Supervision

The supervision of counselor and psychotherapist supervisees is one of the most important processes in training individuals to become practicing counseling psychologists. Supervision is the process by which a more experienced professional provides oversight, guidance, and consultation to one or more less experienced professionals (junior colleagues) or to one or more trainees aspiring to enter the profession (students). The primary function of this relationship, which extends over time (usually months, sometimes years), is to ensure that quality services are provided by the supervisee. A secondary, but very important, function is to enhance the professional development of the trainee. These goals are accomplished through the development of a facilitative relationship between the supervisor and supervisee that includes components of evaluation, teaching and learning, counseling and support, and consultation.

The Supervision Process

Supervisor Role

Supervisors are typically associated with the same agency or training program as their supervisees. They are responsible for ensuring that quality services are provided by the supervisees to their clients and that these services are delivered in a manner consistent with ethical guidelines of the profession (e.g., those of the American Psychological Association or the American Counseling Association) and relevant law. In addition, supervisors are also typically responsible for providing administrative oversight for the supervisee, making sure that procedures, paperwork, and so on required by the agency are followed. To accomplish this, supervisors must have ongoing access to all relevant information concerning the supervisee’s work with clients, including client files, case notes, and assessment information as well as the ability to monitor the supervisee’s interactions with clients through direct observation, video, or (minimally) audio recording mechanisms.

Supervisors typically meet weekly for at least an hour with each of their supervisees and may have additional meetings with groups of supervisees that allow trainees to learn from and give input to colleagues. It is also often necessary, depending upon the level of experience of the supervisee and the presence or absence of other qualified personnel at the agency, for the supervisor to be available at times when the supervisee is working with clients for immediate consultation or crisis intervention. Early on in the supervisory relationship, the availability of the supervisor and regular supervision sessions need to be arranged. In addition, mechanisms should be arranged for feedback to the supervisee from the supervisor and to the supervisor from the supervisee. The specific domains of professional practice that the supervisee will engage in and the method for evaluating the effectiveness of service delivery by the supervisee should be clarified and agreed upon. It is important that the supervisor is competent in the domains of professional practice that will be supervised in addition to having competence in the supervisory process itself.

Supervisors are also responsible for encouraging the professional development of their supervisees. Thus, supervisors need to be aware of the level of competence of their supervisees for the various professional activities they will engage in under supervision. Generally speaking, the less experience and competence the trainee has in particular activities, the more structure, specific direction, and information are provided by the supervisor. Supervisors should also be familiar with various modes of supervision (e.g., individual, group, direct observation, case conferences) as well as different classes of supervisory interventions (e.g., support, positive reinforcement, prescriptive directives, problem solving, process comments).

Supervisee Role

Supervisees may engage in a breadth of professional activities depending upon the training setting.

They may do individual, marital and family, or group counseling or psychotherapy as well as assessments, consultation, supervision of others, psychoeducational programs, and so on. Supervisees typically have had some prior instruction regarding the particular domains of activity they will engage in while being supervised, so that they have a foundation of knowledge from which to develop intervention skills. Additional information and perspectives as well as skills in case conceptualization and implementing interventions are acquired by the supervisee through the supervisory process.

For supervisees to experience optimal development through supervision, as well as to ensure client welfare, they must approach the supervision process with an openness and willingness to learn. To receive the most useful input from their supervisors, supervisees must be willing to share all relevant aspects of their interactions with clients as well as their reactions to them. They must be willing to be observed and be open to feedback and direction from their supervisors. It is also crucially important for supervisees to familiarize themselves with ethical guidelines that guide professional practice and to commit themselves to adherence to these guidelines. Finally, client welfare and the intent to provide effective services must be viewed as paramount by supervisees.

