Contemporary Visions of Psychotherapy Supervision: Sharing Perspective,Identifying Need,and Charting Possibility

Psychotherapy supervision has now celebrated its first centennial, is poised to move boldly forward into its second century of contribution to psychotherapy education, and seems perfectly positioned to further advance our knowledge about and practice of how to effectively facilitate, influence, and mentor our supervisees. Professional interest in and recognition of psychotherapy supervision appears to be at an all time high, and its value as a potentially alchemical educational event seems increasingly incontrovertible. But if supervision is to maintain and even enhance its substance and significance in 21st century psychotherapy education, what are the matters to which we as supervision practitioners, researchers, and theorists must vigilantly attend and vigorously address? In this special supervision issue of the Journal of Contemporary Psychotherapy, we would like to examine some of those matters. The topics that are addressed include: competencies, evidence-based practice, and supervising psychoanalytic/psychodynamic, cognitive/behavioral, humanistic/existential, and integrative/eclectic psychotherapies. The binding theme of “pressing needs and impressing possibilities” will be evident throughout this journal issue. In this introductory paper, I briefly define psychotherapy supervision, consider its beginnings, provide a rationale for this special issue, and identify the specific questions that give focus and frame to each of the succeeding contributions.     

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.     

A Model of Therapist Competencies for the Empirically Supported Interpersonal Psychotherapy for Adolescent Depression

In order to treat adolescent depression, a number of empirically supported treatments (ESTs) have been developed from both the cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT-A) frameworks. Research has shown that in order for these treatments to be implemented in routine clinical practice (RCP), effective therapist training must be generated and provided. However, before such training can be developed, a good understanding of the therapist competencies needed to implement these ESTs is required. Sburlati et al. (Clin Child Fam Psychol Rev 14:89–109, 2011) developed a model of therapist competencies for implementing CBT using the well-established Delphi technique. Given that IPT-A differs considerably to CBT, the current study aims to develop a model of therapist competencies for the implementation of IPT-A using a similar procedure as that applied in Sburlati et al. (Clin Child Fam Psychol Rev 14:89–109, 2011). This method involved: (1) identifying and reviewing an empirically supported IPT-A approach, (2) extracting therapist competencies required for the implementation of IPT-A, (3) consulting with a panel of IPT-A experts to generate an overall model of therapist competencies, and (4) validating the overall model with the IPT-A manual author. The resultant model offers an empirically derived set of competencies necessary for effectively treating adolescent depression using IPT-A and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines. This model, therefore, provides an empirical framework for the development of dissemination and implementation programs aimed at ensuring that adolescents with depression receive effective care in RCP settings. Key similarities and differences between CBT and IPT-A, and the therapist competencies required for implementing these treatments, are also highlighted throughout this article.     

Integrating Relational-Cultural Theory Concepts and Mask-Making in Group Supervision

ABSTRACT

Supervisees in the clinical phase of their counselor training may experience anxiety related to evaluation and competence. Recent literature has suggested that the integration of relational-cultural theory (RCT) concepts in supervision can be used to reframe supervisee anxiety and promote professional growth. Creative arts approaches have been employed in group supervision to increase supervisee self-awareness, improve case conceptualization skills, and foster group cohesion. To date, no research exists on the use of mask-making in RCT-based group supervision. In this article, the author proposes integrating RCT concepts with a mask-making intervention in group supervision to address supervisee anxiety. Limitations and implications for counselor educators and supervisors are discussed.     

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.     

Medical Family Therapy: Charting a Course in Competencies

The skills and training medical family therapists need to be effective in their work is an underdeveloped area in the literature. Training programs in Medical Family Therapy (MedFT) currently vary in duration, intensity, and focus of material and most of this is due to the minimal research done on what core competencies are needed. The results presented in this paper are the product of a larger modified Delphi (Dalkey in Studies in the quality of life, Lexington Books, Lexinton, MA, 1972) study designed to reach consensus regarding the current definition, scope, and practice of MedFT. Thirty-seven experts in MedFT participated in this two-phase investigation. What resulted and will be reported on in this article are the training requirements and recommended core competencies for the practice of MedFT. Participants indicated that 12 academic course content areas and 13 core competencies should be required of those seeking training in MedFT. Recommendations for MedFT core competencies at the master??s, post master??s, and doctoral levels, as well as advancements for future research, are described in detail.     

