Clinical supervision in Cognitive Behavior Therapy improves therapists’ competence: A single-case experimental pilot study

Clinical psychotherapists typically receive supervision from senior psychotherapists both during training and in their subsequent clinical practice. Supervision typically involves discussing challenging patient cases, new treatment methods and other issues related to the practical work of psychotherapists. Clinical supervision is generally proposed to enhance therapists’ competence, improve treatment outcomes and ensure patient safety. However, recent research overviews have shown that there is practically no evidence that supervision has any effects on therapists’ skills or their patients’ well-being. This is a problem since a lot of resources are spent on providing therapists with high quality supervision but it is unknown whether it is meaningful. A study was therefore conducted in order to investigate whether clinical supervision had any effects on therapists’ clinical competence in conducting Cognitive Behavior Therapy (CBT).

To investigate whether supervision had any effect on therapists’ skills, six clinical therapists and their patients volunteered to record psychotherapy sessions during a period when they received no supervision and then during a period when they received supervision from a senior psychotherapist. Audio recordings from the treatment sessions were collected and the quality of the psychotherapy was assessed by a senior psychotherapist that did not know whether the recordings came from a time period when the therapist had had supervision or not. By comparing the quality scores from all the recordings, it became clear that psychotherapy sessions recorded during the periods with supervision overall received higher quality scores than the recordings collected during the period when the therapists had not had supervision. The difference was not large but consistent and the conclusion was that supervision can improve psychotherapists’ practical skills in conducting Cognitive Behavior Therapy.

This is one of the first studies that investigated the effects of clinical supervision and more studies are needed to further investigate what type of supervision is more effective and whether group supervision is comparable to individual supervision. There is an ongoing discussion in higher education about using more experience-based learning methods and the traditional theoretical discussions typically seen in clinical supervision may need to be enhanced with more engaging learning activities such as role-play and other forms of practical skills training. It is also important to investigate other questions regarding clinical supervision for example whether it can affect therapists’ work-related stress and patient outcomes. In the end, supervision should be provided to ensure that patients receive the best possible care in an effective and safe manner. 

Read the full article: Alfonsson, S., Lundgren, T., & Andersson, G. (in press). Clinical supervision in cognitive behavior therapy improves therapists’ competence: A single-case experimental pilot study. Cognitive Behaviour Therapy. doi: 10.1080/16506073.2020.1737571

Pictured: Dr. Sven Alfsonsson

Photo by: Office Now

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