Seminal and key studies on management and supervision in psychosocial therapies. Focus is on evidence of the need for post-training ‘coaching’ and for letting therapists know how their clients are doing – especially when they are doing badly.
S Seminal studies K Key studies R Reviews G Guidance more Search for more studies
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S No need to insist on abstinence; patients can choose goal (1973). Not the first but the most incendiary paper to challenge the then orthodoxy that abstinence must be the only treatment goal for dependent drinkers. See also second- (1976) and third-year (1978) follow-up results. This refutation (1982) based on a 10-year follow-up was itself refuted (1984) by the original authors. Discussion in cell C2. Related contemporary UK study, review and guidance below.
S Recruit the right people to be counsellors (1981). US study showed that responses to written counselling scenarios could be used to assess the interpersonal skills of alcohol counsellors, which were strongly linked to their patients’ post-treatment relapse. Study was later replicated/extended in Finland (2002). Related study and review below. Discussion in cell C2.
K Similar degree of success in UK from choosing abstinent or non-abstinent treatment goals (2010). UKATT was Britain’s largest alcohol treatment trial. Main aim was to compare social network and motivational therapies, but it also shed light on whether services should offer moderation as well as abstinence goals to dependent clients. ‘Let the patient choose,’ seems the implication of the findings. More from UKATT below and in cell A4. Related seminal study above and review and guidance below.
K Screening applicant therapists for empathy saves on training (2005). Research project saved on training by using responses to simulated clients to screen applicant therapists for “accurate empathy”. Free source at time of writing. Study’s screening method could help services spot people with the hard-to-teach (2006) ability to form good relationships with clients. Related study above and review below. Discussion of empathy in cell B2 and of staff recruitment in cell C2.
K ‘Read the manual’ not enough to develop competence in cognitive-behavioural therapy (2005; free source at time of writing). After being told to read the manual just 15% of substance use counsellors and clinicians were acceptably competent. Web-based training comparing role-play responses to the ideal helped but greater and more consistent gains in competence were made after a training seminar followed by expert coaching based on taped sessions with real clients. Related motivational interviewing study and reviews (1 2) below. Discussion in bite’s Issues section.
K Coaching helps counsellors learn to motivate (2004; free source at time of writing). Client responses to trainees improved only when motivational interviewing workshops had been reinforced by continued expert coaching and feedback on performance. See also this Effectiveness Bank analysis of a later report (2005) from the same study. Related cognitive-behavioural study above and reviews (1 2 3) below. Discussion in bite’s Issues section.
K Seven coaching sessions needed before UK therapists competent (2005). The UKATT trial compared social network and motivational therapies for alcohol-dependent patients, in the process developing comprehensive models for recruitment, training and supervision. One lesson was that “supervision after initial training was critical in the acquisition of competence”. More from UKATT above and in cell A4. Related discussion in bite’s Issues section.
K Assess and tell counsellors how their clients are doing (2012). To maximally improve outcomes, feedback should identify which individuals are doing poorly and recommend remedial actions. The same system has been found beneficial (1 2 3) in psychotherapy generally. Related guidance below. Discussion in bite’s Issues section.
K Leaders set the context for training to be implemented (2012). Whether substance use counsellors adopt and spread training-based practice improvements is strongly influenced by the ethos and support stemming from an organisation’s leadership, especially the degree to which it fosters professional development. Similar findings in review below. Discussion in bite’s Where should I start? section.
K Walk in their shoes (2008). When senior staff role-played the process of becoming a new client it helped halve waiting times and extend retention at substance use counselling and residential services. See also this extension (2012) to the programme and this account (2007; free source at time of writing) of the “walk-through” procedure. Discussion in cell C2.
R Offer moderation as well as abstinence as a treatment goal (2013). Concludes that dependent drinkers can cut down, that psychosocial treatments based on this goal are probably just as effective as abstinence-oriented approaches, and that allowing patients a choice improves outcomes. Related seminal study and UK study above and guidance below. Discussion in cell C2.
R One-off workshop training is not enough (2005). Retaining psychosocial therapy skills after this popular training format requires follow-up consultation, supervision or feedback, and trainees’ self-assessments cannot be relied on to assess their progress. Related studies (1 2 3) above. Related reviews (1 2) below. Discussion in bite’s Issues section.
R Motivational interviewing training works best with post-workshop coaching (2013). Synthesis of findings on training clinicians (broadly defined and including but not limited to substance use) in motivational interviewing finds it does develop competence, especially when supplemented by coaching/supervision based on feeding back trainees’ actual performance. Given motivated trainees, initial training can be via books or videos rather than face-to-face workshops. Related review and studies (1 2) above and reviews (1 2) below. Discussion in bite’s Issues section.
R Sustaining motivational interviewing skills after training (2014; free source at time of writing). Retaining motivational interviewing competence after training requires follow-up feedback and/or coaching – at least three to four sessions over a six-month period. Just offering these is not enough – trainees have to attend for competence to be retained. Related studies (1 2) and reviews (1 2) above and review below. Discussion in bite’s Issues section.
R The importance of supervision (2011). Systematic and expert continuing supervision emerged as a key to newly introduced psychosocial treatments actually improving practice and outcomes in specialist substance use treatments. Related studies (1 2) and reviews (1 2 3) above and discussion in bite’s Issues section. Implementation was more likely if supported or mandated by agency leaders or supervisors; related study above and discussion in bite’s Where should I start? section. Trainees whose attitudes were not conducive to a motivational approach benefited relatively little even from extended training and supervision; related studies (1 2) above.
R Let motivational counsellors adapt to client (2005). Effectiveness Bank review and a synthesis of the research (2005; free source at time of writing) find inflexible manualisation of motivational approaches associated with worse outcomes.
R Implementation lessons from trials of psychosocial therapies (2007; free source at time of writing). Research shows importance of therapist selection and post-training supervision, and the pitfalls of assuming researched interventions will translate into routine practice and of relying on the therapist’s self-assessment of their competence. Related discussion in bite’s Issues section.
G UK guidance on choosing treatment goal ([UK] Department of Health and National Treatment Agency for Substance Misuse, 2006). Guidance on models of care for problem drinkers stressed that whatever their goals it should not exclude them from support or treatment, but saw abstinence as the preferred objective for many moderately or severely dependent drinkers. Related seminal study, contemporary UK study, and review above.
G Clinical supervision and professional development of counsellors ([US] Substance Abuse and Mental Health Services Administration, 2009). Related discussion in bite’s Issues section.
G How to use client progress measures in the supervision of counsellors (2014; free source at time of writing). Thoughtful suggestions on how to prompt staff development by incorporating discussion of how their clients are progressing in the clinical supervision of therapists and counsellors. Not specific to substance use but applicable across therapy and counselling. Related study above.
G Skills and abilities needed for clinical supervision ([US] Substance Abuse and Mental Health Services Administration, 2007). See also US checklist of competencies (2017; described here) for people with personal experience of substance use problems who are supervising peer supporters with similar experience. Related discussions in bite’s Issues sections (1 2) below.
G Staff selection, training and supervision for group therapy ([US] Substance Abuse and Mental Health Services Administration, 2005). Consensus guidance on the different types of groups, how to organise and lead them, desirable staff attributes, and staff training and supervision. Related guidance below.
G How to train and supervise addiction counsellors to deliver group cognitive-behavioural therapy (2013; free source at time of writing). Based on experience in developing and evaluating group cognitive-behavioural therapy programmes for depression and substance use for use in addiction treatment settings. Related guidance above.