Contemporary Visions of Psychotherapy Supervision: Sharing Perspective, Identifying Need, and Charting Possibility

How does supervision aid cognitive behaviour therapy skill development? Perspectives of CBT trainees: a thematic analysis

Eleven cognitive behaviour therapy (CBT) trainees in Scotland were interviewed regarding their experiences of clinical supervision and its impact on their skill development. Using thematic analysis, the authors developed four main themes: Linking Theory to Practice, Mirroring CBT in Supervision, The Expert Supervisor, and Trainees’ Reluctance to Give Negative Feedback. Clinical supervision was essential in helping trainees to link theory to practice; particularly through audio recordings, discussing formulations, and modelling and role-play. A CBT-specific approach to supervision and a CBT expert supervisor were also identified as valuable to learning. Trainees were reluctant to give negative feedback to supervisors, fearing negative consequences. The findings inform supervision practice.

Key learning aims

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The supervisory relationship from an attachment perspective: Connections to burnout and sense of coherence in health professionals

Supervision is an essential part of the training and work environment of health professionals, especially of psychotherapists and clinical/health psychologists. However, although the supervisory process is always a relational one and may therefore be influenced by attachment dynamics, the importance of the supervisory relationship for the professional's performance and the well‐being of the supervisee has yet to be fully examined.

In this cross‐sectional observational study, the Experiences in Close Relationships‐Revised (ECR‐RD; avoidant and anxious attachment), the Supervisory Relationship Questionnaire (SRQ), the Maslach Burnout Inventory (MBI) and the Sense of Coherence Scale (SOC‐13) were analysed for 346 (81.8% female) health professionals.

Considering professional experience and number of supervision sessions as control variables, a better supervisory relationship negatively predicted burnout symptoms (β = −.31) but positively predicted sense of coherence (β = .31, both p < .01). The final model, including avoidant and anxious attachment as additional predictors, explained 30% of the variance in burnout symptoms and 41% of the variance in sense of coherence.

The results underline the importance of the supervisory relationship for the well‐being and the professional performance of health professionals. Interactions between the supervisory relationship and underlying attachment parameters should be further explored in future studies.

The biographical gaze: Psychotherapeutic practice in psychosomatic hospitals in Germany

This article introduces the concept of a "biographical gaze" based on two dimensions: On one hand, I draw on findings from my qualitative empirical research on psychotherapists' practice and their interpretation of patients' suffering. The case study was conducted in psychosomatic hospitals in Germany and focused on psychotherapists based on different kinds of data (supervision transcripts, interviews, medical records, and questionnaires). On the other hand, I connect this research with theories on the clinical gaze, as well as Bourdieu's critique of the "biographical illusion." In the article's first section, I discuss the theories that contribute to the clinical gaze, knowledge, and medicine. In the second section, I present methods and condensed findings from my research. In the third section, I connect these findings to theories on biographies and their critics. Finally, I conclude with my theorization of the biographical gaze and its problems.

Development and Validation of a Short Version of the Supervisory Relationship Questionnaire

The Supervisory Relationship Questionnaire (SRQ) is one of the few theoretically sound and psychometrically valid questionnaires for measuring the SR within clinical supervision. However, its length can make it difficult to use in clinical practice and research. This study aimed to produce a shorter version of the SRQ (the Short Supervisory Relationship Questionnaire: S-SRQ) that retained its reliability and psychometric validity. The SRQ's 67 items were initially reduced using the criteria of external, internal and face validity. Two hundred and three UK trainee clinical psychologists then completed a series of online questionnaires including the S-SRQ and other clinical supervision measures. A Principal Component Analysis identified three components of the S-SRQ: 'safe base', 'reflective education' and 'structure', and an 18-item version was produced. Analyses revealed that the S-SRQ has high internal reliability, adequate test-retest reliability and good convergent, divergent and predictive validity. Participants also rated the S-SRQ as easy to use and potentially helpful for providing feedback on the SR in supervision. The S-SRQ (three subscales, 18 items) is a valid and reliable measure of the SR from the supervisee perspective. The current findings also support aspects of existing models of the SR. The S-SRQ is a promising measure for use in clinical, training and research settings. Copyright © 2014 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

The Short Supervisory Relationship Questionnaire (S-SRQ) is a psychometrically reliable and valid 18-item measure of the supervisory relationship based on the SRQ. Clinically, the measure represents a quick and accessible means for supervisees to assess the quality of their supervisory relationship and discuss this with their supervisors. It can also be used in conjunction with the supervisor-completed Supervisory Relationship Measure to support a dyadic discussion about clinical supervision and the supervisory relationship.

Developing psychotherapists' competence through clinical supervision: protocol for a qualitative study of supervisory dyads

BACKGROUND

Mental health professionals face unique demands and stressors in their work, resulting in high rates of burnout and distress. Clinical supervision is a widely adopted and valued mechanism of professional support, development, and accountability, despite the very limited evidence of specific impacts on therapist or client outcomes. The current study aims to address this by exploring how psychotherapists develop competence through clinical supervision and what impact this has on the supervisees' practice and their clients' outcomes. This paper provides a rationale for the study and describes the protocol for an in-depth qualitative study of supervisory dyads, highlighting how it addresses gaps in the literature.

METHODS/DESIGN

The study of 16-20 supervisor-supervisee dyads uses a qualitative mixed method design, with two phases. In phase one, supervisors who are nominated as expert by their peers are interviewed about their supervision practice. In phase two, supervisors record a supervision session with a consenting supervisee; interpersonal process recall interviews are conducted separately with supervisor and supervisee to reflect in depth on the teaching and learning processes occurring. All interviews will be transcribed, coded and analysed to identify the processes that build competence, using a modified form of Consensual Qualitative Research (CQR) strategies. Using a theory-building case study method, data from both phases of the study will be integrated to develop a model describing the processes that build competence and support wellbeing in practising psychotherapists, reflecting the accumulated wisdom of the expert supervisors.

DISCUSSION

The study addresses past study limitations by examining expert supervisors and their supervisory interactions, by reflecting on actual supervision sessions, and by using dyadic analysis of the supervisory pairs. The study findings will inform the development of future supervision training and practice and identify fruitful avenues for future research.

Response to Reactions to Major Contribution

The authors responded to the commentaries on the Major Contribution, “Multicultural Clinical Supervision and Benchmarks: Empirical Support Informing Practice and Supervisor Training.” The commentaries provided a structure of consensus, critical questions, and requests for additional elaboration. The commentators advocated for the urgent need to move forward translating clinical supervision, a distinct professional competency, directly into training and practice in the United States. They also agreed on the essential multicultural framework and the imperative for empirical research to provide validation for the Competency Benchmarks as a developmental training schema. The authors also provided responses with regard to future directions for supervision and training parameters.