Latest / Frontiers of Psychotherapist Development Podcast by Daryl Chow, Ph.D. / Predicting the Impact of Supervisory Alliance on Client Outcome

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Predicting the Impact of Supervisory Alliance on Client Outcome · Frontiers of Psychotherapist Development Podcast by Daryl Chow, Ph.D.

• 0:01
  SPEAKER_01: We know that the working alliance is highly predictive
• 0:06
  SPEAKER_01: of client outcomes in psychotherapy.
• 0:10
  SPEAKER_01: What about in clinical supervision?
• 0:13
  SPEAKER_01: What do we know about the working alliance between the supervisor and the supervisee
• 0:18
  SPEAKER_01: in predicting client outcomes?
• 0:21
  SPEAKER_01: That's what we're going to look into today in unpicking the research.
• 0:26
  SPEAKER_01: And we're going to look at a very recent study that came out.
• 0:29
  SPEAKER_01: It was published by Jung Lu and Dennis Kovigen Jr.
• 0:34
  SPEAKER_01: I noticed that I love studies that come from Dennis.
• 0:37
  SPEAKER_01: He and his team does very excellent research and they explore this very question.
• 0:43
  SPEAKER_01: Does the pattern of alliance that progress over time lead to client outcomes?
• 0:50
  SPEAKER_01: And how does the beneficial alliance dynamics,
• 0:54
  SPEAKER_01: the trajectory of the alliance over time,
• 0:57
  SPEAKER_01: differ or is similar to the process of psychotherapy?
• 1:01
  SPEAKER_01: Comparing that within supervision, And therapy.
• 1:05
  SPEAKER_01: So let's dive in and look at what they found.
• 1:09
  SPEAKER_01: And then at the end, I will give you some takeaways that you can apply if you are
• 1:13
  SPEAKER_01: a clinical supervisor.
• 1:15
  SPEAKER_01: And if you are a supervisee receiving coaching and mentoring and help from a supervisor.
• 1:21
  SPEAKER_01: It's very useful to know the following takeaways from this study.
• 1:26
  SPEAKER_01: So let's dive right in.
• 1:28
  SPEAKER_01: Let's begin with what were the profile of people and what exactly was the setup.
• 1:34
  SPEAKER_01: So first up in this particular study, there were about 28 supervisory diets.
• 1:41
  SPEAKER_01: So there was 28 pairs of therapists and these therapists were third
• 1:45
  SPEAKER_01: and fourth year doctoral students in counseling psychology.
• 1:49
  SPEAKER_01: The analysis consists
• 1:51
  SPEAKER_01: of 1,709 weekly supervision sessions and the client population
• 1:57
  SPEAKER_01: that they were servicing or helping were in a community setting with 261.
• 2:06
  SPEAKER_01: So as they look at this, they were measuring a couple of things.
• 2:10
  SPEAKER_01: They were measuring the outcome of the clients using the OQ45,
• 2:15
  SPEAKER_01: which is the gold standard measure called the Outcome Questionnaire 45.
• 2:20
  SPEAKER_01: And they were measuring the alliance.
• 2:23
  SPEAKER_01: They were measuring also the alliance in supervision.
• 2:26
  SPEAKER_01: So take note that they were measuring The supervisory working alliance taken
• 2:33
  SPEAKER_01: from the supervisee, which is the therapist,
• 2:38
  SPEAKER_01: as well as the working alliance from the supervisor's perspective.
• 2:44
  SPEAKER_01: So they were taking two sets
• 2:46
  SPEAKER_01: of independent working alliance measure in supervision,
• 2:51
  SPEAKER_01: one from the therapist, the other from the supervisor about the experience
• 2:58
  SPEAKER_01: in the weekly supervision.
• 3:01
  SPEAKER_01: In terms of the statistical analysis,
• 3:04
  SPEAKER_01: they use a method that we talked about previously in the last podcast episode
• 3:10
  SPEAKER_01: about the impact of supervision on outcomes in general.
• 3:14
  SPEAKER_01: They use the same analysis called Dynamic Structural Equation Modeling, DSEM.
• 3:19
  SPEAKER_01: It's beyond my pay grade. I don't know too much about this.
• 3:22
  SPEAKER_01: Seems relatively new in the literature.
• 3:24
  SPEAKER_01: I haven't seen this DSEM use pretty much, but it's very interesting.
• 3:29
  SPEAKER_01: They were testing two prior Primary dynamics.
• 3:32
  SPEAKER_01: The first one was the responsiveness, which is the partner effects.
• 3:37
  SPEAKER_01: Does one partner's alliance perception in the previous session predict
• 3:41
  SPEAKER_01: the other partner's alliance perception in the current session?
• 3:46
  SPEAKER_01: So which means from the diet of the supervisee and supervisor,
• 3:50
  SPEAKER_01: does one person's previous session predict the other person's next one?
• 3:54
  SPEAKER_01: And then they were testing variability, which is pretty much the rupture and repair,
• 3:59
  SPEAKER_01: which is the question of how much does the Alliance ratings fluctuate from session
• 4:04
  SPEAKER_01: to session?
• 4:05
  SPEAKER_01: You know, so using this particular modeling, and they were trying to see those things.
