The looking glass effect: the influences of clinical supervision on student attitudes toward evidence based practices Item Type Thesis Authors Leonard, Hugh D. Download date 01/10/2021 21:53:16 Link to Item http://hdl.handle.net/11122/10626 THE LOOKING GLASS EFFECT: THE INFLUENCES OF CLINICAL SUPERVISION ON STUDENT ATTITUDES TOWARD EVIDENCE BASED PRACTICES By Hugh D. Leonard A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Clinical-Community Psychology University of Alaska Fairbanks and University of Alaska Anchorage August 2019 APPROVED: Kendra Campbell, Ph.D., Committee Chair Inna Rivkin, Ph.D., Committee Member Vivian M. Gonzalez, Ph.D., Committee Member Jim Fitterling, Ph.D., Committee Member Vivian M. Gonzalez, Ph.D., UAA Program Director Ph.D. Program in Clinical-Community Psychology Jim Fitterling, Ph.D., Joint Ph.D. Teach Out Program Director Ph.D. Program in Clinical-Community Psychology Todd L. Sherman, M.F.A., Dean of the College of Liberal Arts Helena S. Wisniewski, Ph.D. Dean of the UAA Graduate School Michael A. Castellini, Ph.D. Dean of the UAF Graduate School Abstract The current study explored how graduate students' attitudes toward evidence-based practices (EBPs) are influenced through clinical supervision. Despite being widely endorsed by professional entities, such as the American Psychological Association, members of the profession have mixed attitudes toward the EBP approach. Mixed attitudes toward EBPs have potentially detrimental effects, such as resulting in clinicians simply dismissing the notion of evidence-based treatment decision making and instead utilizing interventions that are without scientific support and potentially ineffective and even harmful. Resistance toward EBPs has been studied, but largely unstudied is how negative attitudes toward EBPs are developed and propagated to others. Professional identity solidifies in graduate school by way of clinical supervision. The goal of this study was to illuminate underlying influences of clinical supervision on graduate student attitudes toward EBPs, as clinical supervision may be the root cause of resistance toward EBPs. Perceived supervisor credibility influences professional identity development and may be influenced by a positive supervisory working alliance, theoretical orientation match, and overall acquiescence to a clinical supervisor; and these factors may affect attitudes toward EBPs. However, no previous research exists to directly confirm this notion. This study sampled from Ph.D. and Psy.D. clinical psychology graduate students who had started seeing patients (n = 157). Participants completed an online survey battery measuring perceived supervisor credibility, supervisory working alliance, student attitudes toward EBPs, perceived supervisor attitudes toward EBPs, and dispositional psychological reactance. It was predicted that students would perceive their supervisor as credible when their theoretical orientations matched, a positive supervisory working alliance existed, and students' psychological reactance was low. It was also predicted that supervisor attitudes toward EBPs i would predict student attitudes toward EBPs when perceived supervisor credibility is high, students' dispositional psychological reactance is low, supervisory alliance is high, and theoretical orientations matched. Simultaneous linear regression and hierarchical regression was used to test the study hypotheses. The results partially supported the study hypotheses. It was found that a positive supervisory alliance predicted perceived supervised credibility. However, the remaining hypotheses were unsupported. Results contribute to the sparse research base on supervisor credibility in that preliminary support is provided that perceived credibility occurs when students and supervisors have a good relationship. Noteworthy are that results yielded from correlations suggested that students' global appreciation for research was related to theoretical orientation match of their clinical supervisor, supervisors' and graduate program's favorable attitudes toward EBP's, and to multi-faceted supervisory relationships such as having a clinical supervisor also as a research supervisor. These findings suggest that student internalization of supervisor attitudes may have less to do with perceived credibility and more to do with attitudes toward research. Future research should consider exploring attitudes toward research in the context of development of attitudes toward EBPs. ii Table of Contents Page Abstract ............................................................................................................................................ i Table of Contents ...........................................................................................................................iii List of Figures/Tables ..................................................................................................................... v List of Appendices ........................................................................................................................ vii Chapter 1: Introduction ............................................................................................................... 1 Chapter 2: Literature Review ...................................................................................................... 7 Section A: Evidence-Based Practices.................................................................................. 7 Evidence-Based Practices........................................................................................ 7 Attitudes toward EBPs .......................................................................................... 10 Areas of Resistance Toward EBPs........................................................................ 12 Conclusion ............................................................................................................ 20 Section B: Clinical Supervision ........................................................................................ 20 Clinical Supervision...............................................................................................20 Models of Clinical Supervision..............................................................................21 Impact of Supervision on Clinical Training .......................................................... 26 Impact of Supervision on Attitudes Toward EBPs ................................................ 29 Conclusion ............................................................................................................ 29 Section C: Social Psychological Factors ........................................................................... 29 Elaboration Likelihood Model ...............................................................................29 Psychological Reactance ....................................................................................... 33 Conclusion ............................................................................................................ 35 iii Study Rationale...................................................................................................... 35 Study Hypotheses .................................................................................................. 37 Chapter 3: Methodology............................................................................................................. 39 Participation Selection ...................................................................................................... 39 Sample Characteristics....................................................................................................... 39 Procedure .......................................................................................................................... 40 Measures ........................................................................................................................... 42 Chapter 4: Results....................................................................................................................... 47 Sample Size Considerations .............................................................................................. 47 Descriptive Results ........................................................................................................... 47 Analyses ............................................................................................................................ 49 Chapter 5: Discussion ................................................................................................................. 59 Summary of Results.......................................................................................................... 59 Exploratory Analyses for Future Research ....................................................................... 62 Practical Applications.........................................................................................................63 Limitations ......................................................................................................................... 63 Conclusion ........................................................................................................................ 66 References .................................................................................................................................... 68 Appendices ................................................................................................................................