Working Together in

Clinical Supervision
Working Together in
Clinical Supervision
A Guide for Supervisors and
Supervisees

Edward A. Johnson

MOMENTUM PRESS, LLC, NEW YORK

Working Together in Clinical Supervision: A Guide for Supervisors and
Supervisees

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 Abstract
This brief, practical guide to clinical supervision uniquely addresses
supervisor and supervisee together. The purpose of the book is to help the
supervisory dyad collaborate effectively to meet the goals of supervision:
to ensure client welfare, educate and evaluate the supervisee, and help the
supervisee cope with the emotional challenges of doing psychotherapy. To
do so, the book provides guidance on how to implement evidence-based
and best-practice recommendations at each stage of supervision: prepara-
tion, beginning, middle, conclusion of active supervision, and the post-
supervision relationship. The emphasis throughout is on developing and
maintaining a positive, collaborative supervisory relationship. Establish-
ing this requires that the members of the dyad understand and agree on
their respective roles and responsibilities, trust each other to carry them
out, and feel safe enough to discuss the process. This book facilitates this
by describing these complementary roles and responsibilities, and by pro-
viding activities that help the dyad establish mutual understanding, set
goals, and complete necessary tasks. The author draws on his experience
to illustrate both successful and unsuccessful ways these roles can be ful-
filled. Other value-added features include sections devoted to: common
problems in supervision and how to prevent or manage them, the com-
petencies that supervisors and supervisees require to be prepared for their
roles, how to incorporate diversity into supervision, and how to complete
supervision contracts and evaluations. Written in an inviting, often con-
versational, tone the book is an invaluable aid to supervisors and super-
visees of all levels of experience.

Keywords
best practice guidelines, clinical supervision, competencies, evaluation,
formative supervision, goals, normative supervision, professional disclo-
sure statement, restorative supervision, supervisee, supervision contract,
supervisor, supervisory working alliance
 Contents
Prefaceix

Chapter 1 Introducing Supervision: Its Importance, Purposes,

and Impact1
Chapter 2 Preparing Supervisors and Supervisees: Then and Now15
Chapter 3 Getting Off to a Good Start: Initial Tasks33
Chapter 4 Co-Creating Supervision Meetings to Get the Most
Out of Them55
Chapter 5 Managing Difficulties in Clinical Supervision79
Chapter 6 A Good Conclusion95

Appendix A: Supervisee Goal Setting Worksheet117

Appendix B: Supervisor Goal Setting Worksheet123
References127
Index139
 Preface
I am excited to share some helpful ideas and strategies for improving
supervision for both supervisors and supervisees in this book. My enthu-
siasm for supervision comes from many sources. Supervising is enor-
mously rewarding and enriching. As a supervisor I have the privilege
of helping to develop students and junior colleagues who are eager to
learn and grateful for guidance. Supervision allows me to give back by
replenishing my profession and by helping clients. Supervision discus-
sions, especially those that arise in my teaching about supervision, often
address interesting and important topics including ethics, therapy tech-
nique, supervisory relationship, client conceptualization, and emerging
developments in research and in the profession. Who would not find
this stimulating? As a supervision researcher and teacher, it is exciting to
see supervision rising in importance as it undergoes rapid development,
moving from being neglected and rarely taught to becoming recognized
as a cornerstone of professional development and training and subject to
increasing research. Finally, supervision is sufficiently complex and mul-
tifaceted that it defies simplistic formulations. In fact, the complexity of
supervision can be daunting. To help overcome this challenge, this book
offers a convenient summary and starting place for the novice supervisor
and supervisee, and all those engaged in supervision who, whatever their
background experience, are seeking a renewed and up-to-date grip on the
essential purposes and methods of supervision.
This brief, practical guide to supervision is meant to complement
more comprehensive textbooks on supervision. It seeks to orient
supervisors and supervisees to their distinct roles and responsibilities. Its
foundational premise is that developing and maintaining a positive super-
visory relationship is the key to successful supervision. The book there-
fore provides guidance and opportunities throughout for supervisor and
supervisee (the dyad) to strengthen the relationship while undertaking
the necessary tasks of supervision.
x PREFACE

