Live Supervision in Psychotherapy: Study Protocol for a Single Case Experimental Design Study (SCED)

Karolinska Institute

Status: Active, not recruiting

Conditions: Competence

Treatments: Behavioral: Live Supervision + Session Goal Formulation; Other: Session Goal Formulation

Study type: Interventional

Funder types: Other

Identifiers

NCT05612113

2022-00352-01

Details and patient eligibility

About

Although clinical supervision is an essential part of psychotherapy training and development, the empirical evidence for effects on therapist competence and patient outcome is limited. However, a novel format, Live Supervision (LS), enables real time feedback during the patient session which counteracts on several of the major identified problems with standard supervision. Pilot studies of LS show promising results, but the effects of LS has never been assessed in a clinical setting with licensed psychologists. Furthermore, manualized LS with a stringent focus at therapists' idiosyncratic challenges has never been evaluated.

The primary aim of this study is to evaluate the effects of LS on therapist competence and perceived therapy challenges in a clinical outpatient setting with licensed psychologists as therapists. Secondary aims are to examine when and how LS is optimal for clinical supervision.

Full description

Objective:

To evaluate the effects of LS on therapist competence and perceived therapy challenges with both qualitative and quantitative data in a sample of licensed psychotherapists working with CBT in outpatient psychiatry or primary care.

Methods:

The study will use a replicated Single Case Experimental Design (SCED) with randomized multiple baselines in combination with qualitative interviews at the end of the trial. Each therapist (n = 6) will take part in the study with one patient for a period of 14 therapy sessions of which 5-9 sessions (randomized for each therapist) consist of the baseline phase, followed by the intervention phase (Live Supervision) for the rest of the study period (5-9 sessions).

Primary outcome measures will be observer rated competence and observer and therapist rated goal attainment. Secondary outcome measure will be the quality of therapy sessions from the perspective of the patients and observer rated competence according to the supervisors perception of the most prevalent skill deficiency of the therapist.

The qualitative data collection will focus on a systemization of how and when LS is for optimal use as well as mapping the degree of correspondence between patients, therapists, and supervisors regarding the therapists competences and skill deficiencies.

Enrollment: 6 patients

Sex: All

Ages: 16+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Patients:

Inclusion Criteria:

1. At least one diagnosis of the following DSM-5 disorders: mood disorders, anxiety disorders, OCD or related disorders, orTrauma or stress related disorders, comorbid severe disorder such as schizophrenia or development disorder,
2. Being able to attend to regular treatment
3. Accepting recording of therapy sessions and providing a written consent
4. Above 16 years old

Exclusion Criteria:

a) Comorbid severe disorder such as schizophrenia, developmental disorder, severe eating disorder, or severe substance use disorder.

Therapists:

Inclusion criteria:

1. Licensed psychologist
2. Working in outpatient psychiatric care or primary care in Sweden
3. Currently providing CBT
4. At least one year work experience of providing psychological treatments in outpatient care

Supervisors:

Inclusion criteria:

1. At least 2 years experience working as a clinical supervisor for CBT
2. Formal supervision training

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Sequential Assignment

Masking: Single Blind

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6 participants in 2 patient groups

Baseline - Session Goal Formulation

Active Comparator group

Description:

In the baseline phase, the therapist will formulate two session goals, see under descriptions of primary outcome measure. In this SCED-study, the baseline phase will be of randomized length (5-9 sessions) for each therapist. The reason for defining this as an active comparator is that we the behavior of formulating two session goals before each session should be considered an intervention, stimulating the therapist to reflect on the upcoming session goals, on defining concrete behaviors to reach the session goal, and to reflect upon his/her session behaviors afterwards. Thus, regarding the baselinephase as a no intervention would be misleading.

Treatment:

Other: Session Goal Formulation

Live Supervision with Bug-in-the-Ear (BITEar) as method

Experimental group

Description:

LS with the Bug-in-the-Ear (BITEar) is a video based supervision format where the supervisor watches the therapy session live through a webcam in the therapy room. During the therapy session, the supervisor provide verbal feedback and guidance to the therapist who wears wireless in-ear headphones. In this SCED-study, the intervention phase consist of 5 to 9 BITEar supervision sessions (number of supervision sessions is randomized between therapists) The BITEar supervision will consist of three phases: Pre-supervision (15 minutes): Discussion of the therapists session goals, how the therapist wants the supervisor's help and agreement on prompts and cues from supervisor Live supervision during the therapy session (≈ 45-60 minutes): Supervisor gives real time feedback and guidance focusing on helping the therapist achieve session goals Post-supervision (15 minutes): Reflection about the session, session goals and the supervision.

Treatment:

Behavioral: Live Supervision + Session Goal Formulation