(p. 727) Conducting Effective Clinical Supervision
The following pan-theoretical recommendations for conducting effective clinical supervision are derived from research evidence, theoretical literature, and clinical experience.
1. Emphasize and readily attend to the supervisory relationship. The supervisory working alliance is the likely foundation for the effectiveness of all supervision. Bordin (1983) conceptualized the working alliance as consisting of a mutual agreement on the (a) goals and (b) tasks of supervision, and (c) an emotional bond between the supervisor and supervisee. The strength of the supervisory alliance has been empirically shown to predict positive supervision process and outcome.
2. Apply models of supervision, as opposed to generalizing models of psychotherapy to supervision. Three supervision-based models have been identified as comprehensive and empirically supported: the Critical Events Model of Supervision (Ladany, Friedlander, & Nelson, 2005), the Integrative Developmental Model (e.g., Stoltenberg & McNeill, 2010), and the Systems Approach to Supervision (Holloway, 1995). Although most models of supervision have a developmental component, this preference seems more heuristically useful than empirically supported. It seems supervisors like to think developmentally but act from a skills-based approach.
3. Attend to supervision’s own unique dynamics. The art and science of conducting supervision is different from the art and science of conducting psychotherapy in at least three ways. First, it is intended to be primarily educative. Supervision occurs with the inherent assumption that the supervisee is there to become more adept at psychotherapy skills. Second, supervision is evaluative. A critical role for the supervisor is to evaluate the supervisee on these predefined skills. Third, supervision is typically (especially pre-licensure and outside the United States) involuntary for the supervisee. In many instances, the supervisee has little choice in whether, or from whom, he or she receives supervision. These three conditions create different dynamics than does psychotherapy, and as such, supervision should be viewed through a supervision, rather than a psychotherapy, lens.
4. Engage in role induction and contracting with all supervisees. In role induction and contracting, supervisors provide supervisees with explicit parameters of supervision work. Although it may be reasonably assumed that more advanced supervisees are aware of what transpires in supervision, it is frequently the case that supervisees’ experiences do not consist of typical experiences. Therefore, supervisors should engage in role induction and contracting that includes supervisor disclosures about educational, training, and clinical experience; theoretical approach to supervision and therapy; confidentiality limits; supervision parameters that include meeting time, length of (p. 728) time, place, fee arrangements, contact and crisis information, and use of taping; and supervisee expectations such as informed consent, who is primarily responsible for initiating the supervisory discourse, supervisee disclosure, note taking, supervisee’s use of self in supervision, supervisory goals, and supervisor evaluation.
5. Tend to administrative responsibilities. Supervisors must fulfill a variety of administrative responsibilities that include maintaining records of supervision, keeping abreast of all clients supervised, ensuring clients are aware of the supervisee’s and supervisor’s status, signing off on supervisee notes, using due diligence in selecting supervisees, and ensuring that supervisees with rigid interpersonal difficulties are prevented from continuing to work with clients. In addition, the supervisory work has a legal dimension that varies by jurisdiction; supervisors are reminded to familiarize themselves with those laws and rules.
6. Supervision should not be psychotherapy for the supervisee. Although it can be legitimately argued that part of supervision is to help the supervisee explore how her or his reactions may influence the therapy work, supervision is not a place solely for therapeutic change in the supervisee. Supervision should focus on supervisee interpersonal dynamics inasmuch as they relate to work with the client. Additional thorough attention should be provided by a personal psychotherapist outside of supervision.
7. Understand micro- to macro-level supervisor skills. Supervisor skills can be conceptualized along three levels: nonverbal skills (e.g., facial expressions, head nods), verbal response modes (e.g., reflection of feelings, restatements, self-disclosure), and strategies. Strategies combine nonverbal skills and verbal response modes into more complex behaviors such as focusing on the supervisory alliance, normalizing the supervisee’s experience, focusing on countertransference, attending to multicultural competence, observing parallel process, focusing on skill and knowledge, focusing on the therapeutic process, exploring the supervisee’s feelings, focusing on the supervisee’s interpersonal dynamics, assessing ethical awareness, evaluating theoretical knowledge, assessing research knowledge, and discussing cases. The supervisor must decide when and how much, each of these competing demands must be attended.
8. Attend to both supervisee-focused and client-focused outcomes. Client outcome, while always alluded to as important, has been examined in only a handful of empirical investigations, and a clear link between supervision and client outcome has not been established. Conversely, supervisee-based outcomes have been clearly identified in the research. These include strengthening the supervisory relationship; enhancing supervisee conceptualization skills, therapy knowledge, multicultural awareness, self-efficacy, tolerance of ambiguity, awareness of countertransference, awareness of parallel process, and therapy skills; decreasing supervisee anxiety; and facilitating the development of supervisee self-evaluation. Supervisors should flexibly approach the supervisee with a mix of collegial, interpersonally sensitive, and task-oriented styles in order facilitate these positive outcomes.
9. Recognize the importance of covert processes. Although supervisee self-disclosure and, at least to some extent, supervisor self-disclosure are implicit assumptions in most clinical supervision, it is likely that what is left unsaid is critical to the supervisor work. Some typical supervisee nondisclosures include negative reactions to the supervisor, clinical mistakes, sexual attraction toward a client, and negative reactions to a client. Some typical supervisor nondisclosures include negative reactions to the supervisees’ therapy and supervision work, supervisor self-efficacy, and sexual issues in supervision. Hence, it behooves supervisors to consider what may not be said in supervision, as well as ways of conducting supervision to minimize important nondisclosures.