• 4:12
  SPEAKER_01: In terms of the working alliance measure that was used for therapy,
• 4:17
  SPEAKER_01: it was the working alliance inventory.
• 4:19
  SPEAKER_01: That's a standard that's used a lot in a lot of research.
• 4:24
  SPEAKER_01: And in terms of the alliance measure that was used In Supervision,
• 4:29
  SPEAKER_01: it was the Supervisory Working Alliance inventory,
• 4:32
  SPEAKER_01: which is a short version that they use, the 12 item one.
• 4:35
  SPEAKER_01: And in this particular 12 item scale, it looks at three features,
• 4:39
  SPEAKER_01: which is the rapport, the client Focus and Identification.
• 4:45
  SPEAKER_01: So let me just read out some of the items from each of these three sections.
• 4:51
  SPEAKER_01: In the focus section, it says,
• 4:54
  SPEAKER_01: I feel helped with working on a specific treatment plan with my clients.
• 5:01
  SPEAKER_01: Another one could be I feel helped by staying on track during our meetings.
• 5:06
  SPEAKER_01: And in the rapport section, it could be during supervision.
• 5:12
  SPEAKER_01: I feel that I could talk more.
• 5:14
  SPEAKER_01: I feel that my supervisor makes an effort to understand me.
• 5:18
  SPEAKER_01: In identification, some of the questions are like,
• 5:22
  SPEAKER_01: I stay in tune with my supervisor during supervision.
• 5:27
  SPEAKER_01: My supervisor seems to be able to stand back and reflect on what I'm saying.
• 5:32
  SPEAKER_01: And then the items get reversed when it's scored by the supervisor.
• 5:37
  SPEAKER_01: So it's reading each of the working lines independently.
• 5:42
  SPEAKER_01: Okay, so now that we've got an overview, let's look at the key findings.
• 5:48
  SPEAKER_01: The first one is that overall averages of the alliance doesn't predict client outcomes.
• 5:56
  SPEAKER_01: So average Supervisory Working Alliance across all sessions had no association
• 6:01
  SPEAKER_01: with the improvement in the OQ45.
• 6:04
  SPEAKER_01: How good the Alliance is on average doesn't seem to explain client progress.
• 6:10
  SPEAKER_01: Okay, take note of number one.
• 6:12
  SPEAKER_01: Number two, which is the key thing, the unique finding,
• 6:16
  SPEAKER_01: one of the first to do a study like this,
• 6:19
  SPEAKER_01: is what Lu and Kadegan calls the anti-phase supervisor-led responsiveness.
• 6:27
  SPEAKER_01: So anti-phase, this is going to be a word that will keep coming up.
• 6:31
  SPEAKER_01: This is the word that the researchers use.
• 6:33
  SPEAKER_01: They said that clients experience Significant greater improvement
• 6:39
  SPEAKER_01: when supervisory diets demonstrated
• 6:43
  SPEAKER_01: anti-phase supervisory-led responsiveness.
• 6:47
  SPEAKER_01: So this is a bit confusing.
• 6:48
  SPEAKER_01: Let's kind of unpack that slowly so that we can understand what this means.
• 6:53
  SPEAKER_01: And when we say antiphase, it's probably used to think about what it means to be
• 6:58
  SPEAKER_01: in phase or in sync, right?
• 7:01
  SPEAKER_01: So if things are in phase would mean that the ratings between your supervisor
• 7:07
  SPEAKER_01: and supervisee will be similar and they'll be moving in the same direction.
• 7:11
  SPEAKER_01: So if the supervisee feels more engaged, the supervisor will feel also similar, right?
• 7:16
  SPEAKER_01: So that means it's in sync.
• 7:18
  SPEAKER_01: What happens in the opposite?
• 7:21
  SPEAKER_01: The opposite is when What the researchers call antiphase,
• 7:25
  SPEAKER_01: which means the ratings move in opposite directions,
• 7:30
  SPEAKER_01: maintaining sort of like a dynamic equilibrium.
• 7:33
  SPEAKER_01: When one goes up, one goes down, one goes down, one goes up.
• 7:36
  SPEAKER_01: So specifically,
• 7:38
  SPEAKER_01: when a supervisee felt a higher than usual alliance
• 7:45
  SPEAKER_01: in the previous week, The supervisor reported a lower than usual alliance
• 7:51
  SPEAKER_01: in the next week.
• 7:54
  SPEAKER_01: So sort of going in the opposite direction and specifically it is led
• 7:59
  SPEAKER_01: by the ratings
• 8:03
  SPEAKER_01: of the supervisee, which means when the supervisee rates one way,
• 8:09
  SPEAKER_01: it seems that the supervisor responds going in the opposite direction.
• 8:14
  SPEAKER_01: This is interesting.
• 8:15
  SPEAKER_01: It does beg the question, why is that the case?
• 8:18
  SPEAKER_01: Why does that Lead to improvement in client outcomes.
• 8:24
  SPEAKER_01: And remember, the work of clinical supervision is strange.
• 8:27
  SPEAKER_01: It's two steps removed from reality. Or one, you would say.
• 8:31
  SPEAKER_01: So it's the clients, it's the therapy that's happening between the therapist and the client.
