The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review

Clinical supervision is a central part of psychotherapist training but the empirical support for specific supervision theories or features is unclear. The aims of this study were to systematically review the empirical research literature regarding the effects of clinical supervision on therapists’ competences and clinical outcomes within Cognitive Behavior Therapy (CBT). A comprehensive database search resulted in 4103 identified publications. Of these, 133 were scrutinized and in the end 5 studies were included in the review for data synthesis. The five studies were heterogeneous in scope and quality and only one provided firm empirical support for the positive effects of clinical supervision on therapists’ competence. The remaining four studies suffered from methodological weaknesses, but provided some preliminary support that clinical supervision may be beneficiary for novice therapists. No study could show benefits from supervision for patients. The research literature suggests that clinical supervision may have some potential effects on novice therapists’ competence compared to no supervision but the effects on clinical outcomes are still unclear. While bug-in-the-eye live supervision may be more effective than standard delayed supervision, the effects of specific supervision models or features are also unclear. There is a continued need for high-quality empirical studies on the effects of clinical supervision in psychotherapy.     

The supervisory alliance: Comparison of measures and implications for a supervision toolkit

Background Clinical supervision lies at the core of the professional development of clinicians providing services within a range of service settings. The supervisory alliance is regarded as the most important construct in effective supervision which underlies the importance of metrics to assess this construct. Aims materials and Method A cross‐sectional self‐report questionnaire design was used to examine clinical supervision constructs. The study used two scales measuring the supervisory alliance (SRQ and SWAI‐T), a scale measuring supervision satisfaction (SSQ) and a scale measuring disclosure (TDS). The questionnaires were administered to 127 clinical psychology trainees who were undertaking a practicum placement. Results Both scales measuring the alliance were positively correlated with satisfaction with supervision and disclosure, with similar sizes of correlation for each alliance scale. There was also a large, positive correlation between the two scales of measuring the alliance. Discussion Both scales were designed for use in supervision and are related to supervision outcome measures in the expected directions. Conclusion The SRQ has some distinct advantages over the SWAI‐T that lend the SRQ to be potentially more useful in clinical and research settings.     

Group supervision meets technology: a model for computer-mediated group training at a distance

Technological advances make the application of computer-mediated communication a supervision tool for group psychotherapy training when students and faculty are at a distance. A brief review of the literature on computer-mediated group dynamics provides the context for training applications. A model group supervision is described and clinical training examples are presented. Recommendations and guidelines for using computer-mediated supervision are proposed.     

Contemplation and compassion: the heart of a Franciscan spirituality of clinical pastoral supervision

After five years of supervising CPE modules in two different hospitals in South Africa, a chaplain supervisor reflects on how his Franciscan spirituality had impacted his supervisory ministry. He describes how he was able to narrow the impact to two defining Franciscan qualities: contemplation and compassion. This article explores the relationship between spirituality and clinical pastoral supervision. Then the Franciscan dimension of contemplation and compassion of Franciscan spirituality are considered. Finally some contours of a Franciscan spirituality of clinical pastoral supervision are described.     

Toward a tripartite vision of supervision for psychoanalysis and psychoanalytic psychotherapies: alliance, transference-countertransference configuration, and real relationship

The psychoanalytic supervision relationship is examined as a tripartite phenomenon, comprised of the supervisory alliance, transference-countertransference configuration, and real relationship. While most supervisory analysts would readily acknowledge that a real (or personal) relationship element exists in analytic supervision, that facet of the supervision relationship has not routinely been incorporated into considerations of psychoanalytic supervision. In this vision of supervision, real relationship, supervisory alliance, and transference-countertransference configuration are presented as integral and complementary constructs that define psychoanalytic supervision. Each of those three components is examined briefly with regard to its beginnings, evolution, and contemporary status; each component is also considered from an empirical perspective. While we have a growing quantitative and qualitative research foundation that supports psychoanalytic practice, psychoanalytic supervision has largely been ignored as a subject and object of scientific study. Supervisory alliance, transference-countertransference configuration, and real relationship are explored as research ready variables. Some clinical hypotheses--eminently testable and worthy of investigation--are proposed with regard to each component of the model, and some ideas--albeit tentative and preliminary--about how to initiate such inquiries are offered.     

Supervision and Analysis at a Crossroad: The Development of the Analytic Therapist: Discussion of Papers by Joan Sarnat and Emanuel Berman

This discussion of papers by Sarnat and Berman on psychoanalytic supervision explores the complex nature of the contemporary psychoanalytic supervisory relationship. It considers how developments in psychoanalytic theory and practice, reflecting relational, intersubjective, attachment, and field theory influences over the past 30 years, have changed the ways in which many analysts practice and theorize supervision. Contemporary supervisors attend not just to the patient being presented, or to the therapeutic dyad, but to the supervisory relationship itself as part of the clinical/supervisory frame of reference. Similarities and differences between therapy and supervision are considered.     

