Educating Psychotherapy Supervisors
Abstract
Introduction
What are the training needs of psychotherapy supervisors themselves? How might those training needs be best addressed in actually preparing supervisors to supervise? How can the development of the psychotherapy supervisor best be facilitated and enhanced?
“ . . . the facts here are staggering: (a) Psychotherapists-in-training typically are closely scrutinized and supervised because becoming a therapist is considered to be a labor-intensive endeavor for which much training and supervision are needed; (b) supervisors have the charge of facilitating the growth and development of their supervisees and, in turn, helping those supervisees facilitate the growth and development of their patients; and (c) though being the ultimately responsible party in the supervisor-supervisee-patient triad, supervisors typically receive little to no training in how to supervise and do supervision. . . . Something does not compute. We would never dream of turning untrained therapists loose on needy patients, so why would we turn those untrained supervisors loose on those untrained therapists who help those needy patients (Watkins, 1997b, p. 604)?
Psychotherapy Supervisor Training in the New Millennium
Of What Does Psychotherapy Supervisor Training Consist and How Is It Delivered?
What Different Topic Areas are Typically Deemed Important to Cover in Supervisor Training?
What Educational Methods, Tools, and Strategies Seem Most Useful When Delivering Supervisor Training?
Within a didactic-experiential framework, how can the essentials of competent, effective supervision be best communicated and taught to supervisor trainees in the most meaningful and impactful way?
What Is the Place of Supervisor Development in Supervisor Training?
What Is the Role of “Competencies” in Contemporary Supervisor Training?
If for whatever reasons you might have stepped away from supervision altogether around the turn of last century only to return 10 years later, what would you find different now, if anything, about supervision? The press of and push toward competency-based, evidence-based, accountable supervision and training would, from my perspective, be the most readily evident, highly substantive change that would have occurred and that continues to occur in psychotherapy education (Watkins, 2012b).
The United States Connection
The United Kingdom Connection
The Australian Connection
knowledge and understanding of the profession,knowledge of and skills in effective supervision practices,knowledge of and ability to develop and manage the supervisory alliance,ability to assess the psychological competencies of the supervisee,capacity to evaluate supervisory process,awareness and attention to diversity, and ability to address the legal and ethical considerations related to professional practice (Psychology Board of Australia, 2011, p. 4).
Summary Comment
The Study of Psychotherapy Supervisor Training
Authors | Setting/Sample | Measures | Analyses/Design | Procedure | Findings/Conclusions | Limita tion s/Stre ngths |
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Baker, Exum, &Tyler (2002) | Experimental group: 6 female and 6 male doctoral students (5 African-American, 7 European-American; mean age = 34 years) participating in clinical supervision practicum; Comparison group: 6 female and 1 male doctoral students (2 African-American, 5 Europe an-American; mean age =40 years) not enrolled in supervision practicum | Psychotherapy Supervisor Development Scale (PSDS); Retrospective interview questions | Independent and dependent t tests; qualitative analysis of interview questions | Students administered PSDS at beginning, mid-point, and end of semester, and administered retrospective interview at midpoint and end of semester | Supervisor development of supervision practicum students increased significantly across semester and was significantly greater practicum students; qualitative findings mixed | Only one semester studied; small sample size; self-report data |
Bambling et al. (2006) | Participants: 80 female and 40 male patients, 96 female and 31 male experienced therapists (supervisees), and 31 female and 9 male experienced supervisors (respective mean ages 39 years, 44 years, and 50 years); purpose of study to evaluate “impact of clinical supervision on client working alliance and symptom reduction in the brief treatment of depression”; therapy manual/16 hour training workshop used to teach therapists Problem Solving Therapy (PST) approach; supervision manual/1-day workshop used to teach supervisors in either alliance-skill or alliance-process supervision approach | Structured interview; Beck Depression Inventory; Social Skills Inventory; Working Alliance Inventory; Treatment Evaluation Scale;Problem Solving Therapy adherence scale; Supervision Focus Adherence Scale | Repeated measures ANOVAs/nested design with multiple measurement intervals | Patients with major depression were randomly assigned to receive 8 sessions of PST from either a supervised or unsupervised therapist; 3 randomly assigned supervision conditions were: alliance skill focus, alliance process focus, and no supervision; therapists received 8 supervision sessions | Patients in supervised as opposed to unsupervised treatment rated the working alliance higher, their symptoms lower, their satMaction with treatment higher, and were more apt to stay in treatment | Possibility of Type II errors; therapist allegiance effects and supervision pretreatment training session potential confounds |