• 8:38
  SPEAKER_01: And then the therapist comes and discuss something that's happened outside
• 8:43
  SPEAKER_01: of that with a supervisor, right?
• 8:46
  SPEAKER_01: So this antiphasing seems to be happening.
• 8:49
  SPEAKER_01: Number three, higher supervisory working alliance
• 8:53
  SPEAKER_01: variability benefits supervision outcomes.
• 8:58
  SPEAKER_01: So in other words, greater session to session variability
• 9:01
  SPEAKER_01: in the supervisory working alliance, let's call that SWA for short,
• 9:07
  SPEAKER_01: for both supervisor and supervisees were associated
• 9:11
  SPEAKER_01: with higher client rated session effectiveness measured by the OQ45.
• 9:19
  SPEAKER_01: Greater variability
• 9:20
  SPEAKER_01: in supervisor-rated alliance
• 9:24
  SPEAKER_01: predicted greater symptom reduction, right?
• 9:27
  SPEAKER_01: So more so that if the variability That happens
• 9:32
  SPEAKER_01: from the supervisor was much more predictive than from the supervisee's perspective.
• 9:39
  SPEAKER_01: Now, I know all these sounds really confusing,
• 9:41
  SPEAKER_01: but let's kind of just sum up what were the main findings.
• 9:43
  SPEAKER_01: Again, there are three.
• 9:45
  SPEAKER_01: Overall averages doesn't predict client outcome.
• 9:48
  SPEAKER_01: Overall averages of the alliance in the supervision.
• 9:52
  SPEAKER_01: Second, it's not the in-sync trajectory,
• 9:56
  SPEAKER_01: it's the not in-sync or the anti-phase Model,
• 10:00
  SPEAKER_01: the trajectory that's going in two opposite directions between supervisor
• 10:06
  SPEAKER_01: and supervisee that seems to predict client outcomes.
• 10:10
  SPEAKER_01: And then number three, the variability, higher variability in the alliance,
• 10:15
  SPEAKER_01: especially from the supervisor, predicts client outcomes.
• 10:21
  SPEAKER_01: This is kind of mind blowing if you think about this,
• 10:24
  SPEAKER_01: which means that the alliance Experience
• 10:29
  SPEAKER_01: in therapy has got different predictive value when you look at the working alliance
• 10:35
  SPEAKER_01: in supervision.
• 10:36
  SPEAKER_01: So some people might say detract working alliance in supervision,
• 10:41
  SPEAKER_01: but then yet that has very little predictive value that translates remotely
• 10:48
  SPEAKER_01: into client outcomes in therapy.
• 10:52
  SPEAKER_01: There are some other secondary findings if you kind of pick it through,
• 10:56
  SPEAKER_01: which I thought are pretty interesting.
• 10:58
  SPEAKER_01: I'm going to look at some of them, probably about three of them or four of them.
• 11:02
  SPEAKER_01: The first one is that Supervisor Rated Working Alliance is not directly predictive
• 11:09
  SPEAKER_01: of client outcomes.
• 11:11
  SPEAKER_01: So in short, a trainee's working alliance score by itself does not tell you
• 11:16
  SPEAKER_01: if client will get better, if their clients will get better.
• 11:20
  SPEAKER_01: Bear that in mind.
• 11:21
  SPEAKER_01: This is sort of embedded in the main finding, but it's just worth highlighting this point.
• 11:26
  SPEAKER_01: It only becomes predictive when it acts
• 11:29
  SPEAKER_01: as an initial signal for the supervisor
• 11:34
  SPEAKER_01: to calibrate their perspective in the subsequent session.
• 11:37
  SPEAKER_01: This was part of the anti-phase model, right?
• 11:39
  SPEAKER_01: So that means if the therapist,
• 11:45
  SPEAKER_01: if the supervisee experience a high alliance,
• 11:50
  SPEAKER_01: It seems that the responsive supervisor will score it lower the next session
• 11:56
  SPEAKER_01: or vice versa, but it has to be led by the change in the score from the supervisee,
• 12:03
  SPEAKER_01: from the therapist.
• 12:05
  SPEAKER_01: Well, the supervisor variability was distinctly more predictive, as I mentioned earlier.
• 12:11
  SPEAKER_01: The second thing is that client-rated alliance,
• 12:15
  SPEAKER_01: now we're talking about now it's in the therapy session,
• 12:19
  SPEAKER_01: client-rated alliance Had zero correlation link
• 12:24
  SPEAKER_01: with supervisory alliance.
• 12:27
  SPEAKER_01: A client's own rating of their therapeutic alliance
• 12:30
  SPEAKER_01: with their therapist showed no statistical significance association
• 12:34
  SPEAKER_01: with the supervisor rated or supervisory rated supervision working alliance.
• 12:40
  SPEAKER_01: So this distilled client's perceptions of the therapeutic relationship.
• 12:46
  SPEAKER_01: It kind of operates independently from what occurs in supervision.
• 12:52
  SPEAKER_01: Another way to put this, there's no relationship,
• 12:54
  SPEAKER_01: no significant relationship between the alliance experience in supervision
• 13:02
  SPEAKER_01: and the alliance in therapy from the client's perspective.
• 13:07
  SPEAKER_01: And then the third one,
• 13:08
  SPEAKER_01: the secondary finding is that discrepancy between supervisor
• 13:15
  SPEAKER_01: and supervisees ratings within the same session was not significant.
