Supervisor Cultural Humility and Supervisee Nondisclosure: The Supervisory Working Alliance Matters

Given that half or more of supervisees (therapist trainees) never have their clinical work monitored or observed, supervisees who withhold salient information in clinical supervision compromise supervisors' ability to monitor client welfare and promote supervisees' professional development. Attempting to further understand the factors explaining supervisee nondisclosure, we tested the supervisory working alliance as a mediator of the hypothesized inverse relations of cultural humility and collaborative supervision with supervisee nondisclosure (supervision-related and clinically-related nondisclosure) among a diverse sample of 214 supervisees in applied psychology and allied mental health programs. Results supported the hypotheses that (1) descriptively, supervision-related nondisclosure was more prominent than clinically-related nondisclosure, (2) cultural humility substantially inversely predicted supervisee nondisclosure, and (3) the supervisory working alliance fully mediated the inverse relations of cultural humility and collaborative supervision with supervisee nondisclosure. Understanding the mechanisms underlying supervisee nondisclosure have broad implications for clinicians and researchers alike.

Comparing Presence and Absence of Initial In-Person Contact and Written Feedback in RE&CBT E-Supervision

This pilot study aims to analyze the effects of the presence and absence of initial in-person contact and written feedback in RE&CBT e-supervision, comparing it on the Supervisory Working Alliance Inventory, the Supervisor Satisfaction Questionnaire, and the Trainee Disclosure Scale. During a period of six months, five supervisees performed ten e-supervision divided into two groups, a control group that did only the initial meetings in-person and an experimental group in which two supervisees completed whole process online. Additionally, in the first five e-supervision, the supervisor reviewed an entire session with written feedback with an additional meeting for each group. In the last five e-supervision, the supervisor only partially reviewed client sessions during supervision. After ten e-supervision, an individual post-interview was conducted with each participant. This study's primary statistical method for calculating and combining effect sizes was Tarlow Baseline Corrected Tau and Open Meta Analyst software. Both groups scored above average on the first two scales, but the disclosure scale had highly irregular and inconsistent patterns. The combined qualitative and quantitative results suggest that novice therapists generally prefer to have their entire sessions reviewed with written feedback and that a single in-person contact is unlikely to influence e-supervision satisfaction and working alliance. Given that there are no adequately validated e-supervision models, this pilot study used a pilot model named Supported Model of Electronic Supervision (SMeS). This model showed potential, but it needs further testing on a larger sample with more clearly operationalized steps. This study experimentally supports the effectiveness of RE&CBT supervision for the first time.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10942-023-00505-2.

Supervision and Ethics: Updates to the CRCC Code of Professional Ethics

Supervision is a key element to the development of ethical skills and awareness in rehabilitation counselors. Ethical standards specific to rehabilitation counselor educators and supervisors were first introduced in 2002 and updated in 2010 and 2017. This article discusses supervision and professional dispositions as constructs that were used to help frame the revision process and outlines some of the key change to Section I. (Supervision, Teaching, and Training) of the Code of Professional Ethics for certified rehabilitation counselors. In conjunction with the revision process, special considerations for multicultural competencies have been strengthened throughout Section I, as well as specific requirements for the measurement and assessment of professional dispositions in educational settings. The article helps to inform and guide supervisors, trainers, and educators as they review Section I and consider their role in the development of ethical skills in those they supervise and their own respective practice.

Self-Coding of Fidelity as a Potential Active Ingredient of Consultation to Improve Clinicians' Fidelity