Borders & Fong (1994) | 7 female and 1 male doctoral students, 1 Ed.S. Student (mean age =37 years, all White) enrolled in supervision practicum; each supervisor trainee assigned 1 to 2 supervisees for weekly individual supervision; all supervisor trainees received weekly individual and group supervision of supervision | Thought listing exercise (TLE); Critical Incidents in Counselor Supervision-Form B (CICS); Stress Appraisal (SAS) | Tests for binomial proportion; t tests for nonindependent samples/Descriptive, discovery-oriented approach | Supervisor trainees completed TLE, CICS, and SAS during group supervision meetings at weeks 2 and 15 of semester | “. . . three types of beginning supervisors’ thoughts in supervision . . . [were found to] change little over the course of a one-semester practicum.” | Only one semester studied; low power; self-report data; small number of participants; no control group |
Borders et al. (1996) | 6 female and 5 male doctoral students (mean age = 36 years; 9 Anglo-American, 1 African-American, 1 Hispanic-American) enrolled in required clinical supervision course; course, which included didactic and experiential components, structured along lines suggested by Borders et al. (1991); supervisor trainees assigned 1 to 2 students to supervise each week; supervisor trainees received weekly individual and group supervision of supervision | Supervisory Styles Inventory (SSI); Supervisor Emphasis Rating Form-Revised (SERF); Stress Appraisal (SAS); Supervisor Assessment Questionnaire (SAQ) | Tests for binomial proportion; paired t tests/Descriptive, discovery-oriented approach | Supervisor trainees completed SSI, SERF, SAS, and SAQ during class meetings at weeks 2 and 15 of semester | Upon completion of course, supervisor trainees reported a decrease in stress and an increase in their supervisory confidence; however, any changes in their supervision conceptualization and planning behaviors were minimal | Only one semester studied; low power; self-report data; small number of participants; no control group |
Bradshaw et al. (2007) | Participants: 89 schizophrenic patients (sex not specified), 14 female and 9 male mental health nurses, and several nurse supervisors (number not specified) | Multiple choice question papers; symptom scale; semi-structured interview | Independent sample t tests; paired sample t tests/quasi-experimental design | Nurses supervisees received 36 days of formal training in Psychosocial Intervention (PSI) and small-group clinical supervision; nurses assigned to experimental group also received workplace clinical supervision (whereas control group nurses did not); supervisors received 2-day course in clinical supervision; data were gathered twice–at very beginning of PSI training and at its end; nurses’ knowledge about serious mental illness and patients’ symptom changes assessed | Nurses in experimental group showed greater knowledge about psychological intervention and schizophrenia; their patients demonstrated significantly greater reductions in both positive and total symptoms; but some favorable changes emerged across both experimental and control conditions (e.g., significant improvements in patient social functioning) | Experimental nurse group significantly older and more experienced than control group; no non-PSI education control group; retrospective comparison group used; no specifics provided about supervisor training course; impact of supervisor training more assumed than evaluated |
Culloty et al. (2010) | 1 female supervision workshop leader; 13 female and 4 male mental health professionals (predominantly mental health nurses) participating in clinical supervision workshop (mean age =40.5 years) | Training Acceptability Rating Scale; Teachers PETS (Process Evaluation of Teaching and Supervision) used for coding video data; Marlowe-Crowne Social Desirability Scale (MCSDS); semistructured interview | Frequencies determined/coded for workshop leader behaviors; means and percentages determined for TARS, MCSDS, and interview da ta/q uasi-expe rime ntal, longitudinal design | Purpose: To evaluate supervisor training by means of fidelity framework; 2 workshops held over 3 consecutive days, each 6 sessions in duration; 185-page evidence-based clinical supervision manual used for training purposes | Manual-based workshop rated favorably, resulted in “relevant [supervisor trainee] learning and transfer” and was delivered with a high degree of fidelity; fidelity framework considered to be “a systematic, feasible and coherent rationale for the evaluation of supervisor training” | Small sample size; data largely self-report; absence of controls |