• 13:21
  SPEAKER_01: Said in another way, the difference between the supervisor and supervisee
• 13:25
  SPEAKER_01: within the same session, you know, that sort of discrepancy of scores in, let's say,
• 13:29
  SPEAKER_01: session, the supervision session number 11,
• 13:33
  SPEAKER_01: the difference between those two scores doesn't predict outcomes.
• 13:37
  SPEAKER_01: It is the antiphase model, which is one session scoring one way,
• 13:43
  SPEAKER_01: And then subsequent session scoring another way,
• 13:45
  SPEAKER_01: the difference between the supervisor and supervisee, that is predictive.
• 13:50
  SPEAKER_01: Now, this is really nuanced and interesting, and I know it sounds confusing,
• 13:55
  SPEAKER_01: and it's really worth unpicking a little bit more and to see its implications
• 14:01
  SPEAKER_01: and what exactly are some other stuff we can take away from this.
• 14:05
  SPEAKER_01: What it seems to suggest, what it reflects,
• 14:07
  SPEAKER_01: at least the interpretation that we're taking from the data itself,
• 14:12
  SPEAKER_01: is that when it's predictive of client outcomes,
• 14:14
  SPEAKER_01: it's because the supervisor is actively calibrating responsively
• 14:20
  SPEAKER_01: to the trainees.
• 14:23
  SPEAKER_01: Ratings of the Alliance in the subsequent session.
• 14:27
  SPEAKER_01: So they're adjusting.
• 14:28
  SPEAKER_01: They're not just talking about stuff, you know,
• 14:32
  SPEAKER_01: just in full congruence and agreement in that way.
• 14:35
  SPEAKER_01: They seem to be going in, again, in an anti-phase sort of approach.
• 14:39
  SPEAKER_01: And they're pushing and they're trying to see what are some of the growth edges
• 14:43
  SPEAKER_01: that this particular trainee needs to work on.
• 14:47
  SPEAKER_01: Once again, the trainees rating of the alliance and supervision was not predictive
• 14:52
  SPEAKER_01: of client outcome. It was this antiphase model that it is.
• 14:56
  SPEAKER_01: And if you make this contrast between supervision, clinical supervision and therapy,
• 15:03
  SPEAKER_01: is that the optimal response in therapy is to have more
• 15:08
  SPEAKER_01: of an in-phase responsiveness,
• 15:09
  SPEAKER_01: which is that outcomes are usually a Ratings are associated with moving
• 15:12
  SPEAKER_01: in the same direction, forming this alliance, which predicts outcomes.
• 15:18
  SPEAKER_01: Whereas in clinical supervision,
• 15:20
  SPEAKER_01: better outcomes are associated with ratings moving in the opposite direction.
• 15:24
  SPEAKER_01: It's sort of a negative cross-lacked relationship, if you like.
• 15:28
  SPEAKER_01: Maintaining this relational homostasis, moving up, moving down,
• 15:33
  SPEAKER_01: which depends on the supervisor's responsiveness based on what the trainee
• 15:40
  SPEAKER_01: In therapy, you know, the session to session variability,
• 15:46
  SPEAKER_01: lower variability is generally beneficial, right?
• 15:49
  SPEAKER_01: I mean, if you have a higher volatility, you know, clients may drop out and such.
• 15:56
  SPEAKER_01: Rupture and repairs are really important in psychotherapy.
• 15:59
  SPEAKER_01: If the therapist is able to pick that up, that's also predictive of outcomes.
• 16:04
  SPEAKER_01: But in clinical supervision,
• 16:06
  SPEAKER_01: higher variability is beneficial compared to lower variability in psychotherapy.
• 16:11
  SPEAKER_01: Psychotherapy, especially when the supervisor is tuned in and trying to go to create
• 16:18
  SPEAKER_01: a learning, conducive learning environment.
• 16:21
  SPEAKER_01: And of course, you know, you might think about the relational context.
• 16:26
  SPEAKER_01: It's different, right?
• 16:27
  SPEAKER_01: For clients, most of the time clients can just terminate whenever they want,
• 16:30
  SPEAKER_01: you know, whereas when there's a programmatic requirement,
• 16:34
  SPEAKER_01: especially like based on the study, you know,
• 16:37
  SPEAKER_01: the supervisee has to stay in the session.
• 16:41
  SPEAKER_01: What about the goals?
• 16:42
  SPEAKER_01: In therapy, it's usually about dealing with the stress or growth,
• 16:47
  SPEAKER_01: whereas in supervision, especially in this particular studies case,
• 16:51
  SPEAKER_01: it's focused on clinical competency and consultancy, which happens.
• 16:55
  SPEAKER_01: It happens quite intensely if you think about this once a week,
• 16:58
  SPEAKER_01: which is a very intensive supervision model that they had.
• 17:01
  SPEAKER_01: It doesn't say if video recording was used like the previous study that we looked
• 17:05
  SPEAKER_01: at in the previous podcast, there was a lot of video recordings being used.
• 17:09
  SPEAKER_01: This was not spelled So I don't know if that was used.
• 17:13
  SPEAKER_01: And what about the overall alliance averages?
