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.     

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.     

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.     

Research misconduct among clinical trial staff

Between 1993 and 2002, 39 clinical trial staff were investigated for scientific misconduct by the Office of Research Integrity (ORI). Analysis of ORI case records reveals practices regarding workload, training and supervision that enable misconduct. Considering the potential effects on human subjects protection, quality and reliability of data, and the trustworthiness of the clinical research enterprise, regulations or guidance on use of clinical trial staff ought to be available. Current ORI regulations do not hold investigators or institutions responsible for supervision and training of clinical trial staff. Given the important issues at stake, the definition of research misconduct should encompass the intentional or negligent mismanagement of scientific projects. Individual institutions and professional associations not only can but should adopt stricter standards of conduct than those reflected in federal regulations.     

All Supervision is Multicultural: A Review of Literature on the Need for Multicultural Supervision in Counseling

This paper discusses several aspects of multicultural supervision, reviews current research literature on cross cultural supervision, which would explain why it is important to be competent in multicultural supervision. The paper also describes the roles of the supervisor and supervision techniques that facilitate multicultural supervision. A Case example is provided for a better conceptualization of the techniques involved in multicultural supervision. The paper also addresses areas that need more research and literature within the field of cross-cultural supervision.     

Through the looking glass: women and ministry supervision

Issues pertaining to women and clinical pastoral supervision are identified and examined in this essay. An in-depth literature review regarding the relationship between gender and supervised pastoral training provides the basis for the identification of the following themes: the relative lack of female supervisors; how and why we ought to talk about gender and ministry supervision; the contextual relevance of systemic marginalization to ministry supervision; the relationship between pastoral care and the "feminine"; the relevance of a panentheistic God to gender and ministry supervision; and, lastly, the relevance of gender to the supervisory relationship. Although the focus is on the ways in which gender dynamics can affect the female supervisee's experience, the author also takes a brief look at how female supervisors might experience the relevance of their gender to the art of supervision.     

Parallel process in supervision

This paper addresses the concept of parallel process and its application in clinical supervision. Parallels between therapy and supervision are examined as well as some of the key issues surrounding the use of parallel process as a supervisory intervention. Although there is a need for more investigation to explain and support this concept further, the authors would argue that parallel process interventions in supervision can enhance the supervisory process and the task of teaching and learning for both the supervisee and supervisor. A case example is provided to demonstrate the parallel process in supervision and its potential as a facilitative intervention.     

The Use of Metaphor in Clinical Supervision

The authors completed a critical review of the literature on the use of metaphor and the efficacy of metaphoric activities in clinical supervision. The authors conclude that these activities might assist students in understanding the process of becoming a counselor and facilitate students' case conceptualization skills. Cautions to consider when implementing metaphoric activities, limitations of research that has investigated the effectiveness of using metaphors in supervision, and suggestions for future research in this area are presented.     

A framework for risk-benefit evaluations in biomedical research

Essentially all guidelines and regulations require that biomedical research studies have an acceptable risk-benefit profile. However, these documents offer little concrete guidance for implementing this requirement and determining when it is satisfied. As a result, those charged with risk-benefit evaluations currently assess the risk-benefit profile of biomedical research studies in unsystematic ways, raising concern that some research participants are not being protected from excessive risks and that some valuable studies involving acceptable risk are being rejected. The present paper aims to address this situation by delineating the first comprehensive framework, which is based on existing guidelines and regulations as well as the relevant literature, for risk-benefit evaluations in biomedical research.     

A Qualitative Investigation of Supervisees' Experiences of Triadic Supervision

Although triadic supervision has existed for some time, few studies have focused on this form of supervision or its effectiveness. In this qualitative study, the experiences of 6 master's‐level students from a counselor education program who participated as supervisees in triadic supervision were explored using in‐depth, open‐ended interviews. The data analysis resulted in 5 major categories, which are discussed. Implications of the findings for clinical supervision and further research are also addressed.     

The community-based supervision of offenders from a positive psychology perspective

In this paper we outline a new model of supervision practices for offenders who are supervised in community settings. Much of the previous work in this area utilized deficits based approaches that primarily seek to reduce risk or remove offence-related behaviors or thinking. We suggest that the concept of well-being or human flourishing that is articulated in the positive psychology literature has important implications for how offender supervision services could be delivered. We propose that the effectiveness of supervision can be further improved if supervising officers are able to integrate practices which promote psychological protective factors in addition to managing risk of further offending. We further suggest that positive psychological practices can be used to develop a more comprehensive and effective model of supervisory practices. In particular, case supervision designed to increase psychological flexibility, self-efficacy, optimism, and hope are hypothesized to be especially effective in ensuring compliance and promoting the adoption of pro social lifestyles.     

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.     

