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Supervision: Research, Models, Competence

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 Supervision      1  

Supervision: Research, Models, Competence

Cal D. Stoltenberg and Brian W. McNeill

Supervision of counseling and psychotherapy has been considered an important area of

research and practice in counseling psychology for decades. The breadth and depth of discussion

and analysis of issues important to supervision has filled numerous books, so our focus here will

be on only certain areas of this rather large literature. We will examine some aspects of the

“what” and the “how” of supervision. Our discussion will be primarily of individual supervision

with limited reference to other modalities. Where useful and as guidance for further work we

refer to recent issues in psychotherapy research and their relevance to supervision. We begin by

discussing two models of clinical supervision that have been developed by counseling

psychologists and provide considerable conceptual depth and detail in addition to being

influenced by evidence from supervision research. Consistent with the common factors

movement in psychotherapy research and practice, we examine conceptualizations of the

supervision process based on similar notions of commonalities among approaches. We will also

examine the breadth of research that has been conducted relevant to supervision including the

supervision process (relationship issues, conflict, counterproductive events, evaluation, client

issues), characteristics of supervisees and supervisors (and clients), multicultural issues, and

ethical and legal issues in supervision. We will also briefly address the competency movement in

professional psychology, particularly as it applies to competence in supervision. We end the

chapter with suggestions for future research and directions for clinical supervision.

Clinical Expertise

Clearly the research literature in psychotherapy supervision provides interesting and

useful guidance, if tenuous, in avoiding pitfalls and enhancing trainee growth through the

supervision process. However, insufficient empirical evidence exists to draw conclusions

 Supervision      2  

concerning which models of clinical supervision are most effective (Stoltenberg & Pace, 2008;

Westefeld, 2009). In the absence of the confirmed superiority of approaches or techniques of

supervision, supervisors are left to rely rather heavily on expertise and clinical judgment in

making decisions about the roles, processes, and outcomes of supervision.

Scott, Ingram, Vitanza, and Smith (2000) report that counseling psychology programs are

more likely to offer training and courses in supervision than are clinical psychology programs,

even with APA’s (2002a) Committee on Accreditation guidelines for training in this area. Such

training is important as research indicates that, similar to other domains of development,

experience in conducting supervision alone doesn’t appear to influence supervisor development

(Steven, Goodyear, & Robertson, 1998). Both experience and training are needed to enhance a

supervisor’s sense of self-efficacy in the supervision process, which has been found to result in a

more supportive and less critical or dogmatic approach.

Models of Psychotherapy Supervision

We limit our discussion to two models that have made important contributions to

counseling psychology, were developed by counseling psychologists, and are intended to be

useful across theoretical orientations to counseling and psychotherapy. In order, we will briefly

discuss Ladany, Friedlander, and Nelson’s (2005) interpersonal approach to supervision, which

Bernard and Goodyear (2009) classify as a process model within the larger developmental

models category and Stoltenberg and McNeill’s (2010) integrative developmental model, which

Bernard and Goodyear consider a stage model of development. Both models take a

pantheoretical perspective noting that they are not tied to any particular therapeutic orientation

but applicable to most, if not all, supervision of therapy approaches. In addition, both models are
 Supervision      3  

presented in book form, which allows for more detail in theory and application than models

presented in article or chapter formats.

Ladany, Friedlander, and Nelson’s Interpersonal Approach

The interpersonal or events-based approach delineated by Ladany, Friedlander, and

Nelson in Critical Events in Psychotherapy Supervision: An Interpersonal Approach (2005)

shines a light on specific events occurring in supervision and provides a framework for working

through these events inspired by a task analysis approach to psychotherapy used by Greenberg

(1986) and others (e.g., Friedlander, Heatherington, Johnson, & Skowron, 1994; Safran, Crocker,

McMain, & Murray, 1990). According to this approach, each event has a Marker, which can be a

supervisee’s statement, statements over time, or behavior which serves as an indication for the

need for specific help. Once recognized by the supervisor, the Marker highlights the need to take

action and dictates the type of action to be taken by the supervisor. Similar Markers can indicate

different problems, while different problems can elicit similar Markers. Understanding the

meaning of the Marker sets in motion the interaction sequences (supervisor interventions,

strategies; supervisee performances, reactions) that constitute the Task Environment. Ladany et

al. list 11 interactional sequences: focus on the supervisory alliance, focus on the therapeutic

process, exploration of feelings, focus on countertransference, attend to parallel processes, focus

on self-efficacy, normalizing experience, focus on skill, assessing knowledge, focus on

multicultural awareness, and focus on evaluation. They note that this list is not exhaustive, the

sequences are not assumed to be mutually exclusive, and these sequences are thought to be most

relevant for events highlighted in the book while other events (not addressed) may suggest other

sequences. Ladany et al. note that each interactional sequence can include various supervisor

interventions, which are described in discussing each event and the associated interaction
 Supervision      4  

sequences approached chapter by chapter in their book, and can be a recursive process. Effective

implementation of the appropriate interaction sequences (facilitative interactions between the

supervisor and supervisee) results in resolution of the event. They conceptualize Resolutions in

four broad categories with increasing or decreasing self-awareness, knowledge, skills, or effects

on the supervisory alliance.

The events-based model posits the supervisory alliance as the foundation of effective

supervision, and they conceptualize it from Bordin’s (1983) perspective (agreement on goals and

tasks, strong emotional bond) citing the positive influence of a strong versus the negative

influence of a weak supervisory alliance. The seven “events” articulated in the events-based

model, which can occur within a single session or across sessions, include; remediating skill

difficulties and deficits, heightening multicultural awareness, negotiating role conflicts, working

through countertransference, managing sexual attraction, repairing gender-related

misunderstandings, and addressing problematic attitudes and behavior (p. 19). They also note

that events can occur within events incorporating more than one type of event into the selection

of interactional sequences.

Ladany et al. (2005) note that their approach is intended to attend primarily to the

interpersonal or relational nature of the supervision process in working through critical events.

Thus, their focus is more on the specific than on the overall development of the supervisee.

However, they go on to note that, “we emphasize the supervisee’s learning, growth, and

development over case management” (pg. 10), which they don’t view as a primary purpose of

clinical supervision. They assume that the focus on critical events should strongly impact

supervision outcomes, but they note that the events-based approach has not been empirically

examined and evidence is currently lacking.

 Supervision      5  

Stoltenberg and McNeill’s Integrative Developmental Model

Work on this developmental approach to supervision has progressed for nearly 30 years

beginning with Stoltenberg’s (1981) rather simplistic (through the lens of time) model that

posited counselor growth through four stages of professional development. Subsequent books

(Stoltenberg & Delworth, 1987; Stoltenberg, McNeill, & Delworth, 1998) significantly expanded

this view with the integration of research and constructs from related areas of inquiry. The model

is currently articulated in IDM Supervision: An Integrative Developmental Model for Supervising

Counselors and Therapists (3rd ed., 2010).

In contrast to the earliest version of the model, that viewed trainees progressing “en

masse” through four stages from neophyte through master counselor, the IDM posits that

professional development occurs in a domain-specific manner, indicated by changes in three

over-arching structures that serve as markers for development. These changes in self and other

awareness, motivation, and autonomy illuminate the developmental progression through three

levels across domains of professional activity. Briefly, for the structure of self-other awareness,

the trainee begins (Level 1) primarily attending to his or her own thoughts, emotions, and

behavior attempting to understand and implement therapeutic processes while dealing with

perceptions of low self-efficacy, anxiety, frustration, and hopefulness. Successful negotiation of

this level moves the trainee to Level 2 where the focus moves away from self-consciousness to

an increasing focus on the client, or other awareness. This allows for greater learning and

understanding of the client’s perspective (cognitive and affective) than was previously possible.

This can have both positive (increasing ability to empathize, perspective-taking) as well as

negative implications (confusion, emotional contagion, frustration). Movement to Level 3 is

marked by more of a balance between a facilitative self-awareness and focus on the client,
 Supervision      6  

allowing for the positive impact of empathy and perspective-taking combined with reflection-in-

action (Schön, 1987) or a greater ability to reflect on past learning, experiences, one’s own

thoughts, emotional reactions, etc. to bring to bear on the counseling process. Similar changes

occur for the structures of motivation and autonomy across levels. Motivation moves from

global and somewhat extrinsic for Level 1 through variably high and low as it changes from

extrinsic to more intrinsic for Level 2 and into a stable, largely intrinsic motivation in Level 3.

The autonomy structure changes accordingly, moving from largely dependent in Level 1 through

dependency/autonomy vacillation in Level 2 to conditional autonomy in Level 3. In general,

trainee development is conceptualized as reflecting quantitative changes within levels and

qualitative changes across levels. This is consistent with the developmental framework upon

which the IDM is based (Lerner, 1986). The final step, according to the IDM is movement to

Level 3i where the focus becomes more on integration of development across domains.

Differing characteristics and needs at each level of development suggest that the

supervision environment should also vary accordingly. In general, the IDM assumes that the

amount of structure for the supervision environment provided by the supervisor should be rather

high for beginners and reduce over time moving toward greater supervisee influence on setting

the structure for the supervision experience as development continues. Supervision interventions

are broadly categorized into facilitative, prescriptive, conceptual, confrontive, and catalytic

which are differentially used across supervisee levels to encourage growth.

An important aspect of the IDM that appears to often be overlooked in critiques and

research is that of domain-specific development. Eight domains of professional activity are listed

in the IDM, but these are noted as overly broad and as indications of some domains in which the

supervisor should attend to differential development among supervisees. The domains are
 Supervision      7  

intervention skills competence, assessment techniques, interpersonal assessment, client

conceptualization, individual differences, theoretical orientation, treatment plans and goals, and

professional ethics. However, as highlighted by Stoltenberg (2008), working with clients from

different modalities (i.e., individual and couples counseling) may constitute different domains of

development and may require moving between supervision environments appropriate for

different levels of development for the same supervisee within a given supervision session as

well as across sessions.

The “integrative” aspect of the IDM includes an examination of theory and research

beyond the area of clinical supervision (and psychotherapy) to help illuminate processes held in

common with other areas of psychology. Stoltenberg and McNeill (2010) articulate the utility of

additional research and conceptualizations in understanding the supervision process including

cognitive models (cognitive and emotional processing; Anderson, 2005, Greenberg, 2002),

schema development and refinement (McVee, Dunsmore, & Gravelek, 2005, Schön, 1987), and

skill development; development from novice to expert (Anderson, 2005); interpersonal influence

(Dixon & Claiborn, 1987; Stoltenberg, McNeill, & Crethar, 1995) and social intelligence

(Goleman, 2006); motivation (Petty & Wegener, 1999, Ryan & Deci, 2000); and, of course,

models of human development (Lerner, 1986).

