The influence of supervision and facilitative conditions on the psychotherapeutic effectiveness of nonprofessional and professional herapists

Abstract

Sixty poorly adjusted, fifth- and sixth-grade males were randomly assigned to experimental groups seen by professional, supervised nonprofessional, and unsupervised nonprofessional therapists, as well as to a no-treatment control. The therapists saw their clients 10 times. Excerpts from the 3rd and 7th sessions were rated by trained raters for facilitative conditions. Change in clients was studied through instruments which assessed change from three vantage points--the child's, his teacher's and his therapist's. Individual as well as group data demonstrated significant superiority of supervised nonprofessionals over unsupervised nonprofessionals. Changes in clients treated by professionals tended to cluster close to those treated by supervised nonprofessionals. Several significantly negative correlations between facilitative conditions and criteria of psychotherapeutic change were discovered.

Research on Training Counselors and Clinicians

“…Such training programs run from 6 weeks to 1 or 2 academic terms. "Traditional" training programs have been shown to have successfully taught interview skills to "paraprofessional" counselors (Karlsruher, 1976;Rioch, Elkes, Flint, Usdansky, Newman, & Silber, 1963), counselor trainees (Burck et al, 1973;Demos & Zuwayliff, 1963;Roark, 1969;Schoch, 1966), and medical students (Johnson, Sribbe, Crowder, Zall, & Wolkon, 1974;Matarazzo, Phillips, Wiens, & Saslow, 1965;Thurnblad, Muslin, & Loesch, 1973;Werkman, Landau, & Wakeland, 1973), as well as behavior therapy skills to medical students and social work and clinical psychology trainees (Houts, Note 3;Poser, 1972), and to produce positive personality changes in counselor trainees (Anderson, 1969;Ashmore, 1968 "Traditional" training's efficacy has been called into question by IDET research's reporting that more advanced trainees in "traditional" clinical programs are less facilitative than less advanced trainees, and that traditional indexes (e.g., GRE, GPA) used to evaluate and select clinical trainees correlate nonsignificantly (and often negatively) with therapist facilitativeness measures (e.g., Bergin & Jasper, 1969;Bergin & Solomon, 1970;Carkuff et al, 1968). Similarly, Havens (1968) found no pre-post changes, associated with a traditional practicum, in trainees' abilities to communicate facilitatively with clients.…”

Comparative effectiveness of paraprofessional and professional helpers.

“…Thirty-five comparative studies have used multi-outcome measures of client change, and 27 studies have collected follow-up data on at least one measure. Representative outcome criteria have included performance on standardized psychological tests and various psychometric instruments (Lick & Heffler, 1977;Schortinghuis & Frohman, 1974), clients' selfreported change and satisfaction with services (Getz et al, 1975;Lamb & Clack, 1974), clinical ratings offered by independent judges (O'Brien, Hamm, Ray, Pierce, Luborsky, & Mintz, 1972), information from significant others (Miles, McLean, & Maurice, 1976;Wolff, 1969), academic or work performance (Mosher, Menn, & Matthews, 1975;Zunker & Brown, 1966), behavior ratings (Appleby, 1963;Ellsworth, 1968), analysis of therapistoffered empathy, warmth, and genuineness (Knickerbocker & McGee, 1973;Truax, 1967), performance in role-playing or in vivo situations (Fremouw & Harmatz, 1975;Moleski & Tosi, 1976), therapist improvement ratings (Karlsruher, 1976), supervisor evaluations (Covner, 1969;Magoon & Golann, 1966), criteria specific to treatment goals, Note. A indicates that the design criteria were mainly satisfied; B, that one or two criteria were deficient; C, that three or four were deficient; D, that five were deficient; and E, that deficiencies were present in more than five criteria.…”

“…In a child therapy study, 60 maladapting fifth and sixth graders were randomly assigned to a no-treatment control condition, treatment conducted by professional therapists (experienced school guidance counselors and psy-chology graduate students), or treatment by two groups of untrained college undergraduates who did or did not receive clinical supervision (Karlsruher, 1976). Treated children received 10 sessions of individual client-centered therapy.…”

Relationships among experience level and value orientation and the performance of paraprofessional telephone counselors

“…In their annual review of psychotherapy, Bergin and Suinn (1975) conclude that "these variables are not as prepotent as once believed; but their presence and influence is ubiquitous" (p. 521). The widespread use of these scales, particularly in the assessment of paraprofessional helpers (Bleach & Claiborn, 1974;Caruthers & Inslee, 1974;Goldstein & Goedhart, 1973;Karlsruher, 1976;O'Donnell & George, 1977;Vander Kolk, 1973) seems to indicate that while they are not without flaws, they have been found to be useful for assessing qualitative aspects of counselor performance.…”