Supervisory alliance as a moderator of the effects of behavioral rehearsal on TF-CBT fidelity: results from a randomized trial of supervision strategies

Abstract

The present study examined relations between supervisory alliance and fidelity to the trauma narrative component of Trauma-Focused Cognitive Behavioral Therapy, as well as how supervisory alliance might moderate the effect of behavioral rehearsals (i.e., role plays) on fidelity. Forty-two supervisors and 124 clinicians from 28 different community-based mental health offices across Washington State participated. Clinicians were randomized to receive one of two supervision conditions—symptom and fidelity monitoring or symptom and fidelity monitoring with behavioral rehearsal. Supervisory alliance alone did not predict adherence or extensiveness of the trauma narrative. One aspect of alliance, client focus, significantly altered the effect of supervision condition on adherence (p=0.05); however, this effect was only seen in 43.5% of clinicians. A second aspect of alliance, rapport, altered the effect of condition on trauma narrative extensiveness with moderate significance (p=0.09). Future research should investigate strategies to improve supervisory alliance or match supervision strategies to specific supervisor-clinician dyads.