Reflections on the Experience of Counseling Supervision by a Team of Genetic Counselors from the UK

Despite it being generally acknowledged that counseling supervision is a vital part of the work for experienced genetic counselors and not just students, not all practising genetic counselors in the United Kingdom and Eire have access to this yet. This case study documents the supervision experience of our team of genetic counselors from Cambridge in the U.K. We document our retrospective thoughts on working practice before supervision was available in our department. We also give an overview of the individual and collective views of having one-to-one supervision only and then one year later, the impact of adding group supervision. Our ‘supervision journey’ is recorded using a practitioner-centred approach with a mixed method of data collection. Two focus group discussions and two written questionnaires were used, at different time points to gather attitudes. This paper captures experiences as our practice of supervision has evolved. This work is relevant to practising genetic counselors around the world who either do not yet have access to supervision, are planning its implementation or else are adding different types of supervision to their practice.     

动觉监督早期介入对动作技能形成的影响

通过人工动作技能项目和典型职业操作技能项目的训练活动,研究了动觉监督早期介入对动作技能形成的影响,结果表明早期进行动觉监督训练可以更为充分、有效地发挥动觉监督的作用,提高动作技能形成的成绩和效率。据此讨论了“视觉为主转化为动觉为主”监督机制观点的局限性,认为自觉的职业操作技能训练活动无须遵循这一结论;提出了含有动觉训练的职业操作技能训练模式。     

The competent psychoanalytic supervisor: Some thoughts about supervision competences for accountable practice and training

What are the competences required to satisfactorily practice effective or “good enough” psychoanalytic supervision? In this paper, I would like to consider that question. Over the past approximate 15-year period, increasing attention has been directed toward more specifically identifying and defining the components of competent psychoanalytic practice. But any parallel attention toward identifying and defining the components of competent psychoanalytic supervision practice has, in comparison, been sorely limited if not virtually absent. If we are to best practice competent psychoanalytic supervision and best train future psychoanalytic supervisors for competent practice, effort needs to be made to concretely delineate the competences that are requisite for such practice. In what follows, I present and adapt six broad-based families of internationally relevant supervision competence areas for use in psychoanalytic supervision: (1) knowledge about/understanding of psychoanalytic supervision models, methods, and intervention; (2) knowledge about/skill in attending to matters of ethical, legal, and professional concern; (3) knowledge about/skill in managing psychoanalytic supervision relationship processes; (4) knowledge about/skill in conducting psychoanalytic supervisory assessment and evaluation; (5) knowledge about/skill in fostering attention to difference and diversity; and (6) openness to/utilization of a self-reflective, self-assessment stance in psychoanalytic supervision. Although by no means an exhaustive list, 30 supervision competences (five per family) are proposed as significant for guiding competent psychoanalytic supervision practice and supervisor training, and a brief explanatory comment is offered in support of each broad-based family of competences.     

On Principles of Educational Change and Principled Action in Psychotherapy Supervision

Change strategies/principles, a well-recognized and accepted component of therapeutic practice, have yet to be comparably considered in psychotherapy supervision. Can there be educational change strategies/principles for psychotherapy supervision? I take up that question subsequently. I contend that supervision is forever a principle-driven activity, that supervisors practice in a principle-driven manner, and that a common core of guiding supervision strategies/principles can be identified. Reasoning by analogy from the seminal works of Goldfried (Am Psychol 35:991–999, 1980; How people change: inside and outside therapy, Springer, New York, 1991; Clin Psychol Rev 33, 862–869, 2013) and Castonguay and Beutler (Principles of therapeutic change that work, Oxford University Press, New York, 2006a; J Clin Psychol 62:631–638, 2006b; Principles of therapeutic change that work, Oxford University Press, New York, 2006c), I propose one such common core: 20 educational strategies/principles that cut across any and all forms of supervision. What follows is foremost a stimulus paper, a starting point, designed to provoke further dialogue about this crucial but unconsidered aspect of supervision practice.     

Psychotherapy Supervision in the New Millennium: Competency-Based, Evidence-Based, Particularized, and Energized

Psychotherapy supervision has increasingly become or is on the fast track to becoming competency-based, evidence-based, particularized, and accountable. In this paper, I explore how that appears to be so by: (1) briefly considering the concepts of ??competencies?? and ??evidence-based practice?? as preeminent guides for psychotherapy supervision practice and training; and (2) briefly reviewing the current status, pressing needs, and future possibilities of psychoanalytic, cognitive-behavioral, humanistic-existential, and integrative psychotherapy supervision. Based on my examination, the following conclusions are proposed: (1) the supervision relationship, individualization, developmental differentiation, and self-reflection (for supervisee and supervisor) appear to be crucial cornerstones for the conceptualization and actuation of supervision process and practice across psychotherapy-based supervision approaches; (2) all indications suggest that three emphases??competency-based supervision, evidence-based practice, and accountability??will continue to substantially influence, affect, and inform psychotherapy supervision practice for its near and distant future; (3) psychotherapy-based supervision approaches will need to be and indeed appear to now be in the process of becoming increasingly particularized in how each of their respective approach-specific competencies are defined and explicated; and (4) psychotherapy supervision has come to be increasingly viewed as an educational process and practice that is best facilitated by: (a) a rich and enriching supervision training environment that vigorously addresses and attempts to meaningfully integrate declarative, procedural, and reflective knowledge bases throughout the supervisory endeavor; and (b) the considered and deliberate utilization of facilitative technology that has the potential to substantially enhance and expand the value of the supervisee??s training/supervision experiences. Some discussion is provided about those four conclusions, and a retrofitted psychotherapy supervision for the new millennium is considered.     

