An APA task force has created guidelines that promise to make clinical supervision a more evidence-based and codified part of psychology training.
By Tori DeAngelis
September 2014, Vol 45, No. 8
Print version: page 42
DeAngelis, T. (2014, September 1). Fostering successful clinical supervision. Monitor on Psychology, 45(8). https://www.apa.org/monitor/2014/09/clinical-supervision
When done well, clinical supervision is key to the thriving and future success of up-and-coming practitioners. Under the wings of a trusted, knowledgeable and competent supervisor, a novice therapist's intellectual understanding transforms into real-life interventions that can profoundly affect others' lives for the better.
But the gold standard of supervision is too often unmet in psychology, in large part because supervisors tend to view the role as a given, supervision experts say. While there is a fairly strong knowledge base in the area, supervisors tend to think the skill is something learned through osmosis.
"A pervasive attitude has been, ‘If you were supervised, you can supervise — what's the problem?'" says Pepperdine University adjunct professor Carol Falender, PhD, who with Edward Shafranske, PhD, wrote the 2008 book "Casebook for Clinical Supervision: A Competency-Based Approach." She's concerned this attitude has resulted in a devaluation of the need to ensure supervisor competence.
A new set of guidelines aims to give psychology supervisors guidance grounded in research and experience. Earlier this year, an APA task force headed by Falender completed two years of work on a document that defines and fleshes out the parameters of good supervision, including a strong, trusting supervisory relationship and sound, modern assessment and feedback methods, among others. The guidelines were adopted as policy by APA's Council of Representatives in August.
"Until now, there has been no national policy or guidance to help psychologists understand the best ways to implement high-quality supervision," says APA Deputy Executive Director for Education Catherine Grus, PhD, who was the APA staff liaison to the guidelines task force. "That's what this document does."
Seeds for the guidelines were planted at a 2002 conference on competencies in professional psychology organized by the Association of Psychology Postdoctoral and Internship Centers and co-sponsored by APA and other organizations. There, psychology educators mapped out eight core areas for students to grasp to become good practitioners. One of these was supervision, detailed in a 2004 article by Falender and colleagues in the Journal of Clinical Psychology. It stated that professional development — including supervision — should be a lifelong, cumulative process that pays strong attention to diversity and takes into account legal and ethical issues, personal and professional factors, and self- and peer-assessment.
The guidelines pick up on these points, organizing them in seven domains that task force members agree are necessary to becoming a good supervisor. They include competence in supervision itself, as well as in diversity issues, the supervisory relationship, professionalism, assessment, evaluation and feedback, and ethical, legal and regulatory considerations.
Practitioners also should be knowledgeable of the literature on supervisory incompetence, which includes inadequate supervision — not meeting your agreed-on schedules or other duties with supervisees, for example. Supervisory incompetence also includes harmful supervision, which may include sexual boundary violations or poor or otherwise erroneous feedback on performance, for example, the document states.
A major point in the guidelines is that supervision should be viewed as a unique set of skills, independent of therapy skills or for that matter other seemingly related skills, such as consulting, teaching, therapy, management, administrative supervision and case management, says task force member Michael V. Ellis, PhD, who is division director of counseling psychology at the University at Albany in New York.
"There has been very little recognition that supervision really is a discipline in and of itself that requires discrete skills, knowledge and attitudes," says Ellis, who has studied supervision for some 30 years. "A lot of people who are practicing clinical supervisors are untrained or unknowledgeable, and that's where a lot of harmful or inadequate supervision is coming from."
The guidelines also discuss research that provides clues about what constitutes good supervision and which areas need further study.
As with therapy, a main issue is the quality of the supervisory relationship. For Ellis, that includes more than an agreement on goals and tasks, or the emotional bond, which are commonly studied variables. It also incorporates safety and trust issues, for example.
"If supervisees can't come in and talk to us about the places they're messing up, then how will they learn to be effective as opposed to doing something inept or harmful?" he says.
To this end, good supervision also entails giving consistent, high-quality feedback, adds task force member and University of Redlands professor Rod Goodyear, PhD, who with Janine M. Bernard, PhD, wrote "Fundamentals of Clinical Supervision" (Merrill), now in its fifth edition.
Good feedback is thorough, timely, honest and helpful, while poor feedback ranges from vague and unclear to blindsiding (for example, a student who thought she was doing well discovers that her supervisor thinks she has important deficits). Getting accurate feedback is intimately connected to the ethical issue of gatekeeping, or keeping poor students from continuing on if there's concern they might harm clients.
"Gatekeeping — rarely easy for supervisors anyway — is made all the more difficult when supervisors feel vulnerable to accusations that they have not been providing feedback, which might have enabled that supervisee to succeed," Goodyear says.
Likewise, good supervisors use assessment methods and strategies that allow them to give appropriate feedback — regular videotaping and discussion of sessions, for example. Third-year Pepperdine University graduate student Mark Miller says it took some time getting comfortable with watching his sessions on videotape, but now he wouldn't choose a practice site that didn't use this strategy.
"For me, giving a supervisor access to my performance and choosing sites that have those resources and mechanisms in place is extremely important," he says. "I'm not sure how deep or effective supervision can be without that."
Finally, good supervisors should be alert to cultural, gender, ethnic and other differences between themselves, their supervisees and their supervisees' clients, Falender says.
"Supervisors should be constantly thinking about their own world views, about others' world views, about their own diversity status on multiple dimensions and how this intersects with the supervisee's world view, and about how all of this relates to the client's presenting problem," she says.
Cultural competence is one area where students may have something to teach their supervisors, rather than the other way around, Falender adds. To this end, the guidelines also emphasize the importance of supervisory relationships that are collaborative.
"Students may have training that might be superior to or different from their supervisors," she says. "By embedding the whole idea of collaboration into supervision, we hope supervisors will understand more fully that they can learn from their supervisees as well as imbue them with knowledge, skills and values."
The guidelines also emphasize that students should be trained to become supervisors while they're still in graduate school, Falender adds. While APA's current accreditation guidelines call for supervision training, the new guidelines will underscore the importance of that activity, she says.
While other mental health professions and psychologists in some other countries have supervisory guidelines, they are something new for American psychology, Grus adds.
"This is a resource that APA has not embarked on before," she says. "It's filling a void that's been there for a long time."
Tori DeAngelis is a journalist in Syracuse, New York.
