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"You Said What?" - Becoming a Better Supervisor
by Carol Falender, Ph.D.

6 CE Hours - $179

Last revised: 09/14/2021

Course content © copyright 2005-2021 by Carol Falender, Ph.D. All rights reserved.

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Learning Objectives

This is an intermediate-level course. After taking this course mental health professionals will be able to:

The materials in this course are based on the most current information and research available to the author at the time of writing. The field of clinical supervision is growing exponentially, and new information may emerge that supersedes or supplements these course materials. This course material is designed to equip supervisors with a comprehensive understanding of clinical supervision, structure of practice, and the strengths of effective practice as well as an understanding of the potential harm inflicted on supervisees by less-than-competent practice.

Outline

Introduction: Background and Current Status

Supervision may well be the highest calling in psychology, social work, marriage and family therapy, nursing and other health and mental health professions. It is the way each profession is communicated and transmitted from generation to generation of practitioners. Until the last decade, remarkably little training or research was devoted to the practice of supervision. Generally, most supervisors have learned to supervise through osmosis, or by internalizing their own supervision experience. The way osmosis worked, the supervisor simply did what had been done for him or her as a supervisee, or did the opposite had their supervisor’s practices been ineffectual, inadequate, or even harmful.

The Association of State and Provincial Psychology Boards (ASPPB) concluded in their task force on supervision that:

Given the critical role of supervision in the protection of the public and in the training and practice of psychologists [and this author believes for all of mental health], it is surprising that organized psychology [and all mental health disciplines], with few exceptions, has/have failed to establish a requirement for graduate-level training in supervision. Few supervisors report having had formal courses on supervision, and most rely on their own experience as a supervisee. (ASPPB, 2003)

Although the Committee on Accreditation of the American Psychological Association (APA) has since addressed supervision training (APA, COA, Implementing Regulations, C8-D), implementation of such training is highly variable across programs. In other disciplines, supervision is in development with multiple foci and challenges existent (Bogo & McKnight, 2008; Bogo & Sewell, 2018).

Becoming a competent supervisor is complex, as it entails developing particular competencies and learning about the research and empirical support for them, all while being mindful of the personal contributions we bring to clinical practice and supervision.

In addition to general supervision competence, multicultural competence has sorely been neglected. Falicov (2014) described clinical and supervision practice as cultural and sociopolitical encounters. Therapists and their supervisors must be mindful of how sociopolitical, theoretical, and professional values and perspectives inform the clinical and supervisory experience. Because neither therapists nor supervisors are value-neutral, the supervisor needs to be attentive and inclusive in understanding these perspectives as well as being aware of the emotional and cognitive impacts on clients and supervision. Essential to clinical supervision are clinician personal values and self-awareness, which require cultural humility and an understanding of the impacts of power and connection (Falender, et al., 2014; Falender & Shafranske, 2021).

Although clinical supervision is a distinct professional practice, the supervisor needs to recognize that competence is a moving target: that knowledge, skills, and attitudes are ever-evolving, research is accruing, and it is a supervisory responsibility to strive to maintain continuing competence throughout one’s career. With the recognition of the high bar for achieving even entry-level competence as a supervisor, there is a need for a formal process of training in clinical supervision as it is – or should be – a core competency in all mental health professions. The supervisor has a major responsibility to support and model effective practice; to identify and work toward achieving goals; to assess and evaluate levels of supervisee readiness, competence, and affect; to reflect upon these; and then to translate it all into effective clinical intervention.

The highest duties of the supervisor are: first and foremost, protection of clients and the public; to serve as gatekeeper, ensuring that only suitable individuals enter the respective professions; and to provide enhancement and support for the development of competence, professionalism, and identity. Keeping in mind that the welfare and development of supervisees is tantamount, supervisors engage in a respectful and responsive manner, modeling ethics and professionalism. While the role of supervisor is weighty, it is also filled with potential for growth, development, inquiry, creativity, and excitement.

Because attainment of supervisor competency may be assumed to be simultaneous with licensure, the training period for new supervisors may be nonexistent or may not contain any specific training in supervision. Or, as in California, it may require two years of licensed experience for anyone supervising Marriage and Family therapists or social workers, or licensed professional counselors who are collecting hours for licensure. For psychologists in California, the requirement is licensure and a six-hour course in clinical supervision every licensure period. To be sure, one must check the requirements for the state in which one is practicing, or for telesupervision, compliance regarding supervisor licensure in the state where the client is located. Currently, in the pipelines of training for the various mental health and health professions, most supervisees in training are not receiving systematic preparation to be supervisors.

In competency-based approaches (Falender & Shafranske, 2004; 2017, 2021), there is an explicit framework and method for initiating, developing, implementing, and evaluating the processes and outcomes of supervision. The trainee is evaluated against a standard rather than in comparison to others. Through use of this framework, supervision becomes more systematic, with particular domains of knowledge, skills, and attitudes/values. Through development of a schema of supervisor competency, increased attention may be devoted to competence evaluation, supervisee and supervisor development, and support of the supervisor’s skills, all of which will benefit the supervisees.

In competency-based supervision, the supervisor may use any theoretical approach (e.g., CBT, psychoanalytic, solution-focused, etc.) and then systematically and intentionally attend to the various components of supervision such as multicultural identities and worldviews of client, supervisee, supervisor, alliance formation, monitoring for strains and ruptures, emotional reactivity or countertransference, legal and ethical issues, and so forth.

Few differences exist in concepts, attitudes, or practice of supervision between psychologists and other mental health professionals (Kavanagh, Spence, Strong, Wilson, Sturk, & Crow, 2003; Bernard & Goodyear, 2019). That is, there is general agreement on best practices of supervision across disciplines.

Bernard and Goodyear’s definition of supervision (2019) emphasizes the transmission of knowledge from a senior member to another in the context of evaluation with regard to legal and ethical considerations. In reality, there are increasing variants on this more traditional stance in that less senior – even less experienced – clinicians are in roles of clinical supervisor and must learn to maximize their ability to supervise effectively.

As we progress toward more evidence-based approaches to supervision and therapy, there is the need for a definition that can be operationalized or translated into measurable categories (Milne, Aylott, Fitzpatrick, & Ellis, 2008). Each supervisor must come to his or her own balance between a positive, facilitative supervisory relationship that embodies strength-based practices including empathy, positive regard, and support, along with the evaluative function that comes with the role. The greater the emphasis on informed consent – informing the supervisee of the parameters, power, and evaluative realities and transparency for feedback in the relationship – the greater the success of the supervisory relationship.

Supervision guidelines and best practices for supervision have been developed by the Association of State and Provincial Psychology Boards (ASPPB, 2015), American Psychological Association (APA) Board of Educational Affairs (2014, 2015), Association for Counselor Education and Supervision (ACES), see Borders, 2014, and the National Association of Social Workers (NASW, 2013). Marriage and Family Therapists have the opportunity to become an Approved Supervisor. These guidelines and best practices share many essential components, and the various topics of these will provide the structure for this course.

More specifically, this course will provide background and methodology for the practice of high-quality supervision in a competency- and strength-based orientation that is multicultural in focus and proactive. In addition to the components of competency-based supervision and their implementation, approaches to prevention of many supervisee dilemmas and problems will be addressed. An emphasis on assets, supplemented with encouragement in areas of lesser strength, provides for a strong supervisory relationship – one that can sustain stress and flourish with ongoing supportive and constructive feedback.

What is Competency-based Clinical Supervision?

Competency-based Supervision is an approach that explicitly identifies the knowledge, skills and attitudes or values that are assembled to form a clinical competency and develops learning strategies and evaluation procedures to meet criterion-referenced competence standards in keeping with evidence-based practices and the requirements of the local clinical setting (Falender & Shafranske, 2007; 2021).

Increasingly, mental health professionals identify competencies in order to define performance of service and developmental trajectories toward competence.

Competency-based Supervision is an international phenomenon in multiple countries (e.g., Australia, New Zealand, U.K.).

Components of Competency-based Clinical Supervision

Competency-based Supervision entails a systematic and intentional approach to the components of clinical supervision, which includes:

It also includes construction of a supervision contract that:

The self-assessment that is the foundation of supervision planning should be conducted using a competencies measure, described later in this course.

Contextually, supervision consists of relationships among:

To understand this complexity, one needs to consider each domain, the interactions among them, the resultant worldviews of each, and the impact of these on assessment, intervention, and supervision.

Diversity and Multiculturalism and Clinical Supervision

Supervisors’ knowledge, skills, and values relating to multicultural diversity is often not as comprehensive as that of their supervisees (Falender & Shafranske, 2021), and supervisors’ perceptions of the success of their efforts to integrate diversity into supervision may not be in total agreement with the supervisees’ perceptions of the same. Supervisors may focus on single factors such as race, gender, and ethnicity (Soheilian, et al., 2014) without an intersectional approach to diversity. Racial color blindness may be exhibited by either supervisors or supervisees – or both – and is a manifestation of implicit bias (Burkhard, Edwards, & Adams, 2016). Racial or ethnic anxiety may be aroused by racially- or ethnically-inciting incidents, speech, or bias, and differentially impacts individuals based on their historical experience. These could result in rumination, distancing, avoidance, or anger.

Discussion of client cultural identities/multiple identities/ intersections, and their impact on assessment/treatment often does not happen in clinical supervision and if discussion occurs, supervisees initiate it.  (Duan & Roelke, 2001; Sohelian et al., 2014).

How do you listen to and acknowledge the experience of others? How do you respectfully introduce multicultural identities and perspectives? How do you share space in the supervision room? How are you respectful and collaborative with your supervisee? How do you give feedback in a reflective, collaborative way, drawing upon strengths? How self-aware are you?

A Framework for Multicultural Clinical Supervision

Although multicultural competence is a necessity in supervision, supervisees continue to find it an area of uneven competence or even deficiency in their supervisors (e.g., Falender, Shafranske, & Falicov, 2014; Jernigan, et al., 2010; Singh & Chun, 2010). Lack of demonstrated supervisor multicultural competence is among the top counterproductive or harmful supervision practices. Depth of discussion of multicultural identities in supervision is associated with more positive supervisory relationships and less role conflict (Phillips, et al., 2017).

Essential to multicultural supervision is cultural humility – an attitude and worldview – the “ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the client” (Hook, et al., 2013, p. 354).

Cultural humility is a worldview – a way of being and connecting, and understanding how culture in all its aspects is implemented in every aspect of interaction, assessment, and intervention. Increasingly supervisees are reporting supervision that: a) is not attentive to cultural diversity; b) is disrespectful of cultural difference; or c) misunderstands multiple identities.

Examples include a supervisor who disrespects identities, calls out supervisees for their attention to culture, or is generally distaining, stating, “we are all the same – all this talk about identities is a time waster.”

Self-assess on the importance you model regarding cultural identities. This course will discuss theories and research to support your multicultural practice.

Falicov (in Falender, Shafranske, & Falicov, 2014) described her Multidimensional Ecological Comparative Approach (MECA) in which supervisor and supervisee consider the aspects of their personal experience in the frame of the client – aspects of cultural humility and empathy.

The generic ecosystemic parameters she describes are:

In Ecological context, the supervisory dyad examines diversity in where and how the client lives and fits into the broader sociopolitical environment. Consider the client’s total ecological field, including: the racial, ethnic, class, religious, and educational communities in which the person lives; their living and working conditions; and their involvement with schools and social agencies.

Migration/ Acculturation – Multiple symptoms, behaviors (nightmares, separation anxiety), or family over- or under-involvement may be precipitated by separations and reunions. A number of clinical issues are tied to such pre-migration experiences, including traumatic ones or reluctant leave-taking. Other clinical issues, from cultural gender gaps between husbands and wives to intergenerational conflicts between parents and children, emerge over time for many. Beyond migration, this refers to losses, or diminution of perceived value or opportunities. Therapists should be alert to marginalization, those psychosocial and mental health consequences of marginalized status, discrimination due to race, ethnicity, poverty, documented or undocumented status, trauma exposure, as well as other forms of powerlessness, underrepresentation, lack of entitlement, and access to resources.

Family organization – Consider the family of origin and current family-collectivistic, socio-centric family arrangements that encourage parent-child involvement and parental respect throughout life, in contrast to nuclear family arrangements that favor the strength of non-blood relationships such as husband-wife over that of the influence of the extended family or elders.

Family Lifecycle includes the timing of stages and transitions, the construction of age-appropriate behavior, various growth mechanisms, and lifecycle rituals and rites to name a few. Therapists should strive to understand the similarities and differences between themselves and their clients – shaped in part by nationality, race, ethnicity, social class, religion, or worldview – regarding lifecycle values and experience and where they are in terms of their own perspective (e.g., beginning a family, experiencing loss, expecting grandchildren), all of which influence worldview.

Falicov’s framework applies to diverse cultural groups, incorporating cultural diversity and social justice lenses. She advocates a postmodern position of not-knowing and curiosity, and a respectful approach to the realities of the family. (Falicov, in Falender, Shafranske, & Falicov, 2014)

Consider a situation in which you are currently supervising (or have been supervised yourself) and think about these variables for each of the participants:

Consider borderlands or shared identities among the client(s), supervisee, and supervisor. Multiple shared identities may be impactful in assumptions made about the family. If the supervisee and client are closer in age, for example, the supervisee may believe (and may or may not be correct) that he/she share an understanding of some life events that differs from that of the older supervisor. Similarly, if religion, ethnicity, race, sexual orientation, or other characteristics are shared by the two, assumptions and beliefs may be acted upon without being purposefully considered.

How do the borderlands with the supervisee impact your supervisory relationship? How do the borderlands with the client impact your supervisory relationship and your treatment and assessment planning?

This excerpt from Falicov, et al.’s comprehensive list is a step in identifying excellent practices in multiculturally competent clinical supervision. Supervisors are cautioned that there are studies that identify the intent of clinicians and supervisors to be multiculturally competent, but that their practice does not keep pace with intent (Hansen, et al., 2006). In other words, one should self-assess in this vital area and be particularly mindful of one’s openness and flexibility about taking a leadership role in introducing these topics as a matter of course and in responding to supervisee initiation of these or other subjects.

Remember, too, that supervisors may not view exposure to cultural differences as influential in supervisee development, while supervisees generally do. Relationship is pivotal to diversity consideration – negative interactions and conflict in communication impede relationships; discussion cannot occur without a good supervisory alliance (Toporek, Ortega-Villalobos, & Pope-Davis, 2004).

Self-awareness

A primary issue is self-awareness. Most of the multicultural frameworks (rooted in the work of Sue, Arredondo, and McDavis, 1992) consider self-awareness to be an essential first step in the process of becoming more culturally competent. There are multiple deterrents to enhanced self-awareness, including the fact that white therapists may not consider themselves to have a culture, or if they do, they question whether it is relevant. There is also disregard of white privilege – and as long as it is disregarded, the multiple power differentials in the therapy equation are disregarded. Self-awareness has not traditionally been a part of training programs. As if therapy were value-free – a premise long discounted – training programs have not attended to what values, assumptions, and belief structures each of us brings to our practice of therapy and supervision.

A second key deterrent is resistance to content, i.e., believing there are no differences among ethnic groups, or feeling a lack of safety in discussing diversity, culture, or trauma.

A third deterrent is neglecting the concept of ecological niches or diversity as an important part of the equation. What are ecological niches? Think of all the descriptors that go into your identity.

For example, gender, religion, profession, sexual orientation, gender identity, culture, ethnicity, socio-economic status, race, and so forth. It has been speculated that each individual could develop an “equation” to describe which of one’s niche characteristics are most impactful, and how they interact. This whole area of discussion requires openness to discussion and self-awareness of culture and diversity status.

Gonzales (1997) has proposed conceptualizing the supervisor as “partial learner,” which places supervisor and supervisee in a collaborative stance. This is similar to the DBT stance in which the supervisor is viewed as fallible. Both of these remove some of the distance between supervisor and supervisee, and allow for a more direct cultural and clinical discussion and mutual problem-solving.

It is important to maintain a balance between knowledge leading to stereotypes versus openness to learning and acquisition of knowledge and skills that are sensitive to individual cultural niches. Cultural niche refers to consideration of an individual as multiply-determined culturally; for example, I am a female, Caucasian, heterosexual, psychologist, mother – to isolate one of these factors would not be an accurate portrayal of me in my entirety. Increasingly, mental health professionals are considering multiple factors in proceeding with treatment and supervision rather than simply pulling out one – “BIPOC,” for example (Black, Indigenous, People Of Color) – and proceeding on stereotyped beliefs acquired about that group which may or may not be relevant to the individual being treated.

Microaggressions?

Although training settings or individual practitioners may be aware that “microaggressions” occur, there is a tendency to normalize or simply ignore or overlook them. Doing so contributes to a toxic work environment of disrespect and harm that is hostile and invalidating. Sue and colleagues (2019) described the harm being done when these microaggressions – which are actually “macroaggressions” – occur and suggested none are “micro.”

They categorized those who hear these as targets, allies, or bystanders. Targets are the object to whom prejudice, and discrimination are directed. Allies are members of dominant social groups and have the power to move toward eradication of prejudice. Bystanders may be well-intentioned, but may anticipate negative reactions to responding and so step back. To directly address such aggressions, Sue and colleagues suggest micro interventions, which include (from a much larger list): (a) making the invisible visible, challenging the stereotype, asking for clarification, and circulating literature or soliciting feedback from others; (b) disarming the microaggression by expressing disagreement, interrupting, or redirecting; (c) educating the perpetrator, appealing to the individual’s values and principles, instituting long-term mandated training, and; (d) seeking external reinforcement or support.

Affirmative Supervision Models

In 2009, an American Psychological Association (APA) Task Force on Gender Identity and Gender Variance (TFGIGV) survey found that less than 30% of psychologist and graduate student participants reported familiarity with issues that transgender and gender nonconforming (TGNC) people experience. A non-binary gender identity perspective defines gender identity as not exclusive to male or female, but includes gender queer, gender fluid, and gender variant. A person’s gender identity may not be the sex assigned at birth.

Gender variant nonbinary and transgender have been neglected in training and literature. Transgender- and gender variant-affirmative counseling and psychological practice needs to be culturally relevant and responsive to the client and the multiple social identities, addressing social inequities, enhancing resilience and coping, advocating reduced systemic barriers to mental and physical health, and building upon client strengths (Singh & Dickey, 2017).

Affirmative supervision models are completely compatible with competency-based supervision and represent the state of the art. A basic premise is that all sexual, gender, and identity orientations are valid, and are to be respected. The supervision environment is a safe and respectful place, with emphasis on supervisee empowerment that will translate to client empowerment. Consideration of the multiple identities of client(s), supervisee, and supervisor will be incredibly helpful. Thus age (generation), gender, sexual orientation, gender identity, religion, socio-economic status, national origin, ethnicity, immigration, acculturation, language, and disability are potent influences in treatment planning and conceptualization to enact with the supervisee. In this context, consideration of identities that are privileged (e.g., middle or high socio-economic status, male) assist in understanding sources of resilience and trauma and the relationship in psychotherapy between the therapist and supervisor.

Supervisor awareness and direct discussion of power, privilege, and oppression in the context of supervisee empowerment are essential components. A self-reflective process, entailing those aspects and addressing issues of transference and countertransference, empowers the supervisee. Singh and Chun’s (2009) Queer People of Color Resilience supervision model provides guidance for the process of supervision. In the various triads of supervision, the supervisor, supervisee, and/or client may be a sexual minority, and this may be unknown to the others or it may be known. It will be important for the supervisor to bring up issues of sexual orientation and address those in supervision. The supervisor, often privileged, must be self-reflective, negotiate the worldviews, biases, and goals of the client and supervisee, while maintaining focus on processes, case conceptualization, skills needed, and outcomes. The goal is creation of an affirmative, empowering environment in which to proceed with supervision and clinical work.

Consider the social power of the supervisor – that person may fail to broach issues of diversity and may implicitly view them as irrelevant. For example, a BIPOC trainee describes a client’s racist comment and the supervisor dismisses it and reframes the story, ignoring the racist comment. “That was likely an effort to connect with you.” Another supervisee, a Jewish woman, reports an anti-Semitic comment made by a client, and the supervisor concludes, "You all are so sensitive – this is not about you!” Consider how the supervisee feels about that, what the experience of supervision has been, and how this impacts not just the supervisee but also the client.

What should occur in response? A reflective conversation of the impact of the comment on the supervisee/therapist, how it is contextualized in the therapy relationship, the goals for treatment, and the impact not simply on the supervisee/therapist but also on the client and the goals for the treatment. And don’t forget the emotional impact of all of this.

