Supervision of psychotherapy for psychosis: A meaning-making approach.

Abstract

Despite its importance in the provision of mental health treatment, the availability of high-quality clinical supervision faces numerous threats in the public sector. Access to high-quality supervision may be especially important for therapists providing services to persons with psychosis. Here, we detail one supervisory approach that has been developed with these considerations in mind; namely, the supervision approach associated with the recovery-oriented integrative therapy metacognitive reflection and insight therapy. We detail three aspects of this approach that have broad appeal and could be easily incorporated into other psychotherapy approaches which include (a) reflecting with supervisees about their experience of the patient, themselves, and the therapeutic relationship, (b) helping supervisees respond to patients’ pain and fragmentation with interventions that promote challenge and joint meaning-making, and (c) dealing with threats to this process from both internal pressures within supervisees as well as those posed externally from their agencies. Limitations of this approach and future directions are discussed.

Reading fiction together to support reflective practice and recovery in serious mental illness: The value of book club.

“…In addition to reflection about self, patient and the therapy relationships, our previous work on supervision has pointed to the importance of creating opportunities to reflect with trainees on the various internal and external barriers to recovery and to the provision of recovery-oriented psychotherapy (Hamm et al, 2022). Again, we see book club as providing a unique context in which to pursue these aims.…”

“…In our work, we have built off these recommendations and our clinical experiences in the development and implementation of book club. The objective and spirit of book club are aligned with a larger training and consultation framework that prioritizes reflection and shared meaning-making as an essential ingredient to offering recovery-oriented psychotherapy for individuals experiencing SMI (e.g., Hamm et al, 2022; Lysaker et al, 2020). In our experience, we have found that book club is well-received by trainees and staff in our community mental health center, with a number of trainees over the years noting it as a highlight of their experience with us and pointing to its novelty in reference to other training experiences.…”

“…The challenges and complexities of recovery-oriented interventions for SMI underscore the need to provide clinicians with high quality training and ongoing supervisory support. In previous work, we have called for a supervisory approach that is focused on cultivating reflective practice and aims to help clinicians to become better able to establish and sustain the type of relatedness with patients that promotes recovery (Hamm et al, 2022). One intervention that may help support this larger supervisory framework is the inclusion of reading fiction as a way to bolster reflection of the self, other, and to promote shared meaning-making.…”

Introduction to the special section: Supervision in publicly funded settings: Best practices.

“…They include integrating three low burden multicomponent supervision approaches, a Primary Care Behavioral Health (PCBH) model (Ogbeide et al, 2023), metacognitive reflection and insight therapy, use of an Adlerian-informed supervision method that integrates the Respectfully Curious Inquiry/Therapeutic Encouragement (RCI/TE) framework, and Heron’s Six Category Intervention Framework (Hamm et al, 2023; McCarty et al, 2023; McMahon et al, 2023; Schriger et al, 2023). Furthermore, this special section applies to various demographics of supervisees, clients, and supervisee–client dyads including the military culture setting, youth with publicly funded insurance, clients with psychosis, trainees with disabilities, and frontline staff at nonprofit organizations (Dawson & Chunga, 2023; Hamm et al, 2023; Reddy et al, 2023; Schriger et al, 2023; Wilbur et al, 2023). Barriers tackled include administrative and fiscal challenges, reduced availability of supervisors, and burnout in highly traumatized environments (Dawson & Chunga, 2023; McCarty et al, 2023; Schriger et al, 2023).…”

“…This special section was inspired by the imperative and multifaceted nature of the supervisor–supervisee relationship including power differentials, compatibility of multiple roles, consultation, and didactics of content information. Of note, Reddy et al (2023) examined the power differentials experienced by military behavioral health technicians within a military cultural setting, Hamm et al (2023) explore providing high quality clinical supervision with recovery-oriented integrative therapy for trainees while managing internal and external agency threats, while Lohani and Sharma (2023) discusses the effect of clinical supervision on self-awareness and self-efficacy of psychotherapists and counselors by offering a systematic review (Lohani & Sharma, 2023).…”