Getz & Agnew (1999) | Supervision group composed of treatment professionals (no specifics provided) | Semantic Differential Scale (SDS); focus group interview | No specific method described for analyzing interview data; mean scores determined for 9 SDS respondents/descriptive approach | Supervisor trainees, all of whom were providing individual supervision, received one-day workshop on clinical supervision; trainees then placed in small supervision of supervision groups, met with supervisor trainer for 1 3-hour monthly meeting for 5 months | Group participants were reported to have “gained in both understanding and practice of supervision” and to have “experienced professional and personal gain” | No control group; self-report data; possible demand characteristics; data analysis methods minimally detailed |
Kaiser & Kuechler (2008) | Stage 1: 72 professionals who participated in supervisor training program (no gender or ethnicity information provided); Stage 2: 20 of 72 professionals from Stage 1 who agreed to complete follow up training questionnaire | Pre-training questions; post-training questions; follow up survey questionnaire | Open coding process of questionnaire responses; percentages determined/grounded theory approach | Supervisor trainees provided questionnaire responses about their training program hopes (pre-training); provided post-training questionnaire responses about program usefulness; follow up questionnaire also inquired about program usefulness | Data seen as being supportive of training program | Self-report data; limited follow up participation; possible respondent bias; no control group; coding/a nalysis procedure minimally detailed |
Kavanagh et al. (2008) | 46 existing supervisor-supervisee pairs (median age for supervisors and supervisees, respectively, 40-49 years and 30-39 years); all practicing mental health professionals who volunteered to participate in clinical supervision workshop | Survey questionnaire drawn from Kavanagh et al. (2003) | ANOVA; ANCOVA/randomized controlled trial | Three conditions tested: Immediate training (where supervisor-supervisee pair immediately received 2-day clinical supervision training workshop); wait-list control (where pair received training 3 months later); and split condition (where supervisors received training 3 months prior to supervisees) | Immediate training condition resulted in better specified supervision agreement and fewer supervision problems (as perceived by supervisors); otherwise, impact of training on practice was considered to be quite limited; “Results suggest that making significant improvements in supervision practice may be more challenging than were initially anticipated.” | Self-report data; no information provided on psychometric soundness of survey measure |
Majcher &Daniluk (2009) | 4 female and 2 male doctoral students (age range late 20s to mid 40s; all Caucasian) participating in 8 month supervision training course (with didactic and experiential components) | Three 1 to 2 hour audiotaped interviews conducted with each supervisor trainee | Interpretive phenomenological analysis and thematic review | In-depth audiotaped interview conducted with each supervisor trainee at supervision course’s beginning, midpoint, and end; main interview questions focused on change process occurring over course of supervisor training | Relationship dimension emerged as core common element for all participants; common themes emerged across each of the 3 interviews (e.g., concerns with developing competence and confidence, role clarity, and growth through supervisor training); 8-month course appeared to contribute to supervisor development | Small sample; single doctoral program; self-report interview data; 8-month training program |
McMahon &Simons (2004) | Experimental group: 9 female and 6 male counselors; Control group: 26 female and 16 male counselors | Clinical Supervision Questionnaire (CSQ; questions about confidenc e/self-awareness, skills/techniques, and th eore tical/concep tual knowledge) | Paired samples t test; oneway ANOVA; repeated measures ANOVA/pretest-posttest experimental design | Experimental group received intensive supervisor training program over 4 days, 6 hours per day, that included didactic and experiential components; program content based on 7 competencies identified in the curriculum guide for training supervisors (Borders et al., 1991); experimental group completed CSQ pretraining, post-training, and at 6-month follow up; control group completed CSQ at time of p re-training and at 6-month follow up | Significant gains in CSQ scores obtained for experimental group post-training; gains maintained at 6-month follow up | Author-constructed measure; psychometric soundness of CSQ largely untested; self-report, self-perception |