Generally, since few training programs explicitly address sexual minority clients, supervisees and supervisors may be unprepared (Bieschke, Blasko, & Woodhouse, 2014). However, competence with sexual minority issues is essential prior to beginning to be a supervisor. Writing about working with gay, lesbian, and bisexual clients, Bruss, Brack, Brack, Glickauf-Hughes, and O’Leary (1997) suggest the supervisor assess the supervisee’s level of competence with diversity, being particularly vigilant for inadequate information, anti-affirmative attitudes, attribution of all problems to sexual identity, and tendency to consider family/intimacy issues in heterosexual terms (from Buhrke & Douce, 1991).

Supervisor self-awareness is also critical, as is willingness to explore countertransference. When gay and lesbian clients were asked about what they wished their therapist understood, they responded that they wished therapists had greater knowledge of how gay and lesbian relationships are invisible, about the coming-out process and how it is not linear, effects of homophobia, and the general history of gay rights and social action (Biaggio, Orchard, Larson, Petrino, & Mihara, 2003).

Frequent heterosexist and gender microaggressions or macroaggressions occur. LGBT trainees report infrequent discussion of cultural diversity, and downplaying or disregarding the importance of sexual orientation and other intersectional cultural identities/considerations (Hagler, 2020). No microaggressions are acceptable in a training environment as they connote disrespect, biases, and a lack of safety.

In addition, therapists should have knowledge of the Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual Clients (APA, 2012), Guidelines for Psychological Practice with Transgender and Gender-Nonconforming People (APA, 2015), and Guidelines for Transgender and Gender Non-Conforming Affirmative Education (Austin, et al., 2016). Note that there is movement toward use of the terms gender-variant (Singh, Hwahng, Chang, & White, 2017) and gender-diverse.

The intersections of LGBT and religion are increasingly challenging and complex, as sexual minority individuals may experience conflict among family members, their religion, and their sexual orientation. This may result in a combination of withdrawing from formal religion, escalating family conflict, and distress.

Consider this scenario: Your recently assigned novice supervisee has an intake today with a client who is self-identified as bisexual and whose presenting problem is depression following a recent relationship breakup and job loss. The supervisee discloses to you that she is a lesbian and wonders whether it would be best to disclose this to the client early on in the intake to enhance the therapeutic relationship and ensure that the client knows that the therapist understands the issues. As supervisor, what issues does this raise? What questions would you want to clarify? How would you decide how to proceed?

Rather than adopting a hierarchical stance, it would be ideal to adopt a reflective stance and discuss the issue with the supervisee, honoring that disclosure and exploring the importance of her disclosure and her life experience to her clinical work generally, and specifically with this client. The supervisee should be praised for her insight in raising this issue in supervision as it is an important one and for her understanding that with self-disclosures it important to use a thoughtful approach. In terms of self-disclosure, what would be the intent of the self-disclosure? For what clinical purpose would it be made? The supervisor could explore the supervisee’s motivation – whether she is making the disclosure to establish rapport, thinking that it will create a strong therapeutic alliance, or whether she is interested in the disclosure because she is feeling less sure about how to proceed clinically. How could her understanding and personal experience be useful in the therapy, while ensuring the client’s needs are addressed? What are the ethical aspects of this? (e.g., principles of beneficence, responsibility, integrity, respect for people’s rights and dignity.) Would it be valuable for the supervisor to disclose an identity? Should the supervisor-supervisee dyad consult a collegue who has competence in these areas, a trusted professor, or an ethics committee of a professional organization?

Racial and Ethnic Diversity Trauma

Directly related to the supervisory relationship and to worldviews associated with clinical assessment and treatment, is knowledge and competence with respect to racial group membership, exposure to racial trauma, including prejudice and discrimination (Pieterse, 2018). Thus, membership in a particular racial or ethnic group has led to job loss or rejection, loss of opportunities, and painfully incorrect assumptions. Much of the trauma literature has omitted mention of these forms of trauma. Some issues to address – and to self-assess on – are how you as a supervisor identify and approach racial trauma. Consider the example of the BIPOC and/or religiously diverse supervisee who comes to you to tell you her client used pejorative racial/ethnic language in session. It was not directly aimed at her, but was very hurtful. Or the supervisee discloses that they perceived differential treatment of their diverse client by office staff. Or they describe their own personal history of trauma that was evoked by the client or staff. Pieterse (2018) suggested some possible approaches:

Considering multigenerational phenomena that the supervisee discloses, discuss the impact on them and on their interactions with the client, without becoming a therapist to the supervisee but rather supporting their growth, development, insight, and empathic engagement with the client.

If, in fact, the situation is related to clinic staff, it is critical for the supervisor to address this within the setting.

Addressing Multiculturalism in Supervision

Framing language to begin supervision is an excellent step. It is recommended that the supervisor take responsibility for the initiation of discussion of multicultural issues in supervision. This includes taking responsibility for having awareness and knowledge of one’s own multiple cultural/diversity identities and having addressed their emotional components. This also entails discovering values, beliefs, biases, and prejudices present in our assumptions about the world, our perceptions, and our actions.

Page and Wosket (2001, p. 212) suggested questions such as, “What would you like me to know that would help me to work most effectively with you?” The supervisor may also model some type of self-disclosure such as “We will see clients through different lenses due to our own cultural identities – I am from a different generation and female and those identities frame my perceptions.” Rather than requiring the supervisee to self-disclose, such a disclosure opens the door to discussion when a client is being discussed and the supervisor and supervisee differ on their diagnostic impressions, and about general multicultural frames. Then the supervisor reminds the supervisee of their own contributions to the process.

Other options include general statements about how important differences in background and culture might be to the supervision, and how critical it is to discuss these. One way of highlighting this is expression of interest in understanding and knowing the supervisee’s values, traditions, and worldviews (Daniels, et al., 1999). Often supervisors initiate this discussion but do not include their own, leaving the supervisee who has less power in the relationship unsure about how to proceed.

(“Worldview” refers to the entire set of an individual’s guiding beliefs, values, logic, concepts of reality, and even concept of self.)

Falender and Shafranske (2004; 2021) urged consideration of the culture and diversity variables of all parties – including client(s), supervisee, and supervisor – and considering how each of these are consonant and dissonant, all of which casts significant light on the clinical formulation, assessment; supervision process; supervision process; and direction of therapy.

Vignette: The client is a 37-year-old BIPOC (Black, Indigenous, and other People of Color) female whose parents moved to California from Mississippi. She is in therapy because she is depressed and she is feeling that she is disrespected generally, an example being her workplace, not being promoted because her boss is racist. She presents “evidence” that all upper management is white. She has a master’s degree in her field and more years’ experience than anyone in upper management. Her therapist, the supervisee, is a 25-year-old intern who was born in Puerto Rico and has lived in Southern California since high school. The supervisor is a 58-year-old Caucasian female.

Consider the cultural complexity by comparing each dimension of client-supervisee-supervisor in terms of known worldview, life experience, ethnicity, and hypotheses about how different belief structures, perspectives, or biases – as well as privilege and oppression – may affect a therapeutic approach. Consider how this would be addressed in supervision to explore and ensure you are not stereotyping

What are some of the aspects that should be considered? List the factors you view as most important in considering these areas. Some possible considerations include the relationship, attitudes, and worldviews of client, supervisee, and supervisor; historical factors of each (regional, cultural, socioeconomic, age; the history of racism, oppression, and privilege); and the ability to conceptualize all of this in a meaningful manner to move the therapy forward in a culturally sensitive manner. If, for example, all of this was unspoken or if the supervisor were to disagree with the client’s belief that she is being overlooked for promotion because of racism, but the supervisee believed strongly that racism was a significant factor in the client’s workplace based on the client’s descriptions, strains or ruptures could occur in all levels of the therapy and supervision, which could likely harm the client as well as the supervisee.

Definitions and Components of Clinical Supervision

Definitions of Supervision

Competency-based Supervision is defined in the Guidelines for Clinical Supervision in Health Service Psychology by the APA as:

A metatheoretical approach that explicitly identifies the knowledge, skills, and attitudes that comprise clinical competencies, informs learning strategies and evaluation procedures, and meets criterion-referenced competence standards consistent with evidence-based practices (regulations), and the local/cultural clinical setting (adapted from Falender & Shafranske, 2007). Competency-based Supervision is one approach to supervision; it is metatheoretical and does not preclude other models of supervision. (APA, 2014, p. 5)

The National Association of Social Workers and the Association of Social Work Boards define clinical (professional) supervision as:

The relationship between supervisor and supervisee in which the responsibility and accountability for the development of competence, demeanor, and ethical practice take place. The supervisor is responsible for providing direction to the supervisee, who applies social work theory, standardized knowledge, skills, competency, and applicable ethical content in the practice setting. The supervisor and the supervisee both share responsibility for carrying out their role in this collaborative process. (NASW, 2013, p. 6)

The American Psychological Association (APA), in Guidelines for Clinical Supervision in Health Service Psychology, defines clinical supervision as:

A distinct professional practice employing a collaborative relationship that has both facilitative and evaluative components, that extends over time, which has the goals of enhancing the professional competence and science-informed practice of the supervisee, monitoring the quality of services provided, protecting the public, and providing a gatekeeping function for entry into the profession. Henceforth, supervision refers to clinical supervision and subsumes supervision conducted by all health service psychologists across the specialties of clinical, counseling, and school psychology. (APA, 2014, p. 5)

The AAMFT defines MFT supervision as:

The process of evaluating, training, and providing oversight to trainees using relational or systemic approaches for the purpose of helping them attain systemic clinical skills. Supervision is provided to an MFT or MFT trainee … through live observation, face-to-face contact, or visual/audio technology assisted means as allowed in this handbook. When a supervisor candidate intends on receiving credit for supervisory experience toward the AS designation, he or she must be actively involved in the supervision; simply observing other supervision, although valuable, does not qualify toward requirements.

Supervisors, supervisor mentors, and supervisor candidates must ensure that supervision using technology complies with applicable laws for ensuring privacy and security of confidential information. (AAMFT, 2014, p. 5)

Note the commonalities. In common, they all place major focus on:

Think about which definition of supervision is most meaningful to you – what are the most important components of supervision? Also, begin to think about which competencies are most important and relevant to your particular supervision context. Competencies are organized and prioritized differently by each professional discipline, so making a tentative list of which are most important to you is useful at this point.

In addition, think about what changes need to occur in your setting – or in your own supervision practice – to transform to a multicultural, competency-based clinical supervision environment. You will see as we proceed, Competency-based Supervision provides more accountability and transparency that serve to enhance the supervisory relationship between you and your supervisees (Kaslow, Falender, & Grus, 2012).

Steps to Achieve Competence in Supervision Practice

As relationship is essential, the following are steps to a supervisory relationship:

  1. The supervisor examines their own multicultural intersections, contextual factors and worldviews, their impact on clients and supervisees, clinical and supervision expertise and competency.
  2. The supervisor welcomes the supervisee, highlights the importance of their working alliance and collaboration within the supervisory hierarchy. The supervisor outlines the power implicit in the relationship, promises transparency in feedback, and welcomes the supervisee’s perspectives and input – and their behavior is in keeping with those promises.
  3. The supervisor clearly delineates supervisory expectations and collaborates with the trainee in developing a supervisory agreement or contract for informed consent including the supervisory expectation, ensuring clear communication in establishing competencies and goals, tasks to achieve them, and logistics.
  4. And, focus on respectful interaction is primary: the supervisor models and engages the trainee in self-assessment and the development of metacompetence (i.e., self-awareness of competencies) from the onset of supervision and throughout.

(Falender & Shafranske, 2021)

Additional components include:Supervisee self-assessment of competency corresponding to his/her profession;

Cultural Humility

Celia Falicov (2014) described clinical and supervision practice as cultural and sociopolitical encounters. Sociopolitical, theoretical, and professional values and perspectives inform the clinical and supervisory experience. Neither therapists nor supervisors are value-neutral; the supervisor needs to be attentive and inclusive in understanding these as well as the emotional and cognitive impacts on clients and supervision.

Clinicians’ personal values and self-awareness require cultural humility and an understanding of the impacts of power and connection. (Falender, et al., 2014)

This includes an accurate perception of one’s own cultural values and other-oriented perspective, incorporating respect and respectful processes, lack of superiority in attitudes or behavior, being open to feedback (even negative) from others.

Descriptors include open, nondefensive, thoughtful and reflective before determining responses to culturally loaded queries or topics, respectful curiosity, ability to question assumptions and beliefs in a cultural frame – all markers of cultural humility.

Consider your own cultural identities and which are associated with power; which with privilege vs. prejudice, discrimination, oppression.

Privilege is defined as status(es) that afford you a benefit or advantage over others.

(Falicov, 2014; Hook, Davis, Owen, & DeBlaere, 2017)

Your Preliminary Self-Assessment

1. What is the greatest influence on your supervision practice? Personal experience of having been supervised; education, training, literature and workshops on supervision; a psychotherapy model; multiculturalism and diversity?

2. Have you taken formal coursework in clinical supervision?

a. A six-hour or some other length course for each licensure period?

b. A semester or term course?

c. Have you been supervised on your supervision practice?

d. Would you describe your supervision as systematic, ensuring attention to multiple competencies and factors in each supervisory session with targeted feedback?

3. How would you describe your model of supervision?

4. Describe how you address your power as a supervisor to your supervisee. Then consider whether your ongoing behavior supports what you described.

Supervision Guidelines

Psychology

In 2014, the American Psychological Association adopted the APA Board of Educational Affairs (BEA) Guidelines for Clinical Supervision for Health Service Psychologists. You may reference the full document at: apa.org/about/policy/guidelines-supervision.pdf.

Social Work

In 2013, the National Association of Social Workers published Best Practice Standards for Supervision. For elaboration, refer to the complete document at: socialworkers.org.

Guidance for social work is provided in the best-practice standards for the social work profession. There is a high degree of agreement on supervision practices across disciplines.

Consider this outline of the above-referenced social work document:

How Supervision Is Distinguished from Therapy and Consultation

From Therapy

It is critical to differentiate supervision from therapy – and also from consultation.

A line must be drawn and maintained to keep the focus on the supervisee’s process and behavior with the client. This becomes an issue of informed consent, with it being extremely important for the supervisor to establish from the beginning that supervision is a distinct practice area and that it is distinct from personal therapy or counseling.

Should the supervisor slide into elaborate exploration of the supervisee’s psyche, early childhood, etc., drifting into an inquisitive, therapist role, a boundary has been crossed and the supervisor has the responsibility to not do that.

Exercise:

Decide which of these situations are appropriate for supervision and which would require a referral for therapy or other external support:

  1. Supervisee discloses that client reminds her of her mother.
  2. Supervisee becomes tearful week after week in supervision when discussing particular cases, even after extensive reflective management of countertransference – and discloses being close to tears in most of those client sessions.
  3. Supervisee repeatedly asks supervisor to give advice on her impending separation and divorce, as she knows the supervisor has recently gone through a similar event.
  4. Supervisee tells supervisor that he feels mildly angry with the mother in the family he is seeing.

Most supervisors would find #2 and #3 to be problematic and requiring additional steps. In #2, immediate attention should be given to the possibility that this client should be transferred to another therapist, as a cardinal rule of every profession is “do no harm” and the highest duty of the supervisor is to protect the client. Then, the supervisor needs to discuss the pattern of response of the supervisee and plan with the supervisee specific steps to ensure that these issues are met outside of supervision.

In #3, the supervisor needs to reinforce the supervisee’s willingness to consider personal situations in the context of therapy she is providing, empathize with the difficulty, set boundaries, assist the supervisee in seeking appropriate supports for this major life event, and explore the impact this might be having on the clients being seen by the supervisee. The supervisor is cautioned to be reflective about personal self-disclosures and institute appropriate self-care. This is especially true if the supervisor is taking time from supervision to discuss the supervisor’s own personal issues with the supervisee. This becomes a category of negligent supervision, as the clients are not being addressed.

In #1 and #4, the supervisor and supervisee should explore countertransference when the supervisee is in a less reactive state, and most likely, engage in an exercise in differentiating the client from the mother or separating the client from other individuals with whom the supervisee might feel or have felt angry; this is likely to have good results. If not, and a pattern emerges, then the additional steps taken in #2 and #3 could be implemented.

From Consultation

Supervision is also distinct from consultation. The difference is that in consultation, the parties may be peers or colleagues. The consultant is not required to obtain all the information about the case, but simply to respond to the question being asked. The supervisor has responsibility to know the case thoroughly. In supervision, clients need to be informed that they are being seen by a supervisee who is not licensed and who is functioning under the licensure of a supervisor who is named and who will have access to their clinical records.

What do you do if another supervisor’s supervisee comes to you for “consultation?”

It would be important to clarify roles and responsibilities – and to coordinate with the other supervisor – perhaps arranging a joint meeting to “provide input” with the supervisor if he/she is willing. It is important to remember that the supervisor of record is legally responsible for the supervisee’s therapy with the clients. Specialized information can be integrated into the next regular supervision session to ensure the client receives the most competent treatment.

How Do I Do This? How Do I Become a Supervisor?

Clinician to Supervisor

Supervision is a distinct professional activity that requires training and education. Taking this course is an excellent beginning! The process of becoming a supervisor is one of integrating theory (of supervision and of therapy), interpersonal skills, and focus.

There needs to be a shift from therapist to the new role of supervisor.

There is a significant “mind-shift” in becoming a supervisor. Borders (1992) describes the cognitive shift from clinician to supervisor. Here are some examples of ways – the first two of which are problematic – clinicians take their skills into the supervisory arena:

1. Supervisors who think like clinicians and see supervisees as surrogates.

These beginning supervisors make thorough, copious notes about the client when they review tapes, generate numerous hypotheses about dynamics, and devise plans for working with the client. They come to supervision very well prepared and tell the supervisee exactly what to do, or actually what they should have done – a monologue or mini-lecture. They act as if they are not aware of supervisee reactions, and fail to hear anything that the supervisee has to say. The supervisee emerges from supervision feeling inadequate and overwhelmed, unable to enact the supervisor’s directives as the next session does not go exactly as planned or as the last one did, and because they have not integrated the supervisor's ideas or conceptualizations into their thinking.

2. Supervisors who focus on the supervisee as a client.

These supervisors are highly attuned to supervisees’ personal issues; they assume supervisee intrapsychic dynamics are the sole reason for shortcomings in the supervisees’ performance. (“What keeps you from doing that?” “Is that true in other areas of your life?” or “I am thinking the depression is actually in you and only being mirrored by the client.”) These supervisors do not assess what skills the supervisee actually has.

In contrast:

3. Supervisors who think of supervisees as learners and themselves as educators.

a. Such supervisors give priority to learning needs and meeting supervisee needs.

b. “How can I intervene so that this counselor will be more effective with current and future clients?”

Some of these developing supervisees in the categories above (#1 and #2) do not progress onward to become good supervisors. This is, of course, a very big problem for their supervisees.

Falender and Shafranske (2004, 2021) describe the even “higher” outcome in which supervisors see supervisees as active contributors to the process and as collaborators in the supervision process, so that supervisee and supervisor both grow through the interaction. To collaborate in the context of the distinct power differential is a high-level skill. Components of the collaborative approach include engaging in supervisor self-assessment and authentic understanding of competence and limits of this, supervisee self-assessment and supervisor feedback to the supervisee on the accuracy of their self-assessment, modeling supervisor lifelong learning, modeling the capacity to set the stage and engage in collaborative reflection; and stepping back from the content and process to look at it nonreactively or accurately identifying and addressing reactivity. This process is facilitated by video or live review of the client session, as reflection can then focus on the process being observed, the emotional state of the participants, and reflection on the process and factors that might have enhanced it.

Making the Cognitive Shift to Supervisor

In a number of states, by regulation, the experience level of the beginning supervisor is such that one may begin supervising at the point of licensure, often with minimal or no training in supervision. Supervisor training and support will result in supervisor competence and confidence in the process. The supervisor should identify and inform the supervisee of the model of supervision in which they are practicing (e.g., psychotherapy-based, competency-based, developmental, a combination of these, etc.). Also the supervisor should inform the supervisee of the psychotherapy theories in which they are competent to supervise. Then the supervisor begins relationship development with the supervisee, translating this to an agreement or contract. And then, they can attend to the various components of competency-based clinical supervision.

“Supervision of supervision” is an excellent modality to support the cognitive shift.

