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

NCT05612113 | Unknown

• 1 other identifier: 2022-00352-01
• Study Type: interventional
• Target: 6
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Competence

Keywords

Clinical Supervision; Therapist Competence; Training and Supervision; Live Supervision; Psychotherapy; Bug-in-the-Ear

Outcome Measures

Primary Outcomes (3)

• Therapist Rated Session Goal Attainment of Idiosyncratically Formulated Session Goals

  All therapists will formulate two individual development goals per therapy session for the 14 weeks. One goal is focusing on a challenging behavioral pattern of the patient (e.g. talkative), and the other focusing on a challenging behavior of the therapist (e.g. being concise). After each session, each therapist rates to what degree they perceived that they managed to reach each of their set up goals on a scale from 0 (not reached the goal at all) to 100 (fully reached the goal) with 5 anchor points with descriptions. They will also rate the perceived difficulty of working with the goal from a scale from 0 (not at all difficult) to 100 (extremely difficult) with 5 anchor points with descriptions.

  Approximately 14 weeks (from session 1 to session 14 with one session per week)

• Observer Rated Session Goal Attainment of Idiosyncratically Formulated Session Goals

  Third-party raters will listen to the audio recordings of the sessions and evaluate the level of goal attainment in each session, blinded to whether the therapist received supervision or not. Observers will be trained in how to evaluate goal attainment.

  Approximately 14 weeks (from session 1 to session 14 with one session per week)

• Therapist Competence measured with Cognitive Therapy Scale - Revised (CTS-R; Blackburn et al., 2001)

  The CTS-R instrument is one of the most used and validated scales for measuring CBT competence. The scale consists of 12 items with a 7-point rating scale format: 0 = poor, 1 = barely adequate, 2 = mediocre, 3 = satisfactory, 4 = good, 5 = very good, and 6 = excellent. In this study, we will analyze both the composite score of the full scale, but also an item per item analysis since one of the aims of the study is to assess for what type of competencies LS may be particularly effective.

  Approximately 14 weeks (from session 1 to session 14 with one session per week)

Secondary Outcomes (4)

• Patient rated degree of satisfaction and usefulness

  Approximately 14 weeks (from session 1 to session 14 with one session per week)

• Patient rated degree of collaboration with the therapist

  Approximately 14 weeks (from session 1 to session 14 with one session per week)

• Observer rated degree of therapist skill deficiency as defined by the supervisor

  Approximately 14 weeks (from session 1 to session 14 with one session per week)

• Observer rated degree of therapist skill deficiency as defined by the patient

  Approximately 14 weeks (from session 1 to session 14 with one session per week)

Study Arms (2)

Baseline - Session Goal Formulation

ACTIVE COMPARATOR

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.

Other: Session Goal Formulation

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

EXPERIMENTAL

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.

Behavioral: Live Supervision + Session Goal Formulation

Interventions

Live Supervision + Session Goal Formulation BEHAVIORAL

Read under "Arms"

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

Session Goal Formulation OTHER

Read under "Arms"

Baseline - Session Goal Formulation

Eligibility Criteria

• Age: 16 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• 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,
• Being able to attend to regular treatment
• Accepting recording of therapy sessions and providing a written consent
• Above 16 years old

You may not qualify if:

• a) Comorbid severe disorder such as schizophrenia, developmental disorder, severe eating disorder, or severe substance use disorder.
• Therapists:
• Licensed psychologist
• Working in outpatient psychiatric care or primary care in Sweden
• Currently providing CBT
• At least one year work experience of providing psychological treatments in outpatient care
• Supervisors:
• At least 2 years experience working as a clinical supervisor for CBT
• Formal supervision training

Sponsors & Collaborators

• Karolinska Institutet: lead

Study Sites (1)

Karolinska Institute

Stockholm, Region Stockholm, 17177, Sweden

Location

Study Officials

• Sven Alfonsson, PhD

  Karolinska Institutet

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Third-party raters, not being involved in the project management of the study or participating in the study, will be blinded to the participating therapists, study phases and the order of recorded sessions. These third-party raters will assess therapists' skills, goal attainment and competences in each recorded session. To test for blinding integrity the third-party raters will note their guesses of which condition the session belonged to (baseline or intervention).
• Purpose: OTHER
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: PhD

Model Details: Replicated Single Case Experimental Design with Multiple Baselines

Study Record Dates

• First Submitted: October 17, 2022
• First Posted: November 10, 2022
• Study Start: October 1, 2022
• Primary Completion: March 1, 2023
• Study Completion: March 1, 2023
• Last Updated: November 10, 2022

Record last verified: 2022-11

Data Sharing

• IPD Sharing: Will not share

Locations

SE (1)