Systematic review of therapist reflective functioning: characteristics, measurement, construct validity and outcome; & Exploring supervisor’s experiences when delivering psychological supervision: an interpretative phenomenological analysis; & Exploring supervisor’s experiences when delivering psychological supervision: an interpretative phenomenological analysis

Abstract

BACKGROUND: This thesis portfolio comprises two main sections. The first involves a systematic review exploring studies that measured therapists' mentalisation capacity, also commonly referred to as reflective functioning (RF). As research into the importance of therapists' RF is relatively new, this review remained exploratory, looking at the characteristics of included studies, RF measurement tools used, the construct validity of such tools, and whether therapist RF appears to influence patient outcomes following psychotherapy. This may help us understand whether therapist RF is an important common factor and indeed change mechanism across psychotherapy models. The second section is an empirical study following on the theme of mentalisation theory but from a supervisory perspective. Supervising is an emotional and relational experience, often with a strong restorative and regulatory focus. Research looking at the emotional and interpersonal demands placed on supervisors is lacking. It is possible that supervisory interactions could also be underpinned by mentalisation processes. This could be from a function of supervision perspective where supervisors may attempt to help supervisees sustain mentalising about their work but also the process of the supervisors’ own mentalising - recognising the emotional work that supervising entails. This research, therefore, sought to explore the emotional and interpersonal experiences of supervisors delivering supervision from a mentalisation theory perspective. This may help us to understand the importance of mentalisation processes within this forum and help inform clinical practice and supervision training models.

METHODS: The review involved a systematic search of three online databases and reference lists to identify relevant articles, determined by strict eligibility criteria. Fourteen articles were identified, which were synthesised and assessed for risk of bias by the standard quality assessment criterion for evaluating primary research papers from a variety of fields (Kmet, 2004). For the empirical project, eight registered psychologists completed semi-structured interviews relating to their emotional and interpersonal experiences of delivering supervision. Interviews were recorded, transcribed verbatim, and analysed using Interpretative Phenomenological Analysis (IPA).

RESULTS: The systematic review revealed large heterogeneity across studies in terms of research design, RF measurement tools used, and treatment modality, meaning cross-study comparison was difficult. There is preliminary evidence of construct validity across RF measures. Therapist RF appears relevant as a potential change mechanism within psychotherapy processes. IPA from the empirical project revealed four main themes: ‘supervisor vulnerabilities’, ‘ the importance of reciprocity’, ‘supervision is relational’, and ‘a mentalising stance’.

DISCUSSION: Studies included in the review highlight the role therapist RF could have as a common factor and as an important change mechanism regardless of psychotherapeutic orientation. This has direct implications in the application of therapy models but also in the selection and training of mental health practitioners. Key themes such as supervisor vulnerabilities give rise to supervisors’ seeking validation of skills and opportunities to demonstrate competence. This is discussed in relation to self-validation literature. Learning from the supervisee appeared to ensure that the supervisor felt useful and validated, valuing the importance of reciprocal learning within the supervisory relationship. The findings also highlight that mentalisation underpins almost all interpersonal interactions, especially in a relational space like supervisory relationships. Evidence of supervisors’ adopting a mentalising stance is explored, alongside a critical appraisal of the research process.