Supervision of supervision (or SOS or “sup of sup” as this is often referred to) is a wonderful opportunity for beginning supervisors – and a great skill-building activity for all involved. A very experienced supervisor meets with one or more (a small group is ideal) of novice supervisors, reviewing their supervision sessions, ideally using video or audio review with consents from all parties. The session would focus on:

Supervision of supervision provides support, knowledge, skill, and often values and attitudes to assist supervisory development. (Falender & Shafranske, 2021)

A resource to enhance the supervisees’ experience (and provide insight for the supervisor) is Getting the Most Out of Clinical Training and Supervision: A Guide for Practicum Students and Interns (2012) ) written by this author (Carol Falender) and Edward P. Shafranske. By preparing the supervisee to maximize and understand the supervision process, the role of the supervisor is streamlined and enhanced.

Competencies

A critical part of Competency-based Supervision is attention to the specific competencies. A guiding definition was provided by Epstein & Hundert (2002), who defined competency as “habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served” (p. 227). This definition, which identifies core aspects of the concept of competency, has been widely adopted across disciplines. It is an important part of understanding competency-based supervision. Supervision competencies are generally defined as knowledge, skills, and attitudes or values associated with supervision. In 2002, the Association of Psychology Postdoctoral and Internship Centers organized the Competencies Conference. The outcome of the Conference was a series of papers on competencies relating to different aspects of practice. One was devoted to Supervision Competencies (Falender, et al, 2004).

The Supervisor Competencies Framework

The framework for supervisor competencies is laid out in the areas of knowledge, skills, values, and social context. This self-assessment is a result of the workgroup sponsored by the American Psychological Association to develop Guidelines for Clinical Supervision of Health Service Psychologists (2014, 2015). The full article describing the guidelines is available at: societyforpsychotherapy.org/guidelines-clinical-supervision-health-service-psychology/

Supervisor Competency Self-Assessment

This supervisor competency roadmap is intended to help you identify both your strengths as a supervisor as well as those areas in which you can develop greater supervisor competence through continued professional learning and practice. Please rate each item using the scale below. (Note: K = Knowledge, S = Skill, A = Attitude)

How characteristic of your own behavior is this competency description?

Not at all/slightly

Somewhat

Moderately

Mostly

Very

  

0

1

2

3

4

  
Domain A – Supervisor competence    

1. I’m competent in the areas of clinical practice that I supervise. When I supervise a case outside my area of expertise, I work to develop my own knowledge, skills, and attitudes in this new area.

K/S/A

  

2. I’m committed to learning more and getting better at providing supervision.

K/S/A

  

3. I communicate and coordinate with colleagues who are also involved in the training of my supervisee.

S

  

4. I learn about the diversity of populations and settings that my supervisees encounter.

K

  

5. When (if) I employ technology in the supervisions that I conduct, I’m competent in its use

K/S

  

Domain B – Diversity

    

6. I pay attention to my own diversity competence, strive to keep my knowledge, skills, and attitudes up in this area of practice, and serve as a good role model of a self-aware psychologist vis-a-vis diversity issues.

K/S/A

  

7. I make efforts to be sensitive to individual differences and diversity in the interest of establishing positive relationships with all of my supervisees, inclusive of their background or individual characteristics.

K/S/A

  

8. I pursue learning opportunities that increase my competence in diversity.

K

  

9. I’m knowledgeable about the effects of bias, prejudice, stereotyping, and other forms of institutional or structural discrimination that may impact my supervisees and/or their clients/patients.

K

  

10. I’m familiar with the literature regarding the impact of diversity in supervision, including the importance of navigating conflicts between personal values and professional practice in the supervision of supervisees (e.g., assisting a client/patient with an issue that conflicts with one’s religious beliefs).

K/S

  

Domain C – Supervisory relationship

    

11. I create and maintain a collaborative relationship with my supervisees.

K/S/A

  

12. At the outset of a new supervisory relationship with a supervisee, I discuss the responsibilities and expectations for each of us.

S

  

13. I regularly revisit the progress of supervision with my supervisee, the effectiveness of our relationship, and address characteristic interpersonal styles that may affect the supervisory relationship and process.

S

  

Domain D – Professionalism

    

14. I’m professional in my interactions with supervisees, and help them learn how to similarly conduct themselves as professionals.

S

  

15. I provide my supervisees with on-going (e.g., formative) as well as summative feedback about their progress in developing professional behavior.

S

  

Domain E – Providing assessment, evaluation & feedback

    

16. I am straightforward and sensitive in providing feedback that is linked to the supervisee’s learning goals.

S

  

17. I’m careful to observe and monitor my supervisee’s clinical performance so that my evaluation is based on accurate information.

S

  

18. My feedback is clear, direct, and timely. It is behaviorally anchored so that my supervisees know explicitly what they do well and how they could improve. I monitor the impact of my feedback on our relationship.

S

  

19. I help my own supervisees to get better at accurate self-assessment, and incorporate their self-assessment in my evaluation of them.

S

  

20. I seek feedback from my supervisees about the quality of supervision I provide to them, and use it to improve my own competence as a supervisor.

K/S

  

21. When dealing with supervisee performance problems, I address them directly and in accordance with relevant policies and procedures of my setting, institution, and jurisdiction.

S

  

Domain F – Managing professional competence problems

    

22. If I see a performance problem, I identify and address it promptly with my supervisee so that they have reasonable time to improve.

S

  

23. I am able to develop and implement a formal remediation plan to address performance problems.

S

  

24. I understand that supervisors have an obligation to protect the public from harmful actions by supervisees and take seriously my role as a gatekeeper to the profession.

K/S/A

  

Domain G – Ethical, legal, and regulatory considerations

    

25. I serve as a positive role model to my supervisees by conducting myself in accordance with professional standards, ethics, and laws related to the practice of psychology.

K/S/A

  

26. My primary obligation as a supervisor is to protect the welfare of my supervisee’s clients. This remains at the forefront of my supervision.

K/A

  

27. I provide clear information to my supervisees about what is expected of them in supervision.

K/S

  

28. I maintain timely and accurate documentation of my supervisee’s performance.

S

  

Scoring: Now that you’ve completed this self-assessment, please take a quick scan at the lowest-rated items. These are areas in which you can focus (and model) your own competency development. If you find that low-rated items cluster in any particular domain, you might consider directed reading, peer consultation, and/or continuing education in this area.

Reprinted from: Falender, C. A., Grus, C., McCutcheon, S., D., Goodyear, R., Ellis, M. V., Doll, B., Kaslow, N. (2016). Guidelines for Clinical Supervision in Health Service Psychology.

Evidence and implementation strategies. Psychotherapy Bulletin (Division 29), 51(3), 6-18. societyforpsychotherapy.org/guidelines-clinical-supervision-health-service-psychology Appendix A.

After completing this self-assessment, highlight sections that are aspirational for you and describe how you plan to enhance your competence. If you are unsure, continue on with the course and return to this later.

For individuals who supervise in Substance Abuse, another document on Supervisor Competencies is the Technical Assistance Publications Series by SAMHSA – TAP 21A. It is available online at: Competencies for Substance Abuse Treatment Clinical Supervisors.

As the above self-assessment was designed for psychology supervisors, think about what other aspects should be added or rearranged to reflect your particular discipline. Some ideas will be available in the competency assessments (for supervisees) that follow.

Supervisee Competencies

Use of competencies marks a significant change in procedures for assessment and evaluation. Defining and measuring competencies sets a standard against which development of the supervisee can be charted and tracked. Multiple disciplines have developed competencies. In this course, we will consider psychology, social work, and marriage and family therapy. Ideally, you will use these various documents with supervisees for whom you provide supervision and thereby help them self-assess and develop goals for their future development.

Psychology Competencies

Competencies Benchmarks is the comprehensive framework for the measurement of competencies. The most current documents are available at: apa.org/ed/graduate/benchmarks-evaluation-system.aspx

This framework, referred to as Benchmarks (see Fouad, et al., 2009 and Hatcher, et al., 2013) focuses on the assessment of development for each of the following transition points for psychology students in preparation to enter professional practice:

Foundational competencies include:

The Benchmarks group added Professionalism, which was not represented in the original cube model.

Functional competencies are:

Supervision and Teaching were revised as separate competencies and Advocacy was added to the original cube model by the Benchmarks group after review by multiple constituencies.

The entire Benchmarks documents are also available in Fouad, et al. (2009) and Hatcher, et al. (2013). The document that is fully elaborated is Fouad, et al (2009) – it has more extensive behavioral anchors.

In Benchmarks, baseline competencies are described as those that supervisees should possess and demonstrate prior to beginning their first practicum placement, internship, and entry to practice. These areas include:

It is important to review these documents carefully as this is a standard of practice, establishing criteria for individuals entering the field of psychology.

Social Work Competencies

Significant effort has gone into the development of the CalSWEC (California Social Work Education Center) documents. They are exemplary and are excellent evaluation and monitoring tools used by many schools of social work and field placements. They address foundational and advanced practice levels. The following is the website to access the CalSWEC documents. The latest version is the 2017 revision:

calswec.berkeley.edu/sites/default/files/2017_calswec_curriculum_competencies_0.pdf.

In the CalSWEC documents, there is a significant focus on culture and linguistically competent practice. Every discipline should find these competencies useful, as they are expansive and comprehensive – and very enlightening. Supervisors will find it useful to self-assess on each document used with supervisees as the presumption is that supervisors will be at least as competent – and hopefully more so – as the supervisees they oversee. The CalSWEC document goes on to describe competencies for practice with individuals, families, groups, community, human behavior and the social environment, and workplace management. This is also a critical document to examine if you are training social workers. Many universities are using it, or a derivative, for evaluation purposes.

For continuing competence development for social workers, the American Board of Examiners in Clinical Social Work, published Professional Development and Practice Competencies in Clinical Social Work (March, 2002). It can be accessed online here:

https://bhdp.sccgov.org/sites/g/files/exjcpb716/files/sw-competencies.pdf

Further, Social Work Supervision is outlined in socialworkers.org/LinkClick.aspx?fileticket=GBrLbl4BuwI%3D&portalid=0

Marriage and Family Therapy Competencies

AAMFT Competencies is a one-point competency document, applicable to the point of entry into the profession (licensure). Competencies are organized around six primary domains and five secondary areas:

Types of skills and knowledge are conceptual, perceptual, executive, evaluative, and professional. It is critical to review this document carefully and track your supervisee’s competence if you are supervising MFT trainees or interns.

The document is available at the following website: coamfte.org/Documents/COAMFTE/Accreditation%20Resources/MFT%20Core%20Competencies%20(December%202004).pdf

An analysis of a group of graduates at the point of entry into the profession revealed that the AAMFT competencies were not being achieved at the hoped-for rates, indicating a greater responsibility for supervisors to assist supervisees in targeting competency development (Nelson & Graves, 2011). The data suggest few AAMFT core-competencies trainees have (fully) mastered them at the time of graduation from master’s programs (Nelson & Graves, 2011) (<10% of competencies). Although graduates may not be performing as well as supervisors might like, they are following the general trend of importance that is set by the expectations of the supervisors. Supervisors may also not be keeping pace with training needs in the current healthcare environment and may need to be prepared to help trainees develop skills that may not have been as important as they were before some of the changes occurred.

Following are two helpful articles that are recommended for supervisors to read. You will find these in the reference section of this course:

An article explaining the development of core competencies, by Nelson, T.S., Chenail, R.J., Alexander, J.F., Crane, D.R., Johnson, S.M, & Schwallie, L. (2007); and

An article exploring the impact of competencies in graduate training and some preliminary outcomes, by Nelson, T. S., & Graves, T. (2011).

A revision in keeping with the various professions was developed. Condensed Competencies Mapped is available in Northy and Gehart (2020). The condensed MFT-CC revised version is mapped to the original MFT-CC, COAMFTE's Foundational Curriculum Areas and the AAMFT Regulatory Board’s six domains, which serve as the structure for the national exam.

Direct Observation in the Assessment of Competence

The American Psychological Association now requires that evaluation of each supervisee in practicum, internship, and post-doctoral fellowship be based on direct observation of evaluated competencies by the supervisor during each training period. (APA, CoA, Implementation Standards)

That observation may be live, by video review, or, if necessary, by audio review of the supervisee’s performance. Ideally, these observations will be planful, organized around an assessment of the supervisee’s competencies.

This author strongly advocates direct observation for ALL supervisees at least once during each training term or rotation.

Interprofessional Supervision

Increasingly, supervisors are conducting interprofessional supervision, supervising individuals who are from different disciplines with varying scopes of practice. These might include social work, marriage and family therapy, psychology, psychiatry, alcohol and drug treatment counseling, and other mental health and health professions.

Complexity arises when the supervisor is from a different discipline and views the clinical work through a different lens. Guidance is provided by Core Competencies for Interprofessional Collaborative Practice (2016).

Other Models and Theories of Supervision

Before you begin this section, think about what models and theories of supervision influence your practice. List them. Then as you progress through this section, think about which of these relate most readily to your own practice. Remember that Competency-based Supervision is applicable to all models, as it is metatheoretical (Falender & Shafranske, 2010, 2021).

Theory-based Models

Among the approaches to supervision are psychotherapy-based approaches; including psychodynamic, cognitive-behavioral, intersubjective or narrative, dialectical behavioral therapies, and systemic and family systems. In these models, supervision typically mirrors the therapy process reflected in the theoretical orientation. A concern with such supervision is that it may not systematically address all the areas critical for supervision (e.g., alliance repair of strains, reactivity or countertransference, diversity and intersectional multiculturalism, legal and ethical issues). Superimposing a competency-based approach onto the theoretical model ameliorates that problem (Falender & Shafranske, 2010). Models also include process-oriented approaches, systems-oriented approaches, and developmental approaches (Falender & Shafranske, 2004; 2008).

There are multiple models that reflect the psychodynamic orientation, and Eckstein and Wallerstein (1972) were very influential in describing the relationships among the three parties in supervision – client, therapist, and supervisor – and how the relationships reflect upon each other. Interest in transference, countertransference, and working alliance and parallel processes have all been exceptionally important to the understanding of supervision and are discussed throughout this course.

A compendium of psychotherapy-based approaches (cognitive therapy [Beck], family therapy [Barenstein], and psychodynamically-oriented therapy [Sarnat]) are presented in Chapter 4 of Falender and Shafranske (2008). Sarnat describes the relational psychoanalytic model in which client, therapist, and supervisor are considered as co-creators of the clinical and supervisory relationship that are intertwined. Symbolic communication between supervisor and supervisee – a widely neglected aspect – addresses unsymbolized affective states that arise. The complexity of the supervisor role as a model for the supervisee/therapist includes the exploration of supervisee emotional reactions as they relate to the client and supervised treatment. The supervisor is encouraged to set limits on exploration. The supervisor has the shared responsibility of exploration of personal dynamics as they impact the supervision and therapy. Focus is always directed to client work and the client, however.

Complete issues of Psychotherapy: Theory, Research, Practice, Training (2010) and the Journal of Contemporary Psychology (2012) are devoted to transforming psychotherapy-based models to competency-based and discussing the competency-based movement.

Cognitive Therapy (CT) supervision parallels the therapy. Cognitive-behavioral models have provided for structured supervision protocols and even for manualized supervision (Henggeler & Schoenwald, 1998). The authors provide an excellent structure for supervision of cognitive-behavioral therapy.

The following organization is presented by Liese and Beck (1997) and provides excellent structure to the supervision process in a CT context:

(Liese & Beck, 1997; p. 121)

For examples of CT supervision, see the section of Chapter 4 of Falender and Shafranske (2008) by Judith Beck.

Family therapy revolves around family systems conceptualizations. Attention is focused on strengths and resources of individuals and the family unit, stories the family tells that support the presenting problem, and parallel or isomorphic processes that occur across the family and supervision sessions. Kaslow, Celano, and Stanton (2005) describe a competency-based approach to family systems.

Humanistic-Existential therapy (Farber, 2010). Use of empathy, acceptance, and genuineness creates a safe and collaborative environment for supervisees and provides a model for the clinical process. Emphasis is on facilitating the client's experiential awareness and use of the psychotherapy relationship to engender change, and the growth, development, and self-learning of the supervisee in a parallel manner in supervision.

Dialectical-Behavioral therapy (DBT) supervision focuses on a type of parallel process with the therapist treating the client and the supervisor “treating” the supervisee (Fruzzetti, Waltz, & Linehan, 1997). Intriguing aspects of this model are the assumptions that the dialectical agreement is negotiated such that there is no absolute truth, and that the therapist is fallible, not necessarily consistent, and consults with the client on interacting effectively with professionals.

Narrative or intersubjective models, also known as Postmodern, deal heavily with context and social interaction. Supervision mirrors the therapy in which the clients present their stories and the therapist is the editor and enhancer. The supervisor assists the supervisee in the client work and in developing a context in the experience of the supervisee, and in constructing the reality around this (Bob, 1999).

Process-oriented Approaches

Process-oriented approaches to supervision include those in which component tasks and roles are defined (Bernard, 1997). In their Discrimination Model, Bernard and Goodyear (1998) describe “teacher,” “counselor,” and “consultant” roles with different foci (intervention, conceptualization, and personalization).

Care should be taken to define terms to ensure clarity should these frameworks be used, as “counselor” might be construed as constituting a boundary crossing; and “consultant” is confusing, as it does not entail the legal liability implicit in supervision.

Other Models

Holloway’s model provides a systems approach. The following grid represents the aspects of the model:

Functions

Tasks
 

Counseling Skill

Case Conceptualization

Professional Role

Emotional Awareness

Self-Evaluation

Monitoring/Evaluating

          

Advising/Instruction

          

Modeling

          

Consulting

          

Supporting/Sharing

          

Holloway, 1995

To implement this model, if, for example, a supervisor were having difficulty with a supervisee who is working with a client with whom she is over-identified but similar to demographically, while the supervisor is from a different cultural and ethnic group, one could use the grid to identify possible interventions of supporting and sharing in the context of self-assessment, advising, or instructing, while assisting in case conceptualization – and assisting the supervisee with teasing out personal factors which may be intersecting with the professional role.

Other models include microcounseling (Daniels, Rigazio-Digilio, & Ivey, 1997) and Interpersonal Process Recall (Kagan & Kagan, 1997).

Microcounseling is a technique for teaching skills and is often used for beginning therapists. Skills are organized in sequence and each skill is taught one at a time. Modeling, shaping, and social reinforcement are important tools. This framework has been expanded to a “Microskills Hierarchy” with steps for culturally effective interviewing. Attending behavior, or being sensitive to verbal and nonverbal cues, is at the base of the hierarchy followed by a basic listening sequence with particular skills for establishing rapport and drawing the client out. This is followed by skills of confronting, focusing, and reflecting, followed by influencing, skill integration, and personalizing the skills to the individual, culture, and particular theory.

Interpersonal Process Recall, or IPR, is based on the premise that individuals behave diplomatically. Thus, much of what the supervisee thinks, intuits, and feels during therapy is disregarded automatically because allowing these perceptions to surface would confront the basic predisposition to be diplomatic. The purpose of IPR is to give the supervisee a safe place for internal reactions. The supervisor’s role is that of facilitator, stimulating awareness beyond that which occurred during the therapy session.

The actual IPR process entails the supervisor and supervisee viewing prerecorded video of the counseling session. At any point, when either of them perceives an important moment that was not being addressed, they stop the video and the supervisee reflects. The supervisee may indicate frustration, anger, impatience, or other emotional reactions. The supervisor does not adopt a teaching stance but allows the supervisee the space to explore internal processes of resolution. The supervisor may ask a series of questions that might include, “What do you wish you had said to her?” “How do you think she would have reacted had you said those things?” “What kept you from saying what you wanted to say?” and “If you had the opportunity now, how might you tell her what you are thinking and feeling?” The process continues with the tape advancing once again. This is an extremely slow process and puts interpersonal dynamics under a microscope that may be magnified so greatly as to be distorted. The role of the supervisor is to determine which interactions are important. This is a technique that should be used only after a significant supervisory alliance is established.

Consider this vignette:

Vignette: The supervisee is worried that the daughter in the family she is seeing (that is much like her own family…and herself) is so remote and cut off from the parents. The supervisee is having significant difficulty deciding how to approach her. She is also finding it difficult to communicate her level of concern to her supervisor. She is grappling with her concerns about the confidentiality of the adolescent, her role with the family, and her feelings of sympathy for the daughter and some identification as it is very much like her own role in her family. Considering the models described above, describe two alternate approaches to this situation.

Consider whether there may be a parallel or isomorphic process at play with the behavior of the supervisee/therapist mirroring that of the client. How should a supervisor proceed?

Meta-theory: The Developmental Model

Developmental Theories and Models

Developmental theories of supervision have been at the forefront of theory and research for the past four decades. There has been such a profusion of models that Watkins (1995; 1997) joined Borders (1989) in urging that a halt to development of any further new models of supervision take place and that the focus turn to consolidating existing models. Developmental models have been central to training in counseling psychology but have been less dominant in clinical psychology, social work, and marriage and family training.

