Bug-in-the-eye supervision: A critical review.

Abstract

An important part of clinical supervision is the manner in which supervisors obtain information about what happens in trainees' treatment sessions. Research has shown that direct observation of sessions is more effective than relying on subjective report alone, and that live observation with concurrent feedback is most effective. However, feedback can also be disruptive. Bug-in-the-eye (BITE) technology was developed to enable supervisors to provide live feedback to trainees in a minimally disruptive manner by observing treatment sessions via live video feed or one-way mirror and discreetly transmitting brief messages via a computer monitor that is visible only to the trainee. In addition to being less disruptive, this format may have positive effects on trainees, clients, and the treatment process. The purpose of this article is to review all relevant studies that have investigated BITE in the context of supervision of psychotherapy. Seven studies were identified, all of which showed BITE to be acceptable, useful, undisruptive, and undamaging to the therapeutic alliance. Some of the studies found that BITE was associated with a stronger alliance, greater trainee adherence, and greater clinical competence than other formats of supervision. These findings suggest that BITE may be a valuable tool in clinical supervision, but more rigorous research is needed to understand its precise effects and how it may best be used. Public Significance StatementThis article reviews a method in which trainee psychotherapists are observed and given feedback by supervisors during psychotherapy. Results show that this method may improve the competence of trainees, as well as the working relationship between trainees and clients. Results also highlight the need for further research into the most optimal forms of supervision of psychotherapists to ensure the highest quality training.

Live supervision in psychotherapy training—A systematic review.

“…Reviews and meta-analyses are methods for collating the empirical evidence based on pre-determined eligibility criteria, in order to address a specific research question (Moher et al, 2009). To the best of our knowledge, there are four reviews on LS (Champe & Kleist, 2003;Gallant & Thyer, 1989;Jakob et al, 2013;Vezer, 2021). Gallant and Thyer (1989) reviewed 15 publications on BITEar supervision .…”

“…Vezer (2021) summarized seven studies on BITEye (2000–2018). Despite some methodological problems relating to the studies (e.g., small samples), they concluded that BITEye is generally acceptable, nondisruptive, and has no negative effects on the alliance.…”

“…They pointed to a potential superiority of BITEye, which was not perceived as disturbing or negatively affecting the therapeutic alliance, but as effective, helpful, pleasant, and easy to handle. Vezer (2021) summarized seven studies on BITEye (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018). Despite some methodological problems relating to the studies (e.g., small samples), they concluded that BITEye is generally acceptable, nondisruptive, and has no negative effects on the alliance.…”

Technology and psychotherapy training.

“…For example, supervisors who are assisting an in-person or telehealth session through a live feed can provide immediate feedback to trainees, which is presented in a visual format appearing on a computer screen that is only visible to trainees. A critical review conducted by Vezer (2021) found that the limited number of studies investigating this supervision approach suggest it may enhance supervision outcomes, such as training adherence and clinical competence, without hindering the working alliance.…”