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"You Said What?" - Becoming a Better Supervisor
by Carol Falender, Ph.D.

6 Credit hours - $99

Last revised: 03/27/2007

Course content © copyright 2005-2007 by Carol Falender, Ph.D.. All rights reserved.

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Learning Objectives

This is an intermediate level course. After taking this course mental health professionals will be able to:

Course Outline

Part I – Introduction and Definitions

Supervision may well be the highest calling in psychology and other mental health professions. It entails the transmission of knowledge and art, mentoring, gatekeeping, monitoring and evaluating, and developing a relationship that serves as the foundation for the process. It is the way the profession is communicated and transmitted from generation to generation of practitioners. This process used to be informal and occurred essentially through osmosis. Now we realize the need for a formal process as the fields have evolved and supervision has become a core competency in mental health. Supervision requires the supervisor to assess and evaluate levels of supervisee readiness, competence, and affect, reflect upon these in the supervisor oneself, and to weave a tapestry of thought and feeling which translates into effective clinical intervention. These supervisory roles seem inherently inconsistent and require substantial articulation and attention. While the role of supervisor is weighty, it is also replete with potential for growth, development, inquiry, and excitement.

The purpose of this course is to provide a philosophy and a methodology for the practice of high quality supervision. Through competency-based supervision, and a strength-based orientation, many supervisee problems will be prevented. Emphasis upon strength, supplemented with encouragement in areas of lesser strength, provide for the sturdiest supervisory relationship and one that can easily sustain—and flourish with constructive feedback.

Competency-based supervision includes 1) identification of competencies site-specific; 2) initial assessment of supervisee’s level of competencies including knowledge, skills, and values; 3) ongoing evaluation and feedback and evaluation of supervisee competencies at completion of the training sequence.

Contextually, supervision consists of relationships among client (s), supervisee (therapist), supervisor, clinical setting of therapy, community, and the associated influences of culture/diversity in its broadest sense (ethnicity, religion, race, gender, SES, gender identity, educational level, etc.) and the discipline(s) in which one is practicing. To understand the complexity, one needs to consider the breadth of each domain, and then the interactions among them.

For the client/family, there is the reason for coming to therapy, often precipitated by a traumatic or painful event, revelation, or disclosure. There are fears or anger and reticence to enter therapy; anxiety about entry, process, and the therapist; paperwork that may be a barrier; cultural or diversity considerations that may make therapy a dystonic experience; lack of familiarity with the system; fears that secrets may be revealed; and hope for the future.

In the supervisee’s domain, there is the developmental status, uncertainty of role, feelings of inadequacy, feelings of dominance and knowing the family/client better than anyone else, eagerness to help the client, eagerness to please the supervisor, fear of failure, theories and ideas of conceptualization, dynamics and interventions, cultural-diversity identification, curiosity, or lack of information, identification with the family, client, and/or supervisor, and a desire to individuate and be a competent independent practitioner.

For the supervisor, there are the multiple roles, the feelings of optimism about the supervisory and therapy process, and perhaps some tentative anxiety about the competence of the supervisee (or the supervisor) to tackle this very difficult client/family. Add the primary supervisory roles of teacher, counselor, consultant (Ellis & Dell, 1986), facilitator, administrator (Bernard & Goodyear, 1998), and monitor/evaluator, instructor/advisor, model, supporter/sharer, and consultant (Holloway, 1999), and that supervision should also integrate supportive and affective components.

Contextual variables include all the community, social, socioeconomic, circumstances and associated attitudes and values. Each profession brings to supervision—and therapy—beliefs about how mental illness comes about, and how one can intervene most effectively.

Although clinical supervision is performed by a majority of psychologists, social workers, marriage and family therapists, psychiatrists, nurses, as well as other mental health professionals, and is the primary form of transmission of clinical skills, formal training and standards have lagged far behind. The Association of State and Provincial Psychology Boards concluded in their task force on supervision that, “Given the critical role of supervision in the protection of the public and in the training and practice of psychologists, it is surprising that organized psychology, with few exceptions, has failed to establish a requirement for graduate level training in supervision. Few supervisors report having had formal courses on supervision, and most rely on their own experience as a supervisee” (ASPPB, 2003, p. 1). Fewer than 20% of supervisors have had formal training in supervision (Peake, Nussbaum, & Tindell, 2002). Marriage and family therapy and counseling psychology have been exceptions however. Marriage and family therapists have a certification in supervision, which entails supervision of supervision. That supervision is a neglected area is clear, but it has now been recognized as a distinct practice area and is a central domain of training (Falender et al., 2004). Training in supervision in doctoral and graduate programs is variable, with greater occurrence in counseling programs than in clinical, but with a huge variety in value attached to such training and implementation strategies (Scott, Ingram, Vitanza, & Smith, 2000).

Definitions of Supervision

There are numerous definitions of supervision. Some of the critical components are protection of the client, gatekeeper for the profession, evaluator of the supervisee, provider of knowledge and skills, and transmitter of values.

In an intriguing definition, described by Bernard and Goodyear (1998) by Acker, the supervisory relationship is described as one between unequals, with the objective of equalization. Although seemingly an inherent contradiction, or a paradox, this is the challenge in supervision

Falender and Shafranske (2004) defined clinical supervision as “a distinct professional activity in which education and training aimed at developing science-informed practice is facilitated through a collaborative interpersonal process (mindful of the power differential). Supervision involves observation, evaluation, self-assessment and feedback, the acquisition of knowledge and skills by instruction, modeling and mutual problem solving, and encourages self-efficacy, building upon the recognition of the strengths and talents of the supervisee. Supervision insures that clinical consultation is conducted in a competent manner in which ethical standards, legal prescriptions, and professional practices are employed to promote and protect the welfare of the client, the profession, and society at large.” (p. 3) Particularly important in this definition are the concepts of collaboration—that the supervisee learns from the supervisor while the supervisor learns from the supervisee—which is a step away from the usual hierarchical supervision model in which the supervisor is on a pedestal. However, there is the power differential since it the supervisor who will sign off on the successful completion of the training and who will write the letters of recommendation.

Another definition of supervision, which comes from the counseling psychology perspective, is that of Bernard and Goodyear. Bernard and Goodyear (2004) defined supervision as “an intervention provided by a more senior member of a profession to a more junior member or members of that same profession. This relationship is evaluative, extends over time, and has the simultaneous purposes of enhancing the professional functioning of the more junior person(s), monitoring the quality of professional services offered to the clients that she, he, or they see, and serving as a gatekeeper for those who are to enter the particular profession” (p. 8).

ASPPB defined supervision as “the relationship focused on the development, enhancement and evaluation of the supervisee’s skills, knowledge and behavior in the practice of psychology” (ASPPB, 2003, p. 2).

In fact, the term “supervision” is derived from the Latin for super (above or over) and vision or sight.

Each definition has a different focus. Falender and Shafranske place significant emphasis not simply on relationship, but also on self-assessment, processes of supervision, and the legal, ethical, and general context in which supervision occurs. They emphasize collaboration between supervisor and supervisee—a respectful interchange, remaining mindful of the power differential. Through collaboration and relationship, the supervisee grows. Bernard and Goodyear emphasize the transmission of knowledge from a senior member to another in the context of evaluation with regard for legal and ethical considerations.

Each supervisor must come to his/her own balance between a positive, facilitative supervisory relationship that embodies empathy, positive regard, and support, and the evaluative function that comes with the role. The greater the emphasis on informed consent—informing the supervisee of the evaluative realities of the relationship—the greater the success of the supervisory relationship.

In competency-based supervision, there are several major components. The supervisor must understand the competencies at entry of the supervisee. The supervisor must have a plan as to what competencies that supervisee must have upon completion of a time interval or training sequence. And the supervisor must him/her self have competencies of the supervisor including knowledge, skills, and values which have been established and will be described in Part IV – Competencies. Components of competency based supervision include the supervisory relationship, understanding of the level and competencies of the supervisee, being a competent supervisor, and engaging in role invocation, discussion of evaluation and the power differential, and providing ongoing feedback, positive and negative.

Think about which definition of supervision is most meaningful to you—what are the most important components of supervision? Also begin to think about which competencies are most important and relevant to your particular supervision context.

