Dynamic accountability in clinical training and supervision: Three orienting ideals

Despite the growing interest on making clinical practice accountable, research on how specific components of professional competence are relevant in actual training/supervision practice is as yet unspecified. This study explores this dynamic aspect of professional supervision. Three supervisory dyads, composed by an experienced supervisor and a doctoral counseling psychology student were used in the study. A qualitative, ethnomethodology-informed design was used to discursively analyze 16 significant episodes (SEs) in actual supervision meetings. This was complemented by 16 follow-up interviews. Three interpretative repertoires – ‘ideals’ – influencing participants’ accounting practices were identified: efficacy, responsiveness, and authenticity. The article discusses how structural (competency-based) and dynamic (practice-based) approaches to accountability can be combined to guide the appraisal of relevant professional competencies.     

A constructivist approach to supervision: Some preliminary thoughts

Supervision from a constructivist point of view is explored. Supervision processes with three different therapists are presented to exemplify this constructivist stance. In this approach the relation between supervisor and therapist is seen as similar to that between therapist and client. Thus, a “therapist-centered” approach for supervision is outlined, the main points of which are as follows: The main focus of a constructivist supervision is the therapist, supervision should be centered on the therapist's complaint, supervision should generate a learning context, the therapist and supervisor have different types of expertise, the supervising context should generate alternative views about the problem, and the supervision context should be reflexive.     

The impact of supervisors' cognitive styles on the quality of research supervision in management education

Background: An aspect of teaching and learning that has been seriously overlooked in higher education is the process of research supervision. High failure rates for research dissertations in the social sciences have been partly attributed to student dissatisfaction with supervision and poor student‐supervisor relationships. One personality variable that has been shown to be partly responsible for shaping the effectiveness of supervisory relationships is cognitive style. Aims: The study examined the effects of supervisor cognitive style on the quality of supervision for students undertaking a research project in the field of management education. Sample: Both parties in each of 118 supervisor‐student dyads within a university business school in the UK participated in the study. Method: Data were collected using the Cognitive Style Index to measure subjects on the analytic‐intuitive dimension of cognitive style. A self‐developed Thurstone attitude scale was used to measure students' perceptions of the quality of supervision. The scale's validity was assured by making extensive use of subjects' (N = 100) judgments from the population of interest in the scale's development. A second parallel scale was developed to test the instrument's reliability characteristics. Results: Findings revealed that students perceived the quality of supervision to increase significantly with the degree to which supervisors were analytic in their cognitive style. Students whose supervisors were more analytic also achieved significantly higher grades for their dissertations. Conclusions: Whilst there may be many factors influencing interpersonal relationships of this nature, this study demonstrated the potential relevance of cognitive style, which may prove to be a fertile area for further investigation.     

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.     

MEASURING REFLECTIVE SUPERVISION WITHIN HOME VISITING: CHANGES IN SUPERVISORS’ SELF‐PERCEPTION OVER TIME

Despite widespread belief in the early childhood field of the benefits of reflective supervision, there has been limited empirical evidence to support the effectiveness of reflective supervision for home visitors and the children and families they serve. The present study examined the psychometric properties of four adapted self‐report measures assessing supervisors’ reflective supervision capacities; the study also investigated whether these measures captured change in reflective capacity over time as supervisors participated in professional development activities focused on reflective supervision. Results from 33 participants (home visiting supervisors and program managers) suggested that three of the four measures demonstrated acceptable internal consistency, and these three measures were correlated with each other. Two of these measures also captured significant change over time. Finally, there was some evidence that those with less education demonstrated more substantial improvement in their reflective supervision capacities than did those with an advanced degree. Findings provide initial evidence for reliable, efficient, and cost‐effective supervisor self‐report measures that could be used in research and program evaluation to assess change in supervisor reflective capacity over time.     

Positive experiences of doctoral-level supervisors-in-training conducting group-format supervision: a qualitative investigation

Experiential learning opportunities are powerful in shaping positive supervisor behaviours. We were interested in examining the positive experiences of supervisors-in-training during their first practice experience as supervisors. Our study was guided by two research questions: (a) what are the experiences that supervisors-in-training viewed as positive during the course of providing clinical supervision to master's-level counselling trainees? and (b) how did these positive experiences contribute to their professional development? We employed a variation of the consensual qualitative research method developed by Hill, Thompson, and Nutt-Williams (1997) and interviewed 10 supervisors-in-training regarding their positive experiences in supervising master's-level counselling trainees. The results included five major categories of positive experiences: (a) the positive value of feedback; (b) enhanced confidence in using a wider variety of supervision tasks and procedures; (c) the impact of the experience on other aspects of professional practice; (d) increased familiarity with the multiple roles of the supervisor; and (e) for some, increased comfort navigating co-supervision dynamics. Each of these categories included subcategories. We discuss our findings within the context of supervision training in graduate education.     

