A Contemporary Approach to Clinical Supervision

The Supervisee Perspective

Liat Shklarski, Allison Abrams, Liat Shklarski, Allison Abrams

• Publisher: Routledge
• Year: 2021
• eBook ISBN: 9781000399011
• Topic: Psicología
• Subtopic: Salud mental en psicología

The most critical and influential relationship affecting one's growth as a mental health professional is the relationship between the clinician and the supervisor. Good supervisors breed good therapists. This book goes beyond facts and figures to provide an innovative perspective on the supervision process. Through contributions by seven supervisees and the supervisor they all shared, readers are offered a rare glimpse into what takes place during the supervision hour.

This book not only offers insight into the elements integral to effective supervision, but also teaches about the supervisory relationship. With contributors from various disciplines, theoretical orientations, and cultures, it shows how the supervisee and supervisor are able to navigate these differences while still gaining the most from supervision. Topics that are covered include cultural competence in multicultural supervision and remote supervision when it is conducted between clinicians in different countries, as well as an original study by the authors on the experiences of supervisees during the global Covid-19 pandemic and the transition to remote supervision.

For mental health professionals who are training to be supervisors or experienced supervisors looking to improve their skills, this book will serve as an invaluable resource for professional development.

Chapter 1

Defining effective supervision through the eyes of the supervisee

A contemporary systematic review

Liat Shklarski and Allison Abrams

Introduction

In this chapter, we will first explore the meaning of the term “clinical supervision”; then, we will focus on the definition of effective clinical supervision as it is described in the literature; and finally, we will report our findings based on a systematic review undertaken as part of the preparatory research for this book.

There is ample literature and research on clinical supervision in the field of mental health (e.g., psychology, social work, psychoanalytic training, etc.). However, research exploring effective supervision from the point of view of the supervisee is limited. In order to support our work with empirical knowledge, we conducted a systematic review of databases to locate the most recent empirical literature focusing on effective supervision from the perspective of supervisees. In particular, we were curious to find out more about (1) the experiences of supervisees in supervision; and (2) supervision outcomes based on supervisees’ perceptions of the working alliance with their supervisor.

Overview of clinical supervision

The question “What is clinical supervision?” is a very complex one. It is almost impossible to answer because it depends on the profession, career stage, educational stage (undergraduate, graduate, or postgraduate), and discipline (e.g., social work, psychology, licensed mental health counseling, licensed marriage and family therapy, art therapy) of the supervisee, as well as the setting where the supervision takes place. A quick search for the keywords “clinical supervision” in a scholarly database yields results on supervision in the medical and helping professions, such as nursing, education, clinical psychology, and social work.

How do we define clinical supervision? Most definitions emphasize that clinical supervision is a form of relationship-based education and training that promotes professional development (Milne, 2009; Counseling Students & Pearson, 2004). Snowdon et al. (2015) define clinical supervision as a process that enhances growth and increases skills in supervisees who are working toward their own professional licensing requirements or are eager to improve their professional skills. During supervision, supervisees learn and refine the clinical skills needed to provide effective psychotherapy (Falender, 2018; Falender & Shafranske, 2014). The supervisor helps the supervisee make sense of the therapeutic work. This in turn becomes internalized by the supervisee and is pulled out whenever necessary (Aronson, 2000).

The roots of clinical supervision can be traced back to the late 1800s, when Sigmund Freud first engaged in peer consultations with Josef Breuer and provided psychodynamically oriented supervision to Max Graf on how best to help his emotionally troubled son, Little Hans (Fleming & Steen, 2013; Watkins, 2013). This type of supervision did not have a structured model and was based on letter exchanges and face-to-face meetings. Since then, supervision has become a routine aspect of good practice. More clinicians, managers, and supervisors understand that supervision is necessary to improve client care, develop the professionalism of clinical personnel, and impart and maintain ethical standards in the field. In fact, all formal clinical training—including in the fields of psychology, social work, mental health counseling, psychotherapy, and psychoanalysis—requires students to attend supervision to consult on cases and connect theory and practice. It is also important to remember that in other cases, particularly within organizations, clinical supervision has become the cornerstone of quality improvement and assurance, specifically when supervision is given in the workplace and at times combined with administrative supervision (Tromski‐Klingshirn & Davis, 2007).

Effective supervision

What is the recipe for effective clinical supervision? Effective supervision has been connected to improved clinical and client outcomes and a positive impact on therapist self-awareness, skills, self-efficacy, theoretical orientation, and support (Egan et al., 2017; Wheeler & Richards, 2007). A common factor shown to be significantly tied to positive supervision outcomes is the concept of the supervisory working alliance (Ladany & Lehrman‐Waterman, 1999; Lucas, 2018). Park et al. (2019) use Bordin’s (1983) definition of the supervisory working alliance that consists of three interrelated variables: agreement on the goals of supervision, the tasks of supervision, and an emotional bond between the trainee and the supervisor. The supervisory working alliance fosters confidence, promotes exploration of countertransference, and improves supervisees’ self-awareness and self-efficacy (Callahan & Love, 2020).