Part II – Beginning the Supervisory Relationship

Supervisory Alliance

A critical first step in the supervisory process is establishing the supervisory alliance. A cardinal rule of supervision is to balance the power differential of the supervisor and the evaluative function, which is implicit in the supervisory role with the development of the supervisory alliance in which both develop shared goals, tasks to achieve these, and an emotional bond (Bordin, 1989). The clearer the expectations are for the supervisory relationship, the better. To establish the supervisory alliance, supervisor and supervisee must establish a relationship of trust. Through the interaction that ensues, the supervisor and supervisee develop a set of goals that are relevant to the developmental level of the supervisee and which are specific to the setting and context in which the supervision occurs. Once established, specific tasks to achieve these are formulated. The emotional bond is created and strengthened through this process in which supervisor and supervisee are focused on the specifics of the supervision process.

Examples of supervisory goals might be:

Specific Tasks which could be developed for these

It is possible to develop goals and tasks using multiple theoretical orientations.

Exercise:

Develop supervisory goals and tasks with a particular supervisee. Or role-play this process with a colleague for practice.

Role Invocation

As a way to orient the supervisee and the supervisor to the task of supervision, it is useful for the supervisor to use “role invocation,” or identification of the specific expectations the supervisor has regarding the supervision experience. Each of us has a sense of what comprises the “ideal supervisee” or the supervisee we prefer to work with. Through role invocation, the supervisor can specify particular behaviors either from Vesper et al.’s (2002) Supervisory Utilization Rating Form (SURF) or simply from making a list of behaviors most important to the individual supervisor or setting.

Types of areas to be covered in role invocation include the expectations and ground rules of supervision starting with such basics as format for supervision; what the supervisee should bring in terms of written, audio, or video materials; ethical, legal, and site regulations; and general expectations such as being interactive, and coming to supervision with a formulation or questions. Thorough role invocation is an excellent part of establishment of the supervisory relationship.

Make a list of the aspects of the supervisee role that are most important to you. Examples might be, being prepared for supervision with treatment notes and questions, accepting feedback, interest in theoretical perspectives, etc.

Another interesting aspect of role invocation is its possible contribution to dialogic reflexivity (Hawes, 1993). Dialogic reflexivity refers to “a process of explicitly turning one’s critical gaze back on oneself as well as the professional, historical, and cultural discourses that empower and constrain one’s capacities to think and act in the context of the relationship” (Hawes, 1993, p. 105-106). Two processes occur—the private thoughts of the participants and the dialogue between them, all considered in the broader context. Through role invocation, the supervisee could become acquainted with the expectation that all these variables are to be considered and of the substantial supervisee role in the process. In proposed collaborative forms of supervision, concern has been expressed that there is the reality of the power differential, which manifests itself in knowledge differentials, and in legal and ethical mandates, including protection of the client’s welfare as the supervisor’s highest duty. Through dialogic reflexivity, the supervisor and supervisee can develop a dialogue about the contextual factors and the particular manifestations of power, both through role invocation in setting the stage and in an ongoing manner. The supervisor can and should initiate this discussion.

Generally, it is most important to infuse supervision with informed consent so that supervisees are aware of the evaluation component, and so that feedback will be forthcoming and ongoing, and that it will NEVER be a surprise. This is directly addressed in the sections on feedback and informed consent.

How Important is Relationship?

Relationship is critical to effective clinical supervision. With relationship comes trust and the ability to disclose, receive difficult feedback, and confront difficult issues in therapy and supervision.

Several researchers provide empirical support for the importance of relationship. Holloway (1992) summarized that, in literature on supervisee characteristics across levels of experience, the only differences were between beginning practicum and intern-level supervisees, and that these involved relationship characteristics. Beginning supervisees appeared to require more support and encouragement while interns were striving for independence and wanting to explore personal issues like countertransference. Cook and Helms (1988) reported that the supervisor’s liking and positive feelings towards supervisees accounted for 69.4% of the variance predicting satisfaction in supervision. The stronger the emotional bond between supervisor and supervisee, the less role conflict was experienced by the supervisee (Ladany & Friedlander, 1995). The emotional bond was also positively related to satisfaction with supervision (Ladany, Ellis, & Friedlander, 1999). Efstation et al. (1990) defined three factors of the working alliance in the context of relationship: client focus, rapport, and identification. These were postulated to be pivotal in development, and provide a different approach to analysis of relationship.

Support should be a constant throughout the training process (Heppner & Roehlke, 1984; Worthen & McNeill, 1996; Worthington, 1984). Manifestation of support changes with personal characteristics and with experience level of the supervisee. The supervision progression seems to move from supportive through encouragement of growth to empowering and trusting enough to explore countertransference issues and to encourage creativity and innovation. For the supervisee, the relationship seems to evolve through dependency, growth of trust, and individuation or evolution of relationship to that of a colleague. Based on existent research, it is impossible to define empirically a quality relationship. Whiston and Emerson (1989) caution that the supervisor needs to ensure that “promoting insight, sensitivity, and personal growth in supervisees does not become counseling” (p. 321). Maintaining appropriate boundaries and not moving into the therapy domain is a central element of effective supervision.

Brief Background on Theory Regarding Relationship in Supervision

In the conceptual framework to approach supervision, consider particular aspects of multiple theories. Hess (1987) in his discussion of Martin Buber’s concept of relationship describes how it relates to the conceptualization of the supervisory process. Hess (1987) encapsulates this as the “mode by which a humanizing, spiritual exchange occurs.” Worthington (1987) points out the neglect of relationship in the literature. That relationship is undervalued in the formulation and articulation of developmental theories is central in Ellis and Ladany’s (1997) critical review of developmental research in support of theory. They conclude, “The quality of the supervisory relationship is paramount to successful supervision.” (p. 495) Holloway (1987) suggests that the supervisory process can more parsimoniously be explained in the supervisor-supervisee relationship; and is “as a result of being in an intensive, evaluative, ongoing, and demanding relationship.” (p. 215)

Also important are attachment theory, personality, and intellectual variables powerful in the formulation of relationships. Attachment theory aids the supervisor in the understanding of the fragile process of attachment-individuation within supervisory relationships. Watkins (1995) suggests the use of attachment styles in understanding pathological relationships in supervision. His premise is that the majority of supervisees in fact develop secure attachments with their supervisors. This would provide a basis for trust and relating throughout the supervisory relationship, and would provide the stage for evaluative feedback, which is such a central part of development. Watkins (1995) suggests that the one-on-one supervisory relationship may be the first place in graduate school where such a “different focus, relationship, process, and demands” (p. 339) are experienced. Equally important is cognizance of the more normative attachment process in which the supervisor may serve as a secure base for exploration, and has the opportunity to shift onus and responsibility gradually to empower the supervisee. The secure base, a concept derived from Bowlby (1988), provides for reduction in feelings of isolation by supervisees, a sense of confidence in monitoring and supervision, and a constant resource—the supervisor, available anytime, without fail (Pistole & Watkins, 1995). The sense of awe, enthusiasm, wonder, and curiosity instilled in supervisees is akin to solution-focused therapists’ approach to both clients and supervision. Add to this respect for the values, learning, and thoughts of the supervisee, and one has the essential elements of quality supervision.

Another important theory is Erikson’s theory of development (Loganbill, Hardy, & Delworth, 1982), and more specifically, a focus on the positive, optimistic, and trusting aspects of supervisees and supervisors as adaptive human beings in their journey (Erikson, 1968). What has been misplaced in some of the theories is this basic optimism about development and Erikson’s focus on fostering “competence, identity, love, and wisdom.” By allowing cognitive theories to supersede these variables, some of the essential core of developmental theory has been lost.

As Seligman and Csikszentmihalyi (2000) described in their positive psychology, we have ignored our “hope, wisdom, creativity, future-mindedness, courage, spirituality, responsibility, and perseverance” (p. 5). This is evident in the process of supervision where the focus on pathology has seriously constricted the range of relationship and experience. The application of positive psychology to the entire supervisory process is powerful. Thinking preventively and positively are the hallmarks of successful supervision.

