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

Abstract

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.