A key goal for implementation science is the identification of evidence-based consultation protocols and the active ingredients within these protocols that drive clinician behavior change. The current study examined clinicians' self-coding of fidelity as a potential active ingredient of consultation for the Attachment and Biobehavioral Catch-up (ABC) intervention. It also examined two other potential predictors of clinician fidelity in response to consultation: dosage of consultation and working alliance. Twenty-nine clinicians (97% female, 62% White, M age = 34 years) participated in a year of weekly fidelity-focused ABC consultation sessions, for which clinicians self-coded fidelity and received consultant feedback on both their coding and their fidelity. Data from the ABC fidelity measure were available for 1067 sessions coded by consultants, and clinicians' self-coding accuracy was calculated from 1044 sessions coded by both clinicians and consultants. Alliance was measured with the Working Alliance Inventory-Trainee and Supervisor Versions. The study was observational, and fidelity and self-coding accuracy were modeled across time using hierarchical linear modeling. Clinicians' ABC fidelity, as well as their self-coding accuracy, increased over the course of consultation. Clinicians' self-coding accuracy predicted their initial fidelity and growth in fidelity. Working alliance was also linked to fidelity and self-coding accuracy. These results suggest that clinician self-coding should be further examined as an active ingredient of consultation. The study has important implications for the design of consultation procedures and fidelity assessments.

An Examination of Street-Level Bureaucrats’ Discretion and the Moderating Role of Supervisory Support: Evidence from the Field

This study aims to provide a deeper understanding of the relationship between the discretion of street-level bureaucrats and their willingness to implement as well as between discretion and client meaningfulness by testing street-level bureaucrat theory in a different context. The effect of discretion on willingness to implement and client meaningfulness may differ due to perceived supervisory support. Data from 241 bureaucrats (labor inspectors) in the Malaysian Ministry of Human Resources indicated that discretion significantly influences bureaucrats’ willingness to implement and client meaningfulness. Critically, the moderating role of perceived supervisory support augmented only the positive impact of discretion on client meaningfulness; for example, this relationship is more significant among bureaucrats who perceive high supervisory support. This study sheds new light on the notable role of supervisory support in ensuring that discretion enhances client meaningfulness and willingness to implement.

Supervisee perceptions of the use of metacommunication in the supervisory relationship

Objective: This study examined the use of metacommunication in supervision from supervisees' perspectives. Method: A total of 129 supervisees completed the Metacommunication in Supervision Questionnaire-MSQ, a measure devised for the purpose of this study to explore the frequency and willingness to use various forms of metacommunication in clinical supervision. Measures of the nature of the supervisory relationship (also from the supervisee's perspective) were taken to explore whether a relationship exists between the nature of supervision and supervisees' perspectives on the use of metacommunication. Results: There was general concordance between supervisee ratings of their own willingness and their perception of their supervisor's willingness to use various forms of metacommunication in supervision. There were significant differences in the reported frequency with which the different types of metacommunication are actually used. A factor analysis elicited a two-factor structure underlying the MSQ and significant correlations with measures of the nature of the supervision relationship were observed. It appears that metacommunication around difficult or uncomfortable feelings in the supervisory relationship occurs less often than other components of metacommunication. Conclusion: Future research needs to further validate the MSQ and assess whether the frequency of metacommunication in the supervisory relationship is related to metacommunication in supervisees' psychotherapy with clients.

Exploring Rehabilitation Counseling Supervisors’ Role in Promoting Counselor Development of Ethical Fluency

Clinical supervision plays an integral role in the professional development of counselors, particularly for developing their awareness of ethical service delivery and decision making. This grounded theory study queried eight rehabilitation counseling supervisors, four from a state rehabilitation agency and four from a nonprofit community rehabilitation organization. The purpose of the study was to determine supervisor perspectives regarding their role in the development of ethical decision making in their supervisees. The emergent construct from the data is termed ethical fluency. Ethical fluency is a cognitive ability representing the interaction between acculturation knowledge, fluid reasoning, and the speed and accuracy with which ethical dilemmas are recognized and processed. Supervisors in this study reported playing a key role in developing ethical fluency in counselors, and the supervisory working alliance was an integral platform from which to approach discussions on ethics. Recommendations for improved practice and future research are provided.

