Theoretical orientation, experience, and the observation of patient behavior in a supervisory setting

This study investigated the role of theoretical orientation and experience levels in a supervisory setting concerned with case conceptualization. Patient behaviors upon which therapist/supervisors based conceptualizations were compared. Seventy-four practicing Ph.D. psychologists with supervisory experience were interviewed regarding theoretical orientation, years of experience, and research/therapy interests. Thirty-six viewed a videotape of an initial interview with an adult female and were questioned regarding case conceptualization. They then re-viewed the tape, identifying behavioral segments that were important in forming their conceptualizations. Comparisons of the selected segments and conceptualizations were made between orientations, overall experience levels, and within orientation experience levels. Orientation catagories were: Psychodynamic (PD), Behavioral/ Cognitive (BC), and Systems/Communication (SC).

Results indicated orientations and overall experience levels were similar with regard to homogeneity of selections. Within orientation experience homogeneity differed for BC but not for PD or SC. Overall selection rate was 19%, averaging 74 selections per viewer. Orientation averages were 88 (PD), 79 (BC), and 57 (SC). Experience averages were: less experience 75, greater experience 74. Respective within orientation averages were: PD (103 and 72), BC (73 and 87), and SC (54 and 50).

Sixty-two of 400 segments met criterion level requirements for final analysis. Orientations differed in selecting 76% of the segments; overall experience levels in 31%. Within orientation experience differed in selection of 47% (PD), 43% (BC), and 27% (SC). Differences between orientations were found for Impairment, Recommended Therapy, and Estimated Length. Differences in overall experience were found for Recommended Therapy. Differences for within orientation experience were found for Identified Problems, Predisposition, Impairment, Recommended Therapy, and Estimated Length. No differences in orientation or experience levels were found for Problem Presence, Remembered Segments, Stress, Prognosis, or Areas to Explore.

Results suggest that differences existed with regard to amount of information utilized by orientations and experience levels in making case conceptualizations. Orientations and experience levels agreed on problem areas but rarely agreed in selecting behavioral segments demonstrating those areas, suggesting that different orientations and experience levels focus on different aspects of the same problem areas.

Implications for teaching and learning conceptualization skills were discussed.