Structured supervision of graduate clinicians in psychodynamic psychotherapy: Alliance and technique

This is the first study to examine longitudinal differences in alliance and technique across multiple cases, controlling for client distress and therapist effects, during structured supervision in psychodynamic psychotherapy. Patient and therapist ratings of alliance as well as independent clinical ratings of psychodynamic interventions were assessed during the 3rd and 9th sessions in the psychotherapy of 58 outpatients, conducted by 24 graduate clinicians. Findings demonstrated that patient-rated alliance was higher across cases at both the 3rd and 9th sessions. These differences in alliance were paralleled by trainees' using significantly more psychodynamic techniques across cases during the 3rd session. All of these differences were in evidence, controlling for patient level of pathology. It is also important to note that there were no significant differences during the course of training for cognitive- behavioral techniques. This is consistent with the specific supervision provided to the graduate clinicians in this training practicum. Practical implications for the use of structured clinical training and issues pertinent to supervision in graduate education are reviewed. Finally, the relationship that structured training may have to graduate clinicians' ability to form a positive alliance with their patients is also discussed.