Using client feedback in training of future counseling psychologists: An evidence-based and social justice practice

Training in counseling psychology has evolved to emphasize both evidence-based practice (EBP) and social justice, though these two dimensions have often seemed disconnected, or even at odds in the practice of psychotherapy. The Partners for Change Outcome Management System (PCOMS), an EBP that monitors treatment outcomes and the therapeutic alliance across treatment (often called “client feedback”), may offer a means to connect evidence-based and socially just practices. The purpose of this article was to outline how the use of PCOMS in psychotherapy and supervision can serve as a useful training tool that is a form of EBP and also promotes a socially just paradigm in psychotherapy. We also offer an implementation example from a counseling psychology doctoral program to demonstrate how PCOMS can be used with clients in psychotherapy and included within the supervisory process.     

Supervising Humanistic-Existential Psychotherapy: Needs, Possibilities

The competency movement within professional psychology, evidence-based practice concepts, and the trend toward incorporating psychological services as a component of an integrated care approach within health care settings are major developments in the changing landscape of psychotherapy practice that have important implications for psychotherapy supervision. This article examines each of these developments as they relate to conducting psychotherapy supervision from a humanistic-existential perspective. The current status of supervision guided by a humanistic-existential framework is described, followed by exploration of needs and possibilities for the future evolution of the supervision approach in light of developments in the field.     

In Treatment

This article deals with current representations of psychotherapy in movies and television and focuses on the recent TV series In Treatment. It is discussed if and how this and other TV series might contribute to a change in the public image of psychotherapy. This discussion is based on studies investigating the public image of psychotherapy and its image within the media as well as the potential to use movies and TV as a stage for psychotherapeutic processes. Among several TV series dealing with psychotherapy, In Treatment plays a special role because of its conception as an intimate play. The series is described and discussed in relation to the question how realistic psychotherapy is staged and whether the hero of the series ??Dr. Paul Weston?? can be used as a model in psychotherapeutic training.     

Convergence,commonality, and context in psychoanalytic supervision

ABSTRACT

What are the binding commonalities that demark and define any and all psychoanalytic supervision perspectives? What do we all do as psychoanalytic supervisors that practically matters? Furthermore, might there be a unifying model that anchors those binding commonalities together into a supervision meaning-making, explanatory framework? In this two-part paper, I take up those questions. In Part I, based on a century-spanning literature review, I identify 50 (non-exhaustive) common Support and Learning factors that appear present across the panoply of psychoanalytic supervision perspectives. Relational, educational, and interventional, these 50 factors reflect the very stuff of which psychoanalytic supervision is made. In Part II, I present and elaborate upon the Contextual Psychoanalytic Supervision Relationship Model (CPSRM) – a theoretically-grounded model that anchors and contextualizes those common Support and Learning factors. Because common factors can be seen as nothing more than atheoretical amalgamation (i.e., lists of desirable characteristics endlessly strung together), the CPSRM is proposed as a theoretically-based antidote. A supervisory extrapolation of Wampold’s contextual psychotherapy relationship model, the CPSRM accentuates relational connection, expectations/goals, and educational action as preeminently supervisee change inducing and learner affecting.     

How does psychoanalytic supervision work? A brief communication

In this brief communication, we offer one perspective – the contextual psychoanalytic supervision model (CPSM) – on how psychoanalytic supervision works. The CPSM, a supervisory extrapolation of Wampold’s contextual psychotherapy relationship model, accentuates four psychoanalytic supervisor–supervisee relationship variables as crucial and change inducing: the learning alliance bond, supervisor–supervisee real relationship, creating supervision expectations/providing an expectation-consistent form of supervision, and the supervisee’s engagement in facilitative educational actions. The CPSM is presented in hopes of stimulating further discussion about what makes psychoanalytic supervision work.     

Measuring the Effectiveness of a Genetic Counseling Supervision Training Conference

Genetic counselors who receive formal training report increased confidence and competence in their supervisory roles. The effectiveness of specific formal supervision training has not been assessed previously. A day-long GC supervision conference was designed based on published supervision competencies and was attended by 37 genetic counselors. Linear Mixed Model and post-hoc paired t-test was used to compare Psychotherapy Supervisor Development Scale (PSDS) scores among/between individuals pre and post conference. Generalized Estimating Equation (GEE) model and post-hoc McNemar’s test was used to determine if the conference had an effect on GC supervision competencies. PSDS scores were significantly increased 1 week (p < 0.001) and 6 months (p < 0.001) following the conference. For three supervision competencies, attendees were more likely to agree they were able to perform them after the conference than before. These effects remained significant 6 months later. For the three remaining competencies, the majority of supervisors agreed they could perform these before the conference; therefore, no change was found. This exploratory study showed this conference increased the perceived confidence and competence of the supervisors who attended and increased their self-reported ability to perform certain supervision competencies. While still preliminary, this supports the idea that a one day conference on supervision has the potential to impact supervisor development.     