• 17:17
  SPEAKER_01: Well, for therapy, it's usually weak to moderate link.
• 17:21
  SPEAKER_01: Overall average alliance strength shows weak to moderate associations in therapy.
• 17:26
  SPEAKER_01: Whereas the overall average alliance
• 17:30
  SPEAKER_01: in supervision has got no association,
• 17:34
  SPEAKER_01: zero association with client improvement.
• 17:38
  SPEAKER_01: So that's interesting for us to note all these nuances and differences.
• 17:43
  SPEAKER_01: On a related note, there was also a very recent study published in 2026
• 17:48
  SPEAKER_01: by Falkenstrom and colleagues that looked at the concurrence between therapists
• 17:54
  SPEAKER_01: and clients session by session in terms of the alliance bond rating
• 17:58
  SPEAKER_01: and predicting changes in outcomes and in symptoms.
• 18:01
  SPEAKER_01: And they found that What Falkenstrom and colleagues did was to get the clients
• 18:07
  SPEAKER_01: to rate the alliance and therapists to rate the alliance independently.
• 18:11
  SPEAKER_01: And here's what they found.
• 18:12
  SPEAKER_01: They found that therapists' congruence did not predict better outcomes.
• 18:19
  SPEAKER_01: Instead, it was the asymmetrical incongruence that predicted outcomes.
• 18:26
  SPEAKER_01: Therapists who rated lower than the client was the most predictive.
• 18:33
  SPEAKER_01: So it's interesting to note
• 18:35
  SPEAKER_01: that when therapists were much more cognizant
• 18:40
  SPEAKER_01: and not just going into flight of automaticity and just going with the flow all
• 18:45
  SPEAKER_01: the time, they're thinking very critically,
• 18:47
  SPEAKER_01: their scores were predictive of outcomes.
• 18:52
  SPEAKER_01: That's just really interesting to note in light of what we were talking about.
• 18:56
  SPEAKER_01: Of course, difference, not the Incongruence is more of an anti-phase model,
• 19:01
  SPEAKER_01: as the researchers says, in supervision that predicts outcomes.
• 19:07
  SPEAKER_01: So there are implications about this.
• 19:10
  SPEAKER_01: Remember, we're really trying to think about how we can have
• 19:14
  SPEAKER_01: the most meaningful impact from clinical supervision that translates or transfers,
• 19:21
  SPEAKER_01: generalizes to the clients passing through from the therapist.
• 19:28
  SPEAKER_00: Here are seven key takeaways.
• 19:31
  SPEAKER_01: The first is whether you're a trainee, whether you're a seasoned therapist,
• 19:37
  SPEAKER_01: I highly encourage you to monitor client outcomes, to be able to use that.
• 19:42
  SPEAKER_01: And if you're a supervisor, encourage, teach, guide your supervisees to use them.
• 19:48
  SPEAKER_01: The reason is because you want to use that to be able to get
• 19:53
  SPEAKER_01: the client's perspective,
• 19:54
  SPEAKER_01: not so much as to just To evaluate or to simply monitor,
• 20:00
  SPEAKER_01: but that information should give you pause.
• 20:03
  SPEAKER_01: It should make you think.
• 20:05
  SPEAKER_01: It should make you change your mindset if it's a bit surprising.
• 20:10
  SPEAKER_01: The main key is to let the data set change your mindset.
• 20:15
  SPEAKER_01: And in this case, your client's data, their perspective of how things are going.
• 20:21
  SPEAKER_01: When they're reading on the form, there's three things that happens to us as therapists.
• 20:26
  SPEAKER_01: We become adaptive.
• 20:28
  SPEAKER_01: We learn to adjust, calibrate.
• 20:31
  SPEAKER_01: Towards where it needs to go.
• 20:33
  SPEAKER_01: The second thing that can happen is it causes us to become humble, right?
• 20:38
  SPEAKER_01: Almost an involuntary humility brings us back to the ground to stay tuned
• 20:45
  SPEAKER_01: to where the client is really at.
• 20:46
  SPEAKER_01: So you may be working with this client for more than a handful of sessions
• 20:51
  SPEAKER_01: and then yet the way the client's waiting On their well-being hasn't really changed.
• 20:56
  SPEAKER_01: It should make you pause to adapt and to let go of ideas you hold to daily
• 21:01
  SPEAKER_01: and to see what are some things that can have leverage to improve outcomes
• 21:05
  SPEAKER_01: for this particular individual.
• 21:07
  SPEAKER_01: The third thing that can happen if you take this approach is You don on the rope
• 21:13
  SPEAKER_01: of responsibility.
• 21:15
  SPEAKER_01: It's upon you now as a therapist to facilitate, to create an environment that's conducive.
• 21:21
  SPEAKER_01: Now, we may not have direct control of outcomes,
• 21:25
  SPEAKER_01: but we have the direct control to create an environment that promotes that.
• 21:30
  SPEAKER_01: So if you're measuring client outcomes, it will make you become more adaptive.
• 21:35
  SPEAKER_01: It will humble you.
• 21:37
  SPEAKER_01: And you will take on the responsibility to help provide the conduciveness
• 21:43
  SPEAKER_01: for growth, change and transformation.