To date there is virtually no evidence supporting developmental models derived from Delworth’s and Stoltenberg’s research (discussed below).

That is in contrast to the developmental structures of competencies (e.g., Benchmarks, CALSWEC) that ARE receiving empirical support.

The premises of developmental models include:

Stoltenberg, McNeill, and Delworth’s Developmental Theory

The most recent revision of the Stoltenberg, et al. theory, IDM (or Integrated Developmental Model (Stoltenberg, McNeill, and Delworth, 1998; Stoltenberg & Delworth, 2010)) is the most comprehensive and complex. The three structures underlying the theory are:

Some of the concepts the authors postulate as being most central to the development of the supervisee are carefully described in auxiliary chapters but are not integrated into the theory per se. These include the relationship of supervisee to supervisor, the supervision environment, and the development of the supervisor. Around these three central structures, the authors weave a sequence of development of increasing autonomy, shifting awareness from self to client, and independent functioning.

The Level 1 – or beginning – therapist may be highly anxious, highly motivated, and highly dependent on the supervisor. Focus in therapeutic interventions is primarily on the therapist’s behavior and performance. Supervisory interventions are structured, contained, prescriptive, and supportive. These authors suggest that theory be put on the back burner with emphasis placed on case conceptualization.

For Level 2 supervisees, who have progressed through some beginning experience and solidified some skills, there is fluctuation of motivation with self-doubt about skills as cases and conceptualizations increase in complexity. There is the possibility of dependence-independence conflicts as the supervisee strives to be more independent while at the same time being realistically unsure of his/her skills. Stoltenberg suggested that at Level 2, supervisees may even have an unrealistic sense of their abilities and may need feedback to provide a more accurate assessment. Supervisory interventions should be balanced so that autonomy and independence are fostered while support and structure are still available. Countertransference considerations are important to introduce into the supervision at this level.

For Level 3 supervisees, motivation is more stable and they are secure with their level of autonomy. They are focused on all aspects of the therapy, including the client, the process, and their own contribution. They are cognizant of their strengths and weaknesses, addressing them directly and moving toward a flexible approach. Supervisory interventions should include continuing to monitor carefully, placing emphasis on increasing independent functioning and conceptualization, being supportive of growth and development of the supervisee, and generally attending to the parallel process and transference-countertransference.

Stoltenberg continues to elaborate stages within the levels, with development more finely scaled within each. Although the Stoltenberg, et al. (1998) model ends with Level 3i, or integrated development, in which the therapist integrates the highest level of proficiency and skill across all levels of practice, it is clear that development never stops – lifelong learning is essential. The arrangement of information presented by Stoltenberg, et al. (1998) conceptualizes development as one factor, albeit a very potent one.

Catalytic Interventions are those that result in a catalytic outcome – similar to a chemistry experiment in which a chemical reaction occurs. An example might be the supervisor watching a video of the therapy session and seeing the dynamics of the session or some part of it in a very different light, or the supervisor focusing on a parallel process observed in supervision that corresponds to what is going on in the therapy session. The supervisee might be passive and accepting of the child’s behavior, just as the mother is in the therapy session.

Vignette: A supervisor requested a first-year practicum supervisee make an audiotape of his third session with a family. On the tape, the client’s mother entered the session describing a huge fight that had taken place between her two children the previous week at a restaurant. The supervisee responded by asking questions, “A taco restaurant? Where is it located? It sounds really good. What kind of tacos did they have? Did they have different colored salsas? What kinds? Do they have fish? What kind?” The mother and children responded to the questions but eventually the mother said she really needed help with managing the children and preventing another episode like that because she was really afraid she might hit them, and she does not want to do that.

Think about how you would approach the next supervisory session. What safety concerns are raised? What would you say and how would you approach discussion of the session on the audiotape? How much assessment should occur? Was that anxiety on the part of the supervisee an accurate presentation of lack of competence or an inadequate therapeutic alliance potentially enhanced through talk of a mutual interest in food? A competency-based approach assists in systematically assessing strengths and determining a course for proceeding.

Take a strength-based approach and develop three possible reasons or rationales for how the practicum student proceeded in the session up to this point.

Commentary: The supervisor, listening to the tape, was very distressed, feeling that this supervisee was much less sophisticated than she had thought, and at a loss to understand what in the world he was doing spending so much of the session talking about food. When the supervisee came in the next day for supervision, the supervisor was about to begin with some feedback about the tape, praising him for making it and bringing it to her so early in the training sequence, but inquiring as to what his agenda had been. Before she could begin, he launched into saying that, as they had described in the goals, he had spent much time thinking about that session and what it had evoked in him. First of all, it reminded him so much of his own mother, a single mom, and the difficulties she had with him and his brother. In addition, he said he had not taken the time to read the parenting manuals that had been assigned and had little to no experience in parent training. And finally, he said that he began the discussion because in the previous session the mother seemed to be resistant to establishing rapport with him, and he saw this as a way to begin to talk with her and approach some of the cultural factors which were different for them, as he was a white male and she and the children were Mexican-American. After a discussion of the personal factors and the engagement strategy, the supervisor suggested the supervisee call the client mother and talk on the phone about how she was doing – particularly with her worry about hitting the children – do a quick phone check-in, and possibly arrange for a sooner session, and give her specific tools to use with the children. In addition, he should praise her for her disclosure about her feelings – perhaps also a parallel process in therapy and supervision with both the client and the supervisee disclosing what they were most worried about.

A lesson to be inferred from this is that the supervisor had established enough “ground work” that the supervisee was able to disclose personal factors and be vulnerable, and the supervisor was then able to help the supervisee to develop appropriate skills and differentiate his own childhood experience from that of this family. It also assisted in the development of the supervisory alliance, which we know translates to the strong development of the therapeutic alliance.

If one were to give this supervisee further feedback, it would be to reinforce the disclosure and his motivation and efforts, and to highlight the value of his willingness to learn and attempt to be culturally attuned – and to identify the high risk factor of a mother who is feeling out of control with her children, and how serious this can be if not addressed. It would serve as a beginning lesson for the supervisee on one of the supervisor’s multiple roles – always keeping the safety of the client as the foremost priority. Further, the supervisee needs to learn appropriate clinical skills for parent work.

Best Clinical Supervision

Features of Good Supervision

What are some of the aspects of good supervision? In Competency-based Supervision, supervisors are attentive to knowledge, skills, and values/attitudes throughout all supervision. The competencies serve as a framework to support supervisee strengths and development, to monitor supervisee progress, and to provide feedback, both positive and supportive/corrective. Ideally, this will be achieved through live observation of the supervisee conducting clinical work at intervals.

Both O’Donovan, Halford, & Walters (2011) and Kavanagh, et al. (2003) describe positive or “best” supervision strategies. In their description of best practices of supervision, O’Donovan, Halford, and Walters (2011) describe functions and processes of supervision (highlighting the intense emphasis in the literature on alliance), contracting, evaluating therapy outcomes for supervisee’s clients, evaluating supervisee competence, the supervisory relationship, and developing supervisee knowledge and skills. They suggest that contracting should occur in supervision and that data should be collected and used for the normative and formative functions of supervision (e.g., assessing competence of supervisee). Supervisors should communicate formative feedback and promote supervisee self-assessment, and manage tension between formative and summative evaluation.

Effective Supervision

These effective supervision practices are elaborated from those described by Falender, Shafranske, and Ofek (2014) and Falender and Shafranske (2021). Consider your discipline and your theoretical orientation when reviewing these, and self-assess on your use of each.

Attitudes

Skills (including the requisite knowledge of each in order to enact)

Please consider how you assess your supervisee’s development/competence. Are you basing all supervision on the supervisee’s self-report? Or do you have live, video or audio review of supervision? If you are using only supervisee self-report, consider if there is a way to directly access observation or provide co-therapy with your supervisee. It is very essential to observe your supervisee at least once during each training segment (a requirement for psychologists under the Committee on Accreditation, APA, Regulations).

Your Best Supervisor

Form a mental image of your best supervisor – visualize that person in as much detail as you can, remembering appearance, style, interactions, and any other dimensions you can recall. Then think of words describing this individual. You will probably find that the words you generate correspond very closely to the literature on best supervisors, although they will probably not be comprehensive. This process is especially meaningful because, as Guest and Beutler (1988) found, the valued and prestigious supervisor’s theoretical orientation exerts a substantial influence on supervisees’ theoretical orientation for three to five years following the conclusion of the training experience.

Inadequate and Harmful Supervision

Increased attention has turned to inadequate and harmful supervision. Supervisees surveyed reported very high rates of inadequate supervision in numerous studies (e.g., Cook & Ellis, 2021; Ellis, et al., 2014; Ellis, 2017; Ladany, 2010). Harmful supervision is defined by Ellis (2017) and others as supervisor action directly harming the supervisee and action known to cause harm even though the supervisee may not identify them as such.

For example, in the Ellis and colleagues sampling (2014), more than 90% of supervisees surveyed were currently receiving some inadequate supervision and 35.3% were currently receiving harmful supervision. More than half of the supervisees had received harmful clinical supervision at some point. More than half reported their supervisor did not use a supervision contract or consent, and nearly 40% reported their sessions were not monitored, viewed, or reviewed, both of which are standards of practice.

A majority of doctoral student respondents enrolled in American Psychological Association accredited programs reported problems in professional competence with faculty in their programs and that these had impacted them (Furr & Brown-Rice, 2016). Among the problematic behaviors reported at high frequencies were: educators’ cultural insensitivity, inadequate supervision skills, unprofessional behavior such as dishonesty, excessive tardiness, class absences, inappropriate boundaries, and inability to regulate their own emotions.

Because of the power differential inherent in clinical supervision, supervisees are not likely to initiate discussion of supervisor competence or ethical concerns. Ladany and colleagues (1999) reported that more than half of supervisees in their sample reported at least one ethical infraction by their supervisor during the course of training, and in a replication, Wall (2009) found that 23% of her sample indicated their supervisor had conducted at least one ethical lapse or violation, while 26% questioned their supervisor’s ethical judgment on at least one occasion during the internship.

In one study, Ellis and colleagues (2014) described examples that include the supervisor threatening the supervisee physically, having a sexual relationship with the supervisee, sharing drugs, or being aggressive or abusive with the supervisee. All of these are negligent supervision – not only is it harmful to the supervisee, it can cause significant harm to the clients being served by virtue of the supervisee not receiving appropriate supervision, and/or the supervisee having experienced harm, thus placing the client(s) at high risk. These examples and this study reinforce the clear and urgent need for training in clinical supervision and for guidelines that provide for appropriate practice. Without specific training, individuals who simply begin supervising are generally not engaging in intentional and systematic supervision. Nor do they value the supervision process.

Beginning the Supervisory Relationship

Supervisory Alliance

The supervisee enters supervision for the first time. She is eager and a little anxious, and is unsure what the supervisor expects. The supervisor is welcoming, encourages the supervisee to discuss her previous experience and what she is hoping to learn in this setting, and provides structure and encouragement to her. The supervisor also describes her own theoretical orientation(s), discloses several of her own multicultural identities that impact her worldviews, and asks for feedback on the profession’s competency document that the supervisee was asked to complete prior to the meeting.

Further, the supervisor models an intersectional approach to the identities of the client(s) being treated. Rather than simply focusing on one identity (e.g., race or ethnicity) as supervisors and supervisees alike often do, the supervisor assists the supervisee in considering the intersections: ethnicity, race, socioeconomic status, age, religion, sexual orientation, gender identity, etc., in the context of the presenting problems.

Together they plan two supervisee goals and tasks for each to perform. The supervisee particularly wants to gain additional competence in Parent-Child Interaction Therapy (PCIT), and would like feedback about her skill development. The supervisor describes how it would be possible to observe her and give feedback. Embedded in this goal could be an eye to cultural adaptation of the model (McCabe, Yeh, & Zerr, 2020) in terms of developing rapport with parents and exploring the parental view of the causes of their child’s problems, the role of extended family members in raising the child, beliefs about discipline, attitudes and expectations for the program, and use of alternative treatments. Further, the program was reframed as educational skill-building rather than mental health, to reduce stigma.

The second goal could relate to the impact of child trauma on her personally, and how to manage that when she sees a traumatized client; in the next session they will develop specific goals relating to that, which will be addressed further in supervision: self-regulation and self-care, again addressing intersectionality of the triad and what is evoked for the supervisee. Clearly, there is a balance here in that the supervisor is never a therapist to the supervisee. However, acknowledgement of the supervisee’s relevant history and the feelings elicited by the client and/or family are highly relevant, and the focus in supervision remains on how all of this impacts the family and the treatment.

Progressive Versus Regressive Supervisory Relationships

Based on Helm’s racial identity development theory, a progressive supervisory dyad is one in which the racial identity of the person holding the most power in the relationship is more advanced in racial identity development than that of the other person (Helms and Cook [1999] p. 282).

Regressive supervisors generally do not raise race, and when supervisees do, it is met with an unsupportive response and a combination of anger, frustration, resentment, discomfort, and confusion – leading the supervisee to withdraw, mistrust, feel isolated and powerless, or feel the need to educate the supervisor – or needing to respond to requests to educate supervisors and/or staff (Jernigan, et al., 2010).

Consider the case of a person with power – the supervisor – with a less developed racial identity understanding – regressive – and a BIPOC supervisee. Power struggles may arise, causing misunderstanding and, ultimately, harm to the client and supervisee. The supervisee reports a complex racial incident that occurred in a session. The supervisor wants harmony – “Just respect each other and are we okay.” The supervisee wants to confront the issues. Frustration and ultimately poor client care result.

In progressive relationships, the supervisor has a more advanced racial identity. The trainee has a less developed racial consciousness. The supervisor is connected, empathically engaged, learning from the supervisee as well as imparting, and is energized and flexible. The supervisee reports the racial incident, and the supervisor is cognitively flexible, curious, and listens carefully to the supervisee’s experience and thoughts. The supervisor integrates the supervisee experience and impact to the client behavior and treatment. A strategy is formed to focus on the here-and-now in the supervision session.

Also, consider the context. Thrower and colleagues (2020) explored the impact of the setting in which one works – the supervisor may be progressive, but the setting may be regressive – which directly impacts the emotional climate and the behavior of the supervisor. That is, the regressive hierarchy or administration may limit, diminish, or generally not allow the supervisor to be progressive. Be very mindful of the power you wield as a supervisor. For change to occur, support needs to arise from the top of the organization. And it is a supervisory responsibility to understand the racial and diversity climate of the setting in which they work and to address inconsistent messages or processes such as unprotective or punitive climates in which progressive supervisors may feel stuck, unsupported, or isolated. An important implication of this is that the supervisor’s behavior alone is not the only indication of a progressive setting; working within an inconsistent, unprotective, or punitive climate is related to supervisor hopelessness, cynicism, and isolation and is divisive and not associated with positive, healthy, training environments.

Role Invocation

As a way to orient the supervisee and the supervisor to the task of supervision, it is useful for the supervisor to use “role invocation,” or identification of the specific expectations the supervisor has regarding the supervision experience. Each of us has a sense of what comprises the “ideal supervisee.” Through role invocation, the supervisor can specify particular behaviors either from Vespia, et al.’s (2002) Supervisory Utilization Rating Form (SURF) or simply by making a list of behaviors most important to the individual supervisor or setting. Items from the SURF for use with supervisees is available in Falender and Shafranske (2012).

The types of areas to be covered in role invocation include the expectations and ground rules of supervision, starting with such basics as:

The supervisor may also elicit from the supervisee expectations for the supervisor. Thorough role invocation is an excellent part of establishment of the supervisory relationship.

Although supervision is collaborative, there is the reality of the power differential. That is, the supervisor holds the power to evaluate the supervisee and is the gatekeeper who decides whether the supervisee is suitable to progress to the next level of training and to enter the profession. The supervisor holds the ultimate power and liability for the supervisee’s work.

Discussion of power is an important aspect of beginning supervision: promising transparency (and ensuring it happens), and assuring the supervisee that when there are concerns noted by the supervisor, they will be the first to learn of them. These may be presented reflectively, “I was wondering why…” or “Let’s think about the impact of that intervention at that moment… .”

Vignette: Susan, your new supervisee, comes to you with extensive training in evidence-based practice from graduate school. She has been research assistant to a professor who has developed models to treat anxiety. The setting she is entering is highly diverse in socioeconomic status, race, ethnicity, and sexual orientation. In the first supervision session, she is enthusiastic and is eager to use checklists she has found to begin the session.

How could you as supervisor help her to understand the importance of her strengths and the importance of cultural humility to establish a therapeutic relationship early on with the client and family? How would you approach this in a strengths-based manner?

With the supervisee in this vignette, how important might it be to consider having her conduct a thoughtful self-assessment to bring to supervision to share – to collaboratively identify aspects of the supervisee’s experience and training that will facilitate client work, and to explore areas as well those aspects that are perhaps less familiar to her such as establishing a therapeutic alliance, multicultural factors, and identifying and processing her own emotional reactivity. To improve competence, the supervisor might suggest readings (e.g., Falender & Shafranske, 2012; 2021; Gehlert, Pinke, & Segal, 2014) to enhance her knowledge and skills. Role play between the supervisor and the supervisee is also highly effective – with the supervisor playing the role of the client and then reversing to play the role of the supervisee.

The Supervisory Relationship: Development of Goals

Examples of supervisory goals:

Sample specific tasks:

Exercise: Think of a supervisee that you are currently supervising or about to begin supervising. Identify tentative ideas about appropriate supervisory goals and tasks, considering your power, multicultural identities, and the supervisee’s previous experience and training. For practice, role-play the supervisor-supervisee alliance formation process with a colleague.

Evaluation and Relationship: How Can You Do Both?

The other element that is often shortchanged or omitted in supervision is feedback – an evaluative function, which provides a context and an ethical and professional structure to the relationship. Supervisors often do not monitor, evaluate, or give corrective feedback (essential components of supervision practice) for various reasons, including fear of disrupting the supervisory relationship. However, monitoring, feedback, and evaluation are critical supervision responsibilities which are essential so that the supervisee knows how to enhance client practice, professionalism, and behavior; and they also fulfill the informed consent aspect of ensuring that the supervisee knows how the supervisor perceives the supervisee’s competence development.

Some supervisors view all feedback as “corrective” and are wary of giving it as they fear it will disrupt the supervisory relationship. Remember, feedback is normative, and is a supervisory necessity.

It is important to lay groundwork for evaluation by letting supervisees know you will be giving feedback at every session and that the “law of no surprises” is operative; the supervisee should be the first to know if the supervisor has concerns about the competence of the supervisee. This introduces a significant transparency into the supervision process in that it gives the supervisee every chance to grow and improve, as well as to clarify aspects of behavior or interventions that may have been misunderstood in supervision.

Instilling the concept of two-way feedback wherein feedback will be a part of every supervision session, is important. Supervisees are encouraged to give ongoing feedback to supervisors as well – what supervisory input was most helpful, what would they like to see more of in supervision. It could be as simple as providing a brief checklist and asking the supervisee if all these were accomplished in the supervision session (e.g., multicultural discussion, evaluation, attention to supervisee goals). Self-assessment by both supervisee and supervisor are critical aspects of the self-reflective process, as spelled out in the Benchmarks document (Fouad, et al., 2009), as well as in documents for marriage and family therapy (AAMFT, 2004), social work (ABECSW, 2002), and nursing.

Exercises:

Review the following scenario and how you might give feedback:

In the fifth supervision session of a second-year student, the supervisor became concerned that the supervisee seemed to be using a very directive approach, constantly telling the adult client what to do. The client seemed to withdraw, become very quiet, and avoid eye contact. It appeared to the supervisor that the supervisee needed to address their approach, but wanted to discuss it with the supervisee and learn their perspective. How would it be best to introduce the topic? Think of several ways you could do this.

A major factor is the supervisory alliance that has been established. Possible approaches are: 1) reflection on how the therapy is going and how the client responded in the session, identifying a change in process that occurred; 2) expression of curiosity about why that particular approach is being used with this particular client; and 3) asking how the supervisee is feeling in the session with the client and what self-reflection they will engage in to examine processes and feelings.

Think of approaches you currently use and identify which are most effective. How do you enhance self-reflection? How do you vary your approach with different supervisees? What are some of the variables you take into consideration?

Think about the issue that if you become very directive, you will be modeling the very behavior you do not want the supervisee to engage in. How could you adopt a reflective approach?

An interesting approach was described by Sobell, Manor, Sobell, & Dum in 2008. They suggest that supervisees review their own sessions, and then discuss the audio or video review with supervisors using principles of Motivational Interviewing (MI).

