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Further, "Just as the models of family therapy are, unsurprisingly, isomorphically represented in their corresponding training models and methods, so the development of the clinical reality of family therapy can serve as a methaphor for the training and supervision area."
However, in 1988 MFT was truly in its earliest states and not much time had gone by since supervision and training was mostly something that was done and not giving forethought on the "how's." Training and supervision were taken for granted; supervisors and clinicians were placed in positions without much prior preparation; and assessment for clinicians, let alone their supervisors, was almost nil.
Yet why was there a need for such training? Liddle compared the beginning of therapy with that of training. Each had to start off on the right foot. Although supervision can easily be defined in a narrow sense -- as the process of teaching a clinician how to conduct therapy -- it has much broader ramifications. Effective supervision prepares trainees for their career as well as upgrades the profession and promotes the field. It can help therapists launch their professional lives toward the highest possible point of self-esteem in terms of maturity, training and experience (154).
Conversely, trainees who consistently have ineffective instructors are at considerable risk of providing inadequate service to their clients and tarnishing their own and profession's standing. Importantly, "supervision thus involves significantly more than the mere transmission of technical information or clinical skills: it challenges participants both personally and intellectually in a context in which the best and worst of a supervisor's or therapist's individual style can emerge" (154).
Even in 1988, despite Liddle's optimism for such supervisory techniques as live and video and individuals behind the mirror there was still "an uncertainty, a lack of standards and guidelines, and a lack of consensus on how best to train and supervise (5)."
Most of the MFT training and supervision in the 1980s was "top down." The supervisor would bestow his/her so far gained knowledge to the trainees. There would be little if any dialogue and two-way give-and-take.
According to Liddle, Bowen approached this inadequacy as he did his therapy. "One cannot attempt to convey the essence of the training regimen without first addressing the basic ideas themselves" (62). With Bowen's approach, noted Liddle, "training is seen essentially as a person-to-person effort, with the instructor having as much to learn as the learner. In a sense the training process becomes a dialogue between engaged minds..." (71). The instructor must be close enough to the student to have an impact, but separate enough not to interfere. "In short, the instructor, along with the learner, continually works on differentiation of self."
In recent years, the thrust for supervision and training has expanded on Bowen's underlying premise. Several studies in the '90s for example, (Bernard & Goodyear, 1992; Holloway, 1995; Holloway & Neufeldt, 1995) noted it is better to understand how supervisors can be trained to do supervision effectively rather than focusing only on how supervision is done and "in a review of the efficacy of supervision, (they) concluded that the effects of specific supervisory interventions to therapist and client change in behavior remained largely unknown."
Likewise, it may be more important to see what factors can limit the effectiveness of training than being concerned about the actual therapy approach. Goodyear et. al (1998) wrote that there are "three especially important barriers to drawing solid inferences from supervision research about the effectiveness of particular approaches: considering 'supervision' and 'training' as interchangeable interventions, an absence of efficacy research in supervision, and a reliance on satisfaction measures for outcomes."
The first challenge to comprehending the effectiveness of a specific supervision approach is that researchers often confuse supervision with training. In numerous reviews of the literature, authors have lumped supervision with training of this type as if they were the same. The second barrier is to determine the supervision approach that promotes more positive results than another necessitates comparative studies of supervisory models. However, supervision studies of this type have not been conducted.
Many psychotherapy researchers consider the 'gold standard' to be the randomized, control group experiment that is used in efficacy and effectiveness studies. Efficacy studies compare a particular treatment to a control group to answer the question 'Does this specific treatment work better than no treatment at all?' Effectiveness studies compare a treatment to one or more others and to answer the question 'How do the outcomes of this treatment compare to those in this other treatment?' (Goodyear 1998).
Goodyear continued that "There appears to be three reasons why supervision research does not have the tradition of efficacy and effectiveness studies. First, there is little theory-driven research in supervision. Second, supervision researchers do not have supervision manuals or protocols to follow to ensure that a reasonably accurate version of a model is being followed. Third, it is difficult to design research that protects clients." It would be unethical and even dangerous to assign some trainees to a supervision intervention and others to a control group where they see clients but receive no supervision.
A third barrier to determining supervision's effectiveness is the widespread dependence on satisfaction measures to assess supervision outcomes. Goodyear presented the following analogy:
imagine asking a number of people leaving a donut shop whether they were satisfied with their donuts and would be willing to return to this particular shop. Most would probably give affirming answers to both of these questions. Their answers, though, are of no use at all to someone interested in ascertaining the nutritional value of those donuts. Similarly, to ask trainees about whether they were satisfied with supervision or their supervisor gives minimal information about the "nutritional" value of their experience.
As a result, Goodyear made suggestions on how research should be conducted to determine effectiveness of training and supervision.
Differentiate Training and Supervision: Counselor educators would be well-served to more clearly differentiate the function of training from that of supervision. One reason for doing this is that the optimal conditions for training might be somewhat different than those for supervision.
Develop Profiles of Students: Sufficient information about particular trainee characteristics for counselor education programs need to be encouraged to develop profiles of students at the onset and throughout graduate training. It will not be possible to know more about training or supervision until better understanding how students' personal characteristics affect these interventions.
Conduct Effectiveness Studies: Because of the proliferation of supervision models in the past 20 years, the researcher can choose models that are distinct enough to warrant investigation.
Liddle (1988) offered some examples that could be found in research, which are seen to decrease the efficiency of training. For example, (183), due to wanting to please their supervisors, trainees will often become robots and follow the instructor's every command. This greatly limits creativity and finding new ways of helping the clients with their needs. The same result occurs if the supervisor intimidates the trainee. The latter becomes afraid of being assertive and discovering his/her own approach. In addition, sometimes the trainee has to adopt a model of MFT that is alien to his/her previous training. The emphasis is not on efficiency, here, but rather on the model itself.
Another tendency commonly involved with negative supervision deals with the isomorphic nature of the liver supervision context: interactive patterns at one level of training that tend to mirror or duplicate those at the other levels. In other words, the relationship between supervisor and trainee may resemble that between trainee and family members or those among family members themselves (Liddle & Saba, 1983 and 1985). Instructors not familiar with this tendency can become involved with escalating situations. If, however, the supervisor recognizes the isomorphic process, he/she will be able to readily notice and alter the negative situation.
The bottom line, say some present-day MFT professionals who are studying the concepts of supervision and training, it may perhaps be most productive to determine the means for the most effective training scenarios across all therapy modalities. Regardless of approach, the goal is to provide the trainees with the most positive and relevant educational experience. The stress in training should first be placed on these productive means of instruction and then secondly on teaching the specifics of the modality itself. There are sure to be principles if followed that trainees will agree offer them the best possible means for constructive therapy with their patients. These include:
Supervision works best when the mentors, supervisors, and therapists have access to and make use of a treatment manual (Corrigan & McCracken, 1997; Milne & James, 2000).
Supervision is more effective if the techniques and procedures to be used are modeled for the therapist (Bryant & Fox, 1995; Isaacs, Embry, & Baer, 1982; Kramer & Reitz, 1980; Street & Foot, 1984; West, Bubenzer, (Pinsoneault, & Holeman, 1993).
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