Construction and Validation of a Supervisor Principle Ethics Scale

Psychometric properties on a newly developed Supervisor Principle Ethics Scale (SPES) are reported. The SPES was created to measure supervisees' perceptions of supervisors' use of ethical principles (Autonomy, Beneficence/Nonmaleficence, Justice, Veracity, Fidelity). Participants were vocational rehabilitation counsellors with a state agency in the United States (US) (Males = 38, Females = 49). They completed the SPES and the Supervisory Working Alliance-Trainee Form (Efstation, Patton, & Kardash, 1990). The five factors of the SPES were significantly correlated with the Supervisory Working Alliance-Trainee Form (SWAI-T), suggesting evidence of construct validity. Potential uses for the SPES in research and training activities are discussed.

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.

Clinical supervision in a competency-based era

Since clinical supervision has become recognized as a distinct professional practice, competency-based supervision has gained considerable traction internationally. Competency-based supervision enhances accountability and is compatible with evidence-based approaches. Competency-based supervision is defined by supervisor and supervisee collaboratively and explicitly identifying the knowledge, skills and attitudes comprising each clinical competency, determining specific learning strategies, and monitoring and evaluating the development of those. Recommendations for supervision practice are described based on the growing evidence base for practice and responsive to emerging ethical and legal issues.

Inadequate and Harmful Clinical Supervision

Two studies were conducted to revise and empirically test Ellis’s framework for inadequate and harmful supervision, and to determine the occurrence of inadequate and harmful clinical supervision from the supervisees’ perspective. For Study 1, we delineated 10 criteria for minimally adequate clinical supervision and defined inadequate and harmful supervision by differentiating self-identified and de facto supervision for each. Ratings from 34 supervision experts were used to generate a taxonomy of 16 de facto inadequate and 21 de facto harmful supervision descriptors. Because harmful supervision was distinct from, yet subsumed by, inadequate supervision, we revised the taxonomy and definitions accordingly. In Study 2, the occurrence of inadequate and harmful supervision was assessed for 363 supervisees; 93.0% were currently receiving inadequate supervision and 35.3% were currently receiving harmful supervision. Over half of the supervisees had received harmful clinical supervision at some point. Implications for research, training, and practice are discussed.

Comfort and challenge: a thematic analysis of female clinicians' experiences of supervision

OBJECTIVE

The supervision of counsellors, counselling psychologists, and psychotherapists is generally perceived to be an invaluable component of training and practice. The present study analysed this process to explore the meanings of supervision and to consider implications for clinical practice and training.

DESIGN

This study presents the accounts of 19 psychological therapists who experienced supervision while working at a London-based women's therapy centre.

METHOD

Demographic information was collected by questionnaire, and semi-structured interviews were conducted to explore aspects of the supervisory experience. The qualitative data were thematically analysed.

RESULTS

Supervision has complex and paradoxical meanings, and it impacts on clinical counselling practice in multifarious ways. Dominant themes highlighted were the usefulness of supervision, specifically support, empowerment, and joining; fear of exposure in supervision versus gaining new information; the comfort versus the challenge of supervision; and supervision as a containing space.

CONCLUSIONS

An experiential model of supervision was developed from the data. This model complements existing models in the field. It could be evaluated and used alongside existing models in various training and supervision contexts. Findings are discussed in relation to the literature on clinical supervision.

Multicultural Clinical Supervision and Benchmarks

The purpose of this Major Contribution is to provide background knowledge and context for competency-based clinical supervision and to showcase a diversity of methodologically sound empirical approaches to study effective supervision, including multiculturally competent supervision, and comparative perspectives on supervision cross-culturally. The intent is to begin to provide the empirical data necessary to assist the supervisor in supporting supervisees’ development of the benchmark competencies and to provide direction for future training of supervisors. Specifically, the articles in this major contribution address competencies in clinical supervision and the Competency Benchmarks on three pivotal topics: empirical support defining effective supervision, innovative empirically based approaches to cross-cultural and international supervision, and an empirical analysis of feminist supervision in a multiculturally diverse group context. Each of the articles addresses particular Competency Benchmarks and provides prototypical models of rigorous research procedures to inform the practice of multicultural supervision and training of supervisors, and implications.