Contract or Training Agreement

The supervisory contract (which is supplemental to the basic supervisory agreement or responsibility statement required in some states and also to some graduate program forms that many state school require) is a means of articulating the roles, responsibilities, expectations, and requirements of the training period in your setting. A state-mandated agreement typically includes all the state regulations relating to supervised professional experience, accumulating hours for licensure, and/or maintaining a particular unlicensed status.

In contrast or addition to the above, components of a supervision contract should include:

To develop the goals, the supervisor and supervisee discuss strengths and areas in development of the supervisee based on supervisee self-assessment of the discipline’s competency document (e.g., Benchmarks, CalSWEC, AAMFT). From this discussion, goals and tasks can be developed and stated. This is a living document: when goals are attained, the supervisor and supervisee collaboratively establish new ones.

The contract is a critical part of the supervisory relationship as it fulfills both informative and collaborative functions.

Supervisory Format

Before you begin this section, think about your preferred supervisory format. Do you meet one-to-one with your supervisee? Observe live or behind a one-way mirror or review video or audio recordings? Conduct group or triadic supervision?

Triadic, as used in marriage and family therapy and social work, refers to two supervisees and one supervisor. It is approved by the Board of Behavioral Sciences in California but NOT by the Board of Psychology. Strengths are similar to those of group supervision: opportunity for peer feedback, support, and learning. However, there are challenges of time allocation, especially when the supervisees are at different levels of development or competence, and of difficulty giving feedback to an individual supervisee (Fickling, et al., 2017).

This data should lead us to evaluate supervisory formats and seek input from supervisees – and perhaps to experiment with alternative strategies such as video or audio review of sessions, group supervision, or live supervision. Ironically, many supervisors believe it is too anxiety-producing for supervisees to be observed – in vivo or via videotape or audiotape. In fact, after a very brief beginning time, most supervisees who have been studied forget about the observation – and report on the incredible usefulness of modalities that involve direct observation and feedback.

Whichever framework is used, Competency Benchmarks in psychology, and competencies in the other mental health professions provide the essential framework for formative feedback and bridge the gap for supervisees, removing the surprise of corrective competence feedback being introduced at the four- or six-month point with no previous notice or opportunity for the supervisee to address it and improve. The steps in these frameworks include:

(Derived from Liese & Beck, 1997; p. 121)

We find that supervisees appreciate structure – not necessarily all of these steps, but setting a supervisory agenda and following it – collaboratively deciding on priorities for the session, and then using capsule summaries to ensure supervisee and supervisor are in agreement moving forward with respect to client care. Doing so can increase the supervisee’s feeling of collaboration and control, and can also provide a comprehensive framework for productive supervision. (See Falender & Shafranske, 2012, for specific examples and protocols.)

Further evidence indicates that lack of a supervision contract is associated with inadequate and even harmful supervision (Ellis, et al., 2017).

Conflict and Resolution in Supervision

Strain and Rupture in the Supervisory Relationship

Supervisors are generally poor at identifying when strain or conflict arise in the supervision relationship. It is essential that a relationship has been established before the strain or rupture event. No repair can take place if there is no relationship existent.

Discriminating between ruptures caused by avoidance and those caused by confrontation is important. Generally, more avoidance occurs in supervision; more confrontation in psychotherapy (Falender & Shafranske, 2021). In Moskowitz & Rupert (1983), we see that when conflict arose, the worst-case scenario was when supervisors did not initiate discussion of the conflict or move toward some type of resolution, so as a result, supervisees engaged in “spurious compliance” or essentially not telling supervisors what they were actually doing, but pretending to be following supervisory directives. This is the worst-case outcome of supervision, as the supervisor is legally and ethically responsible. This will be discussed further in the legal and ethical section; respondeat superior is the ultimate legal responsibility of the supervisor.

Anxiety level actually decreased when supervisors helped to normalize struggles as part of the ongoing developmental progression. This is especially powerful as a supervisor self-disclosure. (Example: “I remember the first time I had to give a family a diagnosis of autism for their child whom they thought was gifted.”) These authors characterized a good supervisory relationship as empathic, nonjudgmental, validating, and with encouragement to explore and experiment. This set the stage for non-defensive analysis by the dyad, as confidence in the relationship was strengthened. In addition, supervisees reported an increased perception of therapeutic complexity, an expanded ability for therapeutic conceptualizing and intervening, positive anticipation to reengage in previous difficulties and issues with which they had struggled, and a strengthening of the supervisory alliance.

Safran and Muran (2000) describe a process of metacommunication in which the supervisor and supervisee attend to the rupture marker, explore the rupture experience, and explore the avoidance. Then, the supervisee asserts and the supervisor validates the assertion. Both may step back from the process and approach it more objectively in order to return to a reflective state and renegotiate the task or goal, clarifying any misunderstanding as appropriate in the instance that the supervisor has erred. It is critical to address strains and ruptures as quickly as possible. Due to the power differential, proceeding with humility, compassion, curiosity, and patience is essential (Muran & Eubanks, 2020).

It is the responsibility of the supervisor to be the one to identify and repair ruptures whenever feasible. Depending on the severity of the rupture, it may be very difficult to adopt the stance of inquiry – stepping back from a defensive mode and gaining insight into the process – in the context of client process. However, it is essential to bear in mind that spurious compliance and other negative outcomes may ensue from not addressing the conflict, rupture, or strain (Safran, Muran, Stevens, & Rothman, 2008).

Steps to Repair a Rupture:

Expanded from Muran, Eubanks, & Samstang, 2021

Types of Conflict

Think about critical incidents that have occurred for you in supervision – times in which things have happened that stand out in your memory as being very problematic. Think about any times when there might have been conflict between you and the supervisee.

In supervision, there are times when there is covert conflict between supervisor and supervisee. In many instances, one or the other is not aware of the conflict and, because of the power differential, it is extremely difficult for the supervisee to raise it in supervision. Supervisors have varying degrees of comfort with power differential and discuss it accordingly. If supervision is structured to be unidirectional, from supervisor to supervisee, there is clarity in the tradition of top-down supervision. However, supervision is increasingly envisioned, at least to some extent, as bi-directional, with the supervisee and supervisor mutually influencing the other and creating a dialogue.

Include discussion of power in the beginning of the development of the supervisory relationship. The supervisor still is the legally responsible entity for all supervision and for the welfare of the client. As such, establishing parameters of legal and ethical responsibility, as well as the significant gatekeeping responsibility to the field, must be discussed. Gatekeeping refers to the supervisor’s responsibility to ensure that particular competencies have been met to responsibly allow the supervisee to progress to the next level of training or practice. Within the gatekeeping function is the evaluative one – that the supervisor must systematically evaluate the supervisee according to a format previously disclosed to the supervisee (See 7.06 in the Ethical Principles of Psychologists and Code of Conduct, 2017).

Multiple events and counterproductive experiences may result in strains or ruptures in the supervisory alliance. Strains may be brought about by:

Challenges inherent in training;

(Falender & Shafranske, 2021)

Indicators of strains in the alliance include supervisee behavior changes such as withdrawal, decrease in disclosure or supervisory interaction, display of hostility or criticism, or passivity or noncompliance (Falender & Shafranske, 2021). Often in the course of the strain, one or both parties become increasingly rigid, controlling, or critical, placing additional strain on the supervisory relationship. Thus, the relationship cycles downward in a negative spiral, resulting in a supervisory alliance rupture.

Moskowitz and Rupert (1983), supporting the results reported by Rosenblatt and Mayer (1975), found that students may engage in spurious compliance as a result of problematic interactions or conflict with a supervisor. Supervisees concealed relevant information, especially their personal feelings. This might be manifested in the distortion of progress notes – or even failure to write progress notes. This is a terrible outcome for supervisors, as they hold legal responsibility for the actions of the supervisee. Spurious compliance is something to be avoided through enhanced communication and sensitivity to the supervisee. It is also important for the supervisor to take the initiative in identifying and exploring perceived conflicts or changes to the supervisory interactions, and to be receptive to discussion should a supervisee raise these subjects. This is one of many areas in which the supervisor bears responsibility. In cases where conflicts were addressed, there was good resolution in many cases and a positive learning experience that strengthened the supervisory alliance.

Nondisclosure

Since disclosure is the primary means for supervisors to gain information for the supervision process (in the absence of video, audio, or live supervision), it is essential for supervisees to disclose relevant data to the supervisor. Nondisclosure may be one of two types: supervision-related or clinical-client-related. Strength of the supervisory relationship is directly related to supervisory disclosures. The supervisory alliance contributed more substantively to supervision-related nondisclosure than to clinical-related nondisclosure (Gibson, Ellis, & Friedlander, 2019), an important finding that relates directly to supervisory responsibility for alliance and the consequences of not establishing that.

Ladany and Melincoff (1999) studied supervisor nondisclosure. They reported that 98% of supervisors withheld some information from supervisees – just as supervisees withhold information from supervisors – which will be discussed below. In some cases, of course, it is positive to withhold information from supervisees, especially in cases in which the information is private and does not relate to the supervisory situation. However, Ladany and Melincoff reported that some supervisors did not disclose negative reactions to supervisee’s therapy and professional performance, which may have occurred because the supervisor may have been considering the supervisee’s developmental trajectory, and could have possibly ended up placing it above that of client welfare. Another rationale for nondisclosure was that it was addressed nondirectively. This finding has been robust and leads to the important conclusion that supervisors need to disclose corrective feedback and concerns they have about the supervisee’s professional performance.

Another area where supervisors did not disclose was their negative reactions to supervisee’s supervision performance. This was a less frequent type of nondisclosure. Ladany and Melincoff (1999) suggested that nonconfrontation of supervisee problematic supervision performance may impede supervisee growth. It may also be associated with supervisees who are later identified as having significantly problematic behavior.

A third category of nondisclosure was regarding the supervisee’s personal issues. It is essential to be respectful of the supervisee’s privacy, and of not crossing the line to convert supervision into therapy. At the same time, the supervisor must be mindful of supervisory responsibility for addressing how a supervisee’s personal issues may be influencing the therapy and the supervisee’s self-awareness and ability to manage that. Identification of personal issues as they impact the client is a competency.

The fourth category of supervisor nondisclosure was negative supervisor self-efficacy. This includes all of the doubts supervisors might have about their own effectiveness or the goodness of fit with the supervisee. Rationales for not disclosing included that the supervisee need not be privy to supervisor insecurity, however it was highly recommended that supervisors seek consultation to distinguish his/her issues from those related to the supervisee.

The fifth category was the dynamics of the training site. These nondisclosures were viewed as appropriate boundary-setting. Next was the supervisors’ clinical and professional issues. The authors indicated that it would be important to balance keeping professional boundaries and professional mentoring in this category.

In addition, supervisees might not disclose conflicts or uncertainty in interactions or interventions with clients.

Positive reactions to the supervisee’s therapeutic and professional competence were not disclosed for reasons not understood to the authors (or to this one), as it would seem this is a critical and essential part of the feedback that needs to be communicated to the supervisee. Attraction to the supervisee was not disclosed and this seemed reasonable, as it is a supervisor issue, not a supervisee issue. However, there was concern expressed that it is important for supervisors to have skills and self-awareness for appropriate working through of sexual attraction as it is not a supervisee responsibility and it is a normative phenomenon – an area seldom discussed or processed in training.

There is also significant literature on supervisee nondisclosures. Supervisees have significant power over what they disclose in supervision, especially when sessions are not videotaped or audiotaped. The most frequent type of supervision practiced is individual case consultation in which the supervisee describes his/her impressions of the therapy session. Supervisees may disclose certain aspects of the session to the exclusion of others.

In a study of supervisee nondisclosure, by Ladany, Hill, Corbett, and Nutt (1996), categories were developed. Categories not disclosed to the supervisor were:

Supervisees reported a mean of eight nondisclosures of moderate importance during the course of supervision to date, and that almost all of supervisees (97% of this sample) withheld some information from their supervisors.

Red flags and warning signs of conflict or other difficulty in supervision:

The supervisor is responsible for identification of warning signs and initiating discussion thereof. Garrett, Borders, Crutchfield, Torres-Rivera, Brotherton, and Curtis (2001) suggested the use of supervisory statements such as “I’m sensing some tension right now between us. I’m wondering if you are experiencing it too, and what sense you make out of it” (p. 153). Ideally, the supervisor will be even more proactive, identifying a possible strain or rupture event, and suggesting a possible connection to the supervisee’s changed behavior – and most importantly, the supervisor taking responsibility for errors.

It is critical to not shame the supervisee. Supervisors need to maintain a compassionate stance, empathizing with the myriad pressures and worries of supervisees and engaging in strength-based feedback and support. (Falender & Shafranske, 2021)

Supervisor Disclosure

In a small sample (N=12), supervisees reported generally positive effects when supervisors disclosed regarding personal information or clinical experiences and when supervisees perceived such disclosures as planful and aimed at normalizing experience, validating, building rapport, and instructing (Knox, Edwards, Hess, & Hill, 2011). However, nonplanful and inappropriate personal disclosures (supervisor psychiatric diagnoses, or personal relationship dynamics seemingly requiring supervisee assistance) were not helpful, although they might serve to support supervisee future practice of only planfully and thoughtfully disclosing.

Personal Factors

Countertransference or Reactivity

Personal and professional sources influence the course of behavior, treatment, and supervision – and become intertwined. Our conscious beliefs, cultural- and diversity-embedded values, and unresolved conflicts are all interwoven (Falender & Shafranske, 2021). As with therapy, supervision is subject to these influences. In discussing countertransference, we must understand that the supervisor and the supervisee’s understanding is perspectival – influenced by personal interests, commitments, and cultures from which we construct personal meanings (Falender & Shafranske, 2004). Countertransference is inevitable and discussion of it is highly desirable.

Also, enhancing supervisee (and supervisor) self-awareness of emotional state and reactivity is a competence. Personal factors include personal reactions, often influenced by worldviews, values, interpersonal styles, clinical situations, or supervisee’s unresolved personal issues (Falender & Shafranske, 2021). Countertransference may take the form of an enactment, when a supervisee who is normally thoughtful and measured in clinical work acts in ways that are not consistent with their professional demeanor. That might be evidenced in spontaneous personal disclosures or acting in ways not consistent with their generally professional demeanor. Identification and exploration of these are an essential part of clinical supervision and critical to the supervisee’s development and protection of the client (Falender & Shafranske, 2021).

Some supervisees think that countertransference is indicative of their own psychological problems and is unresolvable or not appropriate to raise in clinical supervision. To the contrary, it is very desirable for supervisees to identify and address countertransference in supervision – in the context of the client and supervisor, and in reaction to the client and to supervision. Other supervisees might not have had specific training in countertransference or view it as totally tied to psychodynamic theory and thus discount it. Thus, terming the phenomenon as “reactivity” or an unusual emotional response to clinical material or a stimulus, is useful. Emphasizing the utter normality of such responsivity – and reinforcing identification as a competence – is important.

Before countertransference or reactivity can be attended to, there must be a relationship between supervisor and supervisee. Depending on the developmental level of the supervisee, the discussion will vary. One must always be mindful of maintaining a boundary between supervision and psychotherapy as discussed earlier in this course. The guiding principle is that all discussion is anchored in how it relates to the client. If the supervisor or supervisee sees a drift toward exploration of factors relating to the supervisee’s relationships and life apart from reactions to and feelings about the client, the supervisor should stop, rethink, and empathically redirect the supervisee with a statement such as, “And how does that impact your work with this particular client?” This is critical.

An example is the supervisee who presents a pattern of countertransference (angry with the father in every family case, for example), has reactions which appear rto interfere with his/her ability to conduct therapy, or has personal reactions that are inappropriate to engage in with the client (crying whenever child abuse is mentioned, for example). Contrast this with responsivity – becoming sad or even slightly tearful when hearing of severely traumatic events to a child – a response that would be normative for most therapists and is reflective of empathic engagement.

The supervisor assists in identifying reactivity or countertransference (either individually by the supervisee, collaboratively by the supervisor-supervisee dyad, or through a change or deviation in practice – and ideally through video or live review). For example, if the supervisee is seeming overwhelmed by a particular client, or avoidant when in fact that supervisee has done strong work with previous similar clients, it may be indicative of countertransference.

Once the collaborative identification is made, the supervisor discusses steps of integration and differentiation – of the client’s experience from the supervisee’s personal experience – and the supervisee will continue to differentiate, independently, increasing empathy for the client in process. Addressing anxiety management – data is increasingly in support of mindfulness interventions – and discussing the conceptual frame for treatment, are additional steps.

Discussion of countertransference or reactivity is essential when it occurs within the boundaries of clinical practice or supervision. In order to approach the countertransference issue, it is important to help the supervisee return to a reflective stance from a more reactive one. Once in the more reflective position, it will be more readily possible to proceed to address the countertransference.

Diversity Competence and Multicultural Supervision: Ethical Standards

Ethical Standards and Guidelines

Diversity and multicultural competence are ethical standards.

Ethical Principles of Psychologists and Code of Conduct (APA, 2017): Please note that the APA Ethics code is under revision and is expected to be completed by 2023. It will include social justice.

In addition, there are the Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality (APA, 2017b).

It is also important to be knowledgeable about these American Psychological Association guidelines: Guidelines for Psychological Practice with Older Adults (APA, 2014); Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual Clients (APA, 2011); and Guidelines for Transgender and Gender Non-Conforming People (2015).

For social workers, refer to these guidelines for transgender and gender nonconforming (TGNC) affirmative education: Enhancing the Climate for TGNC Students, Staff and Faculty in Social Work Education. (Council on Social Work Education, 2016).

According to a study of social work students, 65% indicated that TGNC issues are introduced into courses by students rather than by instructors, and only 3% of students reported that transgender-specific readings were regularly integrated into their social work classes (Austin, et al., 2016, p. 12), a finding that appears true across mental health disciplines.

The NASW Code of Ethics 2021) also addresses cultural competence:

Ethical Standards

1.05 Cultural Competence

(a) Social workers should demonstrate understanding of culture and its function in human behavior and society, recognizing the strengths that exist in all cultures.

(b) Social workers should demonstrate knowledge that guides practice with clients of various cultures and be able to demonstrate skills in the provision of culturally informed services that empower marginalized individuals and groups. Social workers must take action against oppression, racism, discrimination, and inequities, and acknowledge personal privilege.

(c) Social workers should demonstrate awareness and cultural humility by engaging in critical self-reflection (understanding their own bias and engaging in self-correction); recognizing clients as experts of their own culture; committing to life-long learning; and holding institutions accountable for advancing cultural humility.

(d) Social workers should obtain education about and demonstrate understanding of the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, and mental or physical ability.

(e) Social workers who provide electronic social work services should be aware of cultural and socioeconomic differences among clients’ use of and access to electronic technology and seek to prevent such potential barriers. Social workers should assess cultural, environmental, economic, mental or physical ability, linguistic, and other issues that may affect the delivery or use of these services.

3.01 Supervision and Consultation

(b) Social workers who provide supervision or consultation are responsible for setting clear, appropriate, and culturally sensitive boundaries.

For Marriage and Family Therapists:

CAMFT (2019)

1.1 NON-DISCRIMINATION:

Marriage and family therapists do not condone or engage in discrimination, or refuse professional service to anyone on the basis of race, ethnicity, national origin, indigenous heritage, immigration status, gender, gender identity, gender expression, sexual orientation, religion, age, disability, socioeconomic status, or marital/relationship status. Marriage and family therapists make reasonable efforts to accommodate clients/patients who have physical disabilities. (See also sections 3.2 Therapist Disclosures, 3.7 Therapist Professional Background, and 5.11 Scope of Competence.)

1.2 HISTORICAL AND SOCIAL PREJUDICE:

Marriage and family therapists are aware of and do not perpetuate historical and/or social prejudices when diagnosing and treating clients/patients because such conduct may lead to misdiagnosing and pathologizing clients/patients.

7.8 CULTURE AND DIVERSITY:

Supervisors and educators are aware of and address the role that culture and diversity issues play in their supervisory and educational relationships, including, but not limited to, evaluating, terminating, disciplining, or making decisions regarding supervisees or students.

Informed Consent to Supervisees Regarding Required Personal Disclosures

It is important to consider 7.04 Student Disclosure of Personal Information from the Ethical Principles of Psychologists and Code of Conduct (APA, 2017). (Please note that a similar code is included in the Art Therapist ethics code.)