Enhancing professional competence through developmental approaches to supervision

There has been a recent increase in interest in defining and describing the competencies for professional practice in psychology. Perhaps the most important mechanism for enabling the acquisition of competencies is the process of supervision. This article takes the position, based on a review of relevant research in supervision and the author's experiences, that developmental theories of supervision have stimulated considerable research and provide a direction for future work in research and practice. It is argued that the most detailed of these theories, the Integrated Developmental Model, provides a useful framework for understanding how supervisees change over time and how various supervision environments (broadly) and supervision interventions (specifically) can enhance or detract from the development of professional competencies.     

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.     

Competency‐based Models of Supervision: Principles and Applications,Promises and Challenges

Major changes initiated by the Psychology Board of Australia (the Board) and by professional bodies both nationally and internationally have placed professional supervision in the spotlight for the practising psychologist and supervisor. Further, within the context of a growing impetus towards competency‐based pedagogies for professional training across disciplines, a recent Board document has indicated that supervisor training must adhere to a competency‐based model within a best‐practice supervision framework (Psychology Board of Australia). For the practising psychologist, the recent recommendation closely follows other initiatives including the introduction of mandatory peer consultation and supervisor accreditation. The current article seeks to clarify for the Australian psychologist the characteristics of competency‐based supervision models for training and supervision, and to unpack the many implications for professional practice. The article outlines the features that distinguish competency models from other supervision models, explains the rationale for and the merits that competency‐driven pedagogies promise, and discusses the challenges these changes will bring to supervision theory and practice.     

Do counselling supervisors want or need to have their supervision supervised? An exploratory study

In response to a survey of counselling supervisors, 70 practitioners provided information about their practice as supervisors of counsellors and supervisors of supervisors. Questions were asked about the practice of supervision for supervision and attitudes towards the BAC Code of Ethics and Practice for Supervisors requirement that supervisors have access to supervision for their supervisory work. All but six of the respondents claimed to have supervision for supervision. In response to questions about the helpfulness, general importance, ethical importance and desirability of supervision for supervision, for which a bipolar visual analogue scale was provided, mean scores were all above 70%, indicating that there was considerable satisfaction with supervision for supervision requirements. Factor analysis revealed only one factor including all four questions. Questions were asked about contracts with supervision supervisors. A total of 55.7% used the same supervisor for their clinical work and supervision. In response to a question about issues raised in supervision, four categories accounted for the majority of comments: boundaries, competence of supervisees, training and ethics.     

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.     

Development of the reflective practice questionnaire: preliminary findings

This study introduces a new reflective practice questionnaire (RPQ) that can be used to assess self-reported measures for investigating the experiences, benefits, and potential pitfalls of reflective practice and reflective supervision. This questionnaire sets itself apart from previous self-report measures of reflective practice by the ability to administer to individuals working in any service industry (e.g. psychology, nursing, education, and others). This will allow for future investigations that can compare and contrast across different contexts and professions. This will further the understanding of how reflective practice impacts those engaged with the process. The present study provides preliminary evaluation of the questionnaire with samples from the general public (Study 1), and mental health practitioners (Study 2). The questionnaire includes a number of short four-item sub-scales for evaluating reflective practice including: reflective-inaction; reflective-on-action; reflective with others self-appraisal; desire for improvement; confidence (general); confidence (communication); uncertainty; stress interacting with clients; and job satisfaction. A six-item attitude towards reflective supervision scale is also included in the research. Results suggest that reflective practice can foster confidence and further a desire for self-improvement. However, results also indicate how reflective practice might increase uncertainty and stress in some individuals. Study 2 reveals that a more positive appraisal of reflective supervision is associated with greater selfreported reflection, desire for improvement, and confidence.     

Kontextanalytische Supervision in der psychoanalytischen Ausbildung

Clinical practice with supervision is that area of psychoanalytic education, in which psychotherapeutic competence is learned, developed and imparted. From the results of the current research about education and supervision, the tasks and aims of supervision are derived. Based on that a context-analytical concept of supervision is evolved. In context-analytical supervision a researching attitude is adopted by which the interactional evaluation of the patient/supervisee is captured and understood for to follow this in psychotherapeutic/supervisory acting and intervening. Finally the potential of context-analysis as a method of qualitative research is pointed out.     

The Importance of Competency-based Clinical Supervision and Training in the Twenty-first Century: Why Bother?

