Academic journal article American Journal of Psychotherapy

Beyond the "Acid Test": A Conceptual Review and Reformulation of Outcome Evaluation in Clinical Supervision

Academic journal article American Journal of Psychotherapy

Beyond the "Acid Test": A Conceptual Review and Reformulation of Outcome Evaluation in Clinical Supervision

Article excerpt

Theoretical models abound within clinical supervision, but these rarely have been applied to supervision evaluation. Instead, it appears that reviewers and researchers have simply transferred to supervision the conceptual frameworks used within medicine, especially the idea that clinical outcomes are the "acid test" of supervisory effectiveness or quality. Following a careful examination of the key literature, in this paper I argue that this has led to an overemphasis on clinical outcomes, with the net effect of reducing scientific confidence, understanding, and the effectiveness of supervision. To begin to rectify this bias, an augmented fidelity framework is used to reformulate evaluation, drawing on some of the key concepts guiding evaluation within related fields (i.e. service evaluation; staff development; psychotherapy; applied research). The resulting evaluation model is specific to clinical supervision and can help to increase our understanding, enhance our practice, re-prioritise research, and inspire confidence in supervision.

KEYWORDS: outcome evaluation; clinical supervision

INTRODUCTION

How should we evaluate clinical supervision? The dominant view is that the clinical effectiveness of the supervisee (therapist) should serve as the definitive outcome: "The impact of clinical supervision on client outcome is considered by many to be the acid test of the efficacy of supervision" (Ellis & Ladany, 1997, p. 485). According to this conceptual metaphor, the good clinical outcomes of the supervisee signify that the supervision can be approved or verified as achieving "the gold standard" (the acid test was originally used to verify gold). Such metaphors play a valuable role in science, but they can also constrain or distort our understanding, leading to "crooked thinking." According to Thouless (1930), using verbal devices such as metaphors or analogies to deduce conclusions is "not necessarily dishonest or a crooked way of thought, although it is a dangerous one, always requiring careful examination" (p. 140). In this review I will therefore examine this metaphor in detail. Following a definition and overview of the current issues in evaluating supervision, the concept of intervention fidelity will serve to structure a reformulation of the acid test reasoning, with constructive suggestions drawn from several parallel literatures.

DEFINITION

The history of outcome evaluation within modern healthcare can be traced to Donabedian (1966), who argued that in medicine it represented the most frequently used of three quality criteria: structure, process, and outcome. He defined health outcome as a change that resulted from antecedent healthcare, in terms of recovery, restoration of function, or survival. This builds on the dictionary definition, which refers to an outcome as a result or consequence (Concise Oxford English Dictionary, 2004). In supervision, Wampold and Holloway (1997) defined an outcome as ". . . any phenomena representing a change or state that persists beyond the actual supervision session" (p. 16). Thus, outcomes refer to improvements that are targeted by an intervention like supervision, and outcomes are traditionally regarded as the paramount measure of various forms of healthcare. In turn, an evaluation is "the use of social research methods to systematically investigate the effectiveness of social intervention programs . . . and are designed to inform social action . . ." (Rossi et al., 2003, p. 16). Put more concretely, outcome evaluation entails a judgment about the extent to which supervision objectives are achieved.

At the time of their review, Ellis & Ladany (1997) stated that only nine poor-quality outcome evaluations of the supervisees' clinical effectiveness had been published. A decade later (Ellis, D'Iuso, & Ladany, 2008), it was again concluded that little progress had been made, and the need for an "evolutionary leap" (p. 496) was acknowledged. Specifically, Inman and Ladany (2008) concluded that "more comprehensive and thoughtful" (p. …

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