Growth of the Field

Some form of supervision and training has probably occurred since early practitioners began engaging in counseling and psychotherapy. Unfortunately, it took considerable time for the process to be subjected to empirical scrutiny and for specific models to be developed to explain and guide the practice. For example, Carl Rogers, the pioneer of client-centered therapy, noted in 1957 that research in supervision was rare but that platitudes were plentiful. A fairly common assumption at the time was that if one could do counseling and psychotherapy, then one could supervise others doing counseling and psychotherapy. This perspective continues today, although it has been challenged by the emergence of specific models of supervision training and development.

An early and continuing perspective on supervision has viewed the process as an extension of theories of counseling and psychotherapy. For example, in 1972, R. Eckstein and R. Wallerstein published a volume on supervision and described the process as going through stages in which early assessments of strengths and weaknesses of both supervisor and supervisee lead to attributions of authority as well as influence. Confrontations and conflicts that surfaced along with defenses and avoidance were worked through, which eventually led to more independence of the supervisee.

The 1960s and 1970s saw a dramatic growth of the influence of client-centered therapy, which translated into facilitative approaches to supervision. Although modeling served as an important component of training, R. Carkhuff and B. Berenson found that aspects of client-centered therapy such as support, empathy, warmth, and genuineness by the supervisor were characteristic of effective supervision. Similarly, behavioral therapists (and, later, cognitive-behaviorists) viewed supervision as assisting the supervisee in directing the behavior of his or her clients toward specified goals. Learning how to use aversive conditioning, goal setting, counter conditioning, systematic desensitization, and later, cognitive restructuring and other treatments is the primary focus of supervision. Proficiency is developed through an apprenticeship with an experienced therapist in which the supervisee becomes more knowledgeable about learning theory. Similarly, practitioners who use systemic and family systems theories have devised approaches to supervision using interventions that are consistent with those used by systemic therapists with their clients (e.g., strategic or paradoxical interventions).

Another important category of supervision models includes those that rely less on adherence to a particular theory and more on the process and the specific tasks of supervision. An example of this approach is the skills training model, which is widely used in early methods and techniques of counseling courses. A. Ivey has been influential in proposing that a communication skills laboratory approach is an effective method of training. In this approach, specific skills are learned in limited and focused training segments. These skills are assumed to be fundamental across most, if not all, approaches to counseling and psychotherapy. A variation of this approach by N. Kagan includes the client in a process review of what occurred during a counseling session and the client’s reactions to the process. An important contribution of the skills training approach, in addition to delineating “core” counseling skills, is the amount of research stimulated by the models. Although some studies indicated that the approach was superior to the facilitative model of supervision, others suggested that the skills learned through this approach didn’t transfer well to other situations and would decay over time. However, the skills training model remains a broadly used approach for training beginning counselors and psychotherapists.

Another example of an atheoretical approach to supervision is J. Bernard’s discrimination model. This approach limits its focus to process skills (interventions), conceptualization skills, and personalization skills. Consistent with earlier models, the supervisor is viewed as assuming certain roles in assisting supervisees; these include the teacher role, the counselor role, and the consultant role. Other atheoretical models examine the context of supervision as it occurs within multiple interacting systems, including those represented by the client, supervisee, supervisor, and the agencies in which they function. Additional models have conceptualized supervision from an eclectic or integrative approach, relying on various theories of psychotherapy to generate interventions and approaches to the supervision process.

Most models of supervision have little direct empirical support to argue for their efficacy. Although these models and their descendents remain influential in the practice of supervision, the field has moved toward models that conceptualize the supervision process as different from counseling and therapy and largely independent of the type of therapy that is being supervised. For example, B. Kell and J. Burrow offered a blended model of supervision that relied on psychodynamic theory, a facilitative style of therapy, and used behavioral terminology. The supervisor engaged in the role of therapist when helping the supervisee deal with anxiety and conflict, in the role of teacher in tracing the sources of conflict, and as a consultant to advanced trainees who set their own goals for supervision. Additional work by J. Fleming in 1953 and R. Hogan in 1964 formed the basis for conceptualizing the supervision process from a developmental perspective, which remains an important influence in models of training and supervision research today.