Is There a Best Model?

Similar to the current state of affairs in psychotherapy research, where there is little

evidence for the superiority of any given theoretical orientation over another (Duncan, Miller,

Wampold, & Hubble, 2010; Norcross, Beutler, & Levant, 2006), we have little evidence that any

specific model of clinical supervision is more adequate or effective than others. Of the two

models discussed here, the IDM has stimulated the most research (it has also been around the
 Supervision      8  

longest) but has been criticized as having not been adequately tested (Ellis, Ladany, Krengel, &

Schult, 1996), although a more recent review (Inman & Ladany, 2008) concludes that, “the bulk

of the studies suggest some support for a developmental process operating in supervisees,” and

“both supervisors and supervisees perceive supervisees differently as supervisees gain

experience” (pg. 505). The Ladany et al. model relies on methods and research from task

analysis in psychotherapy suggesting interactional sequences in supervision surrounding specific

events should lead to supervisees’ learning and development. As noted by the authors, this

model has not been empirically examined and is lacking evidence. Thus, neither model has

adequate research support to provide validation, yet both integrate research on supervision into

their models.

Both models integrate research on supervision into their descriptions of the process, and

they also seek guidance from other literatures (e.g., psychotherapy, learning) to more fully

articulate the supervision process. Both models were developed by individuals involved in

research and scholarship in supervision as well as being practicing supervisors. Given the

limitations and challenges associated with research in this area, relying only on empirically

supported constructs and interventions to supervise would leave supervisors with inadequate

guidance. There is more than one recipe for chili, more than one way to get to the grocery store,

no “best” automobile for all conditions and purposes. Perhaps the utility of a given model of

psychotherapy supervision lies in the adequacy with which the model deals with the breadth of

possible conceptions of the interactive influences of the therapist, the client, and the therapy

context (theoretical orientations) that the supervisor is required to supervise, as well as the

degree to which the roles and characteristics of supervisors and supervisees, as well as

characteristics and processes of the supervision context, are conceptualized. Consistent with
 Supervision      9  

Greenberg’s (2002) view of psychotherapy integration, each of these models, as well as others

not addressed, may impact the supervision process at different points yet produce similar

outcomes. This should be examined at the nomothetic and idiographic levels by researchers and

practitioners.

The models reviewed here both note that they are intended to be useful across

psychotherapy orientations, so they are not tied to any one theory of therapy. They both promote

the importance of the supervision relationship, although the focus on aspects of this relationship

tends to differ between models. Ladany et al. (2005) highlight the importance of the supervision

relationship, but their frame of reference is less on teaching and learning and more on an

extension of the therapeutic working alliance for the supervision context (supervisory alliance).

They provide guidance for dealing with specific events viewed as common across supervision

dyads with a view of specific interactional sequences that they believe characterize successful

resolution of these challenging events. Stoltenberg and McNeill (2010) also note the importance

of the supervision relationship and, although they discuss interpersonal models and the

supervisory alliance, they focus more intently on the impact of levels of supervisee professional

development on how the supervisory relationship affects trainee growth and skill acquisition for

given domains. Their focus tends to extend beyond the particular supervisory relationship, and

include a consideration of the trajectory of growth across the training experience and beyond.

They also address supervisor development and how this might interact with supervisee

developmental level.

Ladany et al. (2005) focus on extending the interpersonal psychotherapy approach to the

supervision context. Thus, while specific skills are, of course, used by the supervisor,

conceptualizing the supervision process is linked more directly to interactional sequences which
 Supervision      10  

rely heavily on regular attention to the supervisory alliance and relational factors. Although

supervisor roles such as teaching, consulting, and collegiality are noted, the interpersonal

approach highlights relational aspects of therapy and the supervision process including the bond,

exploration of feelings, focus on countertransference, and attention to parallel processes between

therapy and supervision. Thus, the model appears to highlight similar processes for therapy and

supervision, assumes critical events will occur in supervision, and focuses less on an educational

framework than on processing surrounding these events. Although Stoltenberg and McNeill

(2010) note an overlap in processes between therapy and supervision, they highlight the

educational functions of supervision and how these can be optimized. Rather than positing

specific supervisor roles or functions, or interactional sequences believed to be reflective of how

supervision is conducted, they focus on supervision environments. These environments are tied

to supervisee developmental level for whatever domains are the focus of any given supervision

session. The environments vary broadly in terms of the degree of structure provided by the

supervisor or supervisee, with increasing responsibility for setting the agenda for supervision

assumed by the trainee as she or he develops in a particular area. This translates to broad

categories of supervisor interventions used differentially to meet supervisee needs and enhance

growth. There appears to be general agreement between the models that, at least implicitly, the

roles or functions of the supervisor tend to move from teaching to consultation with support and

attention to the supervisory relationship of essential importance. In addition, both models speak

to the importance of encouraging supervisee reflection processes as a goal of training as well as

focusing on the importance of multicultural issues in supervision and in therapy. Although

organized and prioritized differently, both models address similar supervisor behaviors whether

they are called roles, functions, supervision environments, supervisor interventions, or

 Supervision      11  

interactional sequences. In addition, they also address similar tasks or foci of training, although

the emphasis varies and, sometimes, must be pulled from the narratives of the books rather than

brief outlines of the models. Finally, the Stoltenberg and McNeill model deals more directly with

institutional influences on the supervision context than do Ladany et al.

Common Factors in Supervision

The focus on common factors in psychotherapy, although studied for over 70 years, has

recently increased in visibility, given the lack of strong support for the superiority of any given

therapeutic orientation (Duncan, Miller, Wampold, & Hubble, 2010; Norcross, Beutler, &

Levant, 2006). As with other perspectives first addressed in psychotherapy research and practice,

common factors in supervision have emerged as a way to seek a better understanding of the

supervision process. Lampropoulos (2002) suggests some factors he sees as common across

supervision models and promotes an eclectic and prescriptive approach to supervision. Common

factors in supervision posited by Lampropoulos include: the supervisory relationship (“real”

relationship, working alliance, transference/countertransference); support and relief from tension,

anxiety, and distress; instillation of hope and raising of expectations; self-exploration, awareness,

and insight; theoretical rationale and ritual for supervision; exposure and confrontation of

problems; acquisition and testing of new learning; and mastery of the new knowledge.

From an integrationist perspective, Norcross and Halgin (1997) suggest that supervision

be customized to the individual supervisee, based on a needs assessment, reflected in specific

supervision contracts, utilizing a breadth of supervision methods, clarifying the nature of the

supervisory relationship with supervisees, utilize a coherent framework for supervision, alter

supervision for specific supervisee variables, take the therapy approach into consideration in

deciding how to supervise, attend to the developmental level of the supervisee, their cognitive
 Supervision      12  

style and personal style, evaluate supervisees’ therapeutic skill level, and evaluate the outcomes

of supervision. Both the Lampropoulos (2002) and Norcross and Halgin (1997) views

provide lists of factors common to different supervision approaches.

Morgan and Sprenkle (2007) introduced a common factors view of supervision aimed

primarily at marriage and family therapy training and that provides a framework for examining

existing models. Their descriptive model lays out two content dimensions (what supervisors do)

including the emphasis dimension reflected as a continuum between emphasizing clinical

competence on one pole and professional competence on the other, and the specificity dimension

ranging from idiosyncratic/particular (specific needs of the supervisee and clients) to

nomothetic/general standards. A third dimension concerns the supervisory relationship (the how

of supervision) ranging from collaborative/symmetrical to directive/complementary. Placed on a

four-cornered plane with the emphasis and specificity dimensions forming the vertical and

horizontal coordinates, the relationship dimension is reflected in four supervision roles (coach,

teacher, mentor, administrator), which are described as not mutually exclusive, overlaying the

other two dimensions (see Figure 1). This model provides a rudimentary framework for

conceptualizing and categorizing various supervisory responsibilities, tasks, and roles as well as

a mechanism for considering how models of supervision address these dimensions.

As with the psychotherapy literature, common factors perspectives on supervision may

prove useful as a mechanism for examining the utility and breadth of supervision models as well

as giving supervisors and supervisees a set of variables to consider in their own supervision

experiences. Further development of this frame of reference, through research and examination

of relevant theory, might yield a useful lens for evaluating how comprehensive various models of

psychotherapy supervision are and point to areas where they may need additional development.
 Supervision      13  

An important aspect of the potential benefit of a common factors approach to supervision is the

necessity of implementing a coherent framework for supervision (Norcross & Halgin, 1997).

Sprenkle and colleagues (Sprenkle & Blow, 2004; Sprenkle, Davis, & Lebow, 2009) have noted

that in psychotherapy, common factors work through models which provide the roadmap for the

driving force of common factors. It remains to be seen how common factors will influence our

understanding of and utilization of supervision models.

Research Evidence

According to Inman and Ladany (2008) in their review of psychotherapy-based

supervision research, published studies substantially increased from the 1980’s through the

1990’s, but the growth slowed somewhat since 2000 with only a 4% increase in the number of

published studies. As we will discuss later, the challenges of conducting research on the

supervision process, measurement and methodological issues with this work limit the confidence

with which researchers and practitioners can build upon or implement the findings from these

studies. Although Ellis, D’Iuso, and Ladany (2008) have noted the quality of evaluation studies

in supervision has improved since their earlier reviews (Ellis & Ladany, 1997; Ellis, Ladany,

Krengel, & Schult, 1996), it remains difficult to draw substantive conclusions from research

when the measurements used suffer from psychometric problems. Indeed, they report finding

only one measure that they can tentatively recommend in its current form (the Evaluation

Process within Supervision Inventory; Lehrman-Waterman & Ladany, 2000). Among challenges

for supervision researchers in selecting appropriate measures is the tendency to adapt measures

from other domains (e.g., psychotherapy) for use in supervision research, which contributes to

psychometric problems (Ellis et al., 2008).

 Supervision      14  

The challenges and complexity faced by psychotherapy researchers in conducting and

implementing guidance from research (Duncan, Miller, Wampold, & Hubble, 2010; Norcross,

Beutler, & Levant, 2006) are also present in supervision research with the complications of

additional roles and functions. In addition to considering the interactive influences of therapist,

client, and therapy context, supervision researchers must also consider the roles of supervisor,

supervisee, and supervision context as well as training and evaluation functions.

Supervision Process

As with other areas of research in psychotherapy supervision, process research tends to

be limited by small sample sizes, which require alternative approaches to research design and

statistical methods (Inman & Ladany, 2008) as well as the reliance on correlational studies that

suggest associations but cannot determine causal relationships (Castonguay, Boswell,

Constantino, Goldfried, & Hill, 2010) and the separation of observations from inferences in

assessment (Ellis et al., 2008). Both psychotherapy and clinical supervision processes are

relational in nature, so a number of factors influence both processes. In addition, the training

function associated with clinical supervision should include, as content and focus, consideration

by and education of trainees regarding factors important to the successful implementation of

psychotherapy and related activities.

