Using video to improve your clinical skills and therapy outcome

Therapy supervision has traditionally relied on the therapist’s self-report of their work with clients. Videotaping is gaining traction as a tool used in supervision to help therapists in training develop their clinical skills, and it is now an APA requirement for psychology internships. However, videotapes are still mainly used to support the supervisor’s role: identifying the developmental stage in the student’s training, ensuring patient’s safety, and providing global feedback about the therapist’s intervention skills. Video recordings of therapy sessions can be used in supervision and self-supervision to increase the therapist’s level of effectiveness with their patients by providing the opportunity for intentional, moment-to-moment assessment of the client’s level anxiety and use of coping mechanisms, therapist-client dynamics, and client’s response to interventions.

Therapists in training tend to take a passive role in their own learning. Many times, students do not know how to make the best out of their supervision sessions. Because of the lack of models of supervision that rely on the use of video recording, especially in psychoanalytic and psychodynamic training programs, supervisors are often at a loss as to how to make the best use of the videotapes their supervisees bring in for review. Traditionally trained therapists did not use video as part of their own training, and in most cases, they do not use videos in their own therapy practice.  As a result, video recordings in supervision tend be underused.

How does video recording help to improve clinical skills?

Research in the field of deliberate practice has shown that in order to learn how to master a new skill (playing an instrument, learn a sport, or becoming a medical doctor) students need to be able to observe a more experienced professional in their field perform the tasks that they are aspiring to master. Students’ performance also needs to be closely observed so that they can be provided with specific feedback about their skills, and to be pointed in the right direction for further development.

The opportunity to watch more seasoned therapists doing therapy is of great importance to a beginner therapist. Not only could the supervisor’s own tapes facilitate the process of acquiring specific clinical skills, but they could help with the dynamic of idealization-devaluation that can often interfere with the student’s learning process. Unfortunately, most therapists in training rarely see videos of their mentors, teachers or supervisors conducting a real therapy session.

Although an increasing number of training programs are making use of audio and video equipment for supervision of students, feedback tends to be global rather than specific. While I was in training, my work with clients was not directly observed by any of my supervisors. During my supervision, I reported on my sessions via “verbatim transcripts” based on my memory of the session. Supervision was helpful, and I clearly learned clinical skills that have allowed me to help many people throughout my career. However, the feedback that I received in supervision mainly contributed to enhancing my diagnostic (case conceptualization) skills, while my intervention skills remained less developed.

An additional benefit from watching a video recording of therapy sessions is the access to nonverbal information that at times we are not able to attend to while working with a client. My training in a psychoanalytical-oriented program did not address the topic of non-verbal language in a way that was helpful to my work as a clinician (if it was ever addressed). A verbatim transcript, unless provided by someone who has been specifically trained to observe nonverbal language, lacks the level of detail necessary to assess important aspects of the client’s presentation such as anxiety level, level of involvement, and certain defenses that can only be observed with a trained eye. In my work with clients, when I comment on certain nonverbal cues, aspects of the client experience that are not consciously being attended to have an opportunity to be integrated and very often offer invaluable information that otherwise would have remained inaccessible.

Another benefit of observing your work as it happened, either on your own, in group or peer supervision settings, or with a consultant, is the opportunity to study not only the structure and delivery of your interventions, but also, and perhaps most importantly, to observe and assess which interventions are effective, and which are not, thus increasing your ability to help your client.

Video tapes are the most effective continuing education activity!

Finally, videotaping therapy sessions is a great tool that therapists can use throughout their entire professional life for continuous improvement of their clinical skills, and most importantly, to help our field to become comfortable with video as a tool to train future generations of clinicians. Research on outcome therapy shows that therapist’s effectiveness does not tend to improve over time. What improves overtime is a therapist’s confidence that they are doing a good job. However, being confident in the work that you do as therapists, does not always translate in client’s getting better or reaching their goals.

Psychotherapists care a great deal about their clients and are committed to engaging in continuous training, either by pursuing formal advanced training opportunities, participating in peer supervision, engaging in teaching, and at the very minimal, by obtaining the required credit-hours of continuous education training in order to maintain their licenses. However, learning theory and clinical skills is not enough to become competent or to master that particular new knowledge.

Witnessing your own work is a vulnerable endeavor (even more so when done in a group format), however the benefits of doing so are invaluable for you, and consequently, for the clients you are meant to help.

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