Three Strategies to Strengthen Therapist Follow-Through in Therapy Sessions: Examination of Accountability in Clinical Supervision.

Abstract

Clinical supervision is a natural opportunity for promoting therapist use of clinical practices supported by research in community mental health services. However, the research on thespecific strategies in supervision that are likely to have a positive impact is limited. One model from the organizational management literature suggests supervision behaviors that promote a sense of accountability-i.e., a perceived expectation to fulfill duties or obligations-may represent key strategies by which supervision promotes use of clinical practices supported by research. The present study aimed to identify the presence of "accountability strategies" during clinical supervision and investigate the association between strategies and therapist use of a clinical procedure supported by research during subsequent psychotherapy sessions. Transcripts of supervision sessions (n = 196) and subsequent treatment sessions (n = 196) were observationally coded for supervision accountability strategies and therapist follow-through use of an identified clinical procedure. Binary, multi-level logistic regression models were used to assess the association between accountability strategies during supervision and therapist use of a planned (i.e., "expected") practice during the subsequent therapy session. Results indicated explicit selection of the practice the therapist will use in their next treatment session, preparation through activities such as consulting manuals and practicing role plays, and review of how use of the practice went in the past increased the odds of therapist use of the expected practice during the next treatment session. These findings are notable as they demonstrate that supervision can directly influence therapist behavior through three specific strategies.