Psychologists do not require students or supervisees to disclose personal information in course- or program-related activities, either orally or in writing, regarding sexual history, history of abuse and neglect, psychological treatment, and relationships with parents, peers, and spouses or significant others except if:

(1) The program or training facility has clearly identified this requirement in its admissions and program materials; or

(2) The information is necessary to evaluate or obtain assistance for students whose personal problems could reasonably be judged to be preventing them from performing their training- or professional-related activities in a competent manner, or to be posing a threat to the students or others.

This is a critical area of concern for any supervisor who uses consideration of personal factors or countertransference in their supervisory process. Using option (1) is highly recommended to provide informed consent to incoming supervisees of the expectation that discussion of such material is encouraged in the context of case discussion. The following is a statement recommended to be included in program/setting descriptions that supervisees receive prior to selecting their training site:

While as trainers it does not seem wise to require supervisees to disclose such information, there was concern among the APPIC Board that this statement could be interpreted as discouraging voluntary disclosure of personal information in the course of clinical supervision. It is our experience that such disclosure in the course of supervision can be quite useful as it relates to the clinical work being discussed. It seems clear that one of the implications of the new ethical guidelines as written is that it will be essential for training programs that place value on such personal exploration in the course of supervision to state this value clearly in their internship and post-doc materials. (Illfelder-Kaye, APPIC Newsletter, 2002)

Evaluation, Assessment, and Feedback

Monitoring and Feedback: Ethical Imperatives

An element of supervision that is often shortchanged or ignored is the evaluative function, which provides a context and an ethical and professional structure to the relationship. It is also the sine qua non from the perspective of universities, professional schools, and licensing bodies. This function includes ongoing assessment, feedback, and evaluation. Although there is ample literature on the supervisor’s avoidance of evaluation (Robiner, et al., 1993), such avoidance is a significant ethical error in that the supervisee is not adequately informed of areas of lesser performance. Thus the supervisee is given no chance to improved or address supervisor concerns. Evaluation is inextricably tied to assessment and feedback. The supervisor’s gatekeeping duty requires ongoing assessment, evaluation, and feedback to ensure that the supervisee is meeting competence requirements.

Introduction of competencies by each profession has begun to fill the gap in assessment and evaluation of supervisees. The process entails having the supervisee self-assess using their competencies document (i.e., APA Competencies Benchmarks, CALSWEC, AAMFT competencies) and then collaboratively develop goals for the supervision during that rotation, with collaborative monitoring and setting new goals as the previous ones are achieved. If supervisors do not agree with the supervisee’s self-assessment, it is essential to provide the supervisee with ongoing feedback regarding observed strengths and those areas in development.

Thus, a supervisor might note:

You identified, ‘Listens and is empathic with others’ as your primary goal for this rotation. In my observation, I see that as an area of strength in your work with clients and peers. From my observation, I suggest we consider a goal and tasks relating to ‘Monitors and applies knowledge of self as a cultural being in assessment, treatment, and consultation,’ as that would be more reflective of your current development.

Tasks related to the new goal might include, for the supervisee, reflecting on the process of the session and the multicultural worldviews of client(s) and therapist. The supervisor provides supportive and corrective feedback on these processes. Feedback forms the basis for assessment and evaluation.

The question of how accurate supervisors are when they like their supervisees is pivotal to supervision (Bogo, Regehr, Power, & Regehr, 2007). Supervisors may not be as impartial as they think. Gonsalvez & Freestone (2007) reported the possibility that field supervisory assessments are not as reliable or valid as we assume. Supervisors are affected by leniency bias and demonstrate low inter-rater reliability (except for proficiency in case and assessment report-writing). It appears that a strong supervisory alliance may actually introduce bias. These authors recommend variation in structure and frequency of assessment and the use of assessment methods. Ideally, evaluation is not simply based on supervisee report but on observation, and by input from several sources. Further, supervisor leniency results from the fact that supervisors are not totally rational, dispassionate evaluators, but instead use shortcuts that are culturally bound to make judgments (Gonsalvez & Crowe, 2014). Thus, feedback may result that is driven by irrelevant factors rather than the ones relevant to the clinical setting (Falender & Shafranske, 2021).

Whatever the context or model, there should be a direct relationship among the competencies document and assessment of the supervisees and the training contract so that the expectations of the setting are clear. The greater the clarity, the better the supervision process from beginning to evaluation. Beyond clarity, tracking of competencies and enhancing the supervisees’ self-reflection on development of these, sets the stage for lifelong learning, an essential aspect of supervision and competence in general.

Note that it is frequently reported that supervisees get no evaluation until the last day of their training sequence, and then get some negative feedback which had never been mentioned in the course of training. Supervisors may experience a leniency bias in evaluation, generally giving high evaluation scores to individuals who they like and/or have strong supervisory alliances with. Remember that performance evaluation – actually, lack of such – is the most common ethical violation reported by supervisees regarding supervision (Ladany, et al., 1999). Feedback and attention to competence development should be addressed for a few minutes at the end of each supervisory session.

What are some of the reasons supervisors do not evaluate or, more specifically, do not give negative feedback? Robiner, Fuhrman, and Ristvedt (1993) describe several categories of reasons supervisors are lenient in evaluation. First is the definition and measurement issue. Supervisors say that they are very concerned about the methodology, reliability, and validity of the scales or measures they use, or they are concerned that anecdotal feedback does not meet criteria for accurate assessment. Thus, for example, since many of the assessment forms in use simply ask the supervisor to list supervisee strengths, areas needing improvement, and several other general questions, there is no way to determine levels, to consider validity or reliability, or to conduct an adequate assessment.

Second, supervisors are concerned with legal and administrative issues such as legal liability should the supervisee dispute the feedback (especially in light of the first concern, as they fear the feedback may not be defensible), or should their administrators be concerned about or prohibit such feedback. For example, in some settings, for any employee to receive any type of merit increase, the feedback must be all exemplary. If a supervisee were to receive less than exemplary feedback, it might interfere with his/her limited stipend or merit increases.

Supervisors also might fear that administrators would decide training is just too much trouble, and discontinue the whole training program, or choose another discipline of student to train, citing difficulties with the particular training program as evidenced by the negative feedback given. They might also be fearful of gaining a negative reputation in the training community for being too “tough” on students.

Third, supervisors may be concerned about interpersonal issues. This might include fears that the evaluation might be turned back upon the supervisor such that she might come under unwelcome scrutiny. The supervisor might like the supervisee, and although there are areas that need to be addressed, the supervisor might not want to risk jeopardizing the interpersonal relationship or supervisory alliance established with the supervisee. Furthermore, the supervisor may not want the personal hassles, time, and stress associated with documenting and pursuing supervisee problematic behavior.

Fourth, the supervisor may feel that she has issues that she would prefer not be brought to light. The supervisor may not feel particularly competent, may feel that she has made supervisory errors, or otherwise not want to be under scrutiny. She may be fearful of reactions by other staff members or supervisees to a supervisee’s negative evaluation.

For all these reasons, and others, supervisors often do not provide accurate evaluation to supervisees. Ironically, supervisees report that their best supervisors are those who give abundant constructive feedback and evaluation, a generalized finding that should alleviate some of the apprehensions of supervisors.

Vignette: Andrew is a personable, kind supervisee. Dr. Stone has been working with him for several weeks. The supervision approach is based on assessing Andrew’s strengths and areas needing improvement. Dr. Stone has been very impressed with Andrew’s empathy and warmth. The only problem is that Andrew appears to be so focused on support with the clients that he is avoiding the hard issues that come up. Dr. Stone is hesitant to raise this issue, as he doesn’t want to hurt Andrew’s feelings.

How would you approach assisting Dr. Stone in this situation?

It is useful to think behaviorally when giving feedback. Dr. Stone could use a competency-based approach to refer to Andrew’s self-assessed areas of development, including both foundational and functional competencies, and discuss areas of strength and areas needing improvement more specifically. It appears that there may be a parallel process between the interaction between Dr. Stone and Andrew and that between Andrew as therapist and his client. In other words, in both situations, difficult issues are being avoided. Dr. Stone could make an observation about that parallel process to open the discussion.

Formative vs. Summative Evaluation

Summative evaluation, the type of final evaluation given to supervisees in written form at the completion of the training year or two to three times during that year, relates to a summary of progress and is a type of grading. There is grave concern that supervisees do not receive adequate ongoing feedback and need clear notice when they are not meeting competence requirements. Summative feedback should never contain surprises for supervisees. Supervisees should never first learn of the supervisor’s concerns about their competence in a summative evaluation.

Formative evaluation refers to feedback given to supervisees on an ongoing basis. Ideally it takes the form of monitoring the established goals for the training period and identifying additional goals as they arise. It entails supporting strengths and development, and identifying areas of growth that are needed. Proceeding with behavioral anchors is an excellent technique. So rather than saying, “I am worried about your progress,” a supervisor might say:

You are making good progress in implementing Trauma-focused CBT protocols with fidelity. An area still in development is the role of your self in the process – your emotional response and how you are managing that within the session and how I am observing that in supervision. You alternate between being very distant and then being tearful.

An essential part of competency-based clinical supervision is providing abundant formative feedback to the supervisee. Besides fulfilling an ethical standard, such feedback is a component of the best practices of supervision. Feedback focused directly on the supervisee’s self-assessed competencies on any of the competencies documents previously described will be highly effective and will assist in bringing the respective fields into the competency era.

Moving Toward Two-way Feedback

An important innovation is introducing frequent feedback to the supervisor on the process of evaluation. This introduction of two-way feedback enhances the interactive process, and allows feedback to pass in both directions. Although supervisees may be wary of summative feedback to supervisors, fearing that it may negatively influence their own evaluations, ongoing structured feedback about process or supervisee needs tends to be less stressful and more easily integrated into supervision, especially if the supervisor is truly open to and accepting of the feedback. In supervision trainings, supervisees often complain that their supervisors urge them to give feedback and say they are open to it, but when the supervisee tries, he or she is met with resistance, dismissive behavior, or anger. It is most important to be open to feedback and to discuss it fully with the supervisee, attempting to introduce modifications or structures to deal with the supervisee’s concerns.

Outcomes

In addition to tracking outcomes of supervision, it is valuable to introduce tracking for outcomes in client progress. Lambert’s Outcome Questionnaire is an excellent tool to use for this, but there are other treatment progress or symptom checklists that would work as well. Some supervisors advocate creating their own scales of presenting problems and having clients rate themselves on those. Whatever technique is used, the important piece is to bring the data to supervision and for the supervisee to monitor or graph the client’s self-report of progress. Scott Miller also has outcome rating forms available at his website: scottdmiller.com/

Routine outcome monitoring is an important part of clinical practice and an invaluable tool in clinical supervision, providing data into the client’s self-observed presenting problems and helping the supervisor and supervisee to chart and monitor interventions.

Recommendations for Effective Evaluation

First, use a competency-based approach for evaluation. Using a self-assessment and any of the discipline competency measures (Benchmarks, CALSWEC, AAMFT), the supervisor should have the supervisee self-assess upon entry into the supervision. Then the supervisor adds his/her initial impressions in a second column, and reflects on any differences in impressions between supervisee self-assessment and supervisor assessment. This process could be repeated at intervals throughout the training sequence, to chart progress and to address areas that are still developing and to add new goals as each is achieved.

Other options for evaluation include using measures such as those included in the appendices of the supervision books written by Bernard and Goodyear (2014) or Falender and Shafranske (2004) which include supervision outcomes, alliance measures, and multicultural and diversity competence assessments, among others.

It is most important for the evaluation to be yoked with the goals and tasks for completion of the training year, and that these all be related to the training agreement.

Summative evaluation is not enough. Formative evaluation should be a part of every supervision session. One strategy is for the supervisor and supervisee to rate the process at the end of supervision to determine whether particular components, such as formative evaluation, occurred during the session.

Supervisees With Problems of Professional Competence

Most supervisees have a productive, developing training experience from which they proceed onward in their placements with enhanced skills and confidence. However, sometimes supervisees do not meet competence criteria or standards. As we move into the era of competency-based supervision, such determinations are supported by the competency documents, which serve as the core of the experience. Individuals who truly do not meet standards and do not benefit from improvement or action plans are infrequent in their occurrence. Some estimate that there is one such supervisee every four to five years in a setting. Certain settings report a higher prevalence (summarized in Falender and Shafranske, 2004; 2021).

It is essential that supervisors give competency feedback to supervisees on an ongoing basis, following the law of no surprises! Competence problems should never be a surprise to the supervisee. They should be identified and addressed from the time the supervisor identifies them.

Some red flags for supervisee competence problems may include:

Previously, “impairment” was a term used to denote the supervisee not meeting competence standards. But the word “impairment” has been preempted by the Americans with Disabilities Act (ADA). It now refers to a medical or physical disability. There will be supervisees who apply to or enter a training program who qualify under ADA, but in order to invoke ADA, these supervisees should notify their supervisor(s) and Human Resources of their ADA-qualifying diagnosis and provide supporting documentation. Then, after reasonable accommodations are developed by the Human Resources Department, supervisors can ensure that – with the accommodations – the supervisee meets the established competence standards for the setting/training sequence. It is critical to gain knowledge of ADA and understand fully its implications and all of its aspects. An excellent reference is www.eeoc.gov/policy.

Supervisors should not use “impairment” to refer to supervisees who do not meet performance criteria, or who manifest other problematic behavior. Using the term places the supervisor at risk and risks inflicting harm on the supervisee. There are court cases in which supervisors used this label with a supervisee and the supervisee was therefore regarded as being “impaired,” labeling which was judged to be as injurious as being labeled as disabled. For additional information, see Falender, Collins, and Shafranske (2009) for an extensive discussion with case vignettes and a decision tree to assist in determining courses of action for normative developmental issues, supervisee self-disclosure of a qualifying condition for ADA, and supervisees who do not meet criteria for competence.

Ideally, the supervisor will identify particular behaviors that are not being delivered or are not meeting the competence standard, and will work with the supervisee to improve these. This approach decreases stigmatization, increases the supervisee’s sense of optimism that there can be a positive outcome, and is accountable.

Supervisees With Problems of Professional Competence Defined

Lamb, et al. (1987) defined not meeting competence standards (previously “impairment”) as interference in professional functioning reflected in one or more of the following ways:

(Lamb, et al., 1987, pp. 291-292)

In cases of behavior not meeting competence standards, one or more of the following situations will be evident:

(Lamb, et al., 1986, p. 599)

Lamb and others outlined plans for proceeding once a supervisor has identified a supervisee as not meeting competence standards. These steps, which are adapted from others but elaborated and expanded upon, are suggested as an outline, but it may be necessary to implement them in a different order, or supplement them, depending on the situation, setting, and seriousness of the problem.

A very important caveat is to be sure there is a process in place before there is a problem with a specific supervisee (Forrest, Miller, & Elman, 2008). At each step, determine your feelings as supervisor. If you begin to personalize the situation or feel you cannot be objective, get consultation and support from colleagues and peers.

Be sure you discuss directly with the supervisee the performance problems you identify.

First is a behavioral description of the behavior(s). It is most important to use behavioral terms. Do NOT diagnose supervisees. Stick to the behavior and link it to behavioral expectations/requirements in the training agreement, or in the competency measure, or ideally, both. These may be linked to the competency documents for the respective field. Be as specific as possible as to context, frequency, and other variables. Have documentation including a record of instances in which the problem has occurred. If, for example, the problem is delinquent notes, have a list of the missing case notes and dates for each client. Other categories are problems connected to insufficient training and supervision or difficulties with moral character or psychological fitness:

(Kaslow, Rubin, Forrest, Elman, Van Horne, Jacobs, et al., 2007).

Also, determine whether the problem behavior is occurring with only one supervisor or whether it is occurring more frequently. This calls for consultation with the multiple supervisors who work with the supervisee.

Then discuss the behavior(s) that are not meeting competence criteria with the supervisee. If you are the only supervisor working with the supervisee, explore whether this is something that he has been told before. Try to understand any circumstances, life changes, cultural or diversity aspects, or other contributing factors that may be influencing the behavior. If the supervisee is still in a training/university program, consult with that program.

For example, there would be a very different course of action for each of the following scenarios:

It would also call for a different response if, for example, the supervisee was always late to appointments and explained that at her previous settings, time considerations were not important, and that she did not realize how seriously time was taken here – and corrected the behavior, versus a supervisee who said that she did not see the problem.

After determining that a supervisee is not meeting competence criteria, and giving the feedback directly to the supervisee, and having clearly addressed the issue previously, develop with the supervisee a plan based upon any additional data that can be obtained regarding successful correction of the behaviors in the past, facilitating factors, and a strategy for completion or change.

Keep in mind that supervisees may perceive remediation as punishment and feel unsupported and/or misunderstood (Kallaugher & Mollen, 2017). Evaluative processes need to be conducted by more than one supervisor whenever possible, considering cultural lens and assumptions, and providing support and guidance prior to moving to remediation (Falender & Shafranske, 2021).

An excellent model for a remediation plan is available at: apa.org/ed/graduate/competency.aspx

Be sure to give feedback and notice to the supervisee when you identify performance that is not meeting competence standards. Be specific that the performance is not meeting the standard.

Document every interaction. A timeline should be constructed with intermediate points for check-in, spaced relatively close together.

Be sure to follow up within a few days of the meeting with the initial check-in to track progress. If the supervisee begins to improve, do not stop monitoring. Be sure to follow up with each scheduled check-in and continue to monitor to completion of the tasks or until behavior changes, and continue to monitor beyond that point as well.

If the problem behaviors do not subside, or if the problem is viewed as increasingly serious, take appropriate steps. Possible steps include:

Continue monitoring and checking in with the supervisee to see how she is doing, feeling, and progressing.

If there is no change after all of the increased supports and monitoring, in conjunction with Human Resources and Administration – and with the school if the supervisee is a student – the supervisor needs to begin to think about probation, moving toward possible termination. This would need to have been clearly spelled out at the beginning as a possible consequence of not meeting specific performance criteria, and a specific due process procedure would have to have been given as part of informed consent at the onset of training. Movement toward termination or dismissal would move through steps, with opportunities for the supervisee to dispute the documentation.

The other supervisees at the site are definitely affected by this entire procedure. Some may have been aware of the problem for some time and may have wondered why it took so long to correct. For others, there may be concerns as to whether they would be next, whether the setting is safe, and what safeguards there are for their peers and for themselves.

It is critical that the supervisors NOT discuss with the other students the procedures occurring with the identified student so as to protect the supervisee’s confidentiality. However, once it is determined that the individual will be leaving, it would be important to process feelings of the others about the loss, and that discussion might touch on the process that occurred. Supervisors should be very thoughtful about this, protective of the student who is leaving, and respectful and forthright about the importance of preserving the student’s confidentiality and rights while clarifying and reassuring other students that as long as a supervisee is meeting competence requirements – and is not informed of problems of professional competence – they are in good standing. However, do not discuss the supervisee who is leaving.

All of the steps must be documented.

Increasingly, we are finding that openness and non-defensiveness to feedback are critical dimensions of development. In a very important set of studies (Papadakis, Hodgson, Teherani, & Kohatsu, 2004), it was found that physicians who were disciplined by state licensing boards, and who graduated from several major medical schools, were more likely to have demonstrated unprofessional behavior in medical school than was a matched control group who were not disciplined. These researchers concluded that patterns of unprofessional behavior in many cases are recognized early and are long-standing.

In a subsequent study, Papadakis, et al., (2008) found two predictors of disciplinary action against practicing internal medicine residents: unprofessional behavior and a low score on the internal medicine certification examination. One of the measured components in the first study was a failure to accept and integrate feedback.

Ethical Standards

Ethical standards exist in the Ethics codes of CAMFT (e.g., 4.8; 4.11) and APA (7.06) regarding dismissal and performance appraisal.

Self-care and Burnout

Mental health professionals are often not good at self-care, even though we espouse its importance. Thus, we may not model good self-care to our supervisees. What is the relevance of this to supervision? It is a multilevel issue.

If we are not protective of ourselves, we may supervise when we are not at our best. If we do not have strategies for stress reduction, relaxation, and activities in which we let off the stress and anxiety of the day – having listened to incredible problems and crises others have suffered – we place ourselves at risk. We are vulnerable to vicarious traumatization from our clients, and our supervisees are even more vulnerable as they have had less experience with the types of situations and disclosures that prompt it. Neighborhood violence, drive-by shootings, child abuse including sexual abuse and incest, suicide, death, loss, and all the other situations in which clients experience significant pain are all examples of this trauma.

There is evidence to suggest that our supervisees – and supervisors – may be even more vulnerable than the average person, as a substantial number of therapists are children of alcoholics or survivors of abuse. As a result, the vicarious traumatization is on top of existing trauma, and has a cumulative impact. There is evidence that supervisees exposed to community violence and to suicide or suicide attempts of clients find that the impact is long-standing and pervasive, sometimes manifesting itself in PTSD symptoms.