Genetic Counseling Supervisor Competencies: Results of a Delphi Study

Clinical supervision is a critical component of genetic counseling student preparation, yet empirically-determined competencies for genetic counseling supervisors are lacking. In this study a modified, two-round Delphi method was used to gain consensus about important genetic counseling supervisor knowledge, characteristics, and skills. Program directors and assistant directors of American Board of Genetic Counseling accredited genetic counseling programs in North America (N?=?33) were invited to participate and to recruit three experienced supervisors. Seventy-four individuals completed Round 1 and, of these, 61 completed Round 2. Approximately two-thirds were clinical supervisors from prenatal, pediatrics, cancer, and adult clinics; one-third were program directors. Participants rated the importance for genetic counseling supervisors of 158 items derived from supervision literature in allied health professions. They rated 142 items (89.9 %) as highly important. Content analysis of these items yielded six supervisor competency domains: Personal traits and characteristics; relationship building and maintenance; student evaluation; student centered supervision; guidance and monitoring of patient care; and ethical and legal aspects of supervision. The results provide a basis for training genetic counseling supervisors and for further research to refine and validate supervisor competencies.     

“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.     

Informing supervision practice through research: A narrative inquiry

Intention: This study focused on questions of whether and how clients benefit from supervision. As practitioner research, the study was intended to shape the researchers’ own supervision practice. Method: The qualitative approach was based on interviews with a small number of experienced practitioners about their supervision experiences. The findings are presented in the form of reflexive stories, told by each researcher. Findings: In these stories the researchers tell how engagement with experienced practitioners’ accounts of their past supervision shaped the hopes and intentions the researchers hold for their future supervision. Implications forpractice: The stories suggest there are therapeutic benefits in an ethic of transparency that provides for practices that overtly carry stories in both directions between counselling and supervision.     

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.     

Leading and Learning in the Psychotherapy Supervision Seminar: Some Thoughts on the Beginnings of Supervisor Development

Supervisor development theories typically give focus to growth of the supervisor via practice. But in what ways does the foundational psychotherapy supervision seminar stimulate and first set in motion the supervisor development process? That question is subsequently considered. Based on personal experience in training supervisors via seminars and ongoing reflection about that learning process, five seminar-induced themes that potentially reflect beginning tensions of supervisor development are proposed, and their seeming evolution over the course of the supervision seminar is considered. Points that are raised include the following: (a) the supervision seminar is the first, primary stimulus of supervisor development and sets the stage for later growth via practice; (b) early themes that are identified in supervisor development theories also make appearance in the supervision seminar experience; (c) to best understand the full arc of supervisor development, the seminar as both developmental initiator and intervention preparedness foundation merits more careful scrutiny; and (d) through more completely understanding the seminar as instigator of supervisor development, supervisor educators might be better positioned to develop seminars that most constructively affect the very beginnings of the supervisor development process.     

Consulting with gargoyles: applying narrative ideas and practices in counselling supervision

This article explores waysin which narrative ideas and practices might influence supervisory relationships in counselling and psychotherapy,and questions some of the taken-for-granted assumptions implicit within counselling supervision. This paper, which represents ‘work in progress’ towards further conversations, rather than an exhaustive study,is illustrated with stories from the author'sown practice as a supervisor and trainer and educator of supervisors.     

Therapist orientation,supervisor match,and therapeutic interventions: Implications for session quality in a psychotherapy training PRN

Background: Theoretical orientation is a multifaceted construct that is integral to the process of psychotherapy and psychotherapy training. While some research has been conducted on personal identification with particular schools of psychotherapy, techniques used in psychotherapy sessions, and match between trainees and supervisors in training, there is insufficient information regarding how these may interact with one another. Aim: This study, conducted in a practice research network of trainee therapists, was designed to test whether these variables may be related to one another in predicting session quality. Method: The sample comprised 328 sessions from 26 clients and 11 therapists, with the clients completing session quality measures and therapists completing measures of technique immediately post‐session. Results: Using multilevel linear modelling, the data showed varied results. For behavioural therapy and person‐centred therapy, techniques and orientation were unrelated to session quality in the sample. However, process‐experiential, psychodynamic, and cognitive therapy techniques were all involved in interactions with therapist and/or supervisor orientations. Conclusions: These results suggest that the impact of specific psychotherapy techniques sometimes depends on the orientation of the therapist and/or supervisor. For instance, sessions high in cognitive therapy techniques were only associated with positive outcome when both the therapist and supervisor were highly cognitively oriented. Though preliminary, these results suggest that orientation may be an important variable to consider in training and supervision, especially in the context of other variables.     

