Sheikh_BABCP_Symposium_presentation_July_09
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BABCP Annual Conference, Exeter, July 17th, 2009
THE EVIDENCE-BASE FOR CBT SUPERVISION:
SYSTEMATIC REVIEWS OF THE EMPIRICAL LITERATURE
DEREK MILNE, ALIA SHEIKH; SUE PATTISON; ANDREW WILKINSON
Background
Clinical supervision training regarded as essential.
Yet training not been given systematic attention
(“Something does not compute”: Watkins, 1997) :
concerns that evidence-base generally weak, etc.
One way forward: selective (BES) systematic review of
controlled studies.
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Best evidence synthesis (BES): a novel, affirming
approach to the systematic literature review:
BES “combines the meta-analytic approach of
extracting quantitative information in a common
standard format…with a systematic approach to
the assessment of study quality and study
relevance” (Petticrew &Roberts, 2006, p.181);
Often used in education, to answer questions
about what works (pragmatic focus);
Careful selection of studies - Milne et. al. 2006:
9 inclusion criteria, inc: ‘CS manipulated;
demonstrated effectiveness; in scientific journal’.
Objectives
To assess the degree of empirical support for
supervisor training
To define training methods that are supported
in the selected literature
To specify recommendations for the training of
supervisors
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Methodology
Conducted systematic literature search of three
databases (MedLine, PsycInfo, ASSIA)
Key words: “clinical supervision,” and “clinical
supervisor”
Narrowed search using term “empirical”
Studies selected according to specific inclusion
criteria, based on NICE(R) Manual for
Systematic Reviews of the Clinical Supervision
Literature (Version 11; Milne & James, 2000)
Final sample: 11 studies (N= 145 supervisors;
251 supervisees; 147 clients)
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Methodology
Studies also evaluated according to NICE(R)
(2001) coding manual
Coding system allows analysis of the
methodological quality of studies (e.g., use of
measures, threats to validity, etc) & of the
methods (Independent variables)
2 studies independently coded by researchers,
1 at start (inter-rater agreement=81%) & 1 at
end (82%)
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Results: 2 Questions
Addressing the two questions posed by
Whitman, Ryan & Rubinstein (2001):
What empirical support is there for
supervisor training?
Which elements of such training are
supported by evidence?
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Q1: What empirical support is there
for supervisor training?
11 studies provided empirical support for supervisor
training (e.g. they had sound methodological validity and
an average 67% impact on the 145 supervisors’
learning)
15 training methods- primarily:
corrective feedback (all 11 studies);
educational role-play &
observational learning (both in 8);
teaching (in 5 studies: NB: next slide arranged
by frequency of methods use in training)
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Q2: Which elements of such training are supported by evidence?
Feedback
Educational role-play
Modeling (live/video
demonstration)
Teaching (verbal
instruction)
Written assignments
Behavioural rehearsal
Providing a rationale
Guided reading
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Discussion
Educational needs
assessment
Direct observation
Questions and answers
Agenda-setting
Homework
assignments
Quiz
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These methods were blended, to be:
Multiple (mean 5.1 per study);
Structured (address training cycle);
Complementary (experiential learning cycle)
Structured approach recommended
Loganbill and Hardy (1983):
3 necessary components of training: theoretical content,
simulated experience, and in vivo practise with supervisees;
Russell and Petrie (1994): combine didactic and
experiential (“critical element in an effective supervisory
training programme” ; p. 39). More recent reviews agree:
Steinert et al.,2006 (systematic review; faculty);
Falender et al., 2004; Kaslow et al., 2004 (consensus).
Example: Bambling, et.al. (2006),
Psychotherapy Research, 16, pp. 317-331.
N=40 supervisors
(RCT: CBT or Dynamic;
N= 127 therapists & N= 127 patients)
Trained separately (1 day workshops:
teaching about instruments & role-plays)
Evaluated similarly: learning (self-
rated adherence) & impact (BDI; Working
Alliance Inventory; client satisfaction)
Discussion:
Some problems with BES:
Ignores negative findings?
True, in order to address pragmatic questions; but mixed
results, yet similar conclusions
Problem of induction follows?
True, but accidently coded weak/negative papers were also
similar (failed to falsify);
Also, BES review = falsifiable statement
Generalize to non-LD/brief supervision?
True, there very likely are significant differences:
awaits more studies of ‘complex’ supervision
Conclusions & recommendations
BES systematic review = pragmatic method for
addressing inconsistency between policy and practice
Results offer a ‘foundational’ evidence-base for CBT
supervisor training, consistent with educational theory,
best practise consensus and policies (add ‘complex’
supervision evidence as it emerges)
Mental health professionals should be prepared for the
recognized specialization of supervision following the
structured training format
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Acknowledgements
This study was funded by the Higher Education
Academy, Psychology Network
We are grateful to Helen Aylott, Nasim
Choudhri, Christopher Dunkerley, Helen
Fitzpatrick, and Sarah Wharton for their initial
work on this review
Thanks also to Kathryn Mark, Barbara Mellors,
and Thomas Cliffe for help in preparing the ppt
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Authors
DEREK MILNE, School of Psychology, Newcastle
University, Newcastle upon Tyne, NE1 7RU
[email protected]
ALIA SHEIKH, School of Psychology, Newcastle University,
Newcastle upon Tyne, NE1 7RU
[email protected]
SUE PATTISON, School of Education, Communication and
Language Sciences, Newcastle University, Newcastle upon
Tyne, NE1 7RU
[email protected]
ANDREW WILKINSON, North Tyneside Primary Care
Trust. [email protected]
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