Clinical supervision of the treatment of depression: The role of supervisor, supervisee, and patient characteristics

This thesis investigated the use of clinical supervision in therapy for depression and other disorders. The Introduction addresses the relevant existing literature, leading to this work. Initially, a content analysis indicated that the models literature is unclear, often lacking patient focus. Few models are based on empirical evidence and fewer are empirically tested. Meta-analyses of the empirical literature indicated that supervision has a moderate, positive impact on supervisees, but no impact on patients. Three experimental studies were carried out to investigate the content of supervision sessions for cognitive behavioural therapists treating depression. Results indicated supervisors often lack focus in supervision. There is a tendency for supervisors to hold back on therapeutic techniques or to encourage focus on the alliance or case management aspects of supervision. This pattern of focus often occurs when the patient has a diffuse depression presentation, the therapist is female and anxious, or when the supervisor themselves is more anxious. Findings indicate that supervisors have biases and can drift in their practice, as therapists do. There needs to be greater monitoring of clinical supervision in practice, and the influence of patient, therapist, and supervisor characteristics should be acknowledged in training and protocols. Future research would benefit from similar investigations into other disorders and therapies, and the inclusion of observational and clinical data.