I have adopted a personal voice in parts of this book that speaks to

you directly, whether as supervisor or supervisee. This voice comes from
my experience in each role as well as from teaching clinical supervision in
courses, practica, and workshops. The content of my recommendations
and stories have been selected to illustrate widely agreed-upon principles,

practices, and research concerning supervision. I have embedded the most
recent and important findings from the supervision literature in the text.
I have also structured the content to reflect our professions collective wis-
dom about supervision as gathered in best-practice guidelines and ethical
principles for supervision.
The opportunity to write this book came about after Julie Gosselin,
the series editor, and I led a workshop on clinical supervision for the
Canadian Council of Professional Psychology Programs. I appreciate
Julies enthusiastic support for this book. For their helpful comments on
earlier portions of the book I thank Noah Cain, Brenna Henrikson, Peter
Johnson, and Ruth Johnson. For their detailed feedback on an entire
draft of the book I am grateful to Julie Gosselin, Leslie Johnson, David
Martin, Don Stewart, and Jen Theule. The book is much better as a result
though, of course, any remaining faults are mine. Don and David deserve
special mention for their long-standing support as friends, collaborators,
and sounding boards. Finally, I extend heartfelt thanks for their love and
encouragement to my family: my parents, Ruth and David, and my wife
Leslie and children Alanna and Natalie to whom I dedicate this book.
 CHAPTER 1

Introducing Supervision:
ItsImportance, Purposes,
and Impact
Supervision is EssentialA Personal Anecdote
The importance and complexity of supervision as a professional relation-
ship was first brought home to me in a powerful way during my intern-
ship year, ironically by its absence. I was excited to begin that pivotal
year of my professional development as a clinical psychologist. Having
relocated to a new city and province, I was anxious to get oriented to the
internship. In particular, I was eager to meet my first clinical supervisor
who would oversee my work on an acute inpatient mental health ward,
my first such experience.
To my great surprise, however, I learned on day one that my supervi-
sor was on holiday and would not be back for three weeks! The internship
training directors assurance that a temporary supervisor, who worked on
another ward in a different part of the hospital, would be available for
consultation in the interval felt anything but reassuring. A note of panic
crept in: What will I do? What am I supposed to do? How do I do it?
Internship being new to me, I supposed that this must be how things
are done. After an initial meeting with my temporary supervisor, who
seemed equally uncertain about what to do with me, I decided to turn for
guidance to the warm and welcoming clinician (a non-psychologist) who
worked in the office next to mine. In the absence of other supervisory or
collegial supports, I spent my lunchtime and breaks every day with this
newfound friend whose unusual perspective on our roles intrigued me. So
began my understanding of the ward.
2 WORKING TOGETHER IN CLINICAL SUPERVISION

Little did I realizeuntil my primary supervisor returnedhow far

my thinking about my role had drifted into this clinicians idiosyncratic
worldview. To cope with an unfamiliar and complex multidisciplinary
hospital system, in the absence of a solid orientation and the guidance of
an involved and available supervisor, I took direction from a well-meaning,
but ultimately misleading, source. More than that, the commencement of
my supervision was now more complicated than it would normally have
been. Upon his return, my supervisor was surprised to find me rather
attached to his substitute. He needed to not only create a connection to
me, but to wean me from the influence of his colleague. Fortunately, my
supervisor was able to accomplish this over time and help me get on track
for what was ultimately an excellent training experience.
With the benefit of hindsight a number of things are clearer to me
now. First, the whole episode underscores how essential supervision is for
supervisees, especially at the outset of a new training experience. Without
it I felt lost and a little desperate for professional guidance to navigate my
internship. I also experienced a relational void. I missed having a trusted
and concerned mentor looking out for my best interests who had a stake
in my wellbeing. Clearly, what I needed at that juncture had as much to
do with attachment processes as with professional oversight and guid-
ance. The whole experience illustrates how supervision encompasses a
multifaceted relationship that touches on not just professional roles, but
also on the personal, and interpersonal spheres, and both the cognitive
and the emotional realms. In this book I provide guidance on how super-
visors and supervisees can develop a positive working relationship that
meets the diverse needs of all those affected by supervision: supervisee,
supervisor, and their clients.
Second, once my supervision truly got underway, I observed how my
supervisor skillfully integrated me into the work of the multidisciplinary
team, mentored me regarding its dynamics, sheltered me from interpro-
fessional conflicts and capably advised me on my clinical work. Supervi-
sion plays an essential role in helping supervisees navigate within complex
institutional and interprofessional environments. Having experienced, in
quick succession, first the absence and then the helpful presence of good
supervision I have no doubt about how much it can make a difference.
Later in this chapter I review evidence of supervisions impact.
 INTRODUCING SUPERVISION 3