Therapeutic and Supervisory Relationships. Stoltenberg and McNeill (2010) have noted,

“the supervisory relationship serves as the base of all effective teaching and training” (pg. 137).

Loganbill, Hardy, and Delworth (1982) posited that the relationship serves a similar essential

function in supervision as in psychotherapy, although aspects of the relationships are quite

different. As we have previously suggested (Stoltenberg & McNeill, 2010), the focus on

relationship dynamics is important for the supervisory relationship and the supervision process,
 Supervision      15  

and should enhance the supervisory alliance as well as function as appropriate modeling for the

supervisee by the supervisor. However, as noted by Lambert and Ogles (1997), learning

interpersonal skills can occur as long as the supervisee perceives the supervisor as invested in

being helpful, even when high levels of empathy, genuineness, and unconditional positive regard

are absent.

Similar to psychotherapy research, an important factor in supervision process research

over the past 20 plus years has been the supervision working alliance (Bordin, 1983). Bahrick’s

(1990) Supervision Working Alliance Scale (SWAS) assesses the quality of the goals, tasks, and

bond dimensions of the supervisory relationship (Inman & Ladany, 2008; Ladany & Inman,

2008. Other studies have used the Supervisory Working Alliance Inventory (Efstation, Patton, &

Kardash, 1990). Both instruments have limitations, however, and Ellis (2010) has proposed that

the supervisory relationship may be comprised of 10 facets rather than the three (goals, tasks,

bond) proposed by the supervisory working alliance perspective. Studies using Bahrick’s SWAS

have indicated that a stronger supervision working alliance is related to goal setting and feedback

in supervision (Lehrman-Waterman & Ladany, 2001), supervisee satisfaction (Inman, 2006;

Ladany, Ellis, & Friedlander, 1999), greater perceptions of supervisor attractiveness and

interpersonal sensitivity (Ladany, Walker, & Melincoff, 2001), matching supervisor and

supervisee on stages of racial identity, but not supervisee-supervisor matching on ethnicity

(Ladany, Brittan-Ponell, & Pannu, 1997), and supervisor self-disclosure (Ladany & Lehrman-

Waterman, 1999). Regarding supervisor self-disclosure, Ladany and Lehrman-Waterman (1999)

have noted the importance of communicating positive and negative supervisor reactions to the

supervisee in supervision, as a function of accurate formative and/or summative feedback. Their

work also suggests that supervisor personal issues, supervisor perceptions of their own negative
 Supervision      16  

self-efficacy in supervision, as well as attraction to the supervisee should not be a focus of

supervisor self-disclosure in supervision. The supervisory working alliance also seems to

mediate burnout and the effects of vicarious traumatization as well as enhancing vigor (Deihl &

Ellis, 2009; Fama & Ellis, 2005).A weaker supervision working alliance has been found to be

related to greater supervisee role conflict and ambiguity (Ladany & Friedlander, 1995),

perceptions of poor ethical behavior of the supervisor (Ladany, Lehrman-Waterman, Molinaro,

& Wolgast, 1999), and perceptions of lower supervisor multicultural competence (Inman, 2006;

see Inman & Ladany, 2008, for review).

Bernard and Goodyear (2009) reviewed research on the supervisory working alliance by

examining antecedent factors (supervisor, supervisee, processes) associated with strong alliances

and outcomes. For positively contributing supervisor factors, they listed attractive and

interpersonally sensitive style (Chen & Bernstein, 2000; Ladany et al., 2001; Spelliscy, Chen, &

Zusho, 2007), using expert and referent power bases (Schultz, Osokie, Fried, Nelson, & Bardos,

2002), self-disclosure (Ladany & Lehrman-Waterman, 1999), healthy adult attachments (White

& Queener, 2003), and effective evaluation practices (Lehrman-Waterman & Ladany, 2001).

Supervision processes positively associated with a strong supervisory working alliance include

directly discussing racial/ethnicity issues in supervision (Gatmon et al., 2001), and supervisor-

supervisee complementarity along power dimensions in interactions (Chen & Bernstein, 2000;

Quarto, 2002). Positive outcomes from strong supervisory working alliances noted by Bernard

and Goodyear include better adherence to treatment protocols (Patton & Kivlighan, 1997),

willingness of supervisees to disclose to supervisors (Ladany et al., 1996; Webb & Wheeler,

1998), clients’ perceptions of the therapeutic alliance (Patton & Kivlighan, 1997), reduced role

conflict and ambiguity (Ladany & Friedlander, 1995); and satisfaction (Ladany, Ellis, &
 Supervision      17  

Friedlander, 1999; Ladany, Lehrman-Waterman, et al., 1999; Son, Ellis & Yoo, 2007). Although

this research is suggestive of the importance of these factors to the supervision relationship, the

studies are largely correlational. In addition, the supervision relationship is assessed in various

ways and prior critiques of the psychometric properties of these measures remain (Ellis et al.,

2008).

The supervisory relationship can be influenced by a number of factors including

characteristics of the participants, demands and constraints of the environment in which

supervision is conducted, as well as the level of relevant professional development of the

supervisor and supervisee (Stoltenberg & Pace, 2008). In regards to the latter point, Ramos-

Sanchez et al. (2002) found higher developmental levels for supervisees related to stronger

supervision working alliance and greater satisfaction with supervision, but some aspects of good

or positive supervision experiences that appear to be relatively consistent. Good supervisory

relationships tend to encompass warmth, acceptance, respect, understanding, and trust (Hutt,

Scott, & King, 1983). Supervisors who conduct supervision viewed as good by supervisees tend

to appropriately self-disclose, enable an atmosphere of experimentation, and are tolerant of

supervisee mistakes (Black, 1988; Hutt et al., 1983; Nelson, 1978). As perceived by supervisees,

good supervisors also show an interest in supervision, are experienced therapists, and have

technical and/or theoretical knowledge to convey (Nelson, 1978). Rabinowitz, Heppner, and

Roehlke (1986) found that early clarification of the supervisory relationship (within the first

three weeks) is valued by supervisees across experience levels. Ellis (1991) examined group

supervision of novice supervisors and the individual clinical supervision these students

conducted with their supervisees; he found, through critical incidents methodology, that

relationship issues were the most frequently identified in both contexts. Similarly, Ramos-
 Supervision      18  

Sanchez et al. (2002) concluded that the supervisory relationship is one of the most influential

factors in trainees’ reports of their level of satisfaction with supervision. Ultimately, displayed

empathy by the supervisor may be one of the most powerful influences on supervisee satisfaction

in supervision (Shanfield, Mohl, Matthews, & Hetherly, 1992). Indeed, Ellis (2010) has

suggested that the emotional bond is the most important aspect of the supervisory relationship.

Of course, supervisee satisfaction with supervision is not the ultimate measure of the impact of

supervision and, as reported above, supervisees can learn even in the absence of high levels of

perceived empathy on the part of the supervisor.

Qualitative studies on the supervision relationship have yielded results similar to those

found in correlational research. Worthen and McNeill (1996) reported a phenomenological

investigation of “good” supervision by conducting in-depth interviews with eight intermediate to

advanced supervisees. The supervisees reported perceptions of their status at “baseline” from

fluctuating to a grounded level of confidence and sense of disillusionment to a sense of efficacy

with the therapeutic process. Setting the stage for the good supervision experience was a

perceived need and sense of inadequacy on the part of the supervisees. There was also an

aversion to overt evaluation. Consistent with other studies, the perceived quality of the

supervisory relationship was the major component of a good supervision experience. Effective

supervisors were described as empathic, nonjudgmental, validating or affirming, and

encouraging of supervisee experimentation and exploration. Perceived support by the supervisor

and normalizing the struggles of the supervisee (often through supervisor self-disclosure) were

also seen as important. Growth in supervisees was attributed to reduced self-protectiveness in

supervision and increased receptivity to supervisory input. Nondefensive analyses,

reexamination of assumptions, and developing a meta-perspective were also seen as positive

 Supervision      19  

supervisee behaviors. Good supervision was perceived as leading to a stronger supervisory

alliance, greater confidence, refined professional identity, greater therapeutic perception, and a

better ability to conceptualize and intervene in the therapy process.

Nelson, Barnes, Evans, and Triggiano (2008) also reported the importance of the

supervisory relationship as seen by supervisors. Focusing on creating a strong supervisory

alliance was viewed by supervisors as essential for effective supervision well as discussing

evaluation early on, providing feedback, modeling openness to dealing with conflict, and

engaging in relational processing. These supervisors also reported taking a reflective stance

regarding their work in supervision, coaching themselves to empathize with their supervisees,

being patient, attending to supervisee strengths, and clarifying the developmental needs of the

supervisee.

The supervisory relationship serves as the base of all good therapeutic and professional

training (Worthen & McNeill, 1996). Clear communication and respect by the supervisor appear

to be more influential in quality supervision than the more structural and didactic components of

supervision (Allen, Szollos, & Williams, 1986). Black (1988) noted that the supervisory

relationship is the largest factor in determining whether supervision will be effective or

ineffective. Core to the development of a positive supervisory relationship is mutual trust

between the supervisor and the supervisee. As Bernard and Goodyear (2009) note, “In general,

the higher the supervisee’s level of trust in the supervisor, the less he or she will need to exhibit

the self-protective behavior that occurs as resistance; and, the less supervisee resistance, the

more effective the supervisory relationship” (pg. 173). Without trust between the supervisor and

supervisee, neither is likely to have the sense of safety that enables open communication and

collaboration in the supervision process.

 Supervision      20  

Supervisee Anxiety. Supervisee anxiety is another factor that has been posited as an

important and rather pervasive aspect of the supervision process (Bernard & Goodyear, 2009)

and has been tied to supervisee level of professional development (Liddle, 1986; Ronnestad &

Skovholt, 1993; Stoltenberg, 1981; Stoltenberg & McNeill, 2010). Ellis (2010), however,

suggests that a lack of supervisee self-efficacy, competence, or combination of the two may be

common issues in supervision, but not anxiety, at least as measured by scales developed for the

supervision context by Ellis and colleagues. Perhaps measurement issues are again clouding the

view or methodology differences are producing varying results. Interestingly, in their qualitative

study examining therapists ranging in experience from graduate school through extensive

professional practice, Skovholt and Ronnestad (1992) found higher anxiety during graduate

school reported retrospectively by practicing therapists than by current graduate students. This

may indicate a possible cohort effect or the impact of time and reflection on perceptions of

anxiety, among other possibilities.