• 21:47
  SPEAKER_01: Number two, monitor Alliance in Sessions.
• 21:51
  SPEAKER_01: This is critical because as we know in therapy, alliance is predictive of outcomes.
• 21:57
  SPEAKER_01: And especially if you're sensitized to dips, you know, or contrast between sessions,
• 22:04
  SPEAKER_01: you know, even when it goes down, you want to know what caused that.
• 22:08
  SPEAKER_01: And you're signaling to the client that you're paying attention that even if it was
• 22:13
  SPEAKER_01: a minor thing, something is a little bit off.
• 22:17
  SPEAKER_01: And you're not blind to it.
• 22:18
  SPEAKER_01: You're willing to take the feedback and feed forward and adjust as you go.
• 22:26
  SPEAKER_01: Here's the other thing is you also want to learn what cause not just what goes down,
• 22:33
  SPEAKER_01: but you also want to learn when the client is more engaged.
• 22:39
  SPEAKER_01: Now, even if Alliance improves and if you don't know what contributes to that,
• 22:44
  SPEAKER_01: you're not in such a good way.
• 22:46
  SPEAKER_01: You may be for the client, that's good, but you will not be able to generalize that.
• 22:51
  SPEAKER_01: Or as we've talked about in the previous podcast about transferring that learning
• 22:55
  SPEAKER_01: and generalizing that with other people.
• 22:58
  SPEAKER_01: So you want to be able to know, to learn.
• 23:02
  SPEAKER_01: What caused the down, but what also causes the increase of engagement.
• 23:07
  SPEAKER_01: The other thing is you're measuring alliance is you also want to be aware
• 23:12
  SPEAKER_01: if there are any social desirability effects, you know,
• 23:16
  SPEAKER_01: when some clients Science don't want to cause any sort of conflict,
• 23:20
  SPEAKER_01: very people pleasing.
• 23:21
  SPEAKER_01: Those things can happen and you can't just purely outsource it to measurements.
• 23:26
  SPEAKER_01: You still need to use your clinical intuition to judge if those things are happening
• 23:30
  SPEAKER_01: and to call it out.
• 23:32
  SPEAKER_01: One way you could do this is number three,
• 23:35
  SPEAKER_01: what I call the rate and predict exercise.
• 23:39
  SPEAKER_01: So simply this, much like the study that we just talked about from Lou and Kavlik,
• 23:44
  SPEAKER_01: and it's that you want to get your clients to rate their alliance.
• 23:49
  SPEAKER_01: At the end of the session, near the end of the session,
• 23:52
  SPEAKER_01: but you also rate your experience of the session.
• 23:57
  SPEAKER_01: So you may be using, let's say, the session rating scale.
• 24:00
  SPEAKER_01: The client fills that up in terms of did if you heard, understood and respected.
• 24:04
  SPEAKER_01: Did you talk about things that were vital and important?
• 24:07
  SPEAKER_01: For the client, the approach and method to the session,
• 24:10
  SPEAKER_01: how does it sit with the client, and then overall.
• 24:13
  SPEAKER_01: Then you as a therapist, without seeing the client's rating,
• 24:17
  SPEAKER_01: is you predict what you think they would score.
• 24:20
  SPEAKER_01: That is super useful because when we are wrong,
• 24:25
  SPEAKER_01: when we are not in sync with them in that way,
• 24:29
  SPEAKER_01: when there's an incongruence actually,
• 24:31
  SPEAKER_01: the specific language that was used in that study by Falkenstrom,
• 24:36
  SPEAKER_01: when you could do that, you are now wrong.
• 24:40
  SPEAKER_01: Opening up the synaptic nerve to figuring out what's causing the dissonance
• 24:44
  SPEAKER_01: within you and you want to know and you'll be asking things that kind of off
• 24:48
  SPEAKER_01: or things that are missed.
• 24:50
  SPEAKER_01: So on that social desirability, if the client rated the session very high,
• 24:56
  SPEAKER_01: like 40 out of 40, but for you, you felt something was off,
• 24:59
  SPEAKER_01: maybe specifically the goals and topics you thought that was Not a 10,
• 25:03
  SPEAKER_01: it was actually like a 7.
• 25:05
  SPEAKER_01: You felt that, and you just had a hunch,
• 25:08
  SPEAKER_01: you felt that there was another topic that was not touched on or sort of evaded
• 25:13
  SPEAKER_01: from.
• 25:14
  SPEAKER_01: And maybe it's about a relationship with a parent.
• 25:17
  SPEAKER_01: Maybe it was about something that happened in the past.
• 25:19
  SPEAKER_01: They just sort of brushed it aside.
• 25:21
  SPEAKER_01: They didn't want to talk about the depravities that they have experienced, you know,
• 25:25
  SPEAKER_01: and you thought that may be relevant.
• 25:27
  SPEAKER_01: And you could bring that up and you could address that.
• 25:31
  SPEAKER_01: Remember, the aim is not just to track some numerics.
• 25:35
  SPEAKER_01: It's actually to be able to calibrate, to adjust, prepare for the next session.
• 25:41
  SPEAKER_01: So the read and predict exercise.
