title: The Effects of Bug-in-the-Eye Supervision on Therapeutic Alliance and Therapist Competence in Cognitive-Behavioural Therapy: A Randomized Controlled Trial.
abstract: Live supervision enables a supervisor to have direct insight into the psychotherapeutic process and allows him or her to provide immediate feedback to the trainee. Therefore, live supervision might be superior to traditional supervisory formats that only allow for the provision of delayed feedback. When considering the different live supervision formats, bug-in-the-eye (BITE) supervision is particularly promising because of its improved and less invasive procedure. The current study compared the efficacy of BITE supervision with that of delayed video-based (DVB) supervision. In the present study, 23 therapists were randomly assigned to either the BITE supervision or DVB supervision groups. The participants were psychotherapy trainees who treated 42 patients (19 under BITE supervision and 23 under DVB supervision) over 25 sessions of cognitive-behavioural therapy. Two independent raters blind to the treatment conditions evaluated therapeutic alliance and therapist competence based on 195 videotapes. Therapeutic alliance was significantly stronger among the treatments conducted under BITE supervision than those conducted under DVB supervision. Moreover, a higher level of therapeutic competence was found in the BITE condition than in the DVB condition. However, no differences between supervision conditions were found when the results were controlled for the level of therapeutic alliance and therapist competence demonstrated in the first session. No differences were observed between the supervision conditions with respect to patient outcomes. There is evidence that BITE supervision is able to improve therapeutic alliance and therapist competence. However, these findings should be interpreted with caution because possible pre-treatment differences between therapists might explain the superiority of BITE supervision. Copyright © 2015 John Wiley & Sons, Ltd.
  
  
  CONCLUSIONS
  BITE supervision positively influences the therapeutic alliance and therapeutic competencies during cognitive-behavioural therapy. A supervision format that more directly addresses therapeutic processes is more effective in improving those processes than an indirect supervision format. Pre-treatment differences between therapists might explain the superiority of BITE supervision. BITE supervision can be considered a safe intervention.
authors.affiliation: Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, University of Mainz, Mainz, Germany. flweck@uni-mainz.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Weck
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt am Main, Germany.
authors.forename: Marion
authors.initials: M
authors.lastname: Jakob
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt am Main, Germany.
authors.forename: Julia M B
authors.initials: JM
authors.lastname: Neng
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt am Main, Germany.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Höfling
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt am Main, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Grikscheit
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bohus
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000706:statistics & numerical data*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011369:Professional-Patient Relations; D013811:Psychotherapeutic Processes; D011613:Psychotherapy / Q000193:education* / Q000379:methods*
keywords: Feedback; Live Supervision; Randomized Controlled Trial; Therapeutic Alliance; Therapist Competence