Contrary to Ellis’ (2010) assertion, Stoltenberg, McNeill, and Delworth (1998) do not

describe anxiety as always deleterious. Nonetheless, studies have indicated that anxiety (or

related constructs such as insecurity, lacking self-confidence or self-efficacy) is often present for

beginning supervisees (Heppner & Roehlke, 1984; Reising & Daniels, 1983; Worthington,

1984), who note greater concern for supervisor perceptions of their competence than more

experienced supervisees (Rabinowitz, Heppner, & Roehlke, 1986), and are more fearful of

negative evaluation than more experienced supervisees (Winter & Holloway, 1991). Anxiety

also appears to be inversely associated with performance and counselor self-efficacy

(Friedlander, Keller, Peca-Baker, & Olk, 1986), is associated with role conflict (Olk &

Friedlander, 1992), and (when high) reduces one’s capacity to observe (Domeck & Brody,
 Supervision      21  

1995), but can be reduced by supervisor provided structure (Freeman, 1993). As Bernard and

Goodyear (2009) note, performance suffers with too little or too much anxiety; optimal anxiety

(or arousal) enables rather than inhibits better performance. They note that ambiguity in the

supervision context is likely to be the root cause, across levels of supervisee experience, of

supervisee anxiety.

Conflict and Counterproductivity in Supervision. For the supervision process to be

effective and impactful, there needs to be clear, relevant, and open communication between the

supervisor and supervisee within professionally appropriate interpersonal boundaries.

Supervisors are often limited in their opportunities to directly observe their supervisees’ work

with clients due to the lack of available technology (one way mirrors or video). Thus, they may

be forced to rely largely on supervisee self-report, case notes, etc. in monitoring and evaluating

the effectiveness of the psychotherapy provided by their supervisees. In addition, it is important

to access the thoughts and emotions of the supervisee in the therapy context as well as the

supervision context. Unfortunately, supervision is not always perceived by supervisees as a safe

place to learn. Galante (1988) found that 47% of trainees reported having experienced at least

one ineffective supervision relationship. Similarly, in describing a comprehensive survey of

nearly 400 supervisees, Ellis (2010) notes that 75% reported receiving inadequate supervision

while 51% reported receiving harmful supervision in either current or past supervisory

relationships. Ramos-Sanchez et al. (2002) note that the perceived lack of safety in the

supervision relationship can cause psychological harm to supervisees and these perceptions may

vary according to the strength of the supervision working alliance and the professional

developmental level of the supervisee.

 Supervision      22  

Inman and Ladany (2008) have noted that it is common for supervisees to withhold

important information from their supervisors (Ladany, Hill, Corbett, & Nutt, 1996), particularly

if supervisees experience shame in supervision related to the fear of negative judgments by the

supervisor concerning clinical “mistakes” or in response to negative reactions to the supervisor

(Yourman, 2003). If supervisees do not perceive the supervisory relationship as a safe

environment where their relevant thoughts, feelings, and behaviors can be explored and

processed in a nonthreatening way, the supervisory working alliance will be negatively

influenced (Gray, Ladany, Walker, & Ancis, 2001). This appears to be even more likely in group

supervision (with the additional potential for negative evaluation by peers or public shaming)

than in individual supervision (Webb & Wheeler, 1998).

Consistent with these perspectives, Magnuson, Wilcoxon, and Norem (2000) report the

results of a qualitative study of poor supervisor behaviors (from the supervisee perspective).

They note that these ineffective supervisor behaviors could be categorized as an imbalance of

focus in supervision lacking sufficient attention to all aspects of supervision, providing

developmentally inappropriate interventions, a lack of tolerance of differences, poor modeling of

an integration of personal-professional attributes, an inability to manage interpersonal

boundaries, and professional apathy.

An examination of conflictual supervision from the perspective of the supervisor was the

focus of a study by Nelson, Barnes, Evans, and Triggiano (2008). They identified highly

competent supervisors (from peer recommendations) and conducted a qualitative study on

conflict in supervision. The participants noted in interviews that conflict in supervision is not

inevitable, but when it occurs effective supervisors are open to exploring the conflict,

interpersonal processing, and are willing to acknowledge their own contributions. These
 Supervision      23  

supervisors noted that they are willing to learn from their mistakes and tend to take a

developmental orientation to their supervisee’s training. When conflicts occur, they view

contextualizing the conflicts with regard to supervisee development and environmental factors.

They are likely to seek consultation with colleagues, engage in self-coaching, and accentuate the

strengths of the supervisee. In addition, there is a willingness to interpret parallel processes

between the therapy context and the supervision process and to withdraw from supervisee

dynamics when conflicts occur.

Veach (2001) has noted that a necessary component of conflictual supervision

relationships is counterproductive events, although not all counterproductive events will result in

conflictual supervision relationships. According to Gray et al. (2001) conflictual supervision

relationships tend to be characterized by more frequent or repetitive counterproductive events

rather than occasional ones. Of course, as noted by Veach, perceptions of supervisees and

supervisors may lack consistency. Thus, research on supervision processes, including conflict or

counterproductive events, would benefit from collecting data from multiple perspectives and not

assuming congruence between supervisee and supervisor perceptions of events or processes.

Stoltenberg and McNeill (2010) have concluded that, “when supervisors attend to supervisee

needs and provide the appropriate supervisory environment corresponding to a given

developmental level, the supervisory relationship is strengthened and the potential for conflict is

reduced” (pg. 143).

Therapy Process and Outcomes. An important indication of effective supervision is client

process and outcomes of therapy conducted by supervisees. Inman and Ladany (2008) note that

at least 18 studies of the supervision process examining client outcomes have been conducted

since the 1980s. In a review of 10 of these studies, Freitas (2002) observed that, although the
 Supervision      24  

ultimate benefit of good supervision should be for the clients seen by the supervisees, proving

this empirically is complicated. Aspects of the supervision process that may be viewed as

positive or limiting the effectiveness of the supervisee appear to have limited or inconsistent

impact on client outcomes. Consistent with other supervision research, Freitas notes a lack of

psychometric data reported for the measures used in many studies, failure to control Type I and

Type II error, different levels of experience of supervisees as well as lack of uniformity of client

populations in the studies, failure to randomize therapist assignment to conditions, lack of

multiple measures of client outcome, and lack of “control” conditions (no supervision).

Nonetheless, Inman and Ladany note that the studies do provide some indication of how the

supervision process can impact client outcome.

Supervisees can adjust the way therapy is conducted if they receive ongoing and

consistent information (feedback) about client progress, particularly when problems arise

(Lambert, Hansen, & Finch, 2001). This produces greater client gains when compared with a no-

feedback supervision condition (Reese Usher, Bowman, Norsworthy, Halstead et al., 2009), and

increases the likelihood of reliable change in clients in fewer sessions (Reese, Norsworthy, &

Rowlands, 2009). Interestingly, in the Reese, Usher et al. study, receiving regular feedback on

client progress did not affect supervisee ratings of the supervisory alliance or satisfaction with

supervision. Supervisees in the feedback condition reported a stronger relationship between

counselor self-efficacy and client outcome than those in the no-feedback condition.

Conducting supervision sessions close to critical therapy sessions might also be useful

(Couchon & Bernard, 1984; Kivlighan, Angelone, & Swafford, 1991), although this might be

challenging for scheduling in many sites, particularly with supervisees who are seeing a number

of clients. Also, Kivlighan et al. found that live supervision affected therapist intention use more
 Supervision      25  

than video based supervision, and was related to a stronger therapeutic alliance. However, this

may have been affected by demand characteristics in that immediate feedback from the

supervisor and interruptions in the session could have impacted the clients’ views of therapy and

positively influenced their ratings of outcomes (Freitas, 2002).

Positive results of specific training in supervision on client outcomes were reported by

Cukrowicz, White, Reitzel, Burns, Driscoll, Kemper, and Joiner (2005). They examined changes

in client outcome at a university psychology training clinic as a function of moving from

“treatment and supervision as usual” (TAU) to supervision addressing empirically supported

treatments (ESTs). The authors concluded that this change in focus “produced better outcomes,

within fewer sessions, among a more symptomatic population of patients experiencing a wide

range of psychopathology” (pg. 334). The additional structure introduced for implementation of

treatment as well clinical supervision may have enhanced outcomes. No measures of satisfaction

with supervision were reported. Another psychology training clinic study (Callahan, Almstrom,

Swift, Borja, & Heath, 2009) found supervision accounted for about 16% of the variance in

outcome beyond variance accounted for by the treating therapist’s (supervisee) attributes and the

initial client severity level for dyads with congruent trainee-supervisor orientations. Finally, a

study of community-based interventions for child neglect also implemented a structured

evidence-based practice (EBP) approach in community agencies (Aarons, Sommerfeld, Hecht,

Silovsky, & Chaffin, 2009). There was concern that implementing such a structured approach to

intervention may have a negative impact on staff retention, so a “services as usual” approach was

compared with the EBP approach and for both approaches a fidelity monitoring condition

(consultation/supervision) and a condition without fidelity monitoring were compared. The

fidelity monitoring consisted of supportive consultation/supervision consistent with the IDM

 Supervision      26  

(Stoltenberg, McNeill, & Delworth, 1998). The EBP condition with fidelity monitoring

produced the best retention rates for staff over the course of the 29 month study. The authors

suggest that supportive consultation/supervision paired with structured interventions enhance

retention and reduce the need for regular staff recruitment, increasing program continuity.

Lambert’s program of research on the effects of providing ongoing client progress

information to therapists suggests even rather limited feedback (e.g., “red alarms” for poor

response to treatment) may be sufficient to improve outcomes (see Lambert, 2007, for review).

Castonguay et al. (2010) note that feedback measures on the therapeutic alliance, the level of

therapist engagement in treatment, and the openness of clients to their experiences are available

(Greenberg & Pinsof, 1986; Hill & Lambert, 2004) and may positively affect the therapy process

leading to improved outcomes. Rigidity in psychotherapist application of technique can result in

inadequate client assessment with insufficient understanding of client deficits or impairment,

client resources and coping behaviors (see Castonguay et al., 2010 for review), which are issues

that should be salient and amenable to change through the supervision process. Other issues

including assisting clients in replacing ineffective behaviors with more functional ones (not just

elimination) are important for supervisees to understand and implement (e.g., Goldfried &

Davison, 1994). Finally, optimal exposure duration for some interventions is necessary for client

improvement and suboptimal exposure can contribute to client deterioration (Castonguay et al.,

2010). These issues can be more effectively dealt with through ongoing client progress

information addressed through the supervision process than with supervision as usual without

such assessments.