Effective and Ineffective Supervision

Although supervision is recognized as a significant tenant of professional growth for counseling and psychotherapy students, the variability of the effectiveness, or ineffectiveness, of supervision has come under scrutiny in recent times. Our sample of 128 participants shed light on the most effective (e.g., encouraged autonomy, strengthened the supervisory relationship, and facilitated open discussion) and most ineffective (e.g., depreciated supervision, performed ineffective client conceptualization and treatment, and weakened the supervisory relationship) supervisor skills, techniques, and behaviors. Moreover, effective and ineffective behaviors, along with best and worst supervisors, were significantly differentiated based on the supervisory working alliance, supervisor style, supervisor self-disclosure, supervisee nondisclosure, and supervisee evaluation. Implications for supervision competencies and supervisor accountability are discussed.

Toward a tripartite vision of supervision for psychoanalysis and psychoanalytic psychotherapies: alliance, transference-countertransference configuration, and real relationship

The psychoanalytic supervision relationship is examined as a tripartite phenomenon, comprised of the supervisory alliance, transference-countertransference configuration, and real relationship. While most supervisory analysts would readily acknowledge that a real (or personal) relationship element exists in analytic supervision, that facet of the supervision relationship has not routinely been incorporated into considerations of psychoanalytic supervision. In this vision of supervision, real relationship, supervisory alliance, and transference-countertransference configuration are presented as integral and complementary constructs that define psychoanalytic supervision. Each of those three components is examined briefly with regard to its beginnings, evolution, and contemporary status; each component is also considered from an empirical perspective. While we have a growing quantitative and qualitative research foundation that supports psychoanalytic practice, psychoanalytic supervision has largely been ignored as a subject and object of scientific study. Supervisory alliance, transference-countertransference configuration, and real relationship are explored as research ready variables. Some clinical hypotheses--eminently testable and worthy of investigation--are proposed with regard to each component of the model, and some ideas--albeit tentative and preliminary--about how to initiate such inquiries are offered.

Helpful and Hindering Multicultural Events in Group Supervision

This study examines the relationship between multicultural events in group supervision, group climate, and supervisee multicultural competence using a mixed qualitative/quantitative design. The discovery-oriented approach yielded 196 helpful and hindering multicultural events among 136 participants. The most common events included multicultural learning and peer vicarious learning. Supervisees suggested improving their group supervision through better integration of multicultural issues and more supervisor involvement. Regarding group climate, supervisees reporting peer vicarious learning or multicultural learning experienced higher group engagement, whereas misapplications of multicultural theory related to higher reports of group conflict. Increased multicultural learning and extra-group multicultural events positively related to supervisees' multicultural competence whereas multicultural conflicts with supervisors, misapplication of multicultural theory, and the absence of multicultural events negatively related to supervisee multicultural competence. The findings of this study generated several suggestions for managing multicultural events as well as improving theory, research, and practice for group supervision.

Supervision of Psychotherapy

Current models and issues related to psychotherapy supervision are examined. These include ethical and legal issues, problems of interpersonal competence, and multicultural issues. As a part of this analysis, interviews about supervision with five prominent counseling psychologists are included to provide their perspectives. Implications for the field of counseling psychology are described, and a series of recommendations is presented.

The Student Perspective of Psychology Practica Training

Providing practicum training to graduate students is a valued activity of many mental health settings. Practica are also crucial to the training and socialization of future mental health practitioners. This research surveyed 321 doctoral psychology students about expectations of their practicum training sites versus what they actually received in fundamental domains including supervision, client contact, assessment, and research. While the majority of students reported receiving what they expected, a large minority did not; students also indicated that they were quite hesitant to provide feedback about shortfalls in training. Implications and recommendations for administrators of mental heath settings are presented.

Supervisor self-disclosure: balancing the uncontrollable narcissist with the indomitable altruist

The purpose of this article is to provide supervisors with a framework to determine the effectiveness of self-disclosure in supervision. We posit how self-disclosures can be both memorable to the trainee and facilitative of supervision process and outcome, specifically the supervisory working alliance, trainee disclosure, and trainee edification. Case examples based on the literature and our own personal experiences are offered to illustrate the models' applicability.