The role of the supervisor is to be sensitive to the potential for supervisee burnout or vicarious trauma, and to process such events with the supervisee with care. Supervisees report that this is infrequently done, and that supervisees carry feelings with them for years after the incidents.

Signs of burnout include emotional disengagement, fatigue, hypervigilance, hopelessness, avoidance, and survival coping.

Supervisees generally place self-care on a back burner as well. They may only vaguely remember self-care or leisure activities they loved prior to graduate school and must be prompted to recall exercise, art, music, or other activities. A recent study revealed that quality of sleep and positive supportive relationships are essential self-care factors (Myers, et al., 2012). Sleep is a highly important factor in self-care (Goncher, et al., 2013).

Although it is a multiple relationship for supervisors (who attempt to maximize the productivity of supervisees while trying to safeguard their own self-care), supervisors need to lead the way in modeling self-care and introducing practices such as mindfulness to supervisees. Wise and colleagues (2012) suggest we should not simply survive, but need to flourish. That includes embedding self-care and self-awareness in our professional activities rather than making these a cumbersome add-on. Some strategies include taking time to eat lunch without multitasking or taking a brief walk or other pleasurable activity during a work day.

In a study by Stevanovic and Rupert (2004), respondents who had higher job satisfaction reported various strategies for reducing burnout. These include varying work responsibilities, using positive self-talk, maintaining a balance between their personal and professional lives, spending time with their partners/family, taking regular vacations, maintaining their professional identities, turning to spiritual beliefs, participating in continuing education, reading literature to keep up to date, and generally maintaining a sense of control over work activities. This study is important for supervisors as it gives possible strategies for the supervisor to adopt, to model, and to communicate to supervisees.

Legal and Ethical Concerns

Consider the following supervisor and supervisee ethical issues and identify ethical infractions. Identify specifically what ethical infractions occurred, and match them to the appropriate ethical code in the section below.

It is the responsibility of the supervisor to know and keep updated on regulations, laws, ethics codes, and all developments that influence client care and supervision. Further, it is the responsibility of the supervisor to track supervisee development and competence and attest to that. Supervisees will lose their hours toward licensure if supervisors do not abide by all the rules and regulations in the licensing board regulations. In this section, there will be references to the ethics codes listed below when they have relevant standards. You may use these links to review your own profession’s code in further detail.

Ethical Codes by Discipline

For Psychologists, the Ethical Principles of Psychologists and Code of Conduct was amended in 2017. In Social Work, NASW updated the Ethics Code in 2017. MFTsuse the AAMFT Code of Ethics (2015) or CAMFT Code of Ethics(2011). Professional Counselors use the American Counseling Association Code of Ethics (ACA 2014). Be sure you have the current documents, see links below.

Reference these ethical standards:

Ethical Principles for Psychologists and Code of Conduct (APA, 2017)

National Association of Social Workers Code of Ethics (NASW, 2021)

American Association for Marriage and Family Therapy (AAMFT) (2015)

California Association of Marriage and Family Therapists Code of Ethics (CAMFT) (2011)

American Counseling Association Code of Ethics (ACA) (2014)

In the supervisory contract or agreement, the supervisee should agree to abide by the ethics of her profession and the attendant laws and regulations. An important part of beginning supervision is to provide the supervisee with specifics of legal decisions relevant to the geographical location. For example, in California, the supervisee needs to be introduced to Tarasoff and its extensions. If the supervisee was trained in another state, the duty to protect and warn provisions may not have been in effect or it may have been illegal to warn, as it is seen as a breach of client confidentiality. Other regulations and practices are state specific as well.

See Appendix II for examples of state-specific regulations and practices for California psychologists, as well as recent changes to California Laws and Regulations Relating to the Practice of Psychology and to Statutes and Regulations Relating to the Practice of Marriage and Family Therapy.

Ethics and Law

Supervisors model adherence and attention to the ethical principles of their respective profession, and model identifying ethical issues and engaging in ethical problem-solving. In interdisciplinary supervision, the supervisor should be familiar with the ethics codes of the professions one supervises.

Ethical supervision is more than simply abiding by laws – but of course abiding by laws is essential! Rather than being rule-bound in our practices and our supervision, a shift to positive ethics is indicated. Positive ethics focuses on reflective practice and moral excellence (not minimal obligations) and provides supervisees with knowledge, skills, and attitudes regarding identification, and a meaningful approach to ethical practice. Positive ethics also provides a framework for supervisors to identify ethical issues proactively, teaching supervisees that the ethics code contains answers to a multitude of issues raised in clinical practice. The task then is to identify the issue and refer to the code.

Positive ethics is compatible with the aspirational/foundational principles of ethics that are found in each discipline’s ethics codes (e.g., integrity, competence, dignity and worth of the person, non-maleficence or “do no harm”). Knapp and colleagues describe positive ethics as those encouraging the integration of personal ideals into professional behavior and inspiring mental health professionals to fulfill their highest potential (Knapp, Vandecreek, and Fingerhut, 2017).

Supervisors should model a much higher level of ethical practice.

Liability, Malpractice, and Supervision

Respondeat Superior refers to Vicarious Liability. This is a very important term for supervisors to understand as it applies to responsibility for supervisee actions. It is the legal term that refers to one individual holding a position of authority or direct control over another – a subordinate – and as such being held legally liable for the damages a third individual suffers as a result of the negligence of the subordinate. Generally, clinical supervisors are legally liable for injury caused by the supervisee.

Supervisory liability only typically occurs if the negligent acts of the supervisee occurred within the course and scope of the supervisory relationship. Relevant factors include:

(Disney & Stephens, 1994)

Bennett, et al. (1990) describe four criteria to be met for malpractice:

  1. relationship formed between psychologist and client (legal duty of care);
  2. demonstrable standard of care that was breached;
  3. client suffered demonstrable harm or injury; and
  4. breach of duty to practice within the standard of care was the proximate cause of client injury and the injury was reasonably foreseeable.

Keep in mind that there are two forms of supervisory liability:

Sometimes the situation is not so clear-cut between these two:

The supervisor is “gatekeeper” in that the supervisor holds the power to pass or fail the supervisee by signing off on hours or a completion certification, and, importantly, the supervisor holds the power to protect the client. Supervisors must remember that their highest priority is duty to the client. They must attend to their responsibility to the training of the supervisee, but must always maintain clarity about duty to the client’s safety and well-being, with “doing no harm” the highest priority. Generally, supervisors should practice carefully and be actively involved in supervision. If one makes an error in judgment under those circumstances, the risk is substantially less than for someone who has a history of negligent supervision.

Do supervisors always behave ethically? In one study (Ladany, Lehrman-Waterman, Molinaro, & Wolgast, 1999), 51% of supervisees reported at least one ethical violation by their supervisor. Most frequently reported was failure to adhere to ethical guidelines regarding performance evaluation.

The following are categories of ethical responsibilities that were perceived to have been violated:

Ladany, et al. (1999) reported that about 35% of supervisees discussed their perceived ethical violations by the supervisor with the offending supervisor. Fifty-four percent discussed it with someone other than the supervisor – a peer, friend, significant other, another supervisor, therapist, professor, or relative.

A supervisor’s unethical behavior was associated with less satisfaction with supervision on the part of the supervisee. Greater supervisory unethical behavior was associated with lower goal and task agreement, and a lower emotional bond between supervisee and supervisor (Ladany, et al., 1999).

Subsequent studies have found the same levels of supervisee perceptions that their supervisors conducted ethical infractions.

Confidentiality in Supervision

Supervisors have the responsibility to ensure confidentiality of their supervisees’ clients’ information:

Supervisors have responsibility to ensure that their supervisees understand fully the limits of confidentially (or lack thereof) of their communications with their supervisors:

Supervisors have a responsibility to ensure that if electronic communication occurs (between client and supervisor, supervisee and supervisor, or client and therapist), clients and supervisees are informed in advance of the limits of confidentiality and the possibility that such communications may not be not private.

Informed Consent

The supervisor should disclose supervisory experience, training, theoretical orientation, limits of confidentiality of supervision, expectations for the training period including all logistics, required behavior and productivity, services to be performed, and what constitutes successful completion. The consequences if the supervisee does not complete adequately one or more of the parts of supervision – plus due process steps – should also be disclosed.

Due Process

There should be prior agreement regarding:

One of the biggest mistakes supervisors make is not providing for due process – and not telling supervisees what will happen if they do not meet performance criteria – and what recourse they have.

Multiple Relationships

This is the area of supervision relationships that has been most written about and addressed. It has been referred to as “dual relationships” or “multiple relationships.” Again, it is useful to review the relevant ethics codes.

Critical aspects of supervisor behavior include the avoidance of (1) exploitation, (2) impaired objectivity, and (3) exposing an individual to harm.

Examples of boundary crossings include accepting a gift from a client, going to lunch with a client, or in the case of supervision, accepting a gift from a supervisee or engaging in social activities with a supervisee.

Boundary violations include having sex with a client, having sex with a supervisee, or strongly urging a supervisee to invest in a joint real estate venture with the supervisor (who sells real estate on weekends).

Boundary-crossing Examples

Consider the situation in which the supervisee is very warm and affiliative and generally touches her peers and her clients, squeezing their arm, patting them on the back, or placing her arm around them. Consider a supervisory reaction and response, as well as other considerations including those of an ethical, multicultural, or historical nature.

Examples of supervisor boundary-crossing are touching (a supervisor hugging a supervisee) and requiring the supervisee to go to lunch with him weekly. Or, a supervisor asking to “friend” a supervisee on Facebook.

What is your response to these examples? It is so important for a supervisor to keep in mind several factors: the power differential prevents the supervisee from telling the supervisor a genuine response or that the boundary crossing is a violation of the supervisee’s space, or is otherwise intrusive or potentially hurtful or harmful.

Take for example the supervisor who requires the supervisee to go to lunch during supervision, and requires him to pay for his own lunch. The supervisee has tried not eating (supervisor will not accept this), ordering inexpensive foods (supervisor splits the bill with the supervisee and orders more expensive foods), and asking if the supervisory hour could be changed (supervisor refused, citing lack of other available times.) The supervisee feels violated, as he cannot afford expensive lunches, feels he is sacrificing adequate supervision as he cannot discuss his cases (ethically) in a public place, and feels totally trapped; if he protests too much, it may influence his evaluation or even the supervisor’s signing off on the hours he has accrued.

There could also be the added factor of sexualized complexity, inferences, or pressures. On the walk back to the office, the supervisor starts putting his arm around the supervisee’s shoulder making the supervisee increasingly uncomfortable. For the supervisee who speaks up and asks that the supervisor not do that, the individual may encounter a supervisor who:

Similarly, consider the issues of a supervisor asking a supervisee to “friend” them. Think of the potential downsides for the supervisee and the supervisor. Generally, this is not an appropriate supervisory action. Consider the ethical standards above. Remember that supervisor intent is not as important as what meaning the supervisee draws from the action – and possible outcomes.

Supervisors have the responsibility to behave ethically and to minimize boundary crossings. If boundary crossings occur, supervisors should consider the impact upon the supervisee and use the problem-solving frames below.

What, if any, multiple relationships are appropriate between supervisor and supervisee?

Using boundary crossings versus violations as a guideline, it is important to note that individuals who engage in boundary crossing may be at greater risk when later accused of a boundary violation (Gutheil & Gabbard, 1993). That is, engaging in behaviors that in and of themselves are only crossings, such as hugging clients, going to dinner with an individual intern, or accepting presents from supervisees can be viewed in retrospect as a loosening of boundaries. The minor boundary violations, then, are part of a pattern of escalating violations along a slippery slope.

Gutheil and Gabbard (1993) suggest consideration of:

Supervisors in rural areas have expressed concern about the impossibility of avoiding multiple relationships. The rule that has been proposed is for the relationships to be focused on informed consent and a thoughtful analysis of potential risks or exploitation of the client, and to involve the client in thinking through the relationships. An excellent resource that describes such boundary issues, dilemmas, and problem-solving approaches is written by Schank and Skovholt (2005). For example, if the supervisee resides in a very small town, and is likely to encounter clients in everyday interactions (at the grocery, pharmacy, library, and church), how should the supervisor and supervisee approach that issue? One suggestion was informed consent, informing all clients of the very great possibility of such unintentional encounters, and discussing how the supervisor should respond (ignore, greet, etc.).

Lazarus and Zur (2002) present a thoughtful analysis of when dual relationships and boundary crossings are therapeutically indicated, and how in this era of risk management we have been unduly influenced by attorneys to be risk avoidant in ways that may not be in the best interests of the client. They urge us not to let risk management considerations take precedence over providing the best possible clinical care to our clients. They argue that some multiple relationships are healthy and promote healing, and that demonizing them has harmed psychologists and the profession. It would seem that there should be some balance in this, as in most areas of practice, with adherence to a thorough informed consent process and thoughtful analysis. Please note that Lazarus and Zur are clear in their admonition regarding boundary violations. They are referring to boundary crossing or multiple relationships such as lending books, sending birthday cards, accepting invitations to attend special events, accepting small gifts, playing tennis, or having lunch with a client as part of a designated treatment plan.

Some multiple relationships are mandated or unavoidable. Examples of mandated are the military and prisons; unavoidable include rural or small communities, faith, spiritual, and 12-step or other recovery programs (Zur, 2017). Informed consent to ensure acknowledgement of the multiple relationship and to discuss how to handle these are essential.

It is useful to consider Bennett, et al.’s (1990) caution that one must always consider what the therapist’s (or, in this case, supervisor’s) behavior means to the client (or supervisee). That is, a hug may be intended as a sign of support and empathy by the therapist (or supervisor), but may be interpreted as a sexual gesture or movement toward friendship by the client (or supervisee). In fact, when groups of supervisors are asked about their worst supervision experiences, they often refer to boundary issues of touching, back rubs, hugs, or kisses by supervisors who have no idea that the supervisee is feeling that these are boundary crossings or violations.

Sexual intimacy and sexual relationships with clients or with supervisees are prohibited by all professional ethics codes.

In fact, there has been a decrease in reported incidence of sexual behavior between clients and therapists, and low reported levels between supervisors and their supervisees (1.4%-4%). Supervisees report the incidence as between 5% and 6% (Lamb, Catanzaro, & Moorman, 2003; summarized in Falender & Shafranske, 2004). Thus, there is a slightly higher report of sex between supervisor and supervisee by supervisees than by supervisors. Lamb, Catanzaro, and Moorman (2003) reported in their survey that only 3.5% of the 368 individuals who responded to the survey, or 13 individuals, had had one sexual boundary violation as a professional psychologist. In the case of the very small number of individuals who had a sexual boundary violation with a supervisee, all of them occurred after supervision had ended. Although a small sample, it is noteworthy that 40% of those surveyed did not view their involvement as harmful to the other individual.

Sexual advances, seductions, and/or harassment have reportedly been experienced by 3.6% to 48% of psychology and mental health-related students. Although most mental health educators believe it is unethical and/or poor practice to engage in sexual contact with a supervisee or student, especially during the working relationship, it appeared that such practices do occur. Many students (53%, n = 223) would not feel safe to pursue action if they had firsthand knowledge of a sexual contact occurring, due to fear of loss of anonymity and fear of repercussions (Zakrzewski, 2006).

Having sexual feelings or attraction toward a client at some point in one’s professional career is normative, and approximately 80%-88% of psychologists report they have experienced those kinds of feelings (Blanchard & Lichtenberg, 1998). More than half of all psychologists reported that their training was not adequate in these matters (Pope, Keith-Spiegel, & Tabachnick, 1986).

In fact, it appears that many supervisees do not self-disclose or process sexual attraction unless the attraction is from the client directed toward the therapist. That type of disclosure is much more common and more often discussed. Reflect back on your supervisory experience and how many times a supervisee has ever disclosed sexual attraction to a client.

A good way to increase such discussions – as it is very important to process such information rather than allow for the possibility of it being acted upon – would be to provide the supervisee with some normative data or an article about sexual attraction. A book by Pope, Sonne, and Holroyd (1993), Sexual feelings in psychotherapy: Explorations for therapists and therapists in training, is an excellent resource.

Multiple relationships may be implicit and normative in clinical supervision. Supervisees may be a student in a supervisor’s class, co-therapist, writer of letters of recommendation, research team member, attendee of holiday or other celebrations in the setting, or attending a conference with a supervisor, to name a few (Falender, 2017). Many multiple relationships, when carefully constructed, can be beneficial to supervisor and supervisee alike.

Excellent problem-solving frameworks are available about whether to engage in a multiple relationship in therapy (Younggren & Gottlieb, 2004) and in supervision (Gottlieb, Robinson, & Younggren, 2007). The following are some of the questions regarding supervisory multiple relationships:

(Adapted from Gottlieb, Robinson, & Younggren, 2007)

Consider the example of a supervisee who wants to carpool, having discovered that the supervisor lives one block away from him, and the drive to the setting is 45 minutes. What parameters would one consider? Try the analysis/questions from the Gottlieb, Robinson, and Younggren framework first. Here is one individual’s analysis:

This relationship is most likely not necessary, and although it might save money for gas and wear and tear on both individuals and the cars, it might be very inconvenient in terms of hours. It could potentially cause harm to the supervisee if the supervisee disclosed personal information or data unknown to the supervisor or if the relationship evolved beyond one of supervision. There is a risk the dual relationship could disrupt the supervisory relationship, and there would be a possibility the supervisor could not evaluate the matter objectively, if she developed a friendship with the supervisee, making evaluation difficult or impossible, or if she became financially dependent on the supervisee’s provision of gasoline. Also, there is the possibility that the disclosed information from one to the other could irreparably damage the opinion of one about the other – their integrity, morality, or other aspects that they might inadvertently allude to while in a “quasi-friendship” mode while driving.

Add your own ideas about “worst case scenarios” that might arise.

Hamilton and Spruill (1999) conducted a retrospective analysis of two students who did engage in sex with their clients. They identified a number of commonalities and risk factors that are useful to consider. The students had been paraprofessionals before returning for graduate training and had had quasi-friendship relationships with their clients in those roles. They had moved from different parts of the country and were feeling isolated. Because of limited experience with therapy, they interpreted their clients’ statements of needing them, caring so much for them, etcetera, very literally, rather than considering them as transference phenomena and bringing them to supervision (another reason to actively encourage discussion of sexual attraction in supervision).

Hamilton and Spruill developed a checklist for risk management purposes of behaviors that are potentially problematic. They include therapists who extended the session regularly, scheduled sessions up to clinic closing time, dressed specially for the client, appeared very preoccupied with the client, failed to document or could not remember phone calls or contacts.

Burian and Slimp (2000) developed a decision tree and Likert scales specific to decision-making in the internship setting. Dimensions include:

(Burian & Slimp, 2000)

Considering the carpool scenario within the Burian and Slimp framework, the same supervisor provided this analysis:

There is no apparent professional benefit to this; personal benefit could be to both. The present professional role is supervisor-supervisee (so it is a definite ‘No’). The location of the relationship is in the car, not in the office (a ‘No’). The intern might not be able to leave the activity without repercussion. This might have impact on uninvolved interns feeling that one was receiving preferential treatment or developing a closer relationship, and similar concerns with uninvolved staff members.

These are examples of the types of thought that should go into decisions about multiple relationships with supervisees.

Excellent general frameworks for decision-making are other tools for supervision. One developed by Barrett, et al. (2003) has a first step of considering one’s own, and one’s supervisor’s own, personal or emotional reaction to the ethical issue. Another added step should be consideration of the role of diversity/cultural elements in the decision.

Koocher and Keith-Spiegel (1998) derived an ethical decision-making model from work by Tymchuk and Haas & Malouf. Steps after the personal reaction and consideration of cultural/diversity factors are:

  1. Determine if the matter is an ethical one.
  2. Consult available ethical guidelines that might apply to provide a possible mechanism for resolution.
  3. Consider all sources that might influence the kind of decision you will make.
  4. Locate and consult with a trusted colleague.
  5. Evaluate the rights, responsibilities, and vulnerability of all affected parties.
  6. Generate alternative decisions.
  7. Enumerate the consequences of making each decision.
  8. Make the decision.
  9. Implement the decision.
  10. Consider the impact of the decision.

(Adapted from Koocher & Keith-Spiegel, 2008)

Other ethical standards include Section 7 of the Ethical Principles and Code of Ethics of the American Psychological Association (2017) which addresses Education and Training; and many principles and sections of each professional code of ethics including “do no harm,” beneficence, justice, delegation of responsibility, integrity, assessing supervisee behavior, and responsibility to the profession. For social work, NASW Code of Ethics, Section 3.0 addresses social workers’ ethical responsibilities in practice settings. For marriage and family therapy, Standard IV addresses responsibility to students and supervisees (AAMFT, 2015).