Clinical Supervision of Couple and Family Therapy during COVID-19

This paper addresses the need for a swift transition from in-person clinical supervision to telesupervision during the time of the COVID-19 global pandemic. Five specific areas will be discussed in the effort to enhance the quality of clinical supervision provided to couple and family therapists in training at this time including the following: (1) COVID-19 and the structural changes and technological adaptation of supervision; (2) culturally and contextually sensitive guidelines for clinical supervision during COVID-19; (3) the supervisee’s competence and the clinical supervisory process; (4) the new set of boundaries and the supervisory role; (5) and the supervisory alliance and supervisees’ vulnerabilities in the face of COVID-19.     

Clinical Supervision and Logotherapy: Discovering Meaning in the Supervisory Relationship

Upon review of the clinical supervision literature, the case is made for implementation of logotherapeutic principles within the context of the supervisory relationship. Logotherapy is a meaning-centered approach that may enhance existing supervision styles and models, especially their tendency to de-emphasize the supervisor-supervisee relationship and the inner experiencing factor of what occurs during the process of supervision. The utility of incorporating elements of logotherapy in clinical supervision is presented within the context of supervisor roles (i.e., mentor, teacher, and evaluator), as well as the content and process of effective supervision (e.g., enhancing knowledge, skills, attitudes, and interpersonal ability of supervisees). The importance of supervisor and supervisee personally meaningful values to the supervision process is then discussed, followed by specific avenues for research. Recommendations for incorporating logotherapy into supervision are offered.     

Clinical supervision in cognitive behavior therapy improves therapists’ competence: a single-case experimental pilot study

ABSTRACT

Clinical supervision is a cornerstone in psychotherapists’ training but there are few empirical evaluations on the effects of supervision on therapists’ competencies. The aim of this study was therefore to evaluate the effects of standardized supervision on rater-assessed competency in Cognitive Behavior Therapy (CBT). Six therapists with basic training in CBT were provided with protocol-based clinical supervision in CBT in a single-case experimental multiple baseline design. The supervision focused on specific CBT competencies and used experiential learning methods such as role-play. Each therapist recorded weekly treatment sessions during phases without and with supervision. The therapists’ CBT competence was assessed by third-party raters using the Revised Cognitive Therapy Scale (CTS-R). Statistical analyses showed that the therapists’ CTS-R scores increased significantly during the phase with supervision with a mean item increase of M = 0.71 (range = 0.50–1.0) on the supervision focus areas. This is one of the first empirical studies that can confirm that supervision affect CBT competencies. The results also suggest that supervision can be manualized and that supervisees have a positive perception of more active training methods. Further studies are needed to replicate the results and to find ways to improve the impact of supervision.     

A Study of Clinical Supervision Techniques and Training in Substance Abuse Treatment

Data from 57 clinical supervisors in licensed substance abuse treatment programs indicate that 28% had completed formal graduate course work in clinical supervision and 33% were professionally licensed or certified. Findings raise concerns about the scope and quality of clinical supervision available to substance abuse counselors.     

The embodied analyst: from Freud and Reich to relationality

This paper presents the impact of clinical supervision on once-weekly psychoanalytically-informed training psychotherapy. The development of Oedipus complex theory is presented, culminating in Britton's work on the triangular space that opens up by working through the complex. The geometry of psychic space is described to highlight the importance of supervision, especially when training in therapy. The theme of spiders and cobwebs emerging from the clinical material provides a powerful metaphor for the tensions in psychic space. In the course of this training, the trainee therapist was at times less able to benefit fully from supervision, and thus the third position partially collapsed. Vignettes from anonymised clinical work are presented in the three ‘phases’ of this therapeutic process, illustrating the impact of the presence – and relative absence – of supervision.     

The Reflective Model of Triadic Supervision as a Means of Fostering Cultural Humility

Journal of Contemporary Psychotherapy - Our increasingly diverse world of clinical practice and supervision necessitates clinical supervisors foster supervisees’ abilities to attend to...     

A Constructive Approach to Counseling and Psychotherapy Supervision

Clinical supervision is central to the successful training and ongoing professional development of counselors and psychotherapists. Although clinical supervision shares much in common with psychotherapy, it is a distinct activity from psychotherapy that requires its own distinct theories and techniques (Bernard & Goodyear, 2014). In this article, an approach to clinical supervision (which I refer to as constructive clinical supervision) that is grounded in constructivist principles of learning, growth, and development is presented. In addition to outlining the key constructivist principles that have influenced this approach, I also provide supervision strategies that can be used to facilitate critical self-reflection in supervisees, which includes establishing a solid relationship, asking reflective questions, and implementing reflective-based activities. Additionally, guidelines for conducting supervisee assessment and evaluation in ways consistent with constructivist thinking are described.     

