The Effects of Bug‐in‐the‐Eye Supervision on Therapeutic Alliance and Therapist Competence in Cognitive‐Behavioural Therapy: A Randomized Controlled Trial

Abstract

BITE supervision positively influences the therapeutic alliance and therapeutic competencies during cognitive-behavioural therapy. A supervision format that more directly addresses therapeutic processes is more effective in improving those processes than an indirect supervision format. Pre-treatment differences between therapists might explain the superiority of BITE supervision. BITE supervision can be considered a safe intervention.

The progress cascading model: A scalable model for teaching and mentoring graduate trainees in exposure therapy

“…Perhaps most helpful, because the trainee serves as a co-therapist, the lead therapist can provide invivo correction during sessions if needed. This incorporates the effective live supervision traditionally seen in knock-on-the-door, bug-in-the-ear, or bug-in-the-eye supervision, without the need for investment in facilities upgrades and with minimal disruption to the therapeutic process (Brodsky & Myers, 2014;Rousmaniere & Frederickson, 2013;Weck et al, 2015). For example, if a cotherapist were to suggest that a patient engage in simultaneous deep breathing and exposure, which is not supported by the literature (Abramowitz et al, 2012), the lead therapist can quickly and seamlessly correct the suggestion by redirecting the patient to engage in a slightly different exposure only task.…”

Standardized patients in psychotherapy training and clinical supervision: study protocol for a randomized controlled trial

“…Considering prior studies [24,52], we assume moderate competence differences between the groups (Cohens d = 0.60) and high correlations between competence ratings (r = 0.50). Given an α of 0.05 and a 1-β of 0.80 (power), a sample of 68 participants will be necessary in each experiment, resulting in an overall sample size of 136 (G*Power Version 3.1.9.2) [53].…”

Patients’ and therapists’ experiences of general change mechanisms during bug‐in‐the‐eye and delayed video‐based supervised cognitive‐behavioral therapy. A randomized controlled trial

“…Live supervision has been realized by the phone‐in (e.g., Frankel & Piercy, ) and the knock‐on‐the‐door technique (e.g., Kivlighan, Angelone, & Swafford, ), or with more modern systems such as the bug‐in‐the‐ear (e.g., Smith et al., ) and the bug‐in‐the‐eye technique (BITE; e.g., Weck et al., ). The study at hand focuses on BITE supervision and, therefore, we present more details about this technique.…”

“…One small study with three therapists supported this notion, as BITE supervision was rated more positively than other live supervision formats (Thurber, ). Recent studies on BITE supervision that focused on cognitive‐behavioral therapy (CBT) and dialectical behavioral therapy (DBT) showed promising results: Patients as well as therapists accepted BITE supervision, and BITE supervision increased adherence and therapists’ competences (Carmel, Villatte, Rosenthal, Chalker, & Comtois, ; Jakob, Weck, Schornick, Krause, & Bohus, ; Rizvi, Yu, Geisser, & Finnegan, ; Weck et al., ). For example, Rizvi et al.…”

“…The current study re‐analyzed data from a RCT by Weck, et al. () in which therapists received either BITE or delayed video‐based (DVB) supervision. Weck et al.…”