Vignette: The supervisee comes for the first supervision session. You have met her one time before and felt very positively about her. How will you begin establishment of the supervisory alliance? What will you say? What forms of information and assessment are necessary? What aspects of role invocation will you use?

Evaluation and Relationship: How Can You Do Both?

The other element often shortchanged or ignored is the evaluative function, which provides a context and an ethical and professional structure to the relationship. It is also the sine qua non from the perspective of the universities, professional schools, and licensing bodies. That “evaluation is one of the most critical issues in establishing the supervisory relationship” (Holloway, 1995, p. 3) is a core concept. To varying degrees, at all levels of training, the supervisee, and supervisor are cognizant that the supervisor is a potent force in the supervisee’s future in terms of the evaluation of specific competencies. Although there is ample literature on supervisors’ aversion to evaluation (Robiner et al., 1993), this is not a justification for its omission. A limitation of some of the research has been failure to consider how the evaluative stance influences each step of the supervisee’s journey. Hansen (1965) described the limitations evaluation placed on supervisees’ expectations of supervisory relationships. Role ambiguity was defined by Olk and Friedlander (1992) as the supervisee’s uncertainty about how he/she would be evaluated and what the expectations were.

But how can a supervisor be an evaluator and have a strong supervisory alliance? The most highly rated supervisors are those who give evaluative feedback. Clarity and communication of expectations are a critical component underlying relationship, and therefore working alliance. Ellis and Ladany (1997) support the position that evaluation, being central and implicit in supervision, needs to be operationalized and incorporated into the research. Holloway (1999) describes the supervisory act of monitoring and evaluating performance as a “function of supervision” (p. 20), but warns of the reward and coercive power of the supervisor. Evaluation is the backdrop against which supervision is conducted as supervisors have a sense of standards to which they are comparing performance. Evaluation should also be viewed as constructive, with frequent, ongoing input on the direction of the intervention and therapy. It should not be a distant hallmark at the end of the training sequence.

It is important to lay groundwork for evaluation by letting supervisees know you will be giving feedback every session and that the “law of no surprises” is operative: the supervisee will be the first to know if you have performance concerns.

Think of the following sequence and how you would give feedback:

In the fifth supervision session of a second year student, the supervisor became concerned that the supervisee seemed to be using a very directive approach, constantly telling the adult client what to do. It was not clear to the supervisor this was the best approach, but he wanted to discuss it with the supervisee. How would it be best to introduce the topic? Think of several ways to do so.

An issue is the supervisory alliance that has been established. Possible approaches are 1) reflection on how the therapy is going; 2) expression of curiosity about why that particular approach is being used, 3) wondering how the supervisee is feeling in the session with the client—and many others as well. Think of approaches you currently use and what is most effective. How do you vary your approach with different supervisees? What are some of the variables you take into consideration?

A significant portion of early supervision is socialization and patterning of the supervisee into the interactive mode of supervision, and honing the shared experience with a sense of humor and perspective. There is also the instillation of curiosity into the process so that the supervisee can approach each new client/ family with a spirit of openness and active, accepting curiosity. This approach is along the lines of the solution-focused therapy model. The relationship quality may have mediating or moderating effects. Hess (1987) observed, “because supervision is primarily growth oriented, deals with putatively healthy people, has skill and value inculcation as its goals, and is centered on the relationship, a theory specific to the supervisory relationship is central” (p. 187). In addition, we know that often what happens in supervision is replicated in the therapy process—in a “parallel process” or a reenactment of the process of supervision. Thus, if a supervisor is challenging and angry with a supervisee, that same process may be enacted between the supervisee/therapist and the client.

In cognitive-behavioral supervision, the contract can be constructed around requirements specific to setting, competencies to be attained—evaluation can focus on the competency document as can frequent and ongoing feedback and assessment.

How is Supervision Distinguished From Therapy?

It is critical to distinguish supervision from therapy – and also from consultation. Differentiating between supervision and therapy is a topic that will arise several times in this course. Studies of good and effective supervisors versus those who inflict harm show us that supervisors who cross the boundary and become therapists to their supervisees inflict substantial harm. Whiston and Emerson (1989) described the difficulty of switching from the empathic supervisor to the evaluator (and critiquer of the supervisee’s work), but emphasize the importance of remaining focused on the professional development of the supervisee in the context of his/her work with the client, rather than segueing to the development of action plans for the supervisee’s personal problems. A line must be drawn and maintained to keep the focus on the supervisee’s process and behavior with the client. This becomes an issue of informed consent, with it being extremely important for the supervisor to establish from the beginning of supervision that supervision is a distinct practice area separate from therapy or counseling. Whiston and Emerson (1989) proposed use of Egan’s (1986) model wherein using informed consent, the role of the supervisor when problems arise is elaborated upon, and clarified and explored to determine if the supervisee’s personal problems are interfering with client work. It is possible the process of supervision per se will be creating tensions or increasing personal issues of supervisees. Nevertheless, the supervisor should only explore and clarify problems of supervisees that are creating impasses in their clinical work. It is not the role of the supervisor to move beyond that exploration and clarification. In the second and third stages of Egan’s model, the line from supervision to counseling or therapy is crossed and thus, these stages should not be approached in supervision, but by an independent therapist. These stages entail establishing an action-oriented understanding of the personal problem of the supervisee, and determining through this exploration whether the personal problems are the reasons for difficulty with a particular client. Then, means are determined to accomplish goals to address the problems defined.

The rule of thumb then is that supervision keeps focus on the client and on the supervisory process. When the supervisor slides into exploration of the supervisee’s psyche, early childhood, etc., a boundary has been crossed.

Exercise:

Decide which of these are appropriate for supervision and which would require a referral for therapy or other external support:

  1. Supervisee discloses that client reminds her of her mother.
  2. Supervisee becomes tearful week after week in supervision when discussing particular cases, even after extensive intervention on countertransference. Supervisee discloses she also became tearful with the client in the previous week for no apparent reason she could identify.
  3. Supervisee asks supervisor to give advice on her impending separation and divorce, as she knows the supervisor has recently gone through a similar thing.
  4. Supervisee tells supervisor that she feels mildly angry with the mother in the family she is seeing.

Most supervisors would find 2 and 3 to be highly problematic and requiring additional steps. In 2, immediate attention should be given (probably even sooner than this) to the possibility that this client should be transferred to another therapist, as a cardinal rule of every profession is “do no harm”. Then the supervisor needs to discuss the pattern of response of the supervisee and plan with the supervisee specific steps to ensure that his/her needs are met outside of supervision. This process could even entail a leave of absence if deemed necessary.

In 3., the supervisee needs the supervisor to set boundaries and assist the supervisee in seeking appropriate supports for this major life event, and to explore the impact this might be having on clients being seen.

In 1 and 4, the supervisee can explore countertransference when the supervisee is in a less reactive state, and most likely, an exercise in differentiating the supervisor from the mother (in 1) or separating the client from other individuals with whom the supervisee might feel or have felt angry, have good results. If not, and a pattern emerges, then the additional steps taken in 2 and 3 could be implemented.

How is Supervision Distinguished From Consultation?

Supervision must also be distinguished from consultation. Differences are that in supervision, information is passed from a licensed person, who holds legal responsibility, to an unlicensed person. The unlicensed person is required to follow the directives of the licensed individual who is his/her supervisor. In consultation, both parties are licensed and insured, and the recipient of the consultation is not required to follow the directives or advice of the consultant. In both circumstances, individuals function with informed consent. In supervision, clients need to be informed that they are being seen by a supervisee who is not licensed and who is functioning under the licensure of a supervisor who is named and who will have access to their clinical records. In consultation, clients are informed that their therapist will be consulting with an individual regarding their case and that individual will be given information regarding the client.

What do you do if another supervisor’s supervisee comes to you for consultation?

It would be important to clarify roles and responsibilities—and to coordinate with the other supervisor, perhaps arranging a joint meeting to “consult” or for the other supervisor to obtain input from the second supervisor. Remember that the primary supervisor is legally responsible for the supervisee’s therapy with the clients.

How Is Supervision Distinguished From Mentoring?