• 25:43
  SPEAKER_01: So far, we've talked about Monitoring client outcomes systematically,
• 25:47
  SPEAKER_01: monitoring alliance in session systematically,
• 25:50
  SPEAKER_01: and then the rate and predict exercise,
• 25:52
  SPEAKER_01: sort of a little experiment to get you out of your normal groove to, you know,
• 25:58
  SPEAKER_01: to become prepared to be altered, to be adjust,
• 26:02
  SPEAKER_01: to adjust with the way that you work.
• 26:04
  SPEAKER_01: And then number four, Based on Lu and Clevegan's study that we just talked about,
• 26:10
  SPEAKER_01: this recent study that was published,
• 26:12
  SPEAKER_01: that the alliance of the trainee or supervisee is not predictive of outcome.
• 26:18
  SPEAKER_01: It is the antiphase, right?
• 26:21
  SPEAKER_01: As a clinical supervisor, you want to preempt that there may be moments
• 26:27
  SPEAKER_01: in supervision that you
• 26:30
  SPEAKER_01: and the therapist could be slightly out of sync and we need
• 26:35
  SPEAKER_01: to talk about it.
• 26:37
  SPEAKER_01: Now, the therapist may be likely to rate supervisory lines high
• 26:41
  SPEAKER_01: when they become overconfident with the case or they feel things are going great.
• 26:47
  SPEAKER_01: But then they may rate it a little bit lower if you started to challenge them
• 26:51
  SPEAKER_01: a little bit, looking at cases that were at risk of poor outcomes, let's say,
• 26:55
  SPEAKER_01: or looking at some of the developmental edges beyond their usual comfort zone.
• 27:00
  SPEAKER_01: The key thing we say to get people out of the comfort zone, but to where,
• 27:05
  SPEAKER_01: It's not to get them from the comfort zone to the panic zone.
• 27:08
  SPEAKER_01: We want to get them to their learning zone, the zone of proximal development,
• 27:13
  SPEAKER_01: as Lynn Vygotsky used to say, to get them to that edge where it's the growth edge,
• 27:19
  SPEAKER_01: right?
• 27:20
  SPEAKER_01: There will be challenges involved.
• 27:23
  SPEAKER_01: There will be things that even though previously things are going well,
• 27:27
  SPEAKER_01: but you want them to push nudge towards further development, you know,
• 27:33
  SPEAKER_01: the ratings of Alliance might go down.
• 27:36
  SPEAKER_01: So in short,
• 27:37
  SPEAKER_01: I wouldn't pay too much attention about measuring supervision Alliance per se.
• 27:43
  SPEAKER_01: The key is does all of that actually lead
• 27:48
  SPEAKER_01: To climb improvement.
• 27:51
  SPEAKER_01: That's the primary.
• 27:53
  SPEAKER_01: Some of our biggest priorities in life is to remember what's of biggest priority.
• 27:59
  SPEAKER_01: Number five, look at the caseload before jumping into specific cases.
• 28:07
  SPEAKER_01: So it's easy for a therapist to bring in a case to discuss, right?
• 28:13
  SPEAKER_01: And you could coach for performance,
• 28:14
  SPEAKER_01: look at specific cases and look at where they're stuck and all that. That's fine.
• 28:18
  SPEAKER_01: But it's useful to make sure that you zoom out As well,
• 28:22
  SPEAKER_01: and look at their overall caseload and look at the trajectory of outcomes
• 28:26
  SPEAKER_01: for each client so that you get a gestalt,
• 28:30
  SPEAKER_01: a sense of how they're working in general.
• 28:33
  SPEAKER_01: This is going to be really useful when you move from just Coaching
• 28:39
  SPEAKER_01: for Performance is very focused on a case-by-case, on a client level.
• 28:45
  SPEAKER_01: Coaching for Development is focusing on the therapist and the growth edge.
• 28:51
  SPEAKER_01: This is where you're looking at generalization.
• 28:54
  SPEAKER_01: You're looking at transfer of learning, not just solving for specifics,
• 28:58
  SPEAKER_01: but solving for patterns.
• 29:00
  SPEAKER_01: That's going to be very useful,
• 29:02
  SPEAKER_01: especially also if there were things that you need to pay attention
• 29:06
  SPEAKER_01: to that were not brought up that's in their caseload.
• 29:09
  SPEAKER_01: Number six.
• 29:11
  SPEAKER_01: This one is a simple one, but it's something that is taken for granted.
• 29:15
  SPEAKER_01: It's bringing graphs to supervision.
• 29:18
  SPEAKER_01: Encourage your supervisee to bring in the session by session trajectory of outcomes and aligns.
• 29:25
  SPEAKER_01: That way, help them to see, help you to see and to be able to feel the visceralness
• 29:32
  SPEAKER_01: of the visual. Because once it's visual, it's visceral.
• 29:35
  SPEAKER_01: You can't escape if the Alliance is going a certain way,
• 29:40
  SPEAKER_01: or the outcomes is not really moving,
• 29:43
  SPEAKER_01: or the therapist could feel like they're struggling in spite of the fact
• 29:49
  SPEAKER_01: that the outcomes is improving over time.
• 29:53
  SPEAKER_01: So there's some tension to behold and to be able to discuss,
• 29:57
  SPEAKER_01: especially because the ratings are given from the client's view,
• 30:02
  SPEAKER_01: not just our own bias appraisal.
