Group supervision : Learning psychotherapy in a small group format

Sammanfattning: Group supervision in psychotherapy is today, in Sweden as well as internationally, a common form of supervision. Nevertheless, few systematic studies have been carried out in this field. There is an increasing demand for a more thorough understanding of the specific factors involved in group supervision. This thesis aimed at illuminating some aspects of the learning process in psychodynamically oriented group supervision: the experience of the role as supervisee and supervisor, likewise the experience of group climate and foci of content and, further, their relation to attained psychotherapeutic skill. To this end four studies were carried out using 1) a standardised method SYMLOG to illuminate and compare role patterns, 2) an explorative study to illuminate the experience of the group's inner life, 3) a modified Swedish version (MSES) of the Buckley Self Evaluation Scale to explore the experinces of attained skill after group supervision, and finally 4) a newly constructed questionnarie (TAC) to illuminate foci of content of the supervision and, further, the experience of group climate. Supervisees' as well as supervisors' points of view have been taken into account; although the experiences of the supervisees have constituted the foreground. According to SYMLOG self-ratings made by supervision groups in two psychotherapy training programmes at different levels, there were no differences in role patterns between supervisees at different training levels, whereas the differences between the supervisors and the supervisees, independent of training level were highly significant. Evidently, it was just as difficult to find one's voice and role in a supervision group at an advanced level as at a basic training level. Concerning the experiences of the supervision group, explored in two studies on a basic training level, both supervisees and supervisors reported that individual supervisee factors, as well as factors related to the group composition, exerted a decisive influence on the experiences of the group climate. The importance of interventions on a group level adjusting the group climate was emphasised. Group dynamics were central and remained as an intense experience long after the termination of the supervision. Using MSES self evaluation scale for assessment of attained psychotherapeutic Skill, and Change of skill after supervision, three domains of skill were interpreted: Containing emotionally loaded therapeutic issues, Mastery of working alliance, and Psychodynamic understanding. There were significant increases in Skill in all these dimensions, and significant positive Changes of skill. When supervisors evaluated Change of skill they tended to give higher ratings than the supervisees. Significant correlations of slightly more than medium size between supervisor and supervisee ratings of Change were obtained. Skill, according to ratings in the dimension of Mastery of working alliance made by supervisees after supervision, was related to group supervisor. Themes of group supervision content (Part A) as well as the group climate (Part B) were assessed using the questionnaire TAC. Four factors were interpreted in Part A: Group processes Psychodynamic processes, Professional attitudes, and Theoretical aspects, and two factors in Part B: Openness and creativity and Insecurity and competition (the latter factor was omitted due to a low Alpha level). The focus on Psychodynamic processes received the highest and over time increasing ratings and, moreover, showed a broad effect on the experience of attained skill. Professional attitudes were also considered to be a basic theme. The foci on Group processes and Theoretical aspects had a positive and negative effect, respectively, on the Skill factor Containing emotionally loaded therapeutic issues. The prevalence of these two foci was related to group supervisor. The Group climate factor, Openness and creativity, did not seem to affect the supervisees' experiences of attained skill. However, the evaluations of Openness and creativity of the final supervision period differed due to group supervisor. Study 3 and 4 were carried out on an extensive sample of supervisees and supervisors on a basic level training programme from three Swedish universities.