Supervision always involves the evaluative component. In mentoring, the mentee typically chooses the mentor, the mentor does not evaluate the mentee, and the mentor assists the mentee in acquiring professional role development, contacts with relevant colleagues, research, and a multitude of professional activities including conferences, meetings, etc. Some supervisors do mentor but they use informed consent to think proactively about the possible conflicts that might arise when both roles are occurring with a given supervisee-mentee. Possible worst-case scenarios might include having to give negative, constructive feedback to the supervisee and then presenting a paper together later the same day! Or having to hold a supervisee back from going on internship and then introducing them in a prearranged way to colleagues at a meeting with whom they might collaborate in research.

Part III – How Do I Do This? How Do I Become a Supervisor?

Clinician to Supervisor

The progression of becoming a supervisor is one of integrating theory (of supervision and of therapy), interpersonal skills, and focus. Specific competencies of the supervisor will be described in Part IV – Competencies. There needs to be a shift. Borders (1992) describes the cognitive shift from clinician to supervisor. Here are some examples of ways clinicians take their skills into the supervisory arena—the first two being problematic:

  1. Supervisors who think like clinicians and see supervisees as surrogates… These beginning supervisors make thorough, copious notes about client when they review tapes, generate numerous hypotheses about dynamics, & devise plans for working with client. They come to supervision totally well prepared and tell the supervisee exactly what to do, or actually what they should have done—a monologue or mini-lecture. They act as if they are not aware of supervisee reactions, and fail to hear anything that the supervisee has to say. The supervisee emerges from supervision feeling inadequate and overwhelmed, unable to enact the supervisor’s directives as the next session does not go exactly as planned or as the last one did, and because they have not integrated ideas or conceptualizations into their thinking.
  2. Supervisors who focus on the supervisee as a client… These supervisors are very attuned to supervisees’ personal issues; assume supervisee intrapsychic dynamics are the sole reason for shortcomings in supervisees’ performance (“What keeps you from doing that?” “Is that true in other areas of your life?” or “I am thinking the depression is actually in you and only being mirrored by the client.). These supervisors do not assess what skills the supervisee actually has as opposed to skills they are afraid to do.
  3. Supervisors who think of supervisees as learner and themselves as educators… Strategize to help the supervisee be more effective with the client
    1. Such supervisors give priority to learning needs and meeting supervisee needs.
    2. “How can I intervene so that this counselor will be more effective with current and future clients?” A proactive stance—a discovery/learning process.

Falender and Shafranske (2004) posit that there is an even “higher” outcome in which supervisors see supervisees as active contributors to the process, and as collaborators in the supervision process, so that supervisee and supervisor both grow through the interaction.

Some of these developing supervisees in the categories above (#1 and #2) do not progress onward to become good supervisors. This is a very big problem for their supervisees.

There are other categories of problem supervisor (adapted from Liese & Beck, 1997 in Watkins, 1997). They include:

How to Help Therapists Make the Cognitive Shift to Supervisors

  1. Tape review: supervisors take notes on session as if they were going to meet with supervisee in next 15 minutes. Count number of statements about client, then the number about the supervisee, to focus on meeting with supervisee not the client
  2. Planning for supervision sessions: deliberate educational planning—help supervisees develop 3 to 5 learning goals for a period of time—supervisors review a tape and list strengths and areas for improvement; assess counselor’s developmental issues and stages (this would be concordant with the whole process of development of supervisory alliance)
  3. Draw on own experiences in the supervision-related roles of therapist, teacher, or consultant (This might involve some self-disclosure of a supervisor to a beginning supervisor)
  4. Supervisors write case notes that include goals for supervision session, brief summary, and evaluation of their own performance
  5. Live supervision and live observation
  6. Interpersonal process recall (Bernard, 1989): supervisor recalls thoughts and feelings during supervision session
  7. Peer review: peer group review of videotaped supervision sessions; supervisor establishes goals and requests feedback on his/her own performance.
  8. Modeling and metamodeling; writing learning goals for supervision internship; use of role play, IPR; metamodeling based on recognition of a parallel process and deliberately exploiting that dynamic. An intervention is chosen to parallel the intervention the supervisor and supervisee need to make.
  9. Supervision of supervision including review of therapy tapes by supervisory group, role plays of difficult supervision situations, simulations, sharing of research and theories (adapted from Borders, 1992)

An excellent resource for beginning supervisors is Susan Neufeldt’s Supervision Strategies for the First Practicum (2007) in which the author provides a somewhat manualized approach to supervision through use of topical areas and targeted dialogues.

Part IV – Competencies

A more recent development in supervision is development of specific competencies that define it. In 2002, the Association of Psychology Postdoctoral and Internship Centers conducted a conference and the outcome was a series of papers on competencies comprising different aspects of practice. One was devoted to Supervision Competencies (Falender et al, 2004). A guiding definition was provided by Epstein & Hundert (2002) who defined competency as “habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served (p. 227). Thus, supervision competencies were defined as knowledge, skills, and values associated with supervision. Supra-ordinate factors that were recognized were:

The Supervisor Competencies Framework

The framework for supervisor competencies is laid out in the areas of knowledge, skills, values, and social context. These are conceptualized as basic, entry-level competencies. A full description is available in Falender et al. (2004). Please note these were defined for the psychology supervisor and were a product of the Association of Psychology Postdoctoral and Internship Centers Competencies Conference (APPIC), which occurred in 2002.

Please self-assess your supervisory competencies—presently and what you aspire to. Think about your current practice and directions you would like to increase your knowledge, skills, values and attitudes, and contextual competence.

Supervision Competencies Framework*

(Rank present from 7 (superior) to 1 (absence of knowledge, skill, value); signify high priority to enhance competence items in column with “X”)
   

X

Present

Aspirational

Knowledge
 

Of area being supervised

      
 

Of models, theories, modalities, and research on supervision

      
 

Of professional/supervisee development

      
 

Of evaluation, process/ outcome

      
 

Awareness of diversity in all forms

      

Skills
 

Supervision modalities

      
 

Relationship skills

      
 

Sensitivity to multiple roles: Perform and balance

      
 

Provide effective formative and summative feedback

      
 

Promote growth and self-assessment in trainee

      
 

Conduct own self-assessment

      
 

Assess learning needs and developmental level of supervisee

      
 

Encourage and use evaluative feedback from trainee

      
 

Teaching and didactic skills

      
 

Set appropriate boundaries and seek consultation when supervisory issues are outside domain of supervisor competence

      
 

Flexibility

      
 

Scientific thinking and translation of scientific finding to practice throughout professional development

      

Values
 

Responsibility for client and supervisee

      
 

Respectful

      
 

Responsibility for sensitivity to diversity in all forms

      
 

Balance between support and challenging

      
 

Empowering

      
 

Commitment to lifelong learning and professional growth

      
 

Balance between clinical and training needs

      
 

Value ethical principles

      
 

Commitment to knowing and utilizing available psychological science related to supervision

      
 

Commitment to knowing one’s own limitations

      

Social Context Overarching Issues
 

Diversity

      
 

Ethical and legal issues

      
 

Developmental process

      
 

Knowledge of immediate system and expectations within which the supervision is conducted

      
 

Creation of climate in which honest feedback is the norm (supportive and challenging)

      

Training of Supervision Competencies
 

Coursework in supervision including knowledge and skill areas listed

      
 

Has received supervision of supervision including some form of observation (video or audiotape) with critical feedback

      

Assessment of Supervision Competencies
 

Successful completion of course on supervision

      
 

Verification of previous supervision of supervision document readiness to supervise independently

      
 

Evidence of direct observation (e.g., audio or videotape)

      
 

Documentation of supervisory experience reflecting diversity

      
 

Documented supervisee feedback

      
 

Self-assessment and awareness of need for consultation when necessary

      
 

Assessment of supervision outcomes—both individual and group

      

Other to be defined by supervisor/setting
         
         

*Derived from Falender, C.A., Cornish, J.A.E., Goodyear, R., Hatcher, R., Kaslow, N.J., Leventhal, G., Shafranske, E., & Sigman, S. (2004). Defining competencies in psychology supervision: A consensus statement. Journal of Clinical Psychology, 60, 771-785, with permission of publisher and author.

