Are there parallel processes in psychotherapy supervision? An empirical examination.

Parallel processes in supervision occur when (1) the therapist brings the interaction pattern that occurs between the therapist and client into supervision and enacts the same pattern but with the therapist trainee in the client's role, or (2) the trainee takes the interaction pattern in supervision back into the therapy session as the therapist, now enacting the supervisor's role. We examined these processes in the interactions of 17 therapy/supervision triads (i.e., supervisor, therapist/trainee, and client). Each session was rated for dominance and affiliation, and the similarity of these dimensions across equal status pairs (supervisor-therapist and trainee-client) was examined. It was hypothesized that if parallel process existed, there would be more similarity in dominance and affiliation between equal status pairs in contiguous sessions than would be true relative to general responses; the dominance and affiliation would be more closely matched than would be expected given general response tendencies. This was examined separately for each supervision triad using single-case randomization tests. Significant results were obtained for each dyad indicating the presence of parallel processes in each supervision triad. Additionally, the relation between parallel processes over the course of treatment and client outcome was examined using hierarchical Bayesian modeling. Results indicate that a positive client outcome was associated with increasing similarity of therapist behavior to the supervisor over time on both affiliation and dominance (increasing parallel process) and an inverted U pattern of high-low-high similarity of client behavior to trainee behavior over time. This study provides support for the existence of bidirectional parallel processes at the level of interpersonal interaction. Implications for therapist training and supervision are discussed.

Interpersonal contribution to outcome: The relation of interpersonal distress and symptomatic improvement as a result of psychotherapy.

The study utilized a 32-item brief measure of interpersonal problems (IIP) to examine interpersonal distress in relation to symptomology and treatment outcome as assessed by the Outcome Questionnaire-45 (OQ-45). The study included a community sample of 210 individuals receiving psychotherapy at a mental health training facility. A number of significant correlations were found between interpersonal distresses with symptomology. The highest correlations were found between levels of general interpersonal distress and symptoms relating to psychiatric and social distress at the onset of therapy; in general the IIP did not differentiate between symptomology types. The study failed to replicate previous research indicating a relation between facets of interpersonal problems with treatment outcome.

The bilevel structure of the Outcome Questionnaire-45.

The structure of the Outcome Questionnaire-45 (Lambert et al., 2001) was examined in a sample of 1,100 university counseling center clients using confirmatory factor analysis. Specifically, the relative fit of 1-factor, 3-factor orthogonal, 3-factor oblique, 4-factor hierarchical, and 4-factor bilevel models were examined. Although the 3-factor oblique, 4-factor hierarchical, and 4-factor bilevel models fit the data well, the 4-factor bilevel model fit the data best. The results provided support for the fit of the 4-factor bilevel model where each item loads on 1 of the 3 independent scales of Symptom Distress, Social Role Performance, and Interpersonal Relations, in addition to a nonoverlapping general distress factor.

An examination of the "interpersonalness" of the outcome questionnaire.

This study examined whether the Outcome Questionnaire-45 (OQ) and its subscales assessed unique interpersonal distress. The Inventory of Interpersonal Problems (IIP) was used to assess discriminant validity for unique interpersonal distress. Participants (N = 121) were recruited from a southwestern university counselor training center. Significant correlations emerged between OQ and IIP scores supporting the OQ as a measure of general interpersonal distress. However, the OQ subscales do not significantly assess unique types of interpersonal distress.