10. Keep abreast of ethical and legal issues that influence the practice of supervision. Supervisors accept two types of liability: first, direct liability when supervisors are found responsible for specific actions that cause harm to a client; and second, vicarious liability when supervisors are found responsible for actions of supervisees. Along with liability for (p. 729) supervisees’ clients, supervisors also need to be concerned with malpractice where the supervisee is harmed.
11. Evaluate supervisees consistently and objectively. Bernard and Goodyear (2009), not completely facetiously, postulate that there may be as many evaluation instruments as there are training sites. With this lack of consistency, supervisor evaluation has been a problematic enterprise. Supervisors should consider, and communicate to the supervisee, the components of supervisee work that are under scrutiny. These components will frequently entail mode of therapy (e.g., individual, group, family), domain of supervisee behaviors (e.g., therapy, supervision, professional), competence area (e.g., therapy techniques, theoretical conceptualization, assessment), method (supervisee self-report, case notes, audiotape, videotape, live supervision), proportion of caseload (all clients, subgroup of clients), segment of experience (e.g., a specific session, or a segment of a session), time period (early, middle, or late in client treatment as well as early, middle, or late in training experience), evaluator (e.g., supervisor, clients), level of expected proficiency (e.g., demonstrated skill, comparison to cohort group), and feedback (e.g., quantitative vs. qualitative). No single evaluation can account for all of these components; however, having a clear set of parameters will enhance the effectiveness of supervisor’s evaluation.
12. Set clear goals and provide both summative and formative feedback. Supervisor evaluation consists of both goal-setting and feedback (summative and formative). Effective goal-setting consists of goals that are explicit, specific, feasibly reached, related to identified tasks, clarified early, and mutually agreed upon. To be effective in giving feedback, the supervisor should provide it in a way that is systematic, timely, clearly understood, positively and negatively balanced, and reciprocal.
13. Enhance your own multicultural competence in order to enhance supervisee multicultural competence. As multicultural training has become an integral part of many training programs, so too has the situation in which supervisees are more knowledgeable about multicultural issues than are supervisors. To avoid becoming part of these “regressive” relationships, supervisors need to keep current on the evolving content of multicultural therapy. Multicultural (e.g., gender, race, ethnicity, sexual orientation, disability, socioeconomic status) competence in supervision consists of knowledge, self-awareness, and skills (Inman & Ladany, in press). Hence, supervisors need to develop multicultural competence in order to be adept in assessing supervisees along similar psychotherapy-based dimensions.
14. Consider group supervision and peer supervision as adjuncts to individual supervision. Group supervision, consisting of a leader and typically three to six supervisees, offers an educative experience whereby supervisees can experience the benefit of group work (e.g., universality) along with skill development. Additionally, peer supervision is one avenue through which supervisees may disclose more readily their challenges and receive supplemental guidance.
15. Secure training in clinical supervision. The majority of psychotherapy supervisors did not complete formal training in supervision themselves nor does any mental health organization currently require supervisor training. It seems likely that the lack of supervisor training may be responsible for many of the unmet challenges that supervisors face. Hence, systematic and comprehensive supervisor training is recommended for those who engage in supervision.
References and Readings
American Psychological Association Division of Counseling Psychology, Section on Supervision and Training. (2013). Supervision and training resources. Retrieved March 2013 from from www.div17.org/sections/supervision-and-training
Bernard, J. M., & Goodyear, R. K. (2009). Fundamentals of clinical supervision (4th ed.). Boston, MA: Allyn & Bacon.Find this resource:
Bordin, E. S. (1983). A working alliance based model of supervision. The Counseling Psychologist, 11, 35–41.Find this resource:
Falvey, J. E. (2002). Managing clinical supervision: Ethical practices and legal risk management. Pacific Grove, CA: Brooks/Cole. (p. 730) Find this resource:
Holloway, E. L. (1995). Clinical supervision: A systems approach. Thousand Oaks, CA: Sage.Find this resource:
Inman, A. G., & Ladany, N. (in press). Multicultural competencies in psychotherapy supervision. In F. T. L. Leong (Ed.), APA handbook of multicultural psychology (Vol. 2). Washington, DC: American Psychological Association.Find this resource:
Ladany, N., Friedlander, M. L., & Nelson, M. L. (2005). Critical events in psychotherapy supervision: An interpersonal approach. Washington, DC: American Psychological Association.Find this resource:
Ladany, N., & Bradley, L. J. (Eds.). (2010). Counselor supervision (4th ed.). New York: Routledge.Find this resource:
Ladany, N., & Inman, A. G. (2013). Training and supervision. In E. M. Altmaier and J. C. Hansen (Eds.), The Oxford handbook of counseling psychology. New York: Oxford University Press.Find this resource:
Stoltenberg, C. D., & McNeill, B. W. (2010). IDM Supervision: An integrative developmental model for supervising counselors and therapists (3rd ed.). New York: Taylor & Francis.Find this resource:
Chapter 141, “Responsibilities and Liabilities in Supervision”