Supervisor–supervisee interactions can positively or negatively affect the supervisory working alliance. As a result, supervisors and supervisees must figure out their own authentic way of working together. Contrastano (2020) discussed reciprocal vulnerability in which the supervisor is willing to be vulnerable and uses self-disclosure as an educational tool. Reciprocal vulnerability deepens the relationship and improves the learning experience.

Following the notion that effective supervision relates to the quality of the supervisory relationship, Kilminster and Jolly (2000) conducted a literature review of 55 empirical studies on clinical supervision. They found a recurrent theme across all studies—that the relationship between supervisor and supervisee is a more significant determinant of supervision effectiveness than the supervisory methods that are used. A high association between effective supervision and a strong supervisory relationship is found with supervisors who are empathetic, supportive, respectful, and knowledgeable (Beinart & Clohessy, 2017; Callahan & Love, 2020; Lizzio et al., 2009). Ellis (2017) captured examples of negative supervision experiences including, but not limited to, boundary issues, dishonesty, disrespect, lack of supervisory competency, and/or perceived ethical misconduct/violations by supervisors that adversely affect the supervision process and supervisees’ growth.

The supervisory working alliance can be compared to the therapeutic alliance (Enlow et al., 2019). For example, Watkins (2018) adapted and modified the generic model of psychotherapy developed by Orlinsky and Howard (1987) to create a generic model of psychotherapy supervision (GMPS) (see Figure 1.1). The organizational framework of the GMPS conceptualized the multiple variables that determine effective supervision. It enhanced understanding of the entire process of supervision, including mediating variables that can effectively influence the supervisory working alliance. The GMPS presents the complexity and interconnectedness of the input variables, supervision process, and output variables that affect the supervisory relationship. Both the supervisor and supervisee should be aware of these factors.

Figure 1.1 A generic model of psychotherapy supervision

Source: Watkins (2018). Reproduced with permission.

Input variables

The input variables are pre-existing features that include: (a) the supervisee’s personal/professional/educational characteristics; (b) the supervisor’s personal/professional/educational characteristics; (c) the community and organization in which supervision occurs; and (d) the social and cultural beliefs and values of the supervisor and supervisee.

Supervision process

The supervision process is the core of the model and consists of six critical components that are part of any supervisory relationship: the supervision contract, supervision operations, the supervision bond, self-relatedness (supervisee and supervisor), in-session impacts, and temporal patterns. In particular, the supervision process focuses on (a) all interactions that are experienced by the supervisor and supervisee during supervision sessions; and (b) any supervisor or supervisee experiences or actions that occur outside of supervision sessions (e.g., further reflections on the supervision session).

Output variables

Outputs are postsession supervision outcomes that occur in the real world for both the supervisees and their patients. Outputs contribute to the ongoing therapeutic functioning of the supervisee in their role as a therapist and the ongoing supervisory functioning of the supervisor (i.e., outputs contribute to their respective outside-session development).

The GMPS highlights that supervisory relationships are interrelated with many factors and require in-depth, holistic thinking. In order to add knowledge to the model, in particular the supervision process, we focus our systematic review on the supervision process from the supervisee’s perspective.

Systematic review of the empirical literature on effective supervision from the supervisee’s perspective

Despite the ample literature on supervision, few studies have been based on empirical research, and even fewer have been both empirical and captured the perspective of the supervisee. It is widely assumed by policy-makers, educators, and practitioners that supervision is a good thing. But does the available research, specifically that which expresses the voice of the supervisee, support this assumption about effective supervision?

Search strategy

We based our procedure for conducting and reporting a systematic review on the approaches documented by Stroup et al. (2000). Accordingly, we undertook an initial comprehensive electronic search of the literature. Boolean operations of supervisee AND (clinical supervision* OR supervision* supervisory relationship* OR analytic training* OR psychotherapy* OR parallel process) OR effective clinical supervision AND (supervisee perspective OR supervisees’ perceptions OR supervisees’ experiences) were used to identify relevant articles in the identified databases. The initial...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• List of illustrations
• List of contributors
• Foreword
• Preface
• Acknowledgements
• 1. Defining effective supervision through the eyes of the supervisee: A contemporary systematic review
• 2. Effective supervision during the Covid-19 pandemic: The transition to remote learning
• 3. Social justice and cultural competence in clinical supervision
• 4. Effective supervision despite cultural and theoretical differences
• 5. Remote supervision between Korea and New York: Overcoming cross-cultural challenges in supervision
• 6. Embarking on the journey of psychoanalytic supervision: The supervisor as the fixer
• 7. Psychodynamic supervision in the nonprofit sector
• 8. Supervision across disciplines and theoretical orientations
• 9. Two detectives working on a case
• 10. Supervision and the termination process
• 11. Supervisor: A daunting privilege
• Index