Why then, did I initially think that my colleague would be a good

substitute for my absent supervisor? I now realize I did not have a clear
idea of the scope and functions of the supervisor role and the purposes
of supervision despite having experienced a good deal of it beforehand.
While teaching and consulting about supervision I have noticed many
people hold misconceptions about what supervision is and what it is
meant to accomplish. I believe that when a supervisor and supervisee
share a clear understanding of the purposes of supervision and their
respective roles within it, this sets the stage for an excellent supervision
experience. And that is why I address this book jointly to supervisors and
supervisees to help you develop this essential shared understanding.

How to Use this Book

I have organized this book to reflect the chronological sequence of
events in the work of the supervisor-supervisee dyad (hereafter, simply
dyad). I begin in Chapter 1 by defining what supervision is and is not,
describing the roles and responsibilities of supervisor and supervisee, and
briefly summarizing the evidence of whether supervision achieves its pri-
mary aims. Chapter 2 considers how training in supervisory roles has
changed with the emergence of the competencies framework and what the
major tasks are for supervisors and supervisees according to best practice
guidelines (American Psychological Association [APA], 2014;Association
for Counselor Education and Supervision [ACES], 2011; Association of
State and Provincial Psychology Boards [ASPPB],2015), ethical guide-
lines (Canadian Psychological Association [CPA], 2009; Thomas, 2014),
and prominent texts (e.g., Bernard & Goodyear, 2014; Falendar &
Shafranske, 2004; Milne, 2009). These roles and tasks provide guidance
in navigating the three phases of supervision: beginning (Chapter 3),
middle (Chapter 4), and conclusion (Chapter 6). Between the middle
and concluding phases I include a chapter (Chapter 5) on troubleshoot-
ing and how each member of the dyad can contribute.
Each chapter provides questions to prompt reflection and discussion
for the dyad about the supervision issues presented. Such discussions, if
conducted in a spirit of openness, mutual respect, and responsiveness, are
the essential process through which a positive supervisory relationship is
4 WORKING TOGETHER IN CLINICAL SUPERVISION

built and maintained. Chapters 2 and 3 also contain written exercises that
are designed to help develop the plans, goals, and agreements necessary
for supervision to be successful. The exercises in Chapter 3, namely the
supervisors development of a Professional Disclosure Statement (PDS),
assessment of baseline competence, and completing the supervision con-
tract, set the stage for the entire training experience. Consequently, they
are best completed prior to the commencement of regular supervision
meetings. Accordingly, the dyad may wish to skim Chapter 1 (focusing
on this section and the definition of supervision) and omit Chapter 2
initially, in order to focus on Chapters 3 and 4 (which offers guidance
on organizing supervision meetings) at the outset of supervision. You can
subsequently return to the discussions and material in Chapters 1 and 2
before proceeding to Chapters 5 and 6. As the recommended discussions
are in addition to the regular business of supervision I suggest selecting
two specific exercises or discussion questions to address briefly at the out-
set of each supervision meeting. This would allow the dyad to discuss the
main topics in the book in under 10 supervision meetings. To support the
achievement of this goal, the dyad may wish to incorporate the plan for
reading the book and completing the exercises and discussions into the
supervision contract.
This book is designed for use within individual, rather than triadic or
group, supervision. While these latter forms of supervision certainly have
their place, because they have multiple supervisees present simultaneously
they create a more complex supervisory dynamic than I have space to
address. Also, for the sake of simplicity, I assume that supervision is for a
course of individual adult psychotherapy, though many of the principles
and practices discussed will be applicable to other forms of clinical work.
The guidance provided is intended to be useful across diverse therapeutic
and supervisory orientations. Also, while the primary audience for the
book are supervisors and supervisees in professional psychology, I believe
that much of the material applies to supervisory dyads in related profes-
sions such as social work, psychiatry, occupational therapy, and nursing.
This book may be used as a stand-alone aid for any supervisory dyad.
It may be especially helpful as a supplemental text for novice supervisors
in a course or practicum on clinical supervision, or for more experienced
supervisors wishing to update their knowledge and who are interested
 INTRODUCING SUPERVISION 5