After completing this self-assessment, highlight sections that are aspiration and describe how you plan to enhance your competency.

Considered together, these factors serve as a basis for understanding the competencies needed for a supervisor to be minimally competent. Because supervisory competence is a lifelong process, it is important to consider each of these factors as developmental and continuous, so that supervisory competencies are always evolving and developing.

As this self-assessment was designed for psychology supervisors, think about what other aspects should be added to reflect your particular discipline. Some ideas will be available in the competency assessments (for supervisees) that follow.

Supervisee Competencies

Use of competencies marks a significant change in procedures for assessment and evaluation. Defining and measuring competencies sets a standard against which development of the supervisee can be charted and tracked. Multiple disciplines have developed competencies. We will consider psychology, social work, and marriage and family therapy.

Psychology Competencies

The ADPTC document defines competencies of readiness for practicum and those at completion of practicum experience, at the point of entry into internship. This document is in use by many practicum settings and in university and professional schools to track and assess competency development.

The Benchmarks conference (2006) focused on development of assessment techniques for each of the following transition points:

This document was based on the cube model, distinguishing between foundational and functional competencies.

Foundational competencies include

Supervision is a functional competency. (It will be referenced when it becomes available on the APA Education Directorate website.)

http://www.appic.org/downloads/competencies-supervision.ppt#3

Social Work Competencies:

Significant effort has gone into the development of the CALSWECII documents. They are exemplary and are already adopted as evaluation and monitoring tools for many schools of social work and field placements.

Foundational Year: http://calswec.berkeley.edu/MH_Competencies_Fdn_Year.pdf

Specific Competencies: http://calswec.berkeley.edu/MH_Matrix_Competencies_Fdn.pdf

Advanced Specialization Year: http://calswec.berkeley.edu/MH_Competencies_Adv_Specializn_06.pdf

Specific Competencies: http://calswec.berkeley.edu/MH_Matrix_Competencies_Adv.pdf

Marriage and Family Therapy Competencies: A document is available for supervisee competencies:

http://www.bbs.ca.gov/pdf/mhsa/resource/workforce/aamft_core_competencies.pdf

An article explaining the development of core competencies is available:

Nelson, T.S., Chenail, R.J., Alexander, J.F., Crane, D.R., Johnson, S.M, & Schwallie, L. (2007). The development of core competencies for the practice of marriage and family therapy. Journal of Marital and Family Therapy, 33, 417-438.

Let’s consider some of the components of the Hatcher and Lassiter (2005) competencies document and the CalSwec II.

In Hatcher and Lassiter, baseline competencies are described: those which supervisees should possess and demonstrate prior to beginning their first practicum placement. Areas included are personality characteristics, intellectual and personal skills that include empathy, respect for and interest in other’s cultures, values, etc. Also included are integrity, honesty, valuing ethical behavior, affect tolerance, tolerance of ambiguity, openness to new ideas, personal organization, personal hygiene, and appropriate dress. It is important to review this document carefully as this is a standard of practice, establishing criteria for individuals entering the field of psychology.

In the CALSWEC II document, Foundational competencies relate to Culturally and Linguistically Competent Generalist Practice, including knowledge and understanding of all aspects of diversity, trauma, and legal and historical relationships, especially with the US government and the American Indian/Alaskan Native nations, values of traditional practices, issues facing immigrants and how these relate to mental health and services, assimilation and acculturation, and how social work values impact the individual and each of these, as well as how the student’s own diversity variables and status impacts each client including biases, prejudices, and awareness of disparities. The CALSWEC II document goes on to describe competencies for practice with individuals, families, groups, community, human behavior and the social environment, and workplace management. This is also a critical document to examine if you are training social workers. Many universities are using it or a derivative of this for evaluation purposes.

The AAMFT Competencies are organized around 6 primary domains and 5 secondary: admission to treatment (interactions leading to establishing the therapeutic contract), clinical assessment and diagnosis, treatment planning and case management, therapeutic interventions, legal issues, ethics, and standards, and research and program evaluation. Types of skill and knowledge are conceptual, perceptual, executive, evaluative, and professional. It is critical to review this document carefully if you are supervising MFT students or interns.

Please note that similar documents are available for nursing, psychiatry, and many other disciplines.

Each supervisor should keep with him/her a copy of the respective documents for the disciplines they supervise as well as the respective codes of ethics for the discipline—and refer to them frequently to model good practice to the supervisee.

Competency-based Supervision

Competency based supervision refers to consideration of the component knowledge, skills, and values or attitudes of each area of supervised practice, initial assessment, ongoing assessment and feedback, and final evaluation.

Increasingly, mental health professionals are turning towards identification of competencies, which can define performance of service. This is as significant an issue as the definition of the competencies that constitute supervision. APPIC sponsored a “Competencies Conference” in an effort to describe more thoroughly specific competencies of different aspects of professional functioning. As an outcome of the APPIC Competencies Conference, a number of papers were published. One of these papers, mentioned earlier, was on competencies of the supervisor by Falender, Cornish, Goodyear, Hatcher, Kaslow, Leventhal, Shafranske, Sigmon, Stoltenberg, and Grus (2004).

Also very important is a paper by Nadine Kaslow (2004) in the American Psychologist on competencies. She defined foundational competencies of diversity and ethical practice:

In addition, there are specialty competencies that require additional, specialized knowledge, skills, and attitudes.

Assessment of competence is complex and as defined by Kaslow (2004) takes into account developmental factors and self-assessment, and should be multi-trial, multi-method, and multi-informant. Kaslow (2004) advocates 360-degree feedback which is actually not conceptualized as evaluation but as developmental feedback, in which input is received from multiple constituencies including supervisors, peers, clients, and other parties and involve multiple skill, knowledge, attitudinal, and interpersonal, emotional factors. This process is derived from business and organizational psychology.

It is important for a training site or an individual supervisor to consider the existing documents on competencies and the particular site requirements to determine which competencies are relevant for supervisees in each particular setting. Supervisors who function in specialized settings should seek out supervision literature specific to the models they are using. For example, in Falender and Shafranske (2007) there are examples of cognitive behavioral supervision, psychodynamic, and family systems as well as other applied examples of supervisory experience. Neill (2006) provided approaches to particular child supervision derived from therapy models such as filial therapy, multisystemic, and dialectical behavioral therapy. Whatever the context or model, there should be a direct relationship between the competencies document and assessment of the supervisees and the training contract or agreement so that the expectations of the setting are clear-cut and laid out.

The greater the specificity of competency assessment, the more effective the evaluation and the contract can be.

Contract or Training Agreement

The contract or supervisory agreement (which reaches beyond the basic structure of a supervisory agreement required in some states) is a means of articulating the roles, responsibilities, expectations, and requirements of the training period. Components of the contract include:

The contract or agreement is a critical part of the supervisory relationship. It is the set of expectations that is translated into the evaluation prototype, which is also presented to the supervisee at the onset of the training sequence. Please note that each setting will have its own criteria and competencies, although there may be more overlap in the specific performance expectation section. For this reason, each setting should tailor its competencies, agreement, and evaluation to meet its individual needs.

Part V – Other Models and Theories of Supervision

Before you begin this section, think about what models and theories of supervision influence your practice. List them. Then as you progress through this section, think about which of these relate most readily to your own practice.

Theory-based Models

Among the approaches to supervision are the psychotherapy-based approaches including psychodynamic, cognitive-behavioral, intersubjective or narrative, dialectical behavioral therapy, and systemic and family systems. Supervision mirrors the therapy process reflected in the theoretical orientation. Models also include process-oriented approaches, systems-oriented approaches, and developmental approaches (Falender & Shafranske, 2004).

Although there are multiple models that reflect the psychodynamic orientation, Eckstein and Wallerstein (1972) were very influential in describing the relationships among the three parties in supervision—client, therapist, and supervisor— and how the relationships reflect upon each other. Interest in transference, countertransference, and working alliance and parallel processes have all been exceptionally important to the understanding of supervision and will be discussed throughout the course.

Cognitive-behavioral models have provided for structured supervision protocols and even manualized supervision (Henggeler & Schoenwald, 1998). They provide an excellent structure for supervision of cognitive-behavioral therapy.

