An important part of clinical supervision is the manner in which supervisors obtain information about what happens in trainees' treatment sessions. Research has shown that direct observation of sessions is more effective than relying on subjective report alone, and that live observation with concurrent feedback is most effective. However, feedback can also be disruptive. Bug-in-the-eye (BITE) technology was developed to enable supervisors to provide live feedback to trainees in a minimally disruptive manner by observing treatment sessions via live video feed or one-way mirror and discreetly transmitting brief messages via a computer monitor that is visible only to the trainee. In addition to being less disruptive, this format may have positive effects on trainees, clients, and the treatment process. The purpose of this article is to review all relevant studies that have investigated BITE in the context of supervision of psychotherapy. Seven studies were identified, all of which showed BITE to be acceptable, useful, undisruptive, and undamaging to the therapeutic alliance. Some of the studies found that BITE was associated with a stronger alliance, greater trainee adherence, and greater clinical competence than other formats of supervision. These findings suggest that BITE may be a valuable tool in clinical supervision, but more rigorous research is needed to understand its precise effects and how it may best be used.
Public Significance StatementThis article reviews a method in which trainee psychotherapists are observed and given feedback by supervisors during psychotherapy. Results show that this method may improve the competence of trainees, as well as the working relationship between trainees and clients. Results also highlight the need for further research into the most optimal forms of supervision of psychotherapists to ensure the highest quality training.