• 30:06
  SPEAKER_01: And then finally, number seven, It's to close the loop.
• 30:12
  SPEAKER_01: What that means is as a supervisor, you want to ask, did you apply what we discussed previously?
• 30:19
  SPEAKER_01: And if not, what did you do?
• 30:22
  SPEAKER_01: And how did the client respond to that?
• 30:24
  SPEAKER_01: How did it impact the engagement?
• 30:27
  SPEAKER_01: How did it impact the outcome?
• 30:29
  SPEAKER_01: This is so important for the supervisor.
• 30:32
  SPEAKER_01: When you don't close the loop,
• 30:34
  SPEAKER_01: you're just talking and you're talking and you don't know the actual impact.
• 30:38
  SPEAKER_01: Sort of like shooting a basketball Pass a veil and not seeing whether it lands or not.
• 30:44
  SPEAKER_01: This is why I think, and I suspect for a lot of GPs, general physicians,
• 30:50
  SPEAKER_01: they don't have that loop closed, especially it's not their usual patients.
• 30:55
  SPEAKER_01: They don't know what they Prescribed or what they did, what kind of impact it has.
• 31:00
  SPEAKER_01: And they were shooting blind.
• 31:02
  SPEAKER_01: It's very hard to learn when you don't have that immediacy of feedback.
• 31:06
  SPEAKER_01: As a supervisor, it's very important that you have that too.
• 31:09
  SPEAKER_01: Was things that you suggested too outlandish is the language that you use,
• 31:14
  SPEAKER_01: the metaphors of psychodynamics is not applying to this therapist
• 31:18
  SPEAKER_01: who is not really vibing with that kind of lens or model.
• 31:23
  SPEAKER_01: So those things are useful because ultimately,
• 31:26
  SPEAKER_01: You're hoping what you guide
• 31:30
  SPEAKER_01: or impart to the therapist is transferred
• 31:35
  SPEAKER_01: to the client.
• 31:36
  [music]
• 31:43
  SPEAKER_01: I hope you found this useful looking at this paper by Yen Lu and Dennis Clavigon Jr.
• 31:49
  SPEAKER_01: What an excellent study that they've done.
• 31:52
  SPEAKER_01: I noticed that Dennis does really good studies.
• 31:54
  SPEAKER_01: So keep a lookout for his work.
• 31:57
  SPEAKER_01: Look at, go to researchgate.com and just, you know, follow what he publishes.
• 32:02
  SPEAKER_01: There's very good stuff coming up from me and his team.
• 32:06
  SPEAKER_01: Now, if you're interested, if you're a supervisor and you want to get better,
• 32:10
  SPEAKER_01: or if you're planning to become a supervisor one day, you know,
• 32:14
  SPEAKER_01: join us for a workshop that's happening on the 26th and 27th of November, 2026.
• 32:22
  SPEAKER_01: This workshop is going to be conducted locally in Perth, Western Australia.
• 32:27
  SPEAKER_01: And if you are somewhere nearby, and if you're over east in Melbourne or Sydney,
• 32:32
  SPEAKER_01: or if you're somewhere in the Southeast Asia, or even if you're traveling afar,
• 32:36
  SPEAKER_01: I would like to invite you I want you to come and join us for this two-day workshop.
• 32:40
  SPEAKER_01: The first day is focused on helping clinical supervisors get better.
• 32:45
  SPEAKER_01: Specifically, we're not just looking at coaching for performance and looking
• 32:48
  SPEAKER_01: at cases by cases, but actually to coach for performance and to coach
• 32:53
  SPEAKER_01: for development of the therapist with LARCH so that it generalizes.
• 32:59
  SPEAKER_01: Using that framework, we also look at specific things that supervisors can target
• 33:04
  SPEAKER_01: to help supervisees get better.
• 33:06
  SPEAKER_01: The second day is the inner and outer life of a therapist.
• 33:11
  SPEAKER_01: It's a day of reflection and renewal.
• 33:14
  SPEAKER_01: It's meant to be an immersive retreat style sort
• 33:18
  SPEAKER_01: of workshop for you to be able
• 33:21
  SPEAKER_01: To recollect, to be able to look at the inner and outer lives, its relationship,
• 33:26
  SPEAKER_01: to be less divided in what we do and to take stock before we proceed moving
• 33:31
  SPEAKER_01: into the future.
• 33:33
  SPEAKER_01: So you could come for either of the days or if you could come for both days,
• 33:38
  SPEAKER_01: you'd be more than welcome to join us.
• 33:41
  SPEAKER_01: Click on the link below to get your tickets to join us on the 26th and 27th of November, 2026.
• 33:49
  SPEAKER_01: Thanks for listening to Frontiers Radio.
• 33:52
  SPEAKER_01: I hope you check out our Substack, Frontiers of Psychotherapist Development.
• 33:57
  SPEAKER_01: That's at darylchow.substack.com for all kinds of resources there.
• 34:03
  SPEAKER_01: There's a new menu we've put up.
• 34:05
  SPEAKER_01: You could go into different sections to look at more free resources,
• 34:09
  SPEAKER_01: things about deliberate practice, things about feedback-informed treatment,
• 34:13
  SPEAKER_01: things about clinical supervision.