Dialectical behavioral therapy supervision focuses on a type of parallel process with the therapist treating the client, and the supervisor “treating” the supervisee (Fruzzetti, Waltz, & Linehan, 1997). Intriguing aspects of this model are the assumptions that the dialectical agreement is negotiated such that there is no absolute truth, and that the therapist is fallible, not necessarily consistent, and consults with the client on interacting effectively with professionals.

Narrative or intersubjective models, or postmodern, deal heavily with context and social interaction. Supervision mirrors the therapy in which the clients present their story and the therapist is the editor and enhancer. The supervisor assists the supervisee in the client work and in developing a context in the experience of the supervisee, and constructing the reality around this (Bob, 1999).

Process-oriented Approaches

Process-oriented approaches to supervision include those in which component tasks and roles are defined (Bernard, 1997). In their Discrimination Model, Bernard and Goodyear (1998) described “teacher,” “counselor,” and “consultant” roles with different foci (intervention, conceptualization, and personalization). Hess (1980) described roles (he described these as models) including lecturer, teacher, case reviewer, colleague-peer, monitor, and therapist. Bernard and Goodyear (1998) cited other models with expanded conceptions of supervisor roles including facilitator, evaluator, monitor, and administrator. Each of these models is useful to discuss with supervisees in order to determine what roles supervisors do, in fact, play during the supervisory session, whether these roles are balanced, and whether the supervisee would prefer more or less of one or another. It is also useful to determine whether the supervisee feels that the descriptors are adequate to encompass the entirety of the supervisory process, and if not, what could be added.

Other Models

Other models include microcounseling (Daniels, Rigazio-Digilio, & Ivey, 1997) and Interpersonal Process Recall (Kagan & Kagan, 1997). Microcounseling is a technique for teaching skills, and is often used for beginning therapists. Skills are organized in sequence, and each skill is taught one at a time. Modeling, shaping, and social reinforcement are important tools. This framework has been expanded to a “Microskills Hierarchy” with steps for culturally effective interviewing. Attending behavior, or being sensitive to verbal and nonverbal cues, is at the base of the hierarchy followed by a basic listening sequence with particular skills for establishing rapport and drawing the client out. This is followed by skills of confronting, focusing, and reflecting, followed by influencing, skill integration, and personalizing the skills to the individual, culture, and particular theory.

Interpersonal Process Recall, or IPR, is based on the premise that individuals behave diplomatically. Thus, much of what supervisee thinks, intuits, and feels during therapy is disregarded automatically because allowing these perceptions to surface would confront the basic predisposition to be diplomatic. The purpose of IPR is to give the supervisee a safe place for internal reactions. The supervisor’s role is that of facilitator, stimulating awareness beyond that which occurred during the therapy session.

The actual IPR process entails the supervisor and supervisee viewing prerecorded video of the counseling session. At any point, when either perceives an important moment that was not being addressed, they stop the video and the supervisee reflects. The supervisee may indicate frustration, anger, impatience, or other emotional reactions. The supervisor does not adopt a teaching stance but allows the supervisee the space to explore internal processes of resolution. The supervisor may ask a series of questions that might include, “What do you wish you had said to her?” “How do you think she would have reacted had you said those things?” “What kept you from saying what you wanted to say?” and “If you had the opportunity now, how might you tell her what you are thinking and feeling?” The process continues with the tape advancing once again. This is an extremely slow process and puts interpersonal dynamics under a microscope that may be magnified so greatly as to be distorted. The role of the supervisor is to determine which interactions are important. This is a technique that should be used only after a significant supervisory alliance is established.

Another model of supervision was proposed by Hawkins & Shohet (2000) who suggested the “seven-eyed supervisor model” in two interlocking matrices useful as tools to direct the supervisory process. They advocated attention of supervisor and supervisee directed to therapy sessions themselves with the following foci:

  1. Reflection on content of session especially from client’s perspective.
  2. Considering therapist interventions and strategies to determine alternatives and effectiveness.
  3. Exploring dynamics of process and relationship through attending to boundaries, nonverbal behavior, and variables like images, hunches, and metaphors in material presented. The supervision process is the vehicle through which issues are addressed.
  4. Therapist’s countertransference—reactions to the client stemming from the therapist being unaware of his/her internal process that the supervisor brings to awareness in the supervisory session.
  5. Parallel or mirroring process in which changes in supervisor-supervisee relationship are addressed to gain insight into dynamics of therapist/supervisee-client relationship.
  6. Supervisor’s countertransference—significant material missed by the therapist in session is manifested in the supervisor’s mood changes or unrelated feelings (e.g., boredom, fatigue, embarrassment)
  7. Supervisory context—including the impact of the organization in which supervision occurs, codes of ethics, economic constraints, and social context and expectations of each party. This also includes communication of the professional expectation for practice, and the supervisor’s role as a facilitation active inquiry with the supervisee in supervision.

This is a very interesting model as it integrates many of the aspects of supervision that will be addressed throughout this course.

Vignette: The supervisee is worried that the daughter in the family she is seeing is so remote and cut off from the parents that she is having significant difficulty deciding how to approach the situation. She is also finding it difficult to communicate her level of concern to her supervisor. She is grappling with her concerns about confidentiality of the adolescent, her role with the family, and her feelings of sympathy for the daughter. Considering the models described above, describe two alternate approaches to this situation.

Part VI – Meta-theory: The Developmental Model

Because developmental theory is a meta-theory and has been so influential in supervision thinking, substantial attention will be devoted to understanding the state of the art in this area.

Developmental Theories and Models

Developmental theories of supervision have been at the forefront of theory and research for the past four decades, and have been referred to as the “zeitgeist of supervision thinking” (Holloway, 1987, p. 209). There has been such a profusion of models that Watkins (1995) joined Borders (1989) in urging that a halt to development of any further new models of supervision take place and that the focus turn to consolidating existing models. Developmental models have been central to training in counseling psychology but have been less dominant in clinical psychology training.

Premises of developmental models include:

Developmental models contain 3 to 5 stages of supervisee development.

Rather than levels or stages, it seems more useful to conceptualize a continuum of development in which movement may be forwards or backwards, with fluidity, after Hogan (1964) such that cycles and stages are not linear and may repeat themselves. This eliminates the critiqued issue of a time line in training and even the extreme time variability within discipline and across individuals (Holloway, 1987; Stoltenberg & Delworth, 1988). For example, some practicum or first year supervisees may be more sophisticated clinically than someone who has completed his or her degree program. It is useful to realize also that not all supervisees develop in all areas uniformly. Thus, one supervisee could be exceptionally sophisticated in cognitive behavioral interventions for depressed children but at a very beginning level in comments and reflection on the process in therapy or in structural or strategic family therapy.

An omission in the developmental models has been the absence of a set of skills or competencies towards which the supervisee aspires. Beutler and Kendall (1995) suggested that targeted goals in the context of skill acquisition are a key to professional psychology training. The necessity for a more explicit and empirically established set of competencies defined for supervisees at each level of training and for supervisors was advocated by Holloway (1992). Hess (1983) identified behaviors of supervisees critical from the perspective of supervisors:

Holloway asked a question which is very important to this discussion (Holloway 1997, 1998)—Is developmental theory, or a derivative of such a theory, of value in the determination of the structure of the supervisory situation, the behavior of the supervisee and/or supervisor, or the prediction of performance issues?

A large amount of research and theory regarding developmental conceptualizations of supervision has been advanced over the past four decades. Numerous conceptual frameworks and developmental paths have been put forth and then revised, leading to researchers’ lamenting the lack of progress to provide support for developmental theory in research that occurred between Holloway’s (1992) review to Ellis and Ladany’s (1997) and Goodyear and Guzzardo’s (2000) reviews.

Stoltenberg, McNeill, and Delworth’s Developmental Theory

A predominant developmental theory of supervision was advanced by Stoltenberg (1981), Stoltenberg and Delworth (1987) and refined in Stoltenberg, McNeill, and Delworth (1998). This theory provides a framework for clinical supervision including the stages through which the supervisee progresses and the environment the supervisor should provide.