There are some other legal issues specific to training. Among these is “Borrowed Servant,” which relates to vicarious liability for acts of an individual who is sent to work for another organization. In the case of students, it has been applied to the relationship between graduate school and placement. The placement has benefit for the student, and the expectation is that the student will return to the graduate school to complete training. Articulation as to who is responsible for what part of the training is central to this. It should be clear who is the supervisor of record, who holds the malpractice insurance, and, generally, what is the arrangement for the supervisee in the setting. This needs to be a formal written agreement.

Hostile Work Environment

There is an area of law that relates to individuals who create a hostile work environment. Examples of this include use of culturally offensive language or behavior toward individuals, or modeling such behavior. Adherence to standards of professionalism should preclude such behaviors, but be aware that this might be the topic of many lawsuits in the future.

Sexual Harassment

Most workplaces mandate completion of a comprehensive sexual harassment didactic to introduce the workforce to elements of harassment and to underline the unacceptable and illegal nature of engaging in such acts. These might include sexually explicit language, jokes, or pictures, or sexual innuendos. Clearly, sexual harassment is not tolerated in clinical supervision. Unfortunately, the supervisee may fear to disclose or report due to the power differential and the fear of consequences that could be personally detrimental to the supervisee. It is incumbent upon supervisors to ensure that such practices do not occur.

Tarasoff for Supervisors

Background information

Prosenjit Poddar, who was born in Bengal, India, was a student at the University of California at Berkeley. At folk-dancing classes, he met Tatiana Tarasoff, with whom he fell in love. Although Tarasoff was friendly to him, she was not receptive to his overtures except for giving him a New Year’s Eve kiss. Eventually, she told him she was not interested in a relationship with him. He was devastated by the rejection, and all areas of his functioning were impacted, including school, personal appearance, and mental health.

Eventually, after Tarasoff had left the country for a trip, Poddar began mental health treatment as per a friend’s suggestion. He was interviewed by a psychiatrist, and eventually began treatment with a psychologist. When he disclosed to his therapist his intent to kill Tarasoff upon her return from her trip, his psychologist consulted with superiors in the department, and they agreed Poddar should be involuntarily committed to a psychiatric hospital. The psychologist informed the campus police and asked them to begin commitment proceedings. However, when they picked him up, Poddar did not appear disoriented or dangerous, and he promised to avoid contact with Tarasoff.

Subsequently, Poddar discontinued therapy. When the head of the Department of Psychiatry learned of the police referral, he asked that the psychologist destroy his therapy notes and not attempt to contact Poddar.

When Tarasoff returned from her trip, she was unaware of the danger posed by Poddar. In fact, Poddar had convinced Tarasoff’s brother to share an apartment with him, adding to her confidence that he was not a threat. When Poddar went to Tarasoff’s house, she refused to see him, and he shot her with a pellet gun, pursued her, and fatally stabbed her with a knife. Poddar was convicted of second-degree murder, but later the ruling was reversed and Poddar returned to India.

Tarasoff’s parents filed a wrongful-death suit against the Regents of the University of California, which, in the court’s second decision, resulted in the recognition of a duty to protect and warn by a therapist due to the “special relationship” that exists between therapist and client. The duty to protect arises only when the victim has been identified, or could be identified, “upon a moment’s reflection.” Further, as part of the discharge of their duty, therapists may need to take multiple steps to prevent harm and to protect the intended victim, including warning the intended victim, initiating involuntary commitment, notifying the police, modifying treatment, getting psychiatric/medical consultation, increasing frequency of sessions, hospitalization, or other steps to deter the violence.

What Does this Mean for Supervisors?

It requires supervisors to be knowledgeable and alert to the latest legal status of Tarasoff and its extensions including Duty to Protect. This varies state by state. For example, presently, the duty to protect and warn has been expanded – previously in Ewing vs. Goldstein in the State of California, a communication from a family member to a therapist made for the purpose of advancing a patient's therapy, was protected as a "patient communication" within the meaning of the statute. The father had communicated to a therapist the client’s intent to harm himself and his ex-girlfriend’s new boyfriend. That protected status has been removed in favor of said Duty to Protect.

In addition to a thorough understanding of Tarasoff, and the “duty to warn and protect, and predict” (Behnke, et al., 1998) (which includes reasonable attempts to protect and, if indicated, communicate the expressed threat to the victim and the police, and developing action plans to manage and contain the client), supervisees should be trained in all aspects of risk and danger assessment. They should know how to conduct suicide risk assessments; have protocols for management of potentially violent clients, child abuse, and elder abuse; and have knowledge about the psychologist’s possibility of being harassed or threatened by clients.

It is critical to have written protocols for supervisees on procedures for any type of emergency in terms of:

Training in graduate school may be limited in most of these areas, even though supervisors in internship and practicum settings assume their incoming students have had the training (but will generally provide it as needed). This assumption creates a risk situation unless the actual level of competence of each student is assessed in these areas.

Essentially, supervisors need to ensure that Tarasoff is accurately reflected in informed consent. Supervisors bear responsibility for following the most recent updates on such laws.

The Tarasoff law requires supervisors to have procedures in place for when this or any other emergency or crisis situation arises so that the supervisee knows exactly what steps to take to contact a supervisor and to systematically arrange to protect the client, the potential victim, and to appropriately fulfill the duty to warn and protect. However, supervisors may not be as current or accurate in their implementation of duty to warn and protect as they believe themselves to be (Pabian, Welfel, & Beebe, 2009). Pabian, et al. found that individuals believed they were more aware of and able to implement their state duty-to-warn-and-protect standards than was demonstrated when given actual vignettes.

Supervisors must assess supervisee skills in emergency situations. Kleespies (1993) has suggested that supervisees are inadequately trained in such assessments and in follow-up steps. It is incumbent on supervisors to assess level of competence and provide resources and back-up including possibly joining the session or observing if assessed competence (and the supervisee’s ability to perform the task with the level of supervision provided) is not adequate to the severity of the task.

Foreseeability is a critical piece of Tarasoff – and those who are forseeably at risk have been extended by subsequent legal decisions to include those who are in close proximity to individuals who have been threatened.

Because of the imminent danger, it may be necessary for the supervisor to be physically present with the supervisee or to arrange for another supervisor to do so to ensure complete coverage.

It is interesting that Slovenko (1980) stated that had the director of the clinic in the Tarasoff case interviewed the patient himself, and come to the determination he was not dangerous to self or others, there would have been no cause of action under foreseeability. This has specific implications for supervisors in this type of high-risk situation.

Ultimate responsibility for execution of Tarasoff lies with the supervisor – to ensure that identification, assessment, and appropriate action plans have been completed. An excellent reference is by Caudill (2020), “Warning of the duty: The devolution of Tarasoff” in The California Psychologist. In it, Caudill provides some guidance about duty to warn and protect. He urges consultation with legal counsel in such instances as the case law is complex and evolving.

It is clearly highly traumatic for a supervisee to have a client suicide or make a significant attempt. This is traumatic for even the most experienced professional, and we know that supervisees are more vulnerable and that the effects of such a trauma are long-standing. Care should be taken in how the supervisee is informed of the fact, and of the type of processing, debriefing, and support that occurs (Knox, Burkard, Jackson, Schaack, & Hess, 2006). Discussion of the impact and the pertinent therapeutic and legal issues is also available (Weiner, 2005).

Documentation

Documentation is an important part of the supervisory process. It is important to keep some type of supervisory log so that the supervisor can record that supervision occurred and which cases were covered in the supervision session. In addition, certain boards require formal documentation of the occurrence of supervision and weekly sign-off of that occurrence. It is a supervisory responsibility to know of these requirements and complete them in a timely manner.

There are legal issues associated with use of client names in supervisory records. It might be desirable to code the names of clients numerically, as the log is actually not about the client, but about the progress of supervision.

Be guided by your setting and legal considerations concerning documentation and clarity about records release and client access. Have clarity about what documentation should be included in the case record and client access to all records (e.g., CARES Act for client access to records).

The supervisory log could include:

Follow-up on previous supervisory input.The importance of the log is to document that supervision did occur, that issues were addressed, and that the supervisor is maintaining a reasonable level of scrutiny and responsibility over the supervisee who is functioning under his license.

Please note that if reference is made to actual clients, the supervision notes may become part of the client record. There are multiple contextual factors to consider in this respect, so consult with other colleagues about the format and type of identification you are using. The normative supervision log is not designed to document supervisees with performance problems. Also note that there is a trend toward the requirement of supervision notes. Certain provinces in Canada (e.g. College of Psychologists of British Columbia) mandate supervision notes and outline minimum requirements. Some large providers require supervisors to include supervision notes in the client record.

Some supervisors encourage supervisees to keep their own logs, but it seems most important for supervisors to make note of particular issues that arise that are of concern to them. It should be clearly articulated what notes are to be kept, who holds these notes, where they are to be stored, and for how long. In many instances, it is ideal to have notes co-constructed by supervisee and supervisor.

Ending the Year: Supervisees at the End of the Training Sequence

The end of a training sequence can bring with it many feelings. For the supervisor, there may be a feeling of pride in all that has been accomplished, happiness in the effectiveness of the relationship and the supervisee’s growth and development, and a general satisfaction of a job well done. However, there may be lingering worries about whether the supervisor taught the supervisee everything possible, and whether there are areas that were not covered that will be particularly critical to the supervisee’s subsequent placement or practice. The supervisor may worry that for some reason she did not have the best year, and as a result may not have given the supervisee the best possible training.

For the supervisee, there is the parallel sense of accomplishment and excitement about moving on into an increasingly autonomous role. There is the excitement of the next placement, if known, and the challenges ahead. However, there is also the parallel fear of whether one is as competent as supervisors are saying, and whether he is truly ready for the next step. The artificial nature of client termination may cast a pall on some aspects of the termination process, as may the clients’ reactions, which could include anger, sadness, or ceasing to attend sessions. Clients may disclose pivotal information in the last session, increasing the supervisee’s sense that they are abandoning the client or leaving them at the time they are most needed.

A useful approach is to review the contract or agreement and to think about the goals, achievements, and expectations that were not met. Personally, the relationship of supervisor and supervisee will transform to that of colleagues, but there will still always be some residuals of the old relationship and the power differential, especially since supervisors may be called upon to write letters of recommendation or provide other forms of support.

Attending to the parallel processes with respect to client and supervisor reactions is a useful activity and provides another modeling experience for the supervisee. That could include sadness, worry about whether enough has been achieved, what the future holds.

Vignette: A supervisee’s client disclosed in their very last session that she was sexually abused as a child, thus presenting the supervisee with information that would have been very important to the previous treatment and would be pivotal to future treatment. The supervisee was devastated, not understanding that perhaps the reason for the disclosure was, in fact, that it was the last session. The supervisee was so guilt-ridden that she considered telling her post-doc placement she would have to defer several months to continue with the client.

Vignette: A past supervisee continues to receive calls from his supervisor requesting resources, translations, and other materials that take significant amounts of time for the former supervisee to produce. The supervisee is not comfortable setting limits with the previous supervisor, and is becoming increasingly stressed by the number of demands on his time and resources. However, the past supervisee has loyalty to his former supervisor and is concerned that he may need a letter of recommendation sometime in the future. Therefore, he feels compelled to continue to respond and supply everything that is requested.

For each of these vignettes, consider what the ethical and legal aspects are, how the contract may be a factor, and what types of responses could be given by supervisee and supervisor.

Integration Exercises

Vignette: During the first week of placement, a supervisee is told by her supervisor that he is not sure she is skilled enough for the practicum placement. She is taken aback, since she had applied to, been interviewed by, accepted at, and turned down several other placements to come to this one. She talks to her school, which urges her to continue in the placement and to talk with the supervisor to get a better sense of what the supervisor is referring to when he says, “not skilled enough.” The supervisee decides to inform the supervisor about the other acceptances, and the supervisor agrees to keep her in the placement once he learns she refused those other placements. However, once she begins seeing cases, he constantly reminds her that her skills are not up to par, but does not provide much guidance as to what that means. He favors a highly unstructured, play therapy approach, and her two clients are elementary school children who have severe aggressive behaviors that have been injurious to other children.

An issue in this scenario is the powerlessness of the supervisee. However, should a competency-based approach be adopted, both supervisor and supervisee could be “on the same page” about what the supervisee’s areas of strength and areas needing development are. An underlying issue here is the lack of a supervisory alliance – a sine qua non of supervision. It is extremely difficult for a supervisee to be in a position of having to provide structure. It is incumbent upon all supervisors to take responsibility and to confront difficult situations head on, and to get consultation on issues that are problematic, such as when a supervisor does not like his supervisee or she has negative associations with him. Also, in the two-way process, supervisees may present with more information about evidence-based treatments than supervisors may have competence to supervise. It is critical for supervisors to engage in lifelong learning to update skills and to learn about evidence-based practice.

Exercise: Select a case you are currently supervising and identify one critical incident that has occurred. It could be conflict, disagreement, lack of resolution, or simply an uncomfortable feeling you had after completing supervision. Identify the strain or rupture marker if you can. Think about the actions you have taken to repair the situation or the actions you plan to take. Use metacommunication and a strength orientation.

Future Directions

The practice of supervision is the highest calling in the mental health professions. It is the dissemination of learning, professionalism, and ethical practice from one generation to the next, and in the process, it provides the supervisor with the opportunity to learn and develop from the experience.

As each field moves to increasingly evidence-based assessment and treatment, supervision moves in the direction of competency-based practice. Through this process, accountability and standards of practice are maintained. As each profession continues to refine competency documents, and some develop supervision guidelines and supervisor competencies, the bar for supervisors is rising – and this will be highly beneficial to supervisees. Supporting supervisee trajectories of development and attending to the requisite competencies identified by our professions are giant steps forward in ensuring that supervision practice is not simply through osmosis but is conducted with design and attention to critical components and practices: i.e., competencies. The challenge for each of us will be to maintain the “art” of supervision as we develop increasingly sophisticated measurement paradigms for practice.

It is also important to maintain the personal factors of sense of humor, self-assessment, reflective practice, perspective, and ongoing self-care to ensure that we each function at our best in increasingly stressful and demanding environments. Through supervision and levels of supervisory support, we can provide guidance and assistance to each other, empowering our supervisees and ourselves.

As competency documents become more articulated and used more consistently, the process of supervision is benefiting.

Appendix I – Related Competency Standards

Nursing Competencies:

Nursing competencies are described at:

National Panel for Psychiatric-Mental Health NP Competencies

Professional Chaplain Competencies:

Common Standards and Competencies

General information:

Common Qualifications and Competencies Links

CBT Training Competencies:

For guidelines for CBT Training Association for Behavioral and Cognitive Therapies, see link to BT on ABCT.org, middle column.

Competencies for Health Psychology:

France, et al., 2008

Kaslow, Dunn, & Smith, 2008

APA.org resources

Core Competencies for Integrated Behavioral Health and Primary Care

Psychology, American Psychological Association

https://www.apa.org/ed/graduate/competency.html

Neuropsychology

Lamberty & Nelson, 2012

Stucky, Bush, & Donders, 2010

Shultz, et al., 2014

Family

Stanton & Welch, 2011

Core Competencies for Interprofessional Collaborative Practice (2016)

Gerontology

Karel, Knight, Duffy, Hinrichsen, & Zeiss, 2010

APA Guidelines for Psychological Practice with Older Adults

Forensics/Correctional

Varela & Conroy, 2012

Specialty Guidelines for Forensic Psychologists

Standards for Psychology Services in Jails, Prisons, Correctional Facilities, and Agencies: International Association for Correctional and Forensic Psychology (Formerly American Association for Correctional Psychology) Criminal Justice and Behavior July 2010 37:749-808

Clinical Child and Adolescent

Finch, Lochman, Nelson, & Roberts, 2012

Clergy and Other Pastoral Ministers Addressing Alcohol and Drug Dependence

Core Competencies for Clergy and Other Pastoral Ministers in Addressing Alcohol and Drug Dependence and the Impact on Family Member

Appendix II – California Regulations

The following information is state-specific for California mental health professionals.

Regulations Update 2017/2018

Please note that regulations change; when in doubt and for final verification, please consult the respective websites for current regulations; this is just an update and does not contain all regulations. Some of the entries are complex and require amplification from the websites.

Board of Behavioral Sciences

Effective January 1, 2018, the titles for marriage and family therapist interns and professional clinical counselor interns have changed, as follows:

Marriage and family therapist registrants must use the title “Associate Marriage and Family Therapist” or “Registered Associate Marriage and Family Therapist.” Professional clinical counselor registrants must use the title “Associate Professional Clinical Counselor” or “Registered Associate Professional Clinical Counselor.”

A “Supervisor”

(1) Has been licensed by a state regulatory agency for at least two years as a marriage and family therapist, licensed clinical social worker, licensed professional clinical counselor, licensed psychologist, or licensed physician certified in psychiatry by the American Board of Psychiatry and Neurology.

(2) If a licensed professional clinical counselor, the individual shall meet the additional training and education requirements specified in paragraph (3) of subdivision (a) of Section 4999.20.

(3) Has not provided therapeutic services to the trainee or intern.

(4) Has a current and valid license that is not under suspension or probation.

(5) Complies with supervision requirements established by this chapter and by board regulations.

Licensee and Registrant Information on Telehealth

Individuals who provide psychotherapy or counseling, either in person, by telephone, or over the Internet, to a client located in California, must be licensed in California. Licensure affords the Board authority to take action against a licensee engaged in unprofessional conduct.

Licensing requirements vary by state. If your client is travelling to another state and wishes to engage in psychotherapy or counseling via telehealth with you while he or she is away, you need to check with the state where your client will be to see if this is permitted.

Refer to: bbs.ca.gov/consumers/info.html for additional regulations and parameters for telehealth.

4980.43 Clarifies that associates and trainees shall not be employed or gain experience as independent contractors and/or work reported on an IRS 1099 form.

Advertising

4980.44 The abbreviation “MFTI” shall not be used in an advertisement unless the title “marriage and family therapist registered intern” appears in the advertisement.

4980. 48 Any person that advertises services performed by a trainee shall include the trainee’s name, the supervisor’s license designation or abbreviation, and the supervisor’s license number.

(c) Any advertisement by or on behalf of a marriage and family therapist trainee shall include, at a minimum, all of the following information:

(1) that he or she is a marriage and family therapist trainee.

(2) the name of his or her employer.

(3) that he or she is supervised by a licensed person.

Licensed Professional Clinical Counselor (LPCC)

Effective January 1, 2017, LPCCs who wish to assess and treat couples or families are required to obtain Board confirmation of qualifications, and provide a copy of that confirmation to the following:

For more information and other requirements go to bbs.ca.gov/pdf/forms/lpc/lpc_scope_practice.pdf

To supervise an MFT intern (Associate) or Trainee

LPCCs must:

California Board of Psychology

Changes to Supervision Agreement psychology.ca.gov/forms_pubs/sup_agreement.pdf

New Supervision Agreement forms are on the website of BOP, effective October 1, 2017

You must use the new forms. The following are excerpts from the new form:

Both the primary supervisor and supervisee shall complete, review, and sign an agreement prior to the commencement of the supervised professional experience. Experience prior to preparation of a signed agreement will not count toward licensure.

The primary supervisor should maintain this agreement until the supervisee completes the SPE.

On a separate page, type your responses to the following items:

  1. Describe the specific duties the supervisee will perform as they engage in psychological activities that directly serve to prepare the supervisee for the independent practice of psychology once he or she is licensed.
  2. Summarize the goals and objectives of this plan for SPE, including how socialization into the profession will be achieved.
  3. Describe how and when the supervisor will provide periodic assessments and feedback to the supervisee as to whether or not he or she is performing as expected.

When answering each of the above questions, describe how the plan will meet the requirements of SPE as:

What kind of information must be reported to the Board on an annual basis by the psychological assistant’s supervisor?

Answer: Every supervisor of a psychological assistant must submit to the Board an update that is completed by the supervisor and signed by both the supervisor and the psychological assistant. The update must be submitted on or before the expiration of the registration for the preceding calendar year showing:

  1. Name and license number of all primary supervisors.
  2. Address of all locations where psychological services are currently being provided.
  3. The location, type, extent and amount of supervision.
  4. An attestation from all current primary supervisors that the psychological assistant has demonstrated an overall performance at or above the level of competence expected for his or her level of education, training and experience. This information is required to be reported on the registration renewal form. [16 CCR §1391.10]

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