Although causality has not yet been firmly established, Castonguay et al. (2010) argue

that training in skills that enhance the working alliance should be a focus of clinical supervision
 Supervision      27  

(see Hilsenroth, Ackerman, Clemence, Strassle, & Handler, 2002, for a list of strategies). Thus,

supervisees should become aware of the negative impact on therapy process and outcomes of

hostile control, hostile separation, overly complex interpretations, and disaffiliative processes. In

addition, Castonguay et al. argue that supervisees should become aware of their own rigid or

continued use of some techniques (i.e., cognitive-behavioral interventions, dynamic transference

interpretations) when confronted with ruptures in the working alliance, which may lead to further

deterioration of the relationship and result in poorer outcomes. They go on to note that the focus

of supervision should include attention to Lilienfeld’s (2007) list of potentially harmful

treatments and an awareness that some interventions otherwise viewed as effective may be

harmful in certain circumstances, in interaction with certain clients, in particular contexts, when

delivered by a given therapist. For example, the ineffective management (or awareness of)

countertransference reactions and confrontational self-disclosures may be viewed as noxious by

clients (Gelso, Latts, Gomez, & Fassinger, 2002; Hill, Mahalik, & Thompson, 1989). Possible

common harmful ingredients in potentially harmful treatments may include the use of pressured

confrontation in the presence of intense emotion in the client, inappropriate use of persuasion

and suggestion by the therapist, and evoking strong emotion in the client without concurrently

raising of awareness or facilitation of new meanings.

Castonguay et al. also note the importance of training supervisees in the clinically

flexible implementation of effective interventions (such as accurate interpretations, homework,

and depth of emotional experiencing) and paying attention to timing and contextual issues as

well as adequate client assessment. Finally, consistent with conclusions drawn by others (e.g.,

Goldfried & Davison, 1994), Castonguay et al. note that empathy, positive regard, and

congruence appear not to be associated with negative client outcomes and, therefore, should be a
 Supervision      28  

focus of training to enhance the therapeutic working alliance and, subsequently, therapeutic

outcomes. Thus, a focus in supervision should include education and training regarding the

impact of various supervisee (therapist) skills, rigid versus flexible implementation of

interventions, and potentially harmful treatments (or ingredients) on the development of the

therapeutic alliance.

In summary, the impact of the supervision process appears to vary depending upon where

one focuses attention. Although concerns about measurement of supervision processes remain,

correlational and qualitative studies highlight the importance and positive impact of a strong

supervisory relationship. It appears safe to assume that building a strong bond with agreed upon

goals and tasks are associated with favorable supervisee perspectives of supervision. Without the

trust and safety evident in the effective supervisory alliance, the supervisee openness necessary

for the supervisor to monitor trainee competence development and client progress appears to be

at risk. Also, the growth of supervisee self-awareness of their own cultural values, attitudes, and

their impact on clients is likely to be severely limited when supervisees feel inadequate trust in

their supervisors and safety in the supervisory context. An open process of self reflection and

discussion of difficult issues appears to be inhibited in poor supervisory relationships.

Contributions to facilitative supervisory relationships are made by both the supervisor and the

supervisee. On the other hand, although the quality of the supervisory relationship may set the

stage for important learning on the part of the supervisee, this does not substitute for specific

training in interpersonal skills, therapeutic interventions, and client characteristics. Although it is

challenging to confirm the impact of supervision, ultimately, positive processes and outcomes of

therapy conducted by supervisees remains the primary goal of effective supervision. A singular

focus on supervisee satisfaction as an indication of the effectiveness of supervision is likely to

 Supervision      29  

tap only a limited number of important influences on supervisee learning and performance. This

is highlighted in the studies showing that a greater focus on client feedback, which improves

therapy outcomes, does not necessarily result in greater supervisee satisfaction with supervision.

Finally, longitudinal studies, although complicated and expensive to conduct, are needed to track

short term and long term changes in supervision relationships, supervisee therapeutic behavior,

and therapy process and outcomes.

Participant Characteristics

Wampold’s (2006) work on psychotherapist effects suggests that characteristics of the

psychotherapist may be more predictive of outcome in therapy than the working alliance.

Correlational studies suggest that therapists with anxious attachment styles may demonstrate less

empathy with clients, particularly those with secure or dismissive attachment styles (Beutler,

Blatt, Alimohamed, Levy, & Angtuaco, 2006). In addition, therapists who are hostile toward

themselves also tend to be hostile toward their clients (Henry, Strupp, Butler, Schacht, & Binder,

1993). This suggests that supervision and training should assist supervisees to become aware of

and understand their own strengths, limitations, interpersonal vulnerabilities, and

countertransferential blind spots (Castonguay et al., 2010). Castonguay and colleagues suggest

that it is also important for trainees to become aware of and monitor how their internal

experiences impact the therapeutic relationship, being able to effectively and collaboratively

engage their clients while maintaining appropriate distance from client personal and

interpersonal dynamics within the therapy relationship. They also recommend that training

should specifically assist trainees in understanding that some clients are more challenging to

assist through therapy than others, or may respond better to some interventions than others.
 Supervision      30  

Bernard and Goodyear (2009) identified other supervisee and supervisor characteristics

that have been examined for their impact on the supervision process including cognitive or

learning styles, which have been operationalized as profiles emerging from the Myers-Briggs

Type Indicator (MBTI; Myers, 1962; Myers & McCaulley, 1985). Differences in MBTI profiles

have been found between supervisors and supervisees (Carey & Williams, 1986; Craig &

Sleight, 1990), with some limited influence on supervisor approach to supervisees with various

cognitive styles (Clingerman, 2006), supervisee preference for relationship-oriented versus task-

oriented supervision (Lochner & Melchert, 1997), but has yielded inconsistent results regarding

the effects on supervisee evaluation (Carey & Williams, 1986; Handley, 1982). In addition, some

evidence exists for matching effects for theoretical orientation between supervisors and

supervisees on the supervisory relationship (Kennard, Stewart, & Gluck, 1987; Ramos-Sanchez

et al., 2002) and preference for supervisory style (Lochner & Melchert, 1997), but appears to

have less impact than other relationship factors (Schacht, Howe, & Berman, 1989; Wetchler,

1989). Bernard and Goodyear regard these studies as indications of individual differences in

information processing and suggest supervisors need to develop the ability to flexibly respond to

supervisees with differing cognitive or learning styles.

According to Inman and Ladany (2008), over the years supervisee development has

received the greatest amount of attention in the supervision literature. Consistent with the views

of Stoltenberg (2005), and earlier reviews (Ellis & Ladany, 1997; Holloway, 1982; Stoltenberg,

McNeill, & Crethar, 1994; Watkins, 1995; Worthington, 1987) they conclude that the majority of

studies conducted examining supervisee development support the relevance of conceptualizing

supervision as a developmental process. Bernard and Goodyear (2009) echo this suggestion and

note that level of supervisee (or psychotherapist) experience is often used as a proxy for
 Supervision      31  

professional development (about 20 cited studies), and that support for supervisees at different

levels of experience demonstrating different characteristics and abilities emerges from the

majority of these studies. They warn, though, that many of these studies confound experience

with training (and development), and that there is very little evidence that experience without

training (including supervision) leads to gains in professional development.

Cognitive complexity (Duys & Hedstrom, 2000; Fong, Borders, Ethington, & Pitts, 1997;

Granello, 2002; Stein & Lambert, 1995) is assumed to enhance counseling related ability, but its

impact on cognitive development appears less strong than the impact of supervised experience

(Lovell, 1999) and tends to occur mostly in the latter part of the training program (Granello,

2002) and post degree professional experience (Skovholt & Ronnestad, 1992). Bernard and

Goodyear conclude that supervised experience is associated with supervisee increases in

cognitive complexity, which enables them to more adequately analyze and assimilate counseling

relevant information. Indeed, the growing competencies benchmarks literature assumes a

developmental process in suggesting guidelines for the acquisition of foundational and functional

competencies (Fouad et al., 2009).

Consistent with developmental approaches to supervision (Stoltenberg & McNeill, 2010),

studies indicate that supervisees of different levels of professional development require different

approaches to supervision that enhance their learning and growth. Bernard and Goodyear (2009)

cite over 20 studies providing at least partial support for developmental differences in facilitative

supervision environments for trainees across levels. Inman and Ladany (2008) summarize this

literature as indicating that beginning supervisees require more structured supervision, often

including more specific instruction and the supervisor assuming most responsibility for the

process of supervision than do advanced supervisees. Also, they note that evidence exists that
 Supervision      32  

supervisee development increases ability to engage in productive reflection and cognitive

complexity. Although not totally consistent, supervisors and supervisees tend to view

supervisees, and how supervision should be conducted, as varying as a function of experience.

However, not all investigations have been supportive of matching supervision environment to

supervisee level (Ladany, Walker, & Melincoff, 2001; Sumerel & Borders, 1996). Other studies

have indicated that additional factors such as supervisee reactance potential and crisis situations

(Tracey, Ellickson, & Sherry, 1989) as well as familiarity of the supervisee with particular client

issues (child abuse; Leach, Stoltenberg, McNeill, & Eichenfield, 1997) and severity of individual

cases (Zarski, Sand-Pringle, Panell, & Lindon, 1995) may over-ride supervisee developmental

level considerations regarding what supervision environment supervisees prefer. Stoltenberg and

colleagues (Stoltenberg & Delworth, 1987; Stoltenberg, McNeill, & Delworth, 1998; Stoltenberg

& McNeill, 2010) suggest that supervisee developmental level and needs, and the associated

facilitative supervision environments, will vary by domain and may require differing supervision

environments for various client issues within a given supervision session. Thus, more advanced

supervisees may reflect a breadth of professional development across domains and,

consequently, may require different supervision environments at different points in time

depending upon the focus in supervision. Stoltenberg (2008) describes a supervision case study

that exemplifies this effect. Also, in a qualitative study on the IDM extending over an academic

year (Ashby, Stoltenberg, & Kleine, 2010), the salience for supervisees of issues reflecting

different domains of practice were affected by context and also varied somewhat by

developmental level.

Developing the ability to augment supervision provided by a supervisor with self-

supervision is important, especially since once supervision is no longer required, self-supervision

 Supervision      33  

becomes the norm. Some of the skills noted as important for self-supervision are associated with

one’s ability to self-regulate behavior in the counseling context including reflection, monitoring,

managing, and critiquing one’s own behavior and the counseling process (Dennin & Ellis, 2003).

Evidence exists that training in self-regulation training (addressing these skills) increases a

supervisee’s ability to use metaphor, but doesn’t affect the use of empathy (Dennin & Ellis). On

the other hand, empathy training does appear to be effective in other studies (Crits-Christoph,

Gibbons, Cris-Christoph, Narduci, Schamberger, & Gallop, 2006; Hilsenroth et al., 2002), at

least in the context of training in fostering the therapeutic alliance. Clearly more research is

needed to clarify these issues. As with other areas of supervision research, most of the studies

examining supervisee development rely heavily on self-report and have significant

methodological issues. Also, a lack of longitudinal research limits our understanding of these

processes.

