Supervisor practice when guiding therapists working with depression: The impact of supervisor and patient characteristics

Background: Psychological treatments for depression are not always delivered consistently or effectively. Supervision of therapists is assumed to keep therapy on track and ensure positive therapy outcomes. However, there is a lack of research to support the proposition that supervision has such effects. Aims: This study explored the role of supervision in the treatment of depression. In particular, it examined how supervisors’ own characteristics and those of patients can influence the focus of supervision sessions.

Method: Participants were clinical supervisors who supervised therapists working with patients with depression. Supervisors were asked to indicate their supervision focus for three different patient cases, which varied in clinical complexity. Participants’ intolerance to uncertainty and their self-esteem were also assessed.

Results: Supervisors tended to focus their supervisees on the use of evidence-based therapeutic techniques for both straightforward and complex cases. However, their approach was less evidence-based for diffuse cases. Three supervisory types emerged - an ‘Alliance- and Technique-Focused’ group, a ‘Case Management-Focused’ group, and an ‘Unfocused’ group. Which group the supervisor fell into was related to their personal characteristics.

Conclusions: Findings indicate that supervisors are influenced by factors outside of supervision. Those factors might cause them to drift away from stressing the importance of evidence-based aspects of therapy. Suggestions are made for ways to improve the effectiveness of clinical supervision.