As a prelude to the growth of developmental models of supervision that occurred in the 1980s and 1990s, J. Littrell, N. Lee-Borden, and J. Lorenz examined common roles of supervisors at the time and integrated them into a single model. The supervisor roles of teacher, counselor, consultant, and self-supervisor were combined into a sequence that suggested a developmental influence. Two later models were instrumental in integrating developmental theory into an approach to supervision. The first supervision model that attempted to integrate developmental theory into the supervision process was proposed in 1981 by C. Stoltenberg, who built upon Hogan’s early ideas and introduced concepts from theories of cognitive development. This model viewed trainees as moving through four stages: (1) anxious and dependent, (2) less anxious with a dependency-autonomy conflict, (3) conditional dependency, and (4) culmination, in which the trainee had become a fully functioning autonomous professional. Specific supervision environments were proposed that started with high levels of structure provided by the supervisor and moved toward more supervisee structured and collegial supervision as the supervisee gained experience.

The next year, C. Loganbill, E. Hardy, and U. Delworth published a supervision model that also relied heavily on developmental theory. This approach also conceptualized the supervision process as a stage model that describes trainee growth over time through three stages while eight content issues (e.g., competence, emotional awareness) provide the basis for examining and assessing this growth. This model views trainees as recycling through this developmental process to ever deepening levels.

In the late 1980s, Stoltenberg and Delworth collaborated in publishing the integrated developmental model of supervision (IDM), which built upon two earlier models and more fully integrated developmental issues with the growing body of research on supervision. Among other issues, the revised model attends more directly to domains of professional activity and posits that trainees develop in similar ways but often at different rates across these domains. Thus, supervisors must be cognizant of the differing developmental levels of their supervisees for various domains (e.g., intervention skills competence, psychological assessment, consultation). Development is monitored (and encouraged) across these levels and domains by attending to a progression of change in supervisees for the structures of awareness, motivation, and autonomy. As supervisee professional development occurs within these domains, the supervisor also attends to integrating this growth across domains. The model was expanded and updated again in the late 1990s (with B. McNeill) and remains influential today.

Research addressing developmental models of supervision has been extensive and has been viewed as largely supportive of the important constructs of the models, although problems with the quality of the studies have been raised. In addition, developmental models have been faulted for being too complex as well as too simplistic to fully explain the supervision process.

Constructs from developmental theories have also been applied to supervisors, positing similar processes in the growth of competence in conducting supervision as is seen in counselor and psychotherapist development. More specifically, the development of internship directors, interns, and postdoctoral fellows has also been examined.

Current Status

In general, supervision appears to be an effective mechanism for training professional psychologists. As the number of scholarly articles and research studies examining the supervision process has grown from a few studies prior to 1980 to an impressive body of work, supporting evidence has accumulated. Based on a range of studies, although some of them provide only indirect support, it appears that supervision and training enhances outcomes for the clients of the supervisees. It is also apparent that supervision increases proficiencies in supervisees. Research on psychotherapy has indicated that the therapist-client working alliance is important for success in therapy, and research in supervision suggests that the supervision process enhances the supervisory working alliance, which in turn has a positive impact on the therapist-client working alliance. In addition, evidence suggests that mere experience in conducting counseling and psychotherapy doesn’t enhance therapist development as much as when these experiences are supervised. Thus, it appears that having the opportunity to process what occurs in therapy sessions with a more experienced supervisor enhances the professional development of the supervisee.

Although supervision has been assumed to be an important process in the education and training of counselors and psychotherapists for decades, it has achieved the status of a professional competency only over the last 10 or so years. Important guidelines by professional associations (e.g., the Association of Counselor Education and Supervision, the American Psychological Association Committee on Accreditation) have increased the attention paid to the competency and training of supervisors. However, recent surveys still find that many professional psychologists across settings provide supervision with little formal training in how to do it or exposure to models of supervision. Consequently, they have limited or no familiarity with the empirical research literature that examines the utility and limitations of the supervision process. Thus, many supervisors still largely rely on their own personal experiences in supervision and their understanding of the practice of counseling and psychotherapy to guide their work with their supervisees.