Supervisory reactions: an important aspect of supervision

Anne Alonso was passionate about the practice of supervision. An excellent supervisor herself, she sought to identify and teach the ingredients of effective supervision throughout her career. Her first book, The Quiet Profession (1985), was about the supervisory relationship and the various influences on it from within and without the relationship, and she insisted that the Center for Psychoanalytic Studies training program that she directed for many years include a required course on supervision. While the usual focus in supervision is on the supervisee and the clinical material presented, supervisors often experience powerful emotional reactions. Sometimes this is parallel process, in which the dynamics of the psychotherapy are replayed in the supervisory relationship. However, many other sources can contribute to supervisory affect, including the personality, background, and developmental stage of the supervisor, the impact of the clinical material, and the setting in which the supervision takes place. Supervisory reactions can be informative about the psychotherapy being supervised, about the supervisory relationship, or about the supervisor. Supervisors need self-awareness in order to identify their own contribution to their affective responses in supervision. The use of a supervisor decision tree of 1) awareness of reaction, 2) identification of its source, 3) relevance to current supervision, and 4) appropriate use of the reaction in the current supervision is recommended.     

‘A baptism of fire’: A qualitative investigation of a trainee counsellor's experience at the start of training

Background: Belief in the effectiveness of professional counselling and psychotherapy training is widespread and generally unquestioned. Few studies have attempted to understand the changes experienced by trainees, or identified which aspects of professional training programmes assist them in the process of becoming therapists. Aims: to investigate how a trainee counsellor changes at the start of training, and to identify which aspects of a professional counsellor training programme were helpful in instigating and supporting change. Method: the experience of one trainee counsellor, Margaret, was captured through three semi-structured interviews conducted at the beginning, middle and end of her first term. The data were subjected to systematic qualitative analysis. Findings: Margaret experienced significant change during her first term. Each interview revealed a different phase of her development. The core categories were: becoming something new (week 3); growth in therapeutic confidence (week 6); surviving ‘stressful involvement’ through supervision (week 11). Experiential learning, in particular group supervision, was helpful throughout. The presence of real clients was identified as the main driver for change. Conclusion: The findings were found to be consistent with a number of other studies, which suggest that training is potentially painful because of the emotional demands it places on trainees, particularly at the start of practice. Consequently trainees require opportunities for experiential learning, peer support and supportive supervision to assist them in their development, but most importantly, given that supportive supervision can only minimise the harm of stressful involvement (Orlinsky & Ronnestad, 2005), they need early positive experiences with clients.     

Supervising Cognitive-Behavioral Psychotherapy: Pressing Needs,Impressing Possibilities

While accounts of the practice of cognitive behavioral therapy (CBT) supervision have been available over the past 15 years and have demonstrated consistency in terms of an overall model specifying the structure, process and content of supervision sessions, a number of gaps can be identified in the literature on the clinical supervision of CBT. Comprehensive consensus statements of the competencies underlying clinical supervision have been developed both in the United States (Falender et al., J Clin Psychol, 60, 771–785, 2004) and in the United Kingdom (Roth and Pilling, IAPT supervision competencies framework, University College London, 1992), but there has been a lack of attention to relevant theory and to procedural detail. As a consequence, the literature on CBT supervision has only recently begun to assimilate concepts from the wider supervision field (e.g. developmental models), and there is as yet no manual that would allow supervisors to make explicit determinations of competency. Furthermore, supervision in general continues to suffer both from the absence of compelling empirical support demonstrating its effectiveness in improving clinical outcomes, and there is a lack of explicitly-defined supervisory procedures that can be reliably observed and measured. Unfortunately, this combination of factors hampers the development of CBT supervision (e.g. it complicates efforts to provide a standardized framework for training in supervision). As an important starting point in ‘treating’ the underdeveloped state of CBT supervision, we outline a formulation of its current condition, then suggest some promising interventions.     

The Supervisory Alliance as Quintessential Integrative Variable

The concept of alliance in psychotherapy supervision is now a half century old. But over the course of its first 50 years, how has the supervisory alliance come to generally be viewed by supervision scholars and practitioners? and What is its specific place now within different visions of supervision? In this paper, I would like to consider those two questions by: (a) describing the two enduring perspectives on the supervisory alliance that have dominated and continue to dominate the supervisory scene; and (b) examining the ways in which the alliance appears to currently be conceptualized and implemented across several distinct views of supervision. Each view of supervision is also presented as containing and actuating its own message and meaning about the role of alliance in supervision, and those messages and meanings are accordingly identified. The supervisory alliance appears to now be widely regarded as being a transtheoretical common factor that binds by means of: (a) bond/rapport; (b) supervision goals; and (c) supervision tasks. Much like the therapeutic alliance in psychotherapy, the supervisory alliance has increasingly come to be seen as the very heart and soul of supervision itself and may indeed be the quintessential integrative variable in psychotherapy supervision.     

