Becoming a Competent Psychotherapy Supervisor: How Do I Get There From Here?

“What can I offer my supervisee? I barely know anything!”

How does a newly minted psychiatrist, fresh out of residency, transform into a sage and competent psychotherapy supervisor? Halsted’s traditional medical training method of “see one, do one, teach one,” fails here: simple know-how is not enough to master the complicated skills and cultivate the professional identity of a seasoned psychotherapy supervisor. Learning how to teach requires more than clinical experience. What do we know—and not know—about the internal development and personal evolution of the psychotherapy supervisor?

A body of literature exists, perhaps forgotten, on descriptive models of psychotherapy supervisor development. That golden age of inquiry began in 1983, blossomed over the ensuing 10 years, and continued to have an impact as institutions became aware of the need to facilitate the development of supervisors. Five models emerged, more similar than not, each conceptualized as a series of three or four sequential stages. Unfortunately, little empirical research on these models occurred, despite widespread opinion that better knowledge about how supervisors develop their teaching skills should contribute to a deeper understanding of the overall process of supervision. To get a sense of the affective, cognitive, and behavioral scope of these models, consider the four-stage model proposed by C. Edward Watkins, Ph.D., published in 2012 in the American Journal of Psychotherapy (vol. 66, no. 1).

Watkins termed his first stage “Role Shock.” In this stage, freshman supervisors are beset by uncertainty and self-doubt and fear being a fraud or a phony. Anxious and overwhelmed, they cling to their personal experiences as a supervisee for guidance. To conceal inadequacies, they may exhibit critical, rigid, or controlling behaviors toward their supervisees, potentially hampering supervisees’ independence and inhibiting their self-disclosures.

During the second stage, called “Role Recovery/Transition,” sophomore supervisors feel more grounded and experience less anxiety and dread. “As I began to feel increasingly more self-assured, I found I could listen more easily to my supervisee talk about his patients. I could finally think.” There is a dawning awareness of their clinical abilities, a waxing in confidence, a lessening of dependence on memories of their own supervisors, and the burgeoning of a supervisory identity.

The third stage, labeled “Role Consolidation,” is marked by stable self-reliance, a solid theoretical frame of reference, well-developed clinical skills, a larger capacity for self-reflection, and a deeper appreciation for the dynamics between the supervisee, patient, and supervisor. “I enjoy doing supervision. I like to help my supervisees better understand how to sit with and listen to their patients. I try to help them become more self-aware and reflective and better able to consider how changes in their interventions can make a difference in how their patients respond.”

The final stage, “Role Mastery,” augurs in an exemplary skillset, a fully integrated professional identity, and a superior level of self-awareness. These are the senior supervisors, those fully committed to lifelong learning, who are most able to apprehend the subtle complexities of a case and communicate its import succinctly and effectively. They are able to help their supervisees flourish and grow.

Understanding this developmental process—and that this growth requires, at the very least, a healthy capacity for self-reflection, proficient psychotherapeutic skills, and actual supervisory practice—may be helpful. For example, new supervisors may be reassured that their anxiety and lack of self-confidence is a shared, common experience. And more advanced supervisors may be inspired toward even higher levels of competence by taking advantage of educational opportunities for supervision. This begs the question: what kind of educational training supports do psychotherapy supervisors need to better develop their supervisory skills and professional identities? And how do those needs vary, depending on one’s level, or stage, of supervisory development?

In response to these concerns, an increasing number of academic institutions are addressing the need to help supervisors develop into more effective and competent teachers. For example, through a supervisor evaluation process, supervisees provide valuable feedback about their supervisors’ strengths and weaknesses. In addition, many institutions offer a variety of educational opportunities to their supervisory faculty, for example, weekend workshops, small group seminars, semester-long courses, and peer supervision programs. Topics typically covered include supervisory role and responsibilities, models of supervision, the development and maintenance of the supervisory alliance, boundary issues, the dynamics of supervision including parallel process, techniques for providing critical feedback, assessment of supervisees, ethical and legal issues, and diversity issues. Many of these educational endeavors go beyond listening passively to lectures and usually offer a core didactic piece—a research paper, book chapter, PowerPoint, video—followed by group discussion or an activity such as role-playing. Often, an experiential component is included, for example, notes from a supervisory session or full supervision case are presented, with a critique offered by a discussant or master supervisor.

However, there is little empirical research on which of these educational experiences are most helpful to supervisor development. Even less attention has been paid to tailoring an educational experience to a supervisor’s particular level of development.

More research would be helpful. Yet it is important to note that the majority of today’s psychotherapy supervisors have never received any formal training on how to supervise. Perhaps that’s because educational programs for supervisors have been more widely offered only over the last decade. It is hoped that as more innovative educational opportunities become available, more supervisors will take advantage of them. As Watkins’ model demonstrates, no matter in what stage a supervisor may be, he or she, along with his or her supervisees and patients, can always progress. Learning how to supervise is a lifelong journey and a continuous education. ■

References

1. Kernberg O, Michels R. Thoughts on the Present and Future of Psychoanalytic Education. J Am Psychoanal Assoc. 2016;64(3): 477-493

2. Riess H, Herman, JB. Teaching the teachers: a model course for psychodynamic psychotherapy supervisors. Acad Psychiatry. 2008;32(3): 259-264.

3. Rojas A, Arbuckle M, Cabaniss D. Don't Leave Teaching to Chance: Learning Objectives for Psychodynamic Psychotherapy Supervision. Acad Psychiatry. 2010; 34(1): 46-49.

4. Rubin SS. At the Border of Supervision: Critical Moments in Psychotherapists' Development. Am J Psychother. 1989;43(3): 387-397

5. Weerasekera P. The State of Psychotherapy Supervision: Recommendations for Future Training. Int Rev Psychiatry. 2013;25(3):255-264

Watkins CE Jr. Educating Psychotherapy Supervisors. Am J Psychother. 2012; 66: 279-307.