Does serving the community also serve the company? Using organizational identification and social exchange theories to understand employee responses to a volunteerism programme

Little is known about how employees might respond to their company's socially responsible business practices. Hypotheses derived from organizational identification and social exchange theories were tested to explain why employees (N=162) may respond positively to their company's volunteerism programme, a programme through which employees could spend time volunteering during their paid work hours. Support was found for mediated effects suggesting that employees' attitude towards the volunteerism programme ultimately predicted outcomes (e.g., intentions to stay) through its effect on organizational identification. Results also showed that exchange ideology moderated the effects of volunteer‐programme attitudes on supervisor‐reported organizational citizenship behaviour measured 6 months later, suggesting that some employees reciprocate the benefits they receive from a volunteerism programme. The implications of these findings are discussed for theory and research, and for leveraging volunteerism programmes and other socially responsible business practices to benefit companies and their employees.     

Supervisory Abuse of High Performers: A Social Comparison Perspective

Prior research linking employee performance to abusive supervision suggests that supervisors have instrumental and non-instrumental reasons for engaging in abuse while dealing with low performers in the workplace. Drawing on social comparison theory, we argue that high-performing subordinates can make supervisors envious, which in turn leads to abusive supervisory behavior. Furthermore, we hypothesize supervisor social comparison orientation as a key boundary condition for the indirect positive effect of subordinate performance on abusive supervision through supervisor envy; that is, supervisors are more likely to abuse high performers when the supervisors’ social comparison orientation is high. A multi-source, multi-wave field study was conducted with data collected from supervisor-subordinate dyads (N = 95 supervisors and 385 subordinates). The data supported a positive indirect effect of employee performance on abusive supervision through supervisor envy. Moreover, the indirect effect was statistically significant for supervisors with high social comparison orientation but it was not significant for supervisors with low social comparison orientation. Implications of these findings for reducing abusive supervision are discussed.     

Outcomes of training in supervision: Randomised controlled trial

There is little controlled research on the impact of supervisor training on supervision. The current study examined the effects of supervision training in a sample of 46 supervisor–supervisee pairs of mental health practitioners. It compared Immediate 2‐day workshop training of the pair, a wait‐list control in which workshop training was delayed 3 months, and a condition in which supervisors were trained 3 months before their partners (Split). Benefits of Immediate training were restricted to supervisors reporting fully specified agreements, and to reduction of some perceived problems. Self‐efficacy in providing effective supervision fell in the Split condition, relative to the other conditions. Across conditions in general there was a fall from baseline to post‐test assessment in the proportion of sessions where recommended supervision strategies were used, perhaps partly because the controlled trial extended across the summer vacation period. Results are consistent with other observations of the limited impact of workshop training on practice.     

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.     

Exploring the supervision experience of some mainstream counsellors who integrate prayer in counselling

The use of prayer in counselling can be transformational and promote psychological well‐being, but it can be problematic and requires good supervision. A survey conducted into the extent of the use of prayer in counselling revealed that many counsellors do not bring their use of prayer to supervision. The aim of this research was to discover why this may be. Participants were 19 BACP accredited and CMCS approved counsellors who use prayer in their practice. They were interviewed, and data were analysed using interpretative phenomenological analysis. The data indicate that there is not a culture of openness towards the use of prayer. Counsellors do not feel free to explore their practice of prayer because of fear: of not being understood; of being judged; of losing respect and credibility; of being thought of as transgressing; of exposure by the supervisor; of how the supervisor will treat the disclosure; and of condemnation and dismissal of something that is important and precious to the counsellor. The central implication for supervision is the need to create a culture of openness and a collaborative working alliance where all aspects of the counselling process can be explored with appropriate theoretical consideration and personal challenge, and where the supervisee feels accepted, able and open to exploring all aspects of the work with the supervisor. This prevents unethical practice, protects the client and enables consistency of work.