A Rationale for Evidence-Based Clinical Supervision

Although modern mental health systems increasingly require evidence-based practice (EBP), clinicians continue to object to restrictions on their professional independence, which they may perceive as counterproductive, divisive and even demeaning. In the face of such deep-seated objections, do we really need to strive for an evidence-based approach to supervision? We believe so, and begin our argument by noting a colourful illustration of the problems that can exist in the absence of EBP, those of poor training, therapist drift and weak professional regulation. Next, we present EBP as a mechanism to reduce such unacceptable variability in the way that treatments are delivered. We then apply the lessons from this divisive situation to the practice of clinical supervision, outlining a rationale for an inclusive, synergistic way forward. A number of fundamental psychological motives for this integration are noted, including supervisor training that is informed by practice-based research, corrective feedback on supervision, and a supportive professional system. Illustrative examples are provided in each of these areas. It is concluded that the traditional gulf between research and practice can and should be bridged in relation to supervision.     

The culture of psychotherapy supervision

Psychotherapists in training and beyond are expected to receive regular clinical supervision. In Britain many practitioners are required to have life long supervision. This paper draws on recent research into supervision, and highlights a number of areas that have been identified as problematic, including: power and control, spirituality, touch, ethical issues and secrecy. It is suggested that a professional culture of supervision has been constructed that may not reflect the best interests of either clients or practitioners. The implications of this perspective are explored.     

Ethical Considerations in the Treatment of Compulsive Hoarding

Although empirically supported treatment for compulsive hoarding is in its preliminary stages, some information has emerged regarding ethical challenges experienced in treating this population. Our aims are twofold: (a) to inform the clinical community of ethical complications when conducting treatment for hoarding clients, and (b) to provide a decision-making model for ensuring quality and ethical care of hoarding clients. The ethical challenges (boundary crossings, dual roles, privacy/confidentiality, record keeping, fees, and cultural competence in treatment) were discovered through multiple roundtable discussions, supervision, and in the course of delivering empirically supported treatment protocols. A literature search was conducted to identify research that addressed ethical concerns. A decision-making model addressing ethical challenges in treatment of compulsive hoarding was developed.     

A Qualitative Investigation of Student and Supervisor Perceptions of Live Supervision in Genetic Counseling

Live supervision of genetic counseling students is critical for ensuring quality client care and student clinical skill development. However, no research has investigated students' and supervisors' experience of this primary supervision method. In this study, separate focus groups of students and supervisors discussed their perceptions of the nature and impact of live supervision. A modified Consensual Qualitative Research method (Hill et al. (1997) Couns Psychol 25:517–572) was used to analyze the data. Results suggest that live supervision is an essential and effective method that promotes student skill development and professional development for both students and supervisors. There is a lack of formal training regarding supervision; most learning is trial and error. Students worry about being evaluated, and supervisors wonder if they are providing supervision effectively. Both samples emphasized that client care should not be compromised. Participant recommendations for improving live supervision are described, and suggestions are made for future research.     

What do clinical supervision research reviews tell us? Surveying the last 25 years

What do clinical supervision research reviews across the last 25 years tell us? That question is subsequently examined. Based on database and literature searches, 20 reviews appearing from 1995 through 2019 were identified for survey examination; consistencies, inconsistencies and other defining features were determined across reviews; and the survey findings and their implications are considered. Primary findings are as follows: (a) ‘proof’ for supervision appears to be more ‘proof by association’ than otherwise, being primarily a product of ex post facto, cross‐sectional, correlational study; (b) evidence supporting supervision impact of any type is weak at best, especially so for worker and client outcomes; (c) supervision models generally lack empirical foundation; (d) evidence‐based supervision appears to be more a hope and dream than supervision‐based reality at present; and (e) the primary methodological problems that plagued supervision research in the 1990s are still all too frequent in modern research. Some questions to entertain about supervision going forward, and some remedies for improving its research, are proposed.     

Recognizing Spirituality as an Important Factor in Counselor Supervision

Despite the recent, growing emphasis on spirituality in the counseling and psychotherapy literature, information regarding spirituality and the supervision process is limited. The purpose of this article is to help supervisors and supervisees enhance awareness of spiritual values in supervision. Factors such as counselor competency, conceptualization of spirituality, cross‐cultural awareness, and the similarity of clients' and counselors' values form a foundation for developing effective intervention and supervision strategies. A series of research questions is proposed to spur a program of empirical exploration.     

The detection of malingering in neuropsychological assessment

Although malingering, or the manipulation of data by the patient, is a problem commonly faced by neuropsychologists, there has been little systematic investigation of this problem. This paper reviews the literature on the detection of malingering in assessment instruments commonly used by clinical neuropsychologists. Criticism of previous research is discussed, and suggestions are made both for future research and for clinical practice.     

Through the Looking Glass: The Experiences of Two Family Therapy Trainees with Live Supervision

A thorough investigation of the literature pertaining to therapy supervision reveals that supervision has never been examined from the viewpoint of the trainee. This paper examines live supervision of family therapy from that viewpoint. It suggests that live supervision is a powerful and effective tool—a tool that engenders strong emotional responses.