This contrast between the professed importance of supervision to the training of counselors and psychotherapists and the lack of training in this area for most supervisors has prompted increased attention to indices of competence in the practice of supervision. For example, the Association of Psychology Postdoctoral and Internship Centers organized a conference in 2002 that was cosponsored by 34 professional associations and was attended by 127 delegates (mostly psychologists). The charge of the conference was to explore and articulate the competencies psychologists should acquire across a breadth of professional domains, including supervision. A working assumption of the work group examining supervision competence was that the process is developmental in nature. One of the products of this event was the delineation of a number of aspects of competencies for supervisors. Information, attitudes, skills, and values necessary for one to perform as an effective supervisor were addressed. Specifically, these included knowledge bases such as the area being supervised (clinical domain), models and modalities of supervision, and relevant research, ethics and legal issues, evaluation, and diversity.

Similarly, a set of skill areas for supervisors were offered as important for effective supervision, including building a working alliance in supervision, promoting trainee growth, assessment of self and trainee skill levels, teaching, using and delivering formative and summative feedback, setting boundaries, and scientific thinking. Values were also seen as important areas of competence, including assuming responsibility for supervisee training, reaching a balance between clinical and training needs, sensitivity to diversity, using scientific research, and knowing one’s own limitations. It was also concluded that supervisors should receive formal training, including courses in supervision addressing the knowledge and skill areas of the field. Also, applied training was viewed as critically important, including receiving direct supervision by an experienced supervisor of the supervision provided to trainees. This supervision of supervision should include direct observation (live, video, or audio) of the supervision process by a competent supervisor. Suggestions were also made regarding how these competencies could be assessed.

In order for a supervisor to encourage the growth of supervisees, it is helpful to have articulated competencies for effective counselors and psychotherapists. To be most useful, these competencies should be organized into expectations for various levels of training of supervisees. R. Hatcher and K. Lassiter, in a report written for the Association of Directors of Psychology Training Clinics, conceptualize supervisees as changing in their response to training in counseling and psychotherapy in a progression from novice to intermediate, advanced, proficient, and expert levels. They delineated competencies as including personality characteristics, intellectual and personal skills, knowledge from classroom experience, relationship and interpersonal skills, and competencies in working with colleagues and supervisors, among others. The intent of the report was to describe core competencies for professional psychologists and characterize the level of competency to be expected at the end of the practicum experience prior to internship training.

Taking this report and other studies together, it is evident that the field of supervision has made considerable progress in articulating competencies required for professional psychologists and trainees. Reaching these competency goals is enabled by conducting effective supervision informed by knowledge of models of the supervision process, particularly those that articulate a developmental sequence to guide training for various levels of trainees. Finally, competencies that lead to augmenting the influence of the skilled supervisor and forming baseline expectations for the practice of supervision are becoming more clearly defined. A better, more complete picture is emerging of the characteristics of trainees at different points in the training process and of how to encourage their development through levels of professional competency. In addition, the competencies associated with effectively guiding the supervision process and evaluating this progress are becoming clearer. However, a great deal of work is needed to more adequately delineate and expand upon our understanding of the process of supervision as well as evaluate the effectiveness of the training process.

Future Directions

It appears likely that the growth in attention to issues related to supervision will continue into the foreseeable future. The next 5 to 10 years are likely to bring about more specific guidelines for the practice of supervision and the credentialing of psychologists who engage in it. Professional ethical guidelines call for psychologists to practice within their areas of competence. As supervision competencies become more clearly articulated, providing evidence for these skills, attitudes, and values will become more important. The American Counseling Association has supported the establishment of training standards for supervisors, and organizations within the field of psychology have shown similar interest in examining this possibility for the training of professional psychologists.