“She was on my side,and grounded me when I needed it:” Research supervision in the field of therapy,based on counsellors’ and psychotherapists’ views on their engagement with research

Research‐supported practice is increasingly emphasised within counselling and psychotherapy at all stages of training. Guided by an interest in how to support therapists in their efforts to develop research knowledge during doctoral training, this paper focuses on research supervision. Research supervision is a surprisingly under‐researched area. Little is known to date about how supervisors “go about their supervision” (Bruce & Stoodley, 2013, p. 5), despite the fact that “high failure rates for research dissertations in the social sciences have been partly attributed to student dissatisfaction with supervision and poor student–supervisor relationships” (Armstrong, 2004, p. 134). Between 2016 and 2019, we explored accredited counsellors' and 'psychotherapists engagement with research during or after their doctoral training. This paper explores research supervision with these two previous studies serving as the backdrop (Bager‐Charleson et al., 2018; Bager‐Charleson et al., 2018b), together with a literature review into research supervision within social sciences and psychotherapy. Supervision is discussed as a crucial coping/support strategy to (a) link research with practice in therapy work, practically and epistemologically; (b) contain and make sense of the use of transformative learning; (c) balance “enculturation” with critical thinking and emancipation; and (d) support reflective and reflexive development. This paper discusses an adaptive research supervision model, akin to a “holding bond” (Stevens, 2016) which supports the student to reflexively position her/himself personally, intersubjectively, theoretically and socio‐culturally, whilst “negotiating the tension” (Lee, 2008) during a process of enculturation into the discipline, and also fostering critical thinking and emancipation to contribute to new knowledge.     

Supervising Integrative Psychotherapy in the 21st Century: Pressing Needs,Impressing Possibilities

Supervisors and teachers who are interested in advancing integrative psychotherapy in the 21st century have the dual task of surveying the range of treatment approaches that have been developed and distilling these approaches down to a manageable number of influences that have been found to have the greatest impact on clinical practice over time. It has been proposed that there are four bona fide schools of psychotherapy that would be most useful for comprehensive training and supervision that would contribute to either (a) case conceptualization or (b) the process of clinical interviewing: psychodynamic psychotherapy; cognitive-behavioral psychotherapy; family systems therapy; and, humanistic/client-centered therapy. The goal for such broadly based clinical instruction would be for students, trainees, and interns to have an ability to provide a multi-level case conceptualization for any of the psychotherapy cases for which they are providing treatment. Thorough instruction in clinical reasoning and decision-making in this type of multi-level case formulation can provide some of the most valuable tools for novice and experienced clinicians alike.     

What Must You Know and Do to Get Good Outcomes With DBT?

Because little research has been conducted on which therapist-client interactions lead to intermediate and end-point improvements in Dialectical Behavior Therapy (DBT), we have a small evidence-base from which to specify what therapists must know and do in order to obtain good outcomes using DBT. As with other evidence-based practices, dissemination of DBT has defaulted to assumptions and methods from the “psychotherapy technology model,” which emphasizes transfer of the validated treatment package from the research clinic to routine settings with high fidelity (Morgenstern & McKay, 2007). However, serious limitations of the psychotherapy technology model require pursuit of alternative complementary models to guide dissemination. One complementary approach is to use well-designed practice-based training research. In this approach, therapists learn modular competencies linked to a highly structured yet flexible clinical decision-making framework. Modular training of therapist competencies emphasizes the continuity of the component therapist strategies across evidence-based protocols rather than emphasizing the packages or manuals as separate and distinct. Key hypotheses about the change processes responsible for client change and the associated treatment strategies used to influence these change processes should be specified and measured at the level of client, therapist, and service delivery setting. Adopting this approach may offer advantages that apply to the dissemination and implementation of DBT and other evidence-based practices (EBPs).     

Reflections on Contemporary Psychotherapy Practice, Research, and Training

We do not lack for criticism about psychotherapy practice, research, and training. Admittedly, there is much there that needs to change. But, thus far, what have we done right? What are some of the positive, affirming, constructive strides that have been made with regard to therapy practice, research, and training? In this paper, those questions are addressed. Ten broad-based themes about some aspects of psychotherapy are presented and discussed; while by no means exhaustive, each is considered to be quite robust and clearly reflective of some of the truly constructive facets now evident in the field.