Multicultural Issues

The Multicultural Guidelines (APA, 2002c) serve as the general foundation of training in

issues of cultural and individual diversity, as well as more recent proposals for developing

diversity competencies (e.g., Miville et al. 2009). However, as previously noted by both

Ponterotto, Fuertes, and Chen (2000) and Constantine, Miville, and Kindaichi (2008), the

effectiveness of training in multicultural counseling competencies in regard to client outcome

remains unanswered. In contrast, research into perceptions and measurement of multicultural

competencies and related cultural issues in supervision has continued. For example, Gloria, Hird,

and Tao (2008) assessed the self-reported supervision practices, experiences, and multicultural

competence of White intern supervisors. Those who were training directors reported higher self-

perceived multicultural supervision competence than staff psychologists. Female supervisors

 Supervision      34  

also reported higher multicultural supervision competence and spent more time processing

cultural differences with their supervisees than male supervisors. From the trainee perspective, a

study by Vereen, Hill, and McNeal (2008) demonstrated a relationship between those receiving

clinical supervision related to multicultural issues and conducting counseling with more non-

White clients and perceived multicultural competence, but not for number of multicultural

courses taken. Again, these findings are based on self-reported multicultural competencies.

  Two recent studies investigated the multicultural conceptualization skills of therapists in

training. Lee and Tracey (2008) found that rated general case conceptualization skills related to

clinical training, and multicultural case conceptualization skills related to multicultural training

as advanced trainees demonstrated significantly greater complexity and expertness than

beginners. Results also demonstrated that trainees included more culturally relevant ideas when

culture was explicitly stated in case scenarios as a presenting problem, versus when culture was

implied. No differences in the conceptualizations of White trainees and trainees of color were

found. A qualitative study by Neufeldt et al. (2006) in which trainees responded to counseling

vignettes that varied along cultural dimensions also indicated that while trainees attended to both

aspects of general and multicultural case conceptualization, they varied in their ability to apply

diversity factors in their conceptualizations. Trainees of color in this small sample (N=17) also

appeared more attentive to cultural issues.

Burkard et al. (2006) found that culturally diverse trainees experienced more incidents of

“culturally unresponsive” supervision where cultural issues were ignored, actively discounted, or

dismissed by supervisors with adverse consequences for the supervisee, the supervisory

relationship, and/or client outcomes than did their European American counterparts. In contrast,

in culturally responsive supervision, trainees of all backgrounds felt supported, which positively
 Supervision      35  

affected the supervisee, the supervisory relationship, and client outcomes. Evidence presented by

Constantine and Sue (2007) also indicates that culturally diverse trainees, in this case African

Americans, continue to experience racial microagressions from White supervisors in the form of

invalidating racial-cultural issues, making stereotypic assumptions about Black clients and Black

supervisees, and offering culturally insensitive treatment recommendations, again with

detrimental effects on the trainee and supervisory relationship. Bhat and Davis (2007)

investigated the role of race, racial identity attitudes and working alliance in a sample of

predominantly White supervisors. Results revealed stronger supervisor perceptions of working

alliances for supervisory dyads with similar high levels of racial identity development and the

weakest working alliance for pairs low in racial identity development.

A recent qualitative investigation by Jernigan et al. (2010) of culturally diverse

supervisees’ viewpoints in regard to their experiences with their supervisors of Color yielded

some nuanced descriptions of the nature of their supervisory relationships around dynamics of

race and racial identity. In general, supervisees believed that they more often raised the issue of

race in supervision, and perceived positive responses from their supervisors when they did,

describing their supervisors as challenging, encouraging, and enlightening. However, when they

perceived supervisors’ responses as unsupportive, trainees felt angry, confused, resentful, and

discouraged resulting in an internalization of self-doubt and incompetence. Another recent

qualitative investigation by Verdinelli and Biever (2009) explored Spanish language services

supervision experiences of bilingual graduate students and professionals (predominately

Latina/o) in a summer training program. Findings indicated that participants felt burdened and  

stressed by the additional responsibilities of providing services in Spanish and their sense of

obligation to their Spanish-speaking clients. They also reported that they had previous
 Supervision      36  

inadequate training or supervision, relying on peer support and networking to cope with such

challenges. Conversely, trainees appreciated having supervisors who were culturally competent

and open to client’s cultural values. These qualitative studies provide rich, detailed descriptions

of the phenomena under investigation, serving to provide supervisors with recommendations for

working with issues of race in supervision, as well as to stimulate further research utilizing

diverse methodologies.

In a similar vein, a recent special issue of Training and Education in Professional

Psychology titled Sharing Wisdom: Ethnic Minority Supervisor Perspectives provides a number

of narrative accounts of culturally diverse supervisors and supervisees from Asian-American

(Yabusaki, 2010; Lo, 2010; Murphy-Shigematsu, 2010), Latina/o American ( Reynaga-Abiko,

2010; Millán, 2010), and African-American perspectives (Butler-Byrd, 2010). Other recent work

from a theoretical/conceptual viewpoint has addressed issues of mentoring of culturally diverse

students (Alvarez, Blume, Cervantes, & Thomas, 2009), supervision of Latinas from a

multicultural developmental perspective (Field, Chavez-Korell, & Domenech Rodríguez, 2010),

enhancement of multicultural competence in supervision (Ober, Granello, & Henfield, 2009),

supervisee competence in the context of poverty (Smith, 2009), multicultural assessment

supervision (Allen, 2007), training in spirituality (Hage, Hopson, Siegel, Payton, & DeFanti,

2006) a social justice approach to supervision (Hernández, 2008), feminist multicultural

perspectives on supervision (Nelson et al., 2006), and the integration of multicultural supervision

domains with gay/lesbian models of supervision (Singh & Chun, 2010). This recent theoretical,

descriptive, and conceptual literature represents a diversity of dynamic, innovative thinking with

the potential to generate any number of hypotheses that might generate further empirical

scrutiny. Such topics might include, but are certainly not limited to the effects of
 Supervision      37  

microaggressions, cultural identity, and relational safety upon the supervisory process and

relationship.

Some issues are emerging in importance in this area. Group supervision in regards to

multicultural issues has received some recent attention in the form of models of structured peer

group supervision (Lassiter, Napolitano, Culbreth, & Ng, 2008) and the investigation of helpful

and hindering multicultural events in group supervision (Kaduvettoor et al., 2009). Helpful

events related to supervisee multicultural competence fell into categories of peer vicarious

learning, multicultural learning and conceptualization, extra-group events, and supervisor direct

influence. Hindering events included indirect discussions and peer multicultural conflicts,

supervisor multicultural conflicts and misapplications of multicultural theory, which were

negatively related to supervisee multicultural competence. Riva and Erickson Cornish (2008)

surveyed predoctoral internship sites in regards to group supervision practices and multicultural

considerations in group supervision and found 91% of group supervisors indicated that they

attended to multicultural issues, which ranked second to ethical and legal issues as part of

discussions or special topics in group supervision.

Another topic that has recently received increased attention is the training and

supervision of international students. Mori, Inman, and Caskie (2009) found that international

student supervisees who had lower acculturation levels but greater cultural discussion in the form

of dialogues with their supervisors regarding cultural influences, showed more satisfaction with

supervision, and that cultural discussion partially mediated the relationship between perceived

supervisor cultural competence and satisfaction with supervision. Other recent studies have

documented the experiences of international students, which reveal adjustment problems, a need

for more academic and career support, and increased recognition for their cultural differences
 Supervision      38  

(Mittal & Wieling, 2006), as well as the interestingly different approaches and experiences of

Korean clinical supervisors who appear to apply developmental concepts and exploration of

trainee’s personal issues within a uniquely Korean cultural context (Bang & Park, 2009).

Ethical and Legal Considerations in Supervision

Prior reviews by Werth, Cummings, and Thompson (2008) and Ladany and Inman (2008)

addressed ethical and legal issues in supervision, and there continues to be a dearth of

empirically based research examining ethical issues and behaviors in supervision. While Barnett,

Cornish, Goodyear, and Lichtenberg (2007) appropriately assert that modeling ethical and

professional behavior with an emphasis on ethical practice in supervision is an essential quality

of effective supervisors, Ladany, Lehrman-Waterman, Molinaro and Wolgast (1999) previously

found that 50% of surveyed trainees perceived their supervisors to have engaged in unethical

practice during their supervision experience. In addition, Worthington, Tan, and Poulin (2002)

found that both supervisors and supervisees reported engaging in various types of ethically

questionable behaviors. More recently, a national survey of APA student affiliates by

Zakrzewski (2006) continues to present a somewhat mixed picture in that 9.2 % of all

participants indicated that they had experienced a sexual contact, advance, or both with a

psychology educator while they were a student, typically initiated by the educator. In addition,

53% of the students reported that they would not feel safe to pursue appropriate actions if they

had firsthand knowledge of a sexual contact occurring. Clearly, more research is needed to

determine the effects of the typically mandated ethics training in accredited programs, as well as

the practices of educators and supervisors.

On the other hand, recent theoretical and conceptual literature has addressed issues of

multiple relationships in supervision (Gottlieb, Robinson, & Younggren, 2007; Heaton & Black,
 Supervision      39  

2010), the use of contracts in supervision to provide informed consent (Thomas, 2007), and

supervision of couples cases (Stratton & Smith, 2006). Handelsman, Gottlieb, and Knapp (2005)

present a conceptualization of ethics training as an acculturation model in which students are

confronted with new ethical principles and rules reflective of the culture of psychology, which

may be inconsistent with their own moral value traditions. Additionally, Schwartz, Domenech

Rodriguez, Santiago-Rivera, Arredondo, and Field (2010) have recently opened up a dialogue

on the increasingly important ethical considerations regarding the cultural and linguistic

competencies in the supervision of culturally diverse trainees and their diverse clientele in

languages other than English (e.g., Spanish).

Competence to Supervise. As previously noted by Werth et al. (2008), research in regard

to the competence of faculty and supervisors is “essentially nonexistent” (p. 8). Stoltenberg and

McNeill (2010) reviewed the various sections of the current Ethical Principles of Psychologists

and Code of Conduct (APA, 2002) that addresses the education and training of students and

design of training programs (Standard 7.0), student feedback processes (Standard 7.06), student

disclosure of personal information (Standards 7.04-05), sexual relationships between students

and supervisors (Standard 7.07), as well as Standard 3.08 prohibiting exploitive relationships and

Standard 2.05 regarding delegation of work to others which are both applicable to supervisees.