Providing clinical supervision is challenging. Responding to the provocative question, “Why competency-based clinical supervision?” this paper provides the rationale of greater accountability in transforming supervision practice to a competency-based one. This emphasizes a focus on strength-based competency assessment and continuous professional development. Competence, an essential defining ethical component, is described. The progression of historical development of competency-based approaches in psychology, the range of available competency-based applications, and the benefits of competency-based supervision practice are discussed.     

The effects of supervisory interruptions on therapists and clients

Abstract

The general acceptance of live supervision has not been without criticism, specifically that it is a disruptive intrusion into the therapeutic process. The present study attempted to determine what effect supervisory interruptions had on the participants in a therapy session. Using a within-subjects design, excerpts from a session were analyzed to determine differences between a no-interruption condition and conditions of supervisor-initiated, therapist-initiated, and telephone interruptions. While each of the participants were affected to varying degrees by the interruptions, there were no consistent effects. It was concluded that the act of interrupting a therapeutic session, in and of itself, is not sufficiently disruptive to negate it use. Implications for supervision and practice are discussed and recommendations are given for managing interruptions during supervision and daily clinical practice.     

Report from the UK and Eire Association of Genetic Nurses and Counsellors (AGNC) Supervision Working Group on Genetic Counselling Supervision

The Association of Genetic Nurses and Counsellors (AGNC) is the professional organisation which represents genetic counsellors and genetic nurses in the United Kingdom (UK) and Eire. The AGNC recognises that genetic counselling supervision is instrumental to the practice, training and registration of genetic counsellors in the UK. The AGNC formed a Supervision Working Group, whose terms of reference were to collate information on supervision and create a list of ‘best practice’ recommendations for its genetic counsellor members. This report delivers the findings from the Supervision Working Group and has been peer reviewed by the AGNC membership in the UK and Eire and ratified by the AGNC Committee. It offers a working definition of genetic counselling supervision, gives an overview of some of the literature on supervision and concludes with practice recommendations. Group Authorship: AGNC Supervision Working Group Membership of the AGNC Supervision Working Group     

Practice‐based supervision research: A network of researchers using a common toolkit

Aim: Given that various systematic reviews of supervision literature have revealed how little is known about supervision, that studies are not usually routed in practice, and that a multitude of diverse measures are used, the primary aim of this project was to support and encourage practitioner research related to supervision using a prescribed common set of instruments. Method: Funded by the British Association for Counselling and Psychotherapy (BACP), a Supervision Research Practice Network (SuPReNet) was established. A toolkit (a series of measures) that could be used routinely by practitioners was selected following the assembly of available measures of supervision and an assessment of them. Findings: The appraisal, conducted by the three authors, yielded five core measures, free for anyone to use, and accessible through the SuPReNet website. The measures are being piloted through a practice research network at a university counselling and psychotherapy research clinic where supervision data are being collected through a special module of CORE Net. Discussion: The potential yield from this initiative for practitioners, researchers, and the developing evidence‐base is discussed and a model proposed for the next generation of research on supervision.     

A challenge to church leaders: the necessity of supervision for ordained ministers

This article is an explicit challenge to church leaders and ministers of all denominations to take seriously the necessity of obligatory supervision for ordained ministers. To support this challenge, the author describes fundamental principles of pastoral care that found the moral demand for and benefits of the supervision of pastoral practice. Before offering practical suggestions on the implementation of supervision, reasons for the personal and institutional resistance to supervision of ordained ministers are depicted.     

Infant mental health home visiting therapists’ reflective supervision self-efficacy in community practice settings

In recent years, there has been an increase in the research on reflective supervision, including the development of tools designed to measure reflective practice in the context of reflective supervision. The Reflective Supervision Self-Efficacy Scale for Supervisees (RSSESS) is a self-report measure that has been used in previous evaluations and is designed to assess perceived reflective practice self-efficacy for Infant Mental Health-Home Visiting (IMH-HV) therapists. Properties of the RSSESS including factor structure and reliability are explored in a first study that lays the foundation for the use of the RSSESS in an IMH-HV evaluation in the State of Michigan. IMH-HV therapists completed the RSSESS at 4 time points over a 12-month period and also completed a Clinician Profile Form that included questions about their IMH background and their work experience, including job satisfaction and burnout. Results indicated that the RSSESS is a reliable tool to measure change in reflective practice skills. IMH-HV therapists demonstrated growth in their use of reflective practice skills with families and their observational skills over the 12-month period. In addition, results indicated correlations between reflective supervision self-efficacy and job satisfaction as well as burnout.     

Deconstructing Agnes – externalization in systemic supervision

Externalization is seen in this paper as a valid and useful part of the process of clinical supervision in systemic family therapy training. We offer a discussion on the use of externalization based on an example from a supervision group on a London M.Sc. in Family Therapy. Externalizing practices are located in the context of a postmodern perspective and narrative ideas within systemic family therapy. We explore the use of narrative ideas and the recursive relationship between theory, practice and the subjective experience of the trainee, within the practice of systemic supervision.     

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.