The most recent revision of the Stoltenberg et al. theory, IDM (or Integrated Developmental Model (Stoltenberg, McNeill, and Delworth, 1998)) is the most comprehensive and complex. The three structures underlying the theory are self- and other-awareness relating to cognitive and affective aspects of awareness of the client and of the self; motivation relating to perceived efforts, enthusiasm, and investment across time; and autonomy defining individuation and independence as it evolves. Some of the concepts the authors postulate as most central to the development of the supervisee are carefully described in auxiliary chapters but are not integrated into the theory per se. These include the relationship of supervisee to supervisor, the supervision environment, and the development of the supervisor. Around these three central structures, the authors weave a sequence of development of increasing autonomy, shifting awareness from self to client, and independent functioning.

Thus, for example, the Level 1, or beginning, therapist is highly anxious, highly motivated, and highly dependent on the supervisor. Focus in therapeutic interventions is primarily on his/her own behavior and performance. Supervisory interventions are structured, containing, prescriptive, and supportive. These authors suggest that theory be put on the back burner with emphasis placed on case conceptualization.

For Level 2 supervisees, who have progressed through some beginning experience and solidified some skills, there is fluctuation of motivation with self-doubt about skills as cases and conceptualizations increase in complexity. There is the possibility of dependence-independence conflicts as the supervisee strives to be more independent while at the same time realistically unsure of his/her skills. Stoltenberg suggested that at Level 2, supervisees may even have an unrealistic sense of their abilities and may need feedback to provide a more accurate assessment. Supervisory interventions should be balanced so that autonomy and independence are fostered while support and structure are still available. Countertransference considerations are important to introduce into the supervision at this level.

For Level 3 supervisees, motivation is more stable, and they are secure with their level of autonomy. They are focused on all aspects of the therapy including the client, the process, and their own contribution. They are cognizant of their strengths and weaknesses, addressing them directly and moving toward a flexible approach. Supervisory interventions should include continuing to monitor carefully, placing emphasis on increasing independent functioning and conceptualization, being supportive of growth and development of the supervisee, and generally attending to the parallel process and transference-countertransference. Stoltenberg continues to elaborate levels within the stages with development more finely scaled within each.

Although the Stoltenberg et al. (1998) model ends with the Level 3i, or integrated, development, in which the therapist integrates the highest level of proficiency and skill across all levels of practice, it is clear that development never stops—lifelong learning is essential.

Summary of Stoltenberg et al. (1998) supervisory environment adapted by Falender (2005)

 

Level I

Level 2

Level 3

  

Anxiety Management

Supervisor manages

More autonomy for supervisee

Supervisee manages

Exception in crisis cases

Structure

Supervisor provides structure

Less supervisor-imposed structure

Increased autonomy

Supervisee imposed structure

Focus on personal/professional integration

Exception in crisis cases

Supervisory Interventions

Facilitative

Prescriptive

Interpretive of dynamics*

Conceptual

Catalytic

Evaluative feedback

Facilitative

Prescriptive-less

Confrontational

Conceptual-more

Catalytic

Facilitative

Confrontational-less

Conceptual

Catalytic-to blocks

Parallel process

Encourage self-evaluation

  

Mechanisms

Observe

Role play

Interpret dynamics

Group supervision

Balance of ambiguity/conflict

Address strengths, then weaknesses

Skills training

Modeling +

Reading

Closely monitor clients

Observe

Role play-less

Interpret dynamics, parallel process

Group supervision

Group supervision

Peer supervision

Strive for integration

  

Relationship

Empathic, understanding Affirmation through self-disclosure

Interpersonal processing better left until transition to L2

Respect, Understanding of expectations, Definition of supervisory relationship

Fostering independence

Processing personal issues

Empathic, nonjudgmental

Supportive, safe environment

Encouragement to experiment and explore

Use relationship to increase insight, use of parallel process

Mutual respect and collegial exploration

Empowering +

  

Evaluative Function +

Maintains throughout

      

Interface with Agency

Maintains throughout

      

* derived from Stoltenberg
+ CF & ES

This arrangement of the information presented by Stoltenberg, et al. (1998) is a synthesis of some of the most intriguing portions of the model. Encircling relationship and evaluation around this structure seems to be a very effective way of presenting developmental theory. Development is conceptualized as one factor, albeit a very potent one. You may ask what catalytic interventions are. They are interventions that result in a catalytic outcome—similar to a chemistry experiment in which a chemical reaction occurs. An example might be the supervisor watching a video of the therapy session and seeing the dynamics of the session or some part of it in a very different light, or the supervisor focusing on a parallel process observed in supervision that corresponds to what is going on in the therapy session. The supervisee might be passive and accepting of the child’s behavior, just as the mother is in the therapy session.

Supervisor Development

Another group of developmental theories is of supervisor development. With recent changes in state regulations, the experience level of the beginning supervisor is lowered. A supervisor may be a Level 2 supervisee. As supervision practicum occurs very early in the training sequence in graduate curricula, one could imagine even less sophisticated therapists assuming a supervisory role. Supervisors with no clinical experience are less effective than those with significant experience (Russell & Petrie, 1994). We share the concerns expressed by Bernard and Goodyear (1998) regarding potential parallel tendencies of novice supervisees paired with novice supervisees to intervene in a rigid and overstated manner. There is concern as well for lack of support, insight, humor, perspective, and flexibility.

The theories of supervisor development share many of the characteristics of the supervisee development models: meta-theoretical, sequential, and progressing to a fixed endpoint. Supervisory developmental models have been articulated by Stoltenberg et al. (1998), Watkins (1993), Rodenhauser (1994), and Hess (1986, 1987).

Vignette: A supervisor requested a first year practicum supervisee to make an audio tape of his third session with a family. On the tape, the client’s mother entered the session describing a huge fight that had taken place between her two children the previous week at a restaurant. The supervisee responded by asking questions, “ A taco restaurant? Where is it located? It sounds really good. What kind of tacos did they have? Did they have different colored salsas? What kinds? Do they have fish? What kind?” The mother and children responded to the questions but eventually the mother said she really needed help with managing the children and preventing another episode like that because she was really afraid she might hit them, and she does not want to do that.

Think about how you would approach the next supervisory session. What would you say and how would you approach discussion of the session on the audio tape? How much assessment should occur. Was that anxiety on the part of the supervisee or accurate assessment of lack of competence or an inadequate therapeutic alliance potentially enhanced through talk of a mutual interest in food? A competency-based approach assists in systematically assessing strengths and determining a course for proceeding.

Take a strength-based approach and develop three possible reasons or rationales for how the practicum student proceeded in the session up to this point.

Vignette: A supervisee enters her first supervisory hour with a new case, a chaotic family. The mother and younger sibling are being treated for chronic pain secondary to severe physical abuse by a father who is no longer with the family. The identified patient is depressed, withdrawn, and not eating, but is a straight A student. Mother describes her as an “overachiever.” The supervisee expresses worry to the supervisor about the severity of pathology. The supervisor immediately says she will be a CO-therapist to the supervisee.

Conceptualization: A session should have occurred before the case assignments in which levels and previous training and experience are discussed, and a supervision plan is developed. Great specificity should be used to understand the supervisee’s level of competence with different diagnoses, developmental levels (of children and adolescents), and modalities. Also at that time, the evaluation measures and criteria would be introduced and discussed as well as particular parameters and contractual requirements of the supervision (use of video/audio tapes, timing of turning in progress notes, procedures for emergency contact, what comprises an emergency, etc.). Having the supervisor jump in might undermine the supervisee’s confidence, or might be justified given the severity of the presenting problem and the level of supervisee.

What are the developmental considerations that would dictate an approach to this situation? What are the assessment steps that could be taken to determine supervisory approach?