We also noted that there are no explicit guidelines regarding the conduct of supervision,

qualifications, or competencies of clinical supervisors.

In contrast, the Association for Counselor Education and Supervision in its Ethical

Guidelines for Counseling Supervisors (1993) explicitly states that supervisors should have

training in supervision. In addition, the Approved Clinical Supervisor credential and the

accompanying Code of Ethics (Center for Credentialing and Education, 2001) require graduate
 Supervision      40  

training and/or experience in supervision content areas, leading to certification as a clinical

supervisor. The current edition of the American Counseling Association Code of Ethics (ACA,

2005) devotes a complete section on supervision, teaching, and training including supervisor

preparation. Recent work by Falender et al. (2004) as part of the APPIC Competencies

conference provides supervision competencies addressing such areas as knowledge, skills,

values, and social contexts. Additional competencies address the need to train supervisors via

coursework and experience as a supervisor, and assessment of supervisor competence. While a

survey of internship training directors by Rings et al. (2009) indicated agreement on the

importance of these competencies, they demonstrated disagreement on the importance of

coursework and supervision of supervision as competencies. Participants who had received these

types of training experiences were more likely to endorse their importance in training

supervisors.

Perhaps the findings of Rings et al. (2009) explain the somewhat curious situation that

the development of supervisor competencies has yet to influence the majority of state boards of

psychology, which typically require only that supervisors possess experience as a clinician.

Similarly the Association of State and Provincial Psychology Boards (ASPPB) Guidelines for

Practicum Experience (ASPPB, 2008) assume only that a qualified supervisor is one who is

licensed or certified to engage in the practice of psychology, and that supervisors have “adequate

training, knowledge, and skill to render competently any psychological service which their

supervisees undertake” (p. 3). In addition, the ASPPB (1998) Supervision Guidelines, while

addressing the setting, nature, duration of contact, and necessity to provide feedback, again do

not set any qualifications for supervisors beyond experience as a clinician.

 Supervision      41  

Other Issues of Liability. In addition to the work on problematic students, previous work

by Dennis Saccuzzo, who is both a licensed psychologist and attorney, provides perhaps the most

useful and comprehensive review of liability and standards of care in supervision (2002, 2003).

More recently, articles by Recupero and Rainey (2007) and Hall, Macvaugh, Merideth, and

Montgomery (2007) also provide updates and helpful guidelines for risk management for

psychotherapy supervision. This work, as well as the previously mentioned articles by Elman et

al. (1999) and Kaslow et al. (2007) should be considered essential reading for Directors of

Training, as well as university attorneys who are often not aware of the issues specific to

problematic students in professional psychology programs.

An emerging issue regarding ethics and legal considerations is online supervision.

Mallen, Vogel, and Rochlen (2005) provided a comprehensive review of the ethics, training,

technology, and competency issues related to online counseling, as well as the issues related to

supervision of online counseling and provision of online supervision. Certain limitations are

apparent including the establishment of the supervisory relationship with the absence of

contextual and nonverbal cues, immediate availability of supervisors for emergency or

immediate consultation, and full disclosure of online procedures to clients. Bacigulape (2010)

advances the case for “e-supervision” citing the opportunity to work with supervisees at different

geographical locations, expanding services to areas of need, and obtaining supervision or

consultation from experts in areas of expertise not locally available. However, Vaccarro and

Lambie (2007) raise a number of ethical considerations including confidentiality/security,

liability, and technological competence. These authors also note the lack of procedural and

ethical guidelines by most professional organizations regarding computer-based supervision.

Additionally, the rapidly evolving nature of online communication technology challenges the
 Supervision      42  

most technologically competent supervisor in terms of managing confidentiality, informed

consent, jurisdictional, and legal issues.

Attempting to address these issues, the APA Commission on Accreditation (COA, 2009a,

2009b) recently released mandated guidelines on both distance and electronically mediated

education in doctoral programs, as well as “telesupervision” which is defined as “clinical

supervision of psychological services through a synchronous audio and video format where the

supervisor is not in the same physical facility as the trainee” (2009a, p. 1). While practicum

experiences must be conducted face-to-face and cannot be completed through distance education,

a number of guidelines apply to telesupervision. These guidelines include the necessity for a

formal policy with an explicit rationale for using telesupervision, how it is consistent with the

program’s model of training, how and when it is utilized, how it is determined which trainees can

participate, and how an off-site supervisor maintains full professional and responsibility for

clinical cases. In addition, the formal policy must address how non-scheduled consultation and

crisis coverage are managed, assurance of privacy and confidentiality issues for clients and

trainees, and the technology, quality, and educational requirements for trainees and supervisors.

Finally, “telesupervision may not account for more than 50% of the total supervision at a given

practicum site, and may not be utilized at all until a student has completed his/her first practicum

with substantial intervention experience with the doctoral program (2009a, p. 1)” or in the case

of pre-doctoral internship programs “may not account for more than one hour (50%) of the

minimum required (as defined in the G&P) two weekly hours of individual supervision, and two

hours (50%) of the minimum required (as defined in the G&P) four total weekly hours of

supervision (2009a, p1). Despite the above guidelines, the growth of telesupervision appears to
 Supervision      43  

be out pacing the ability to generate research to account for its potential strengths, limitations,

ethical guidelines, and legalities.

Competencies

There has been considerable movement over the past few years in the development of

competency benchmarks for professional psychology with a focus on health service practice

which, of course, includes counseling psychology. Essential resources for exploring the

competency framework include the Fouad et al. (2009) article on competency benchmarks and

the accompanying article from the same issue (Kaslow et al., 2009) on the competency

assessment toolkit. Additional articles in that issue of Training and Education in Professional

Psychology highlight strengths and challenges of the identification, assessment, and

implementation of the competencies framework. Fouad et al. note that the benchmarks document

is not intended to be prescriptive, but rather to “describe a path to this end as opposed to

prescribing what programs need to do” (pg. S8). Preliminary to this effort, yet still quite useful,

is an outline of competencies for practica offered by Hatcher and Lassiter (2007).

  Fouad et al. present 15 core competencies including foundational and functional

competencies, each of which is defined with essential components and behavioral anchors for

each of three levels of professional development (i.e., readiness for practicum, readiness for

internship, readiness for entry into practice). The foundational competencies include:

professionalism, reflective practice, scientific knowledge and methods, relationships, individual

and cultural diversity, ethical and legal standards and policy, and interdisciplinary systems. The

functional competencies include: assessment, intervention, consultation, research and evaluation,

supervision, teaching, administration, and advocacy. Fouad et al. note, “By examining these

descriptors for each competency, one can see the development of knowledge, skill, and attitude
 Supervision      44  

expected with the competency area” (pg. S8) for each developmental level. It is apparent that a

number of the foundational and functional competencies may be addressed in the supervision

process, and there is considerable overlap with areas of focus of supervision articulated by

various models and discussions of supervision. Attending to these competencies, the associated

essential components, and the behavioral anchors may provide useful guidance to supervisors,

supervisees, and training programs regarding what should be addressed and evaluated in

supervision. The specific functional competency labeled “supervision” reflects the importance of

understanding the supervision process including both the supervisee and supervisor roles at the

three levels of professional development (readiness for practicum, internship, entry into

practice). As can be seen, these components tap a range of aspects of supervision including the

following essential components: expectations and roles, processes and procedures, skills

development, awareness of factors affecting quality, participation process, and ethical and legal

issues, which are further refined with behavioral anchors (see Figure 2).

The companion article (Kaslow, Grus et al., 2009) presents a “toolkit,” which lists

specific methods to assess the competencies noted in the benchmarks article, essential

components, whether the tool is useful for formative or summative evaluations, and the

developmental level(s) for which the method is appropriate. Assessment methods are offered

(15) that are identified as very useful, useful, or potentially useful for each essential element of

the core competencies. For example, under the supervision functional competency, skills

development (essential element), “very useful” methods include: consumer surveys, objective

structured clinical examinations, ratings performance, simulations/role plays, and standard

patient interviews.
 Supervision      45  

The development of the competencies benchmarks and competency assessment toolkit is

a monumental undertaking reflecting the work of a number of professional psychologists,

particularly representatives of the training councils. It also entails a fundamental “culture” shift

from monitoring courses completed, practica hours, and other “exposure” criteria to behaviorally

anchored essential elements across 15 competencies. Although significant progress has been

made regarding the delineation of competencies, differences are likely to remain in perceptions

of which competencies are important for various specialties (e.g., clinical, counseling, school),

different training models (e.g., clinical scientist, scientist-practitioner, scholar-practitioner),

therapeutic theoretical orientations, and institutional settings (Lichtenberg et al., 2007). In

addition, the competency benchmarks lack empirical validation and it remains to be seen which

of the aspects of the approach appear most salient for different constituencies, and how

psychometric rigor balances with costs, efficiencies, and informativeness (DeMers, 2009). In

discussing the challenges faced by competency assessments in medicine, Schulte and Daley

(2009) have noted the relatively poor accuracy, reliability, and validity of the assessments due to

the “highly contextualized nature of service delivery” and the ratings of performance dimensions

intended “to capture nuanced judgments of trainees” (pg. S55). They go on to note that these

ratings can be easily influenced or distorted by raters, their personal theories, values, and the

consequences of evaluation outcomes. However, a positive attribute of the competency

benchmarks document is the provision of a conceptual map, allowing programs and supervisors

to consider the breadth of issues relevant to training and suggestions for how to operationalize

them for evaluation and decision-making.

Future Directions
 Supervision      46  

The domain of psychotherapy supervision is alive and well, yet many challenges remain

and considerable work is left to be done. We have argued that supervision shares processes in

common with psychotherapy, but is not the same as psychotherapy. Still, the challenges that

psychotherapy research and practice face are some of the same challenges encountered by those

who engage in supervision. However, the research through which we understand the supervision

process and acquire evidence to support the practice of supervision remains quite limited. Also,

the quality of the research and the confidence we may have in the conclusions we can draw from

this research are also limited.

Ellis, D’Iuso, and Ladany (2008) note that none of the measures typically used to

evaluate supervision have adequate psychometric development regarding reliability and validity.

They make specific recommendations for future measures for supervision including identifying

the constructs and contexts of interest, developing item pools, sampling issues, score stability,

using multimethod-multitrait approaches to measurement, and testing inferences. Clearly,

without sound measures we lack confidence in how to interpret current supervision research.

Ladany and Inman (2008) offer a number of recommendations for future research and

scholarship in supervision including attention to covert processes (what is not said in

supervision), supervisee development, parallel processes between therapy and supervision (how

they occur, what are the benefits), self-supervision (adequacy and training, the role of reflective

processes), supervisor self-disclosure, recording supervisee counseling sessions (although

advisable, researching positive and negative implications), supervision ethics (violations by

supervisors and implications), supervisor countertransference (how it influences supervision),

supervisor training (how it influences supervision), and the impact of supervision on client

outcomes, among others.