Milne (2010) | 25 female/male clinical psychology supervisor trainers; 256 female/male clinical psychology supervisor trainees receiving professional development training (modal age=25 to 35 years) | Training Acceptability Rating Scale; Manual Acceptability Rating Scale | t tests; Mann-Whitney U tests/comparative posttest only design | Supervisor trainees assigned to either supervision training manual only group or supervision training manual plus consultancy group; study’s purpose-to provide a national pilot study of an evidence-based clinical supervision (EBCS) manual; manual only group focused exclusively on materials provided in EBCS manual; manual plus consultancy group received an extra hour of discussion about EBCS implementation | Trainers and supervisor trainees rated manual in highly favorable fashion; supervisor trainees in manual plus consultancy group rated their workshop leaders and the EBCS approach more favorably | Possible demand characteristics; self-report data; causal inferences not possible |
Milne & James (2002) | 1 49 year old male consultant clinical psychologist (who provided supervision of supervision); 1 33 year old male clinical psychologist supervisor trainee; 3 female and 3 male qualified mental health practitioners (e.g., psychiatric nurses) participating in professional development experiences (approximate mean age = 39 years) | Teachers PETS (Process Evaluation of Teaching and Supervision) used for coding video data; Supervision Feedback Form | Frequencies determined/coded for 1,387 supervision interactions/longitudinal N = 1 methodology | Induction period lasting 2 weeks; then video recordings made of all sessions occurring between consultant-supervisor trainee dyads and supervisor trainee-supervisee dyads; during first intervention period, the consultant employed a “supervision as usual* approach; during second intervention period, consultant employed routine consultancy plus video-based feedback and satisfaction assessment data (from supervisor trainees’ supervision sessions); maintenance period evaluations also included | Concluded that “competence in supervision appears to require training”; both routine consultancy and consultancy plus feedback conditions found to contribute to increases in supervisor trainee competence | Groups varied at outset on one-on-one supervision received prior to study; single subject methodology |
Milne &Westerman (2001) | 1 49 year old male consultant clinical psychologist (who provided supervision of supervision); 1 45 year old male qualified mental health nurse supervisor trainee; 2 female and 1 male qualified mental health nurses receiving supervision as part of their postgraduate training (mean age =38 years) | Teachers PETS (Process Evaluation of Teaching and Supervision) used for coding video data; Supervision Satisfaction Questionnaire | Frequencies determined/coded for supervisory behaviors/longitudinal N=1 methodology, multiple baseline design | Supervision of supervision provided in hourly weekly meetings over 8-month period to supervisor trainee; routine supervision (baseline) followed by consultancy intervention (see Milne & James, 2002, panel above for elaboration); video recordings made of all sessions occurring between consultant-supervisor trainee dyads and supervisor trainee-supervisee dyads; maintenance evaluated at 6-month period; Kolb’s experiential model informed supervision process | Consultancy condition was found to be “mildly effective in promoting successful supervision” | Limited number of research participants; single subject methodology |
Nelson, Oliver, & Capps (2006) | Study 1 sample: 10 female and 3 male doctoral students (7 European-American, 6 Hispanic) who were supervisors in training Follow-up sample: 4 female and 1 male doctoral students (2 Europe an-American, 1 Hispanic, 2 African-American) used for confirmatory/disconfirmatory purposes of Study 1 results | 8 primary research questions asked of each participant (e.g., “How did this process help you develop supervisory skills?”) | Individual/focus group interview transcripts, student interview notes, and researcher memos/reflections analyzed by constant comparative | Data gathered by means of individual interviews; focus group for discussion/clarification purposes, with sample 1 thematic data being used to stimulate further supervisor development discussion in follow-up sample’s focus group | Six major themes in supervisor growth identified (e.g., learning through academics and experience, reflection, integration); “[o]ver the year and a half of . . . study, [supervisor trainees showed] . . . less need for structure, increased confidence and decreased anxiety about supervision, and a transition from relying on external resources to relying on internal resources” (p. 29) | Limited number of research participants; single doctoral program; self-report interview data 3-semester period studied |
Peace & Sprinthall (1998) | 10 female and 1 male professional counselors participating in in-service supervision course | Paragraph Completion Method (PCM); Defining Issues Test (DIT); Flanders Interaction Analysis Sc ale-Adapted for Counselor Supervision (FIAS-CS); subjective journal entries | t tests; percentages determined; journal entries reviewed | Data collected over period of 2-semester course, involving didactic and experiential components; PC I and DIT completed 3 times over semester 1; PCI completed 2 times over semester 2; FIAS-CS used during individual supervision conferences | Increases in supervisor trainee cognitive complexity, principled reasoning, and skill development occurred over course of training experience; concluded that trainees “did master the fundamentals of developmental supervision” | Limited number of research participants; data largely self-report; no control group |
