• Identifying and working with non-responsive and deteriorating patients within the process of supervision: methods of practicing supervisors

      Rast, Katrina Anne; Gifford, Valerie; David, Eric John; Geist, Charles; Lardon, Cecile; Whipple, Jason (2018-05)
      Clinical supervision is widely considered to be an essential part of psychotherapy training, encouraging trainee growth, and ensuring the best possible outcome for patients. The use of routine outcome monitoring (ROM) systems in clinical practice has been shown to be beneficial in improving patient outcome within psychotherapy. In addition to its utility in clinical practice, research has suggested that the use of ROM systems and patient feedback within the supervisory process may also have a positive impact on patient outcome. Despite these potential benefits, there is no existing literature about how supervisors identify and work with patients at risk for deterioration within the supervision process. This study aimed to explore the influence on regulatory focus and the use of ROM systems within supervision. Additionally, this study sought to explore two questions: 1) How do supervisors currently identify supervisee patients who are unresponsive to treatment or deteriorating? and 2) How do supervisors currently work with unresponsive or deteriorating patients in supervision? Using a quantitative approach, results suggest that the majority of supervisors rely heavily on clinical judgment in order to identify treatment non-responders and irregularly use ROM systems in order to identify these patients. In addition, the results suggest that the majority of supervisors respond to deteriorating patients in a way that coincides with existing literature pertaining to common practices within psychotherapy. Furthermore, there appears to be a prominent lack of understanding of the purpose and use of ROM systems within supervision. Finally, results indicate that promotion scores are a predictor of the use of ROM within supervision. Implications for research and clinical practices are discussed, in addition to limitations and future directions of the study.
    • Routine outcome monitoring and clinical supervision: do therapists really care about their patients?

      Dexter, Kyle Raymond Kwon; Whipple, Jason; David, Eric John (EJ); Gifford, Valerie; Lardon, Cecile (2017-08)
      Psychotherapy has repeatedly been shown to be an acceptable form of treatment for a variety of psychiatric conditions. However, despite the success of psychotherapy, not all patients improve during a course of treatment. In fact, research has suggested that some patients actually become worse while engaged in psychotherapy. Thus, it becomes important to identify patient deterioration and provide this information back to therapists. Additionally, the ability to detect patient deterioration cannot be solely the result of clinician judgment. Research has shown that utilizing actuarial methods of identifying patient non-responders is superior to that of clinician judgment alone. In turn, the field has moved toward implementing routine outcome monitoring tools/management systems to assist in the process of identifying patients who are failing to respond to treatment. The present study explored potential relationships between routine outcome monitoring, deliberate practice, and routine clinical supervision. Results suggest that the vast majority of practicing therapists do not utilize routine outcome monitoring tools/management systems as part of their daily practices of psychotherapy, and most do not incorporate feedback results into their personal clinical supervision experiences. Additionally, results suggest that therapists who have received formalized training with routine outcome monitoring tools and/or are required to engage in weekly supervision, are more likely to monitor their patient outcome as part of their daily practices of psychotherapy. Moreover, self-assessment bias seems to be present within the sample in regards to identifying patient improvement, non-response, and deterioration. Implications for clinical practice and research are discussed, along with limitations and future directions.