 Supervision      47  

Work has begun in these areas, but clarification of the influence of these issues across

supervisors, supervisees, and supervision contexts remain. As suggested by Stoltenberg and

McNeill (2010), and consistent with emerging work on competencies benchmarks, examining

issues for particular levels of supervisee development is important work that remains to be done.

How various issues, characteristics, components, and factors influence the learning process in

supervision for trainees at different junctures in their professional growth needs to be examined,

domain by domain, in considerably more detail that what we have accomplished. Examining

trainee learning and development within specific supervision relationships (often quite time-

limited, three to four months), across supervision relationships (how does the focus on which

domains in prior supervision dyads affect the focus and learning in subsequent dyads), and

across the training experience (from entry to graduate school to advanced professional status)

remains to be accomplished. This necessitates longitudinal studies with all the challenges and

expenses associated with this approach. Also, empirical examination of the developmental

sequences proposed by Ladany et al. (2005) that are hypothesized to occur within specific

supervision dyads is necessary. For example, are the supervision relationships adequately

characterized by Bordin’s (1983) model, or do they significantly differ from the psychotherapy

relationships that formed the basis of this model? How are all of these factors impacted by

individual characteristics of the supervisor and supervisee including, of course, issues of

diversity and cultural influences as well as personal growth and adjustment?

As we have noted, the growth of telesupervision and electronically mediated education

appears to be outpacing our understanding, evaluation, and research on the impact of the new

technologies. Considerable work remains to examine the possible advantages, disadvantages,

ethical challenges, and legal implications of these practices.

 Supervision      48  

The work undertaken on common factors in psychotherapy has stimulated considerable

discussion and debate. Is the search for common factors in supervision a productive path toward

understanding and optimizing the supervision process? Similarly, the foundational and functional

competencies (and associated components and behavioral anchors) of the competencies

movement need to be carefully operationalized for various training environments and the impact

of attending to and evaluating these competencies for clinical supervision needs to be assessed.

Does engaging in this process produce greater professional development than current

supervision-as-usual approaches? Is the “what” that is focused on in supervision and training of

primary importance, or is the “how” of supervision more impactful on learning and

development? Does the “what” impact the “how,” or are supervision processes sufficiently

robust across issues, topics, and therapy theoretical orientations?

Wampold (2001, 2006) has challenged the primacy of specific therapy theories and

specific techniques in psychotherapy. Does the “dodo bird” hypothesis fly (or, more accurately,

not fly) for supervision as for psychotherapy? Are most supervisors doing a good job, while

some are excellent and others inadequate? What distinguishes these classifications and to what

extent can training impact these effects? We see parallels between Wampold’s (2010)

recommendations for psychotherapy research and practice and where supervision research and

practice should focus. Specifically, research should focus primarily on understanding the process

of supervision and how outcomes (supervisee and client) can be improved. Although we have

little evidence suggesting any approach to supervision is superior to others, we should avoid

engaging in “race horse” comparisons or mandating approaches until we know considerably

more about the supervision process and how it is impacted by supervisor and supervisee

characteristics, contexts, and clients. Finally, supervisors should be accountable for the outcomes
 Supervision      49  

of supervision, which includes supervisee learning and development and client improvement. To

this end, supervisees need access to information about their clients’ perceptions of the

therapeutic relationship and outcomes, and supervisors need to assess the impact of their

supervision sessions on the supervisee and his or her work with clients. Applying Wampold’s

perspective on psychotherapy to supervision, practice-based evidence may have as much or more

impact on the processes and outcomes of supervision than evidence-based practice. Although we

have rudimentary “maps” available to organize our efforts, we need to implement, evaluate, and

modify them to move forward with a full understanding that the map is not the territory

(Korzybski, 1948).

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 Supervision      76  

Clinical
Competence Coach Teacher

Emphasis

Mentor Administrator
Professional

Competence

Idiosyncratic / Nomothetic /
Particular Specificity General
 Supervision      77  

Figure 1  
 
From “Toward a common-factors approach to supervision,” by M. M. Morgan and D. H.
Sprenkle, 2007, Journal of Marital and Family Therapy, 33, p. 11. Coopyright [2007] by
John Wiley & Sons, Inc. Reprinted with permission.    
 Supervision      78  

Supervision- Supervision and training in the professional knowledge base and of evaluation of the
effectiveness of various professional activities

Developmental Level

A. Expectations and Roles

Readiness for Practicum Readiness for Internship Readiness for Entry to Practice

Essential Component: Essential Component: Essential Component:

Basic knowledge of Knowledge of purpose for and Understands complexity of the

expectations for supervision roles in supervision. supervisor role including ethical,
legal, and contextual issues

Behavioral Anchor:
Behavioral Anchor: Behavioral Anchor:
• Articulates a philosophy or model
• Demonstrates knowledge of • Identifies roles and of supervision and reflects on how
the process of supervision responsibilities of the this model is applied in practice,
supervisor and supervisee in including integrated contextual,
the supervision process legal, and ethical perspectives

B. Processes and Procedures

Readiness for Practicum Readiness for Internship Readiness for Entry to Practice

Essential Component: Essential Component: Essential Component:

Knowledge of procedures and
Knowledge of the processes of supervision Knowledge of procedures and
practices of supervision
Behavioral Anchor:
• Identifies goals and tasks of
supervision related to
developmental progression Behavioral Anchor:
Behavioral Anchor:
• Tracks progress achieving
goals and setting new goals • Prepares supervision contract
• Demonstrates basic • Demonstrates knowledge of limits
knowledge of supervision of competency to supervise
models and practice (assesses metacompetency)
• Constructs plans to deal with areas
of limited competency
 Supervision      79  

C. Skills Development

Readiness for Practicum Readiness  for  Internship   Readiness  for  Entry  to  Practice  

Essential Components Essential  Component:     Essential  Component:  

Interpersonal skills of Knowledge  of  the  supervision   Engages  in  professional  reflection  
communication and openness literature  and  how  clinicians   about  one’s  clinical  relationships  with  
to feedback develop  to  be  skilled  professionals   supervisees,  as  well  as  supervisees’  
relationships  with  their  clients    
   
 
 
Behavioral  Anchor:  
Behavioral  Anchor:    
• Clearly  articulates  how  to  use  
Behavioral Anchor • Successfully  completes   supervisory  relationships  to  
coursework  on  supervision   leverage  development  of  
• Completes self-assessment • Demonstrates  formation  of   supervisees  and  their  clients  
(e.g., Hatcher & Lassiter, supervisory  relationship  
2006) integrating  theory  and  skills  
• Integrates including  knowledge  of  
faculty/supervisor feedback development,  educational  praxis  
into self-assessment  

D. Awareness of factors affecting quality

Readiness for Practicum Readiness  for  Internship   Readiness  for  Entry  to  Practice  

Essential Component: Essential  Component:   Essential  component:  

Basic knowledge of and Knowledge  about  the  impact  of   Understanding  of  other  individuals  
sensitivity to issues related to diversity  on  all  professional   and  groups  and  intersection  
individual and cultural settings  and  supervision   dimensions  of  diversity  in  the  context  
differences (i.e., the APA participants  including  self  as   of  supervision  practice,  able  to  engage  
definition) as they apply to defined  by  APA  policy;  beginning   in  reflection  on  the  role  of  one’s  self  
the supervision process and knowledge  of  personal   on  therapy  and  in  supervision  
relationships contribution  to  therapy  and  to  
 
supervision  
 
 

Behavioral  Anchor:   Behavioral  Anchor:  

Behavioral Anchor: • Demonstrates  integration  of  diversity  
• Demonstrates  knowledge  of  
and  multiple  identity  aspects  in  
 Supervision      80  

• Demonstrates basic ICD  literature  and  APA   conceptualization  of  supervision  

knowledge of literature on guidelines  in  supervision   process  with  all  participants  
individual and cultural practice   (client(s),  supervisee,  supervisor)  
differences and engages in • Demonstrates  awareness  of   • Demonstrates  adaptation  of  own  
respectful interactions that role  of  oppression  and  privilege   professional  behavior  in  a  culturally  
reflect that knowledge on  supervision  process   sensitive  manner  as  appropriate  to  
  the  needs  of  the  supervision  context  
and  all  parties  in  it  
• Articulates  and  uses  diversity  
appropriate  repertoire  of  skills  and  
techniques  in  supervisory  process    
• Identifies  impact  of  aspects  of  self  in  
therapy  and  supervision  

E. Participation in Supervision Process

Readiness for Practicum Readiness for Internship Readiness for Entry to Practice

Essential Component: Essential Component: Essential Component:

Awareness of need for Observation of and Provides supervision

straightforward, truthful, participation in supervisory independently to others in routine
and respectful process (e.g., peer supervision) cases
communication in
supervisory relationship

Behavioral Anchor: Behavioral Anchor:

• Reflects on supervision Behavioral Anchor:

• Demonstrates willingness to
admit errors, accept process, areas of strength and
those needing improvement • Provides supervision to less
feedback
• Seeks supervision to improve advanced trainees, peers or other
performance, presenting work service providers in typical cases
for feedback, and integrating appropriate to the service setting.
feedback into performance
F. Ethical and Legal Issues
 Supervision      81  

Readiness for Practicum Readiness for Internship Readiness for Entry to Practice

Essential Component: Essential Component: Essential Component:

Knowledge of principles of Knowledge of and compliance Command of and application of

ethical practice and basic with ethical/professional codes, relevant ethical, legal, and
skills in supervisory ethical standards and guidelines; professional standards and
decision making, knowledge institutional policies; laws, guidelines
of legal and regulatory issues statutes, rules, regulations, and
in supervision case law relevant to the
practice of psychology and its
supervision

Behavioral Anchor:
Behavioral Anchor:
• Behaves ethically
• Recognizes ethical and legal Behavioral Anchor:
• Demonstrates
understanding of this issues in clinical practice and
supervision • Spontaneously and reliably
knowledge (e.g., APA
identifies complex ethical and
2002 ethical principles)
legal issues in supervision, and
analyzes and proactively
addresses them
• Demonstrates awareness of
potential conflicts in complex
ethical and legal issues in
supervision

 
 Supervision      82  

Figure 2

From “Competency benchmarks: A model for understanding and measuring competence in

professional psychology across training levels,” by N. A. Fouad, C. L. Grus, R. L.

Hatcher, N. J. Kaslow, P. S. Hutchings, M. B. Madson, F. L. Collins, Jr., and R. E.

Crossman, 2009, Training and Education in Professional Psychology, 3, pp. S21-S23.

Copyright [2009] by American Psychological Association.

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