five aspects of training were identified as responsible: (1) personally challenging experiences with clients; (2) supervisors who live the paradigm; (3) the demystification of theory; (4) a safe supervisory space; and (5) the development of trusting peer relationships. Interns also described, in turn, how their personal development affected their clinical work, particularly in the development of compassion and empathy. This study serves to highlight training practices that support reflective practice in systemic family therapy.     

A Conceptual Model and Clinical Framework for Integrating Mindfulness into Family Therapy with Adolescents

Individual and group‐based psychotherapeutic interventions increasingly incorporate mindfulness‐based principles and practices. These practices include a versatile set of skills such as labeling and attending to present‐moment experiences, acting with awareness, and avoiding automatic reactivity. A primary motivation for integrating mindfulness into these therapies is compelling evidence that it enhances emotion regulation. Research also demonstrates that family relationships have a profound influence on emotion regulation capacities, which are central to family functioning and prosocial behavior more broadly. Despite this evidence, no framework exists to describe how mindfulness might integrate into family therapy. This paper describes the benefits of mindfulness‐based interventions, highlighting how and why informal mindfulness practices might enhance emotion regulation when integrated with family therapy. We provide a clinical framework for integrating mindfulness into family therapy, particularly as it applies to families with adolescents. A brief case example details sample methods showing how incorporating mindfulness practices into family therapy may enhance treatment outcomes. A range of assessment modalities from biological to behavioral demonstrates the breadth with which the benefits of a family‐based mindfulness intervention might be evaluated.