Rapisarda, Desmond, & Nelson (2011) | 5 female and 2 male doctoral students (mean age = 37.7 years; of varied ethnicities;) taking supervision practicum course | Interview process used to examine how supervisor trainees changed during supervision practicum course | Constant comparative method used/collective case study design | At beginning and midpoint of semester, 45-minute interview conducted with each participant | Two main themes identified in supervisee to supervisor transition: (1) establishing a supervisory relationship; and (2) developing a supervisory skill set. | Only one semester studied; limited number of participants; single doctoral program; self-report interview data |
Sundin et al. (2008) | 15 female and 6 male supervisor trainees (mean age=50 years; all Caucasian) enrolled in psychotherapy supervisor training program; 3 female and 3 male highly experienced clinical psychology supervisor trainers (all Caucasian) | Evaluation of Knowledge Attainment and Relations in Group Supervision (EKARGS); Usage of the Supervisory Group Scale (USGS); Supervisor Style Questionnaire (SSQ); separate supervisor trainee and supervisor versions of EkARGS,USGS, and SSQ; supervisor version asked about supervisor perceptions of supervisor trainees | Regression analyses/naturalistic, longitudinal design | Supervisor training program built on theoretical seminars and group supervision, 2-year part-time course of study; each supervisee completed EKARGS,USGS, and SSQ after 6, 12, and 18 months of supervised practice; each supervisor completed supervisor version of same 3 measures at same time points | Increases in supervisor trainees’ knowledge and skill occurred over the course of training program (according to both trainee and supervisor ratings); concluded that the study results provided “an important and promising start” | Limited number of participants; self-report or opinion data; no control group |
White & Winstanley (2010) | Participants: 170 patients (sex not specified), 186 mental health nurses (sex not specified), 54 unit staff (sex not specified), and 17 female and 7 male nurse supervisors | Manchester Clinical Supervision Scale (MCSS); General Health Questionnaire; Maslach Burnout Inventory; Short Form Health Survey; Nursing Work Index; Mental Health Problems Perceptions Questionnaire; Service Attachment Questionnaire;Psychiatric Care Satisfaction Questionnaire; Perception of Unit Quality; semi-structured interview; qualitative diary data | Chi squares; t tests; Mann-Whitney U tests; Wilcoxon matched pairs signed ranks test/randomized controlled trial | 24 nurse supervisors received 4-day residential course in clinical supervision; then assigned to conduct yearlong group supervision of beginning supervisees at their work sites; control group was no-supervision condition; quantitative data from mental health nurse supervisees (baseline/12 months), patients (baseline/6 and 12 months), and unit staff (6 months); qualitative diary data collected monthly from supervisors | Nurse supervisors scored significantly higher on Manchester Clinical Supervision Scale (MCSS) after 4 day training course; differences maintained at 12 month follow up; nurse supervisees’ MCSS scores did not change significantly over 12-month supervision period; statistically significant differences not demonstrated in either quality of care or patient satisfaction | Supervision occurred only once a month for 45-60 minutes per session; influence of middle managers appeared to frustrate or facilitate supervision across work settings |
Ybrandt & Armelius (2009) | 6 female and 3 male supervisor trainees (mean age=48 years; all Caucasian) participating in three-semester postgraduate supervisor/teacher training program; supervisor group consisted of 7 female and 5 male highly experienced clinical psychology supervisors (mean age =49 years) | Swedish Structural Analysis of Social Behavior (SSASB) | Paired sample t tests | SSASB self-image questionnaire mailed to supervisor trainee group participants before training, after training, and at four-month follow-up | Supervisor trainees’ self-image found to change over the course of supervisor training; gains maintained at follow-up | Small sample size; self-report measure used; training effects studied over three semesters plus four-month follow-up |
“[t]here is no evidence that a particular sequence or combination of didactic-experiential training is [any] more effective [than any other]”, “direct comparisons of different training programs have not been reported”, and “training experiences of supervisors beyond the novice stage have [typically] not been studied” (Borders, 2010, p. 135).
Conclusion
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