DESENVOLVIMENTO DE COMPETÊNCIAS TERAPÊUTICAS PELO TREINAMENTO DE SUPERVISORES CLÍNICOS EM TERAPIA COGNITIVO-COMPORTAMENTAL

Abstract

Introduction: The search for competent professionals in the field of Clinical Psychology necessarily derives from the quality of the supervised practice offered in training courses. However, often the approach and format of clinical supervision are a decision of the supervisor himself, conditioned to his academic and professional training, as well as previous experience as a student of supervision, without specific objective criteria or systematization of this process. The literature on supervisor training and its impact on the development of therapeutic competencies and treatment outcomes are still scarce and marked by methodological limitations, with little contribution to the implementation of effective practices of dissemination of Cognitive-Behavioral Therapy. Objectives: This study aimed at understanding the current panorama of supervised clinical practice in cognitive-behavioral therapy specialization courses in Brazil and evaluating the results obtained in therapeutic competence and in the perspective of supervisees regarding supervision after five training sessions of a group of clinical supervisors, in comparison to the control group. Method: Initially, all coordinators of accredited Cognitive-Behavioral Therapy specialization courses were invited to fill out an electronic questionnaire, with no respondent identification, on the supervised clinical practice offered in their specialization courses. Descriptive analyzes were performed with the objective of knowing the frequency of the studied variables. In the second stage of the research, 18 clinical supervisors of a private training center were randomly divided into 2 groups according to the moment of exposure to the intervention and again allocated to each subgroup of supervision previously drawn by the institution. The experiment group underwent five training sessions in core competencies in supervision. The evaluation of the development of therapeutic competences by 37 supervisees was performed using the Cognitive Therapy Scale by an evaluator blind to the participants' allocation, who evaluated sessions recorded before and after the intervention, and the performance of the clinical supervisor was evaluated immediately after each group supervision session, through the supervisory feedback form, which is part of the Supervisor Competence Scale. Results: Most courses offer monthly, group supervision, and the minimum course load reserved for clinical supervision sessions was of at least 75 hours. The absence of a supervisory structure has been identified in more than half of the courses and the use of recorded sessions does not seem to be part of the clinical supervision sessions of the specialization courses in the country. The recruitment of clinical supervisors follows criteria related to their academic background and clinical experience, with little emphasis on the supervisor's training process and meta- supervision sessions. In terms of the proposed intervention, there was an absence of evidence (p-value = 0.164) on the effectiveness of training in supervision skills, which can be explained by the educative nature of the experiment and by the recognized dilution effect of the training impact in pyramid training initiatives. In this study, supervisors who were trained in supervisory skills had more positive points (β = 0.701, p-value <0.001) and fewer negative points (β = -0.893, p = 0.043) identified in their performance by their supervisees. Therapists who experienced the first supervision term identified more negative aspects (β = 0.744, p- value = 0.044) and points to improve (β = 0.811, p-value <0.001) in the performance of their supervisors than the therapists who were about to complete the specialization course. Among the supervisors of the experiment group, it was also observed that the risk of having a reflexive learning enhancing action identified was 4.64 times the risk of it occurring among the therapists in the control group (Risk ratio = 4,641, p-value <0.001). Conclusion: The data obtained confirmed the informal nature of supervised clinical practice and the training of clinical supervisors in specialization courses in Brazil. It is necessary that training initiatives are accompanied by the development of a new professional culture in which information about one's own performance is perceived as essential to the exercise of psychotherapy and any difficulties, as opportunities for learning.