To the Editor.—
In a recent article, Chevron and Rounsaville1 demonstrated the high rate of nonconcordance between different methods of evaluating psycotherapists' skills. The authors were surprised to find that traditional methods of supervision (therapists presenting process notes to supervisors) predicted therapeutic outcome better than assessment of videotaped therapy sessions.The authors offered the hypothesis that in traditional supervisory sessions, patient behaviors and progress, rather than therapist interventions, are focused on, and consequently this method, although a better predictor of therapeutic outcome, is a less accurate assessment of clinician therapeutic expertise. They suggested that patient variables, ie, "motivation and aptitude for psychotherapy," were not controlled for and may have been the determining factors in treatment outcome, although no data were presented to support this hypothesis.There are other possible explanations of the finding that the traditional method of supervision is the best predictor of therapeutic outcome. A very disconcerting
Silberman EK, Mazza MD. Supervision of the Psychotherapeutic Process. Arch Gen Psychiatry. 1985;42(7):739–740. doi:10.1001/archpsyc.1985.01790300107019
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