in doing so along with their supervisee(s). Supervisees will benefit from

learning more about their role and responsibilities as a supervisee. Also,
by seeing behind the curtain about what supervisors are trying to do,
they may better understand their current and future supervisors inten-
tions and be better prepared for when it is their turn to supervise.

Taming the Complexities of Clinical Supervision with

aUseful Definition
Owing to its inherent complexity, the nature and purpose of clinical
supervision can be ambiguous and hence a source of uncertainty for both
supervisees and supervisors. Furthermore, the nature of that complexity
is different for supervisors and supervisees.
For supervisors, the complexity arises from the fact supervision can
simultaneously involve one or more supervisees, who may each be pro-
viding treatment to one or more clients, who are each likely dealing with
multiple, and different, issues. For each supervisee, the supervisor will
need to consider the needs and well-being of each of his or her clients,
and the supervisees level of professional development, competencies,
unique learning goals, and personal responses to clients. All these consid-
erations must be kept in mind as the supervisor undertakes the main tasks
of supervisionthose being to monitor, guide, support, and evaluate the
supervisees work.
From the supervisees perspective, the complexity of supervision
emerges over time. Supervision, as it is experienced when moving from
one supervisor to another, can often seem to be a very different enter-
prise. Each supervisor has a different therapeutic orientation, teaching
style, personality, way of communicating, and set of expectations for their
supervisees. As a result, even advanced supervisees can feel like novices
again when commencing with a new supervisor. The challenge for super-
visees in the face of all this variability is to flexibly develop a coherent
set of competencies that reflect their unique personality, strengths, and
interests.
All these elements come together to form supervisions multidimen-
sional nature. Although this complexity can be somewhat overwhelming
for each of you as supervisor and supervisee, these understandable feelings
6 WORKING TOGETHER IN CLINICAL SUPERVISION

will be replaced with a greater sense of predictability and control as you

learn more about supervision and begin to apply your knowledge.

Defining Supervision

Many people use the term supervision quite loosely to refer to what are
in practice distinct professional relationships. Therefore, let me begin by
clarifying what supervision is not. Supervision is not peer consultation.
In peer consultation one practitioner consults another about a client. The
consultant may provide advice or guidance that looks much like supervi-
sion in form and content. What distinguishes it from supervision, how-
ever, is the fact that the consultant ultimately bears no legal or professional
responsibility for the client or for the outcome of the matter and typically
has no formal role in evaluating the performance of the consultee. As a
result the consultants guidance is merely advisory for the person seeking
that guidance. In fact, the entire relationship is voluntary in consultation
but is obligatory in supervision. What makes supervision obligatory is
that supervisees are not legally qualified or sufficiently competent to prac-
tice independently and the supervisor plays a key role in helping them
develop such competence. As we will see, the differences that distinguish
supervision from consultation have an enormous impact in terms of the
responsibilities of supervisor and supervisee and the dynamics of the
relationship.
Supervision may be defined as the:

formal provision, by approved supervisors, of a relation-

ship-based education and training that is work-focused and which
manages, supports, develops and evaluates the work of colleague/s.
It therefore differs from related activities, such as mentoring and
therapy, by incorporating an evaluative component and by being
obligatory. The main methods that supervisors use are corrective
feedback on the supervisees performance, teaching, and collabo-
rative goal-setting. The objectives of supervision are normative
(e.g., case management and quality control issues), restorative
(e.g., encouraging emotional experiencing and processing, to aid
coping and recovery), and formative (e.g., maintaining and
 INTRODUCING SUPERVISION 7

facilitating the supervisees competence, capability, and general

effectiveness). (Milne, 2007, as updated and cited in Milne &
Watkins, 2014, p. 4.).

Let us unpack the main elements of this definition. The first part
of the definition, formal provision by approved supervisors means that
supervision is an explicitly contracted arrangementnot ad hocthat
typically involves ongoing meetings that span the duration of the service
activitynot a one-offand which is sanctioned by one or more rele-
vant organization(s), which might include a professional training pro-
gram, licensing body, or an institution, which approves the supervisor to
supervise. Although the criteria to be approved as a supervisor have his-
torically been rather minimal (e.g., licensure) this situation is changing. I
consider the training and experience necessary to supervise competently
in Chapter 2.
Supervision is relationship-based. Milne (2007) observes that super-
vision is confidential and highly collaborative, being founded on a learn-
ing alliance and featuring (e.g.,) participative decision making and shared
agenda setting; and therapeutic inter-personal qualities, such as empathy
and warmth (p. 440). These relational elements distinguish supervision
from other forms of learning, which can be impersonal (e.g., lectures) or
independent (e.g., solitary study). The relational aspects of supervision
are addressed in Chapters 3 through 6.
Work focused clarifies that supervision has an applied focus on aid-
ing a supervisees work with particular clients, and so typically addresses
topics and material selected by the supervisee with the supervisor adding
professional and ethical or regulatory knowledge and skills as needed.
It also defines a useful boundary when considering whether the focus
or nature of the relationship is supervisory or is crossing a boundary
into another type of relationship (e.g., therapeutic, friendship, intimate,
exploitative). I address the boundaries of the supervisory relationship in
Chapters 3 through 6.
The phrase manages, supports, develops and evaluates the work of
colleague/s speaks to how the supervisor achieves the normative, restor-
ative, and formative functions of supervision (Proctor, 1988). The nor-
mative function ensures clients receive services that meet professional
8 WORKING TOGETHER IN CLINICAL SUPERVISION

standards and are not harmed. The restorative function facilitates the
supervisees emotional processing of clinical work (e.g., to enhance effec-
tiveness and reduce the likelihood of burnout). The formative func-
tion develops and evaluates the supervisees competencies (e.g., specific
skills) and ability to continue learning independently. Although all three
functions are essential to supervision, research has discovered that the
normative and restorative functions often receive much less attention
in supervision than does the formative function (Hyrks, 2005; Milne,
2007; Snowdon, Millard, & Taylor, 2016). In Chapter 4, I provide strat-
egies for addressing all three functions in supervision.

Supervisor and Supervisee Roles and Responsibilities

The above definition is consistent with other writings in the supervision

literature regarding the supervisors role. Specifically, there is a clear con-
sensus internationally that supervisors bear clinical, ethical, and legal
responsibility for their supervisees work (Thomas, 2014) and that ensur-
ing the welfare of the client is supervisions overriding purpose (Milne &
Watkins, 2014). Enhancing client welfare requires a collaborative effort
between supervisor and supervisee that depends on supervisors and super-
visees forming and maintaining a strong supervisory relationship in which
the qualities of mutual respect, openness, commitment, and support are
present. When supervisees feel a safe and trusting supervisory relationship
is in place supervisors can more effectively undertake the educational and
evaluative components of their role. These teaching and feedback func-
tions need to be tailored to the unique goals, needs, and requirements of
each supervisee including issues of diversity (Beinart, 2014).
For their part, supervisees are responsible to follow the guidance of
their supervisors and to honestly and faithfully report on their work
with clients, raising any concerns for client welfare in a timely way.
More generally, supervisees can enhance the supervisory relationship by
being open to learning, demonstrating enthusiasm and commitment,
adopting a proactive stance, working hard on their own development,
and making a productive contribution to the clinical service (Clohessy,
2008).
 INTRODUCING SUPERVISION 9

Finally, both supervisor and supervisee need to engage in the supervi-

sory relationship and with the client(s) in a respectful and ethical manner.
Returning to the dilemma I faced when I began my internship, had I
better understood just what supervision is properly meant to be, includ-
ing the roles and responsibilities of supervisor and supervisee, I might
have better appreciated that the clinician could not possibly substitute
for my absent supervisor. I also would likely have appreciated that the
responsibility for supplying proper supervision was not mine but the
internships.

Reflections for Discussion: The Three Aims of

Supervision
Recap. The definition of supervision and subsequent elaboration iden-
tifies supervisions three primary functions: the normative (ensuring
client welfare and outcome), formative (promoting supervisee learning
and professional development), and restorative (fostering supervisee
emotional processing).

1. How well does this three-pronged description fit with how you
have experienced supervision in the past? Does anything about the
definition surprise you? Why? Share your reactions to the defini-
tion with each other.
2. The description of the supervisors role places considerable empha-
sis on the supervisors primary responsibility for client welfare and
for enhancing the clients treatment outcome (normative func-
tion). Do you think this emphasis on the clients welfare can be
integrated with supervisions other role in developing and support-
ing the supervisee? How might these two emphases at times con-
flict? How do you each feel about how supervision should balance
these two emphases? Share your thoughts about this issue with
each other.
3. As you look ahead to your work together, identify one thing that
excites you and one thing that is a question or concern about your
role or responsibilities. Share these with each other.
10 WORKING TOGETHER IN CLINICAL SUPERVISION

Supervision is NecessaryBut is it Effective?

Having defined what supervision isand, what it is notthis is a good
time to ask a few fundamental questions: Why do we need supervision
at all? Whats the rationale for it? From a cost-benefit perspective it is an
expensive undertaking that consumes many hours of time from highly
trained personnel. To illustrate, by the time the average clinical psychol-
ogist becomes licensed for independent practice in North America she or
he will have received anywhere from 400 to 600 or more hours of super-
vision. Is all of this supervision really necessary, and if so, is it effective?
The necessity of supervision follows from the fact that prior to
becoming licensed for independent practice, psychologists-in-training,
and other mental health professional trainees, are not yet competent to
practise independently. By law, trainees are required to have their clin-
ical work supervised by a licensed practitioner whose job is to protect
the help-seeking public from possible harms, by monitoring the work
of trainees and developing their competence. But that still leaves unan-
swered whether supervision is effective in doing so.
Before we can answer that question, however, we must address another:
Effective at what? Recall that supervision has not one, but three, primary
functions: the normative, formative, and restorative. In the remainder
of this chapter I will briefly summarize what we know about the impact
of supervision on each of these three goals. Before doing so, however, a
word of warning is in order. The reader who is familiar with the volumi-
nous psychotherapy outcome literature will be disappointed to discover
that the literature on supervision outcomes is much more limited both
in number and quality (Watkins, 2011). For instance, in their review of
the effects of supervision, Wheeler and Richards (2007) found only 18
studies that met their criteria.
One reason for the scarcity of good research is that supervision effec-
tiveness research is methodologically and conceptually difficult (Milne,
2014). For example, the strongest study designthe controlled trialis
simply not appropriate for studying supervision in the context of training.
It would be unethical to deprive trainees (and their clients) of supervision
to study its effects. This means that comparisons of supervised versus
unsupervised practitioners must be done with qualified practitioners.
 INTRODUCING SUPERVISION 11

Because qualified practitioners, unlike trainees, are presumably compe-

tent suggests that the impact of supervision (relative to no supervision)
on qualified practitioners is likely to be underestimated relative to what
would be seen with unqualified trainees. So, although it is a bit of a leap
to assume that the effects of supervision observed with qualified practi-
tioners would generalize to trainees, it seems reasonable to do so knowing
that the effect of supervision is probably larger among trainees. This is an
important point since the focus of this book is on using supervision to
enhance the work and competency of trainees.

Effects of Supervision on Clients: Normative Outcomes

As mentioned, little research has been conducted on supervisions impact

on client welfare and what has been done often suffers from poor method-
ological quality (Carpenter, Webb, & Bostock, 2013; Dawson, Phillips,
& Leggat, 2013; Watkins, 2011; Wheeler & Richards, 2007). This is
surprising because many supervision researchers regard the overriding
purpose of supervision as being to safeguard and promote the well being
of the client, calling client well being the acid test of supervision effec-
tiveness (Ellis & Ladany, 1997).
Interestingly, if supervision enhances client outcomes even among
competent licensed practitioners, this would have potentially enormous
policy implications. Specifically, this could justify extending the require-
ment for supervision beyond the attainment of licensure to be an ongoing
requirement for all clinical service providers. This is now the case for some
professions in some jurisdictions (e.g., in the United Kingdoms National
Health Service).
In his 2011 review of supervision outcomes on client welfare, Watkins
could find only three reasonably well controlled studies that warranted
close consideration. Since then, I have discovered no other rigorous stud-
ies. Of the three studies, only one examined the effects of psychotherapy
supervision on client outcome. In this well controlled study of psycho-
therapy supervision, Bambling, King, Raue, Schweitzer, and Lambert
(2006) randomly assigned qualified therapists, primarily Masters level
Australian psychologists, to supervision or no supervision conditions.
Therapists in both conditions used a problem-solving therapy manual to
12 WORKING TOGETHER IN CLINICAL SUPERVISION

guide treatment and supervisors followed a common supervision man-

ual. Compared to the clients of unsupervised therapists, supervised ther-
apists clients reported stronger alliances with their therapists throughout
treatment and greater symptom reduction. They were also more likely
to remain in treatment and to evaluate treatment favorably. The fact
that supervision had a clear benefit to clients on a range of indicators is
impressive, especially since the therapists were all qualified and used a
common therapy manual. These factors likely ensured a consistently ade-
quate s tandard of therapy in both conditions, thereby reducing v ariability
in client outcomes and hence the scope for demonstrating an effect of
supervision. Notwithstanding these findings, the field requires much
more high quality research before any conclusions can be drawn about
the efficacy of psychotherapy supervision on client outcome.

Effects of Supervision on Supervisees: Formative and Restorative

Outcomes

The majority of research on the effects of supervision has examined its

impact on supervisees. Overall, this body of research indicates that super-
vision has a positive impact on enhancing supervisee competencies such
as self-awareness and clinical skills, promoting supervisee self-efficacy,
and provides theoretical guidance and interpersonal support (Wheeler &
Richards, 2007). Nonetheless, the research base has a number of import-
ant limitations including uncertainty concerning the sources of the out-
comes, and the need to study the effects of recursively incorporating client
and supervisee feedback into supervision (Falendar, 2014).

Reflections for Discussion: The Effectiveness of

Supervision
Research on the outcomes of supervision is quite limited to date.
Nonetheless, existing findings suggest that supervision may improve
client and supervisee outcomes. Conceivably, the benefits of super
vision to clients and supervisees may depend considerably on how well
or carefully supervision is implemented. With this in mind discuss the
following questions in the dyad:
 INTRODUCING SUPERVISION 13

What do you think are the essential ingredients for effec-

tive supervision? For instance, how frequently, and for how
long, should supervision meetings be?
How much time should be allocated to discussing clients
(e.g., conceptualization, outcomes) versus the supervisee
(competencies, self-awareness, responses to clients)?
What do you think needs to happen in supervision to
improve client outcomes? Is this different from what needs
to happen to improve supervisee outcomes? Are the two
linked? How?

Chapter Summary
Supervision is a complex, multifaceted activity that functions to ensure
the well being of clients through the collaborative efforts of supervisor
and supervisee. It involves normative, restorative, and formative elements
and is likely beneficial to clients and supervisees, although more research
is needed to further support and understand how this occurs. Supervisor
and supervisee play complementary roles in this process. While supervi-
sors are responsible for guiding and overseeing the course of treatment
and developing and evaluating supervisee competencies, supervisees are
active collaborators in the process as they deliver treatment, report on
therapy process and outcome, set goals, and pursue new learning.
 Index
Abductive inference, 6566 Feedback, 6971
Acid test, 11 client, learning from, 9798
Apprenticeship model dialogue on, 71
for supervisee, 2629 elements of effective, 70
for supervisor, 1518 Formative supervision, 1213, 6369
Assessing experiencing mode, 6465
baseline competencies, 5052 planning and experimenting,
6769
Canadian Code of Ethics for reflective reasoning, 6567
Psychologists and Practice Foundational competencies, 2122
Guidelines for Providers of Functional competencies, 2122
Psychological Services, 48
Canadian Psychological Associations Goals of supervision, 5557
Ethical Guidelines for Guidelines for Clinical Supervision
Supervision in Psychology, 88 in Health Service Psychology
Client feedback, learning from, 9798 (APA), 23
Client files, closing and Guidelines for Supervision leading to
documentation, 98 Licensure as a Health Provider
Client termination, 9596, 99 (ASPPB), 24
Client transfer, 9697, 99
Competencies Harmful supervision, 8082
assessing baseline, 5052
in supervisees, 2023, 2931 Inadequate supervision, 8082
in supervisors, 2023 Ineffective supervision, 8283
Conceptualizing activity, supervisees, Integrated Developmental Model of
67 Supervision (Stoltenberg), 28
Confidentiality in supervision, 38,
4748 Meta-competency, 21
Conflict-reduction and resolution
strategies, 8993
Negative supervision, 8384
Counterproductive supervision,
Normative supervision, 1112, 5763
8283
client safety, 5760
Cultural humility, defined, 4041
outcome monitoring in, 6263
supporting competent care, 6062
Diversity in supervision, 3942
Documentation of client files, 98 PDS. See Professional Disclosure
Statement
Experiencing mode in supervision, Positive affective bond in supervisors,
6465 3438
Experiential learning cycle, 64 Postsupervision relationship, 112114
Evaluations of supervisor, 107109. Problems, 7988
See also Summative evaluation in supervision, 8788
140 Index