Although the growth of scholarship and research in supervision has been impressive over the past couple of decades, much work remains in investigating the supervision process. For example, it is not clear why at a given point in time for a particular trainee a specific supervisory intervention is effective, when at other times or when used with other trainees it may be ineffective. Attention to issues related to trainee characteristics and needs at different levels of development may shed much needed light on this issue, but specific evidence is lacking. Similarly, why certain interventions that appear to work for some trainees frustrate and inhibit the growth of others needs further clarification. Again, perhaps timing is an important consideration, as the structure and prescriptive interventions that a supervisor might use effectively with a trainee of limited experience may produce resistance and lack of progress with a more experienced supervisee. On the other hand, providing the limited structure and guidance favored by more experienced supervisees may elicit distracting anxiety and confusion in inexperienced supervisees. More specifically, for the same trainee, will these different approaches prove more or less effective depending upon the particular domain of practice that is the focus of supervision at any given point in time? Indeed, do supervisees develop at different rates across domains of practice as a function of experience and training? How do personal characteristics of the supervisee and supervisor (including racial/ ethnic/cultural identity) affect the supervision process and, subsequently, the outcomes with clients?

The scientist-practitioner training model that is characteristic of the field of counseling psychology holds much promise for advances in our knowledge and practice of supervision. Through extensive research on supervision informed by practice, and through the practice of supervision informed by research, competence as a field in this important training process should continue to be enhanced. Ultimately, this should have a positive impact on ser-vice delivery to clients.

References:

  1. Bernard, J. M. (1997). The discrimination model. In C. E. Watkins (Ed.), Handbook of psychotherapy supervision (pp. 310-327). New York: Wiley.
  2. Bernard, J. M., & Goodyear, R. K. (2004). Fundamentals of clinical supervision (3rd ed.). Boston: Allyn & Bacon.
  3. Bradley, L. J., Kottler, J. A., & Lehrman-Waterman, D. (2001). Ethical issues in supervision. In L. J. Bradley & N. Ladany (Eds.), Counselor supervision (3rd ed., pp. 342-360). Philadelphia: Brunner-Routledge.
  4. Ellis, M. V., & Ladany, N. (1997). Inferences concerning supervisees and clients in clinical supervision: An integrative review. In C. E. Watkins, Jr. (Ed), Handbook of psychotherapy supervision (pp. 447-507). New York: Wiley.
  5. Falender, C.A., Cornish, J. A. E., Goodyear, R., Hatcher, R., Kaslow, N. J., Leventhal, G., et al. (2004). Defining competencies in psychology supervision: A consensus statement. Journal of Clinical Psychology, 60, 771-785.
  6. Goodyear, R. K., & Guzzardo, C. R. (2000). Psychotherapy supervision and training. In S. D. Brown & R. W. Lent (Eds.), Handbook of counseling psychology (3rded.). New York: Wiley.
  7. Hatcher, R. L., & Lassiter, K. D. (2005). Report on practicum competencies. Retrieved from https://www.aptc.org/public_files/Practicum%20Competencies%20FINAL%20(Oct%20’06%20Version).pdf
  8. Saccuzzo, D. P. (2002). Liability for failure to supervise adequately: Let the master beware. The National Register of Health Services Providers in Psychology: The psychologist’s legal update, 13, 1-14.
  9. Scott, K. J., Ingram, K. M., Vitanza, S. A., & Smith, N. G. (2000). Training in supervision: A survey of current practices. The Counseling Psychologist, 28, 403-122.
  10. Stoltenberg, C. D. (2005). Enhancing professional competence through developmental approaches to supervision. American Psychologist, 60, 857-864.
  11. Stoltenberg, C. D., McNeill, B. W., & Delworth, U. (1998). Watkins, C. E., Jr. (Ed.). (1997). Handbook of psychotherapy IDM supervision: An integrated developmental model for supervision. New York: Wiley.

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