The Role of Intersectionality in Marriage and Family Therapy Multicultural Supervision

This paper offers a framework for understanding intersectionality and its role within marriage and family therapy multicultural supervision. An explanation of intersectionality, social identity relationships, multicultural supervision foundations and the influence of power through supervision will be discussed. Further, this paper will describe foundational concepts in the multicultural supervisory dyad and challenges integrating intersectionality within marriage and family therapy supervision. Implications for clinical supervision and research directions are discussed through cross cultural models, a randomized control design and conversation analysis.     

Training Public Sector Clinicians in Competency-Based Clinical Supervision: Methods,Curriculum, and Lessons Learned

This article describes an initiative to train public sector clinicians in competency-based clinical supervision. It was delivered as an 18-session course taught online to clinicians employed in departments of behavioral health in nine Southern California counties. The curriculum was co-constructed by a team of clinical supervision scholars and leaders who then served as instructors. Each two-hour meeting addressed a specific topic for which a training video had been prepared, usually featuring a member of the training team who had expertise in that topic. The second part of each meeting focused on a class member’s supervision case presentation. Those presentations revealed 35 themes; the four most frequently occurring were: developing supervisees’ clinical competencies, addressing countertransference and parallel process, balancing clinical and administrative supervisory roles, and addressing record keeping/paperwork. Participants’ pre-to-post supervisory self-efficacy changes demonstrated a moderate effect size (Cohen’s d?=?.46) for the training, with the greatest pre- to post-training changes being in the use of technology, multicultural competencies (awareness of oppression, bias, and stereotyping in clinical work and in clinical supervision), and contracting. They reported that the strengths of the course included an inclusive learning environment and opportunities to reflect on and apply new knowledge and skills, though they also reported struggling with the assignments and the course platform software. Lessons learned reflected the use of technology in this online program, the importance of obtaining buy-in from agency decision makers and being prepared to address challenges related to the use of direct observation in supervision, gatekeeping, and enacting the simultaneous roles of administrative and clinical supervisor.

     

Toward the science‐informed practice of clinical supervision: The Australian context

Although supervision of clinical practice is mandatory for trainee psychologists, surprisingly little is known about the key ingredients of effective supervision and the relationship between supervision and patient outcomes. The purpose of this paper was to review current regulations that shape supervision in Australia and explore the links between these regulations and the components of effective supervision. Although recent developments including supervisor training and other quality control programs are an indication of progress, there are several empirical and conceptual issues in the supervision literature that require resolution. The second part of this paper identifies the gaps in the supervision literature and suggests steps to advance the development of a mature science of clinical supervision. The main areas requiring attention include the identification of the mechanisms by which supervision produces change in supervisees and their patients, the refinement of measurement methods and instrumentation, and the need to pursue collaborative research that maximises the generalisability of research findings.     

Assessment of Clinical Supervisor Competencies

As the field of clinical supervision develops, there is expansion of conceptual models and methodology of practicing supervision. The evaluation emphasis in supervision has been on assessing the supervisory relationship and the supervisee. This article presents a focus and process to assist those training clinical supervisors to assess the competencies of the supervisor.     

Communication flow and change theory within a family therapy supervision model

This article portrays a model of family therapy clinical supervision using change theory that is most appropriate for use with the videotape, audiotape, case presentation and debriefing from the live session. The most powerful tool during this process is that of communication and assessment of change theorys tools of confidence and conviction. The concepts presented are meant to add an additional dimension to family therapy supervision in cooperation of other theories, not as an end in themselves.Special thanks to Ms. Geri Koncilja of the Informational Technology Center at Colorado State University, Pueblo for illustration and graphic assistance.     

Understanding supervisee nondisclosures in supervision with videorecording review and interpersonal process recall

The purpose of this qualitative multiple case study was to obtain an in‐depth understanding of supervisees' in‐the‐moment nondisclosure experiences, perceptions and internal processes as they occurred in clinical supervision involving videorecording review. The supervisees who participated in the study were students in their first year of a master's‐level counselling practicum in Western Canada. Utilising interpersonal process recall (IPR) interview methods, supervisees were asked to share their moment‐by‐moment nondisclosures that occurred during a recent videorecorded supervision session in which the supervisory dyad reviewed a videorecording of the supervisee's clinical work. Thematic analysis across cases yielded five overarching themes: (a) validation; (b) safety; (c) growth and accomplishment; (d) performance anxiety; and (e) avoidance. The findings revealed a broad range of positive and negative supervisee nondisclosures that were influenced by the supervision modality of videorecording review and the IPR interview. Implications for clinical supervision, limitations of the study and suggestions for future research are discussed.     

Family therapy supervision: A review and critique of the literature

This article reviews literature related to family therapy supervision which appeared in major journals between 1980 and August, 1985. The authors conclude that the level of theoretical inquiry and research regarding family therapy supervision has not kept pace with broader developments in theory and practice in the field. A selected review of clinical supervision literature from allied disciplines is included to provide an impetus for the family therapy field.