supervisee behavior and, 8485 when remediation plan fails,

supervisor behavior and, 7984 110111
Problems stemming Supervisees tasks, 49
from supervisory relationship, 85 Supervision
from training site, 8586 aims of, 9
Professional development and scaling apprenticeship model, 1518
of criteria, 101102 client feedback in, 6263
Professional Disclosure Statement competencies in, 2023
(PDS), 4449 conclusion of, 95114
confidentiality in, 4748
Qualifications of supervisor, 2326 conflict-reduction and resolution
strategies, 8993
contract, 5253
Resistance. See Supervisee resistance defining, 68
Restorative supervision, 1213, developing trust and safety in,
7176 4244
difficulties in, 8889
Scaling of criteria, 101102 disclosure in, 31
Self-assessment, supervisee, 106107 diversity in, 3942
Self-efficacy, 16, 17, 62 effectiveness of, 1013
Sessions, supervision, 74 effects
SMART goals, 5152 on clients, 1112
Social cognitive model of learning, on supervisees, 1213
1618 ensuring client welfare, 9599
Social persuasion, 17 formative, 6369
Socratic questioning, 66 functions of, 10
Summative evaluation goals and plans in, 5052, 5557
comprehensiveness, 100101 guidelines and standards for, 18
elements of, 99100 importance of, 13
issues in, 100104 important basis for, 16
procedure, 104106 limits of confidentiality in, 38
scaling of criteria, 101102 multicultural competencies in,
validity and reliability of, 103104 4041
Supervisee goal setting worksheet, 52, nature and purpose of, 510
117121 necessity of, 10
Supervisee resistance, defined, 84 normative, 5763
Supervisee(s) positive and negative experiences
to become an effective, 2629 of, 1920
building positive affective bond, postsupervision relationships,
3438 112114
competencies in, 2023, 2931 problems in, 7988
conflict between supervisor and, 18 inadequate and harmful
learning strategies, 2629 supervision, 8082
orienting via PDS, 4449 ineffective and counterproductive
progressing, 111112 supervision, 8283
roles and responsibilities, 89, 27 negative supervision, 8384
self-assessment, 106107 as relationship-based form, 3334
summative evaluation, 99108 services delivered under, 48
vehicles of improvement, 28 sessions, 74
 Index 141

setting priorities in, 7576 roles and responsibilities, 89,

SMART goals, 5152 1617
strategies for, 2526 Supervisor goal setting worksheet, 52,
timeline of psychotherapy, 5557 123125
training, 2023 Supervisors task, 49
goals in, 5052 Supervisory ethics, 8889
transitions, 109114
Supervisor
Termination, client, 9596
conflict between supervisee and,
Timeline of psychotherapy
18
supervision, 5557
evaluations of, 107109
Training, supervision, 2023
as gatekeeper, 109
PDS, 4449 goals, 5052
plan to remediate problems,
109110 Workplace, job satisfaction in, 18
postsupervision relationship, Worksheet
112114 supervisee goal setting, 52, 117121
qualifications, 2326 supervisor goal setting, 52, 123125