Assessment:

Analysis of Level of the Supervisee

  1. Anxiety, Competency, Sense of self
  2. What clinical skills & experience has this supervisee had? (Assessment should encompass experience with family therapy, child development, pain management, treatment of child abuse, depression, eating disorders)
    1. Performance
    2. Knowledge strengths and deficits
    3. Clinical skill base
    4. Theoretical orientation
    5. Presentation to supervisor

Analysis of Level of the Supervisor

  1. Anxiety, Competency, Sense of self
  2. What clinical skills & experience with this presenting problem
  3. Knowledge strengths and deficits
  4. Clinical skill base
  5. Theoretical orientation
  6. Experience with supervising

Relationship

  1. What, if any, interaction has there been between supervisor and supervisee? Has a supervisory alliance been established?
  2. What, if any, dimensions have been clarified regarding:
    1. Theory
    2. Process of supervision
    3. Expectations of supervisor for supervisee
    4. Expectations of supervisee for supervisor
    5. Identifying areas of compatibility and areas of dissonance
  3. What are strengths and areas of competence of supervisee and supervisor?

Evaluation

  1. Have parameters and criteria for evaluation been clearly elucidated?
  2. What are they?
  3. Are they easy to assess and for the supervisee to track?

A preliminary analysis would be to consider the anxiety level of the supervisee and the supervisor. This was an initial supervisory session, and neither engaged in the usual introductory behavior, including evaluating the level of the other. Most critical is that the supervisor has a clear sense of the experience, conceptual, and clinical level of the supervisee:

  1. What was happening with the supervisee?
  2. Was she anxious due to inexperience?
  3. Was she eager to please?
  4. Was she anxious due to the novelty of the placement, supervision requirements, case, or specifics of some aspect of these?
    1. It may be useful to think about countertransference, especially if there is an aspect of this particular case which touches a nerve for the supervisee or supervisor
    2. Think about safety considerations for the clients and for the supervisee
  5. Was her anxiety due to feelings about the case, her competence, or performance anxiety?
  6. Was the supervisor being protective, assuming supervisee level without knowledge, inferring level from behavior? Was the supervisor responding to her own anxiety or to the anxiety of the supervisee? Was the supervisor thinking primarily of the best interests of the client family and feeling she could do better clinical work?

What steps could be taken in such a supervisory scenario to prevent premature closure or inappropriate interventions? It is critical to approach the anxiety of the supervisee and to consider the impact of alternative approaches:

  1. First, ask the supervisee to describe the case in all detail known.
  2. Secondly, ask the supervisee to describe the interventions she is considering, and the immediate, short-term, and long-term dimensions.

Depending on the response to this, the supervisor needs to outline the treatment issues, and integrate information from the supervisee’s description into a formulation and hypotheses about proceeding clinically. The amount of input from the supervisee should be supplemented and framed by the supervisor. If the supervisor suspects the supervisee is not describing all that she actually could, some gentle prompting is indicated. The supervisor could say, “I noticed you worked with abused children last year. How would that experience contribute to your understanding of this case?”

  1. Thirdly, consider a case conference with all involved therapists to discuss treatment planning. This would include teacher input as well as the mother’s and sibling’s therapists and pain specialist.

What Do Supervisors Need to Know About Developmental Models?

Part VII – Best Psychotherapy Supervision

Your Best Supervisor

Form a visual mental image of your best supervisor: imagine that person in as much detail as you can, remembering appearance, style, interactions, and all the dimensions you can recall. Then think of words describing him/her. You will probably find that the words you generate correspond very closely to the literature on best supervisors, but may not be comprehensive. This process is especially meaningful because as Guest and Beutler (1988) found, the valued and prestigious supervisor’s theoretical orientation exerts a substantial influence on supervisees’ theoretical orientations for three to five years following the conclusion of the training experience.

Descriptions of best supervisor have included:

The last two points are especially important as they highlight the importance of two-way feedback: supervisor to supervisee AND supervisee to supervisor.

Putney, Worthington & McCullough (1992) reported that theoretical orientation might mediate relationship in that cognitive-behavioral supervisors were perceived to be in a consultant role and to focus on skills and strategies more than humanistic, psychodynamic, or existential supervisors were. Those latter were perceived as using a relationship model with a focus on conceptualization. However, they found no differences in use of growth and skill development models or focus on the supervisee as a function of theory.

Nelson (1978) concluded that interest in supervision appeared to override experience and knowledge as an essential component. Other factors in “best” supervision included theoretical grounding or working within a cohesive theory (Allen et al., 1986), a shared theoretical framework (Kennard et al., 1987; Putney, Worthington, & McCullough, 1992), and comments focused on the client (Shanfield, 1992).

There has been some research to support developmental theory, leading Ellis and Ladany (1997) to conclude that:

  1. Relationship and personal issues affecting treatment seem to be viable supervisory issues.
  2. There exists a hierarchy among supervisory issues (Sansbury, 1982) that may be dependent on the developmental level of the supervisee
  3. Supervisees may significantly increase in autonomy as they gain experience such that beginning supervisees may prefer more structured supervision (Stoltenberg et al., 1998).
  4. Relationship quality as a mediating or moderating construct should be integrated into existing theories (Ellis & Ladany, 1997).

Continuities Supervisees Prefer Across Developmental Level

Level I

Level II

Level III

  

Skill acquisition

Skill Acquisition
Different skills

Skill Acquisition Different skills

Heppner & Roehlke, 1984

Support

Support

Support

Worthington, 1984; Russell & Petrie, 1994; Heppner & Handley, 1982; Kennard et al., 1987

Encouragement

Encouragement

Encouragement

"

Expertness

Expertness

Expertness

Heppner & Roehlke, 1984

Trustworthiness

Trustworthiness

Trustworthiness

"

Differences Across Disciplines

Although the sample was very small, Nelson (1978) reported supervisee discipline differences in supervisor characteristics preferred. Social work supervisees preferred genuineness and ability to provide feedback above interest and experience in supervision. Advanced psychiatry supervisees preferred research and academic pursuits by their supervisors rather than applied work. Psychiatric residents did not favor the supervisor functioning as a CO-therapist

Social work supervisees and supervisors both reported strengths in supervisors related to knowledge skills, experience in the work being supervised, and the ability to develop positive supportive relationships with supervisees (Kadushin, 1992). A specific theoretical orientation, a structured, directive style, and clear, unambiguous directives were preferred (Lazar & Eisikovits, 1997). Among marriage and family therapy supervisees, results (Anderson, Schlossberg, & Rigazio-Digilio, 2000) bore some similarity to Allen et al.’s (1986) results with psychology supervisees. Variables associated with best supervisory experiences included longer duration, more frequent contacts per week, and a balance of personal growth with development of technical skills. Best supervision was in a facilitative environment of openness, respect, support, and an appreciation of individual differences. Better experiences were associated with viewing the supervisor as more interpersonally attractive, trustworthy, and expert. Wetchler’s (1989) results with marriage and family therapists highlighted the importance of interpersonal skills including respect, helping the supervisee assess his/her own strengths and growth areas, and encouraging the development of personal style.

In family therapy supervision, Liddle, Davidson, and Barrett (1988) described criteria for supervisor competence correlated with supervisee satisfaction. These included supervisor’s relationship skills (humor, sensitivity, communication, respect, challenge, support, and enthusiasm); supervisory feedback; supervisor’s conceptualization ability; supervisor as role model; and a supervisor who can provide:

There is some suggestion that what was viewed as best at the time of supervision may not persist over time, but may in fact be replaced by alternate supervisors. Close to the time of supervision, those rated best might be those who were warm, supportive, and congenial. However, in retrospect, if the same individuals were interviewed years later, they might view as best those supervisors who were more strict, demanding, and challenging, even though at the time of supervision, they were more difficult and seemed perhaps unduly rigorous or demanding.

What emerges is that supervisees view as “best” a supervisor who focuses on supervisee personal development and enhanced self-understanding, while creating a safe environment for risk-taking.

Worst Supervision

Many supervisees can remember more “worst” than “best” supervision situations. Some of the worst seem to be very memorable.

Worst experiences were more diffuse and difficult to define—no single characteristic was identified as critically important in a majority of worst experiences. It seems to be characterized by what the supervisor failed to provide rather than by what actually occurred. Exceptions are authoritarian or sexist behaviors by supervisors. Other behaviors include disrespect; distance; disinterest; preoccupation with the supervisor’s own process, cases, insights, or personal dilemmas; failure to assess supervisee developmental level and act appropriately; and insensitivity to the supervisee.

Communication is central to best and worst supervision.

Objectionable supervisors: