Internet Editor’s Note: Download a free accompanying PowerPoint presentation from Dr. Barnett here.
Clinical supervision is an essential aspect of the training of every psychotherapist (Bernard & Goodyear, 2014). It supplements and significantly adds to the academic education that those in training receive. Clinical supervision received during one’s training can lay the foundation for the neophyte psychotherapist’s clinical competence and professional identity. Thus, supervisors play an extremely important role in each trainee’s professional development.
Clinical Supervision Can Aid in Developing the Trainee’s:
- Professional identity as a psychotherapist and as a member of one’s profession.
- Theoretical orientation and approach to treatment.
- Understanding of the role of research and how it is to be integrated into one’s treatment of clients.
- Understanding of multiple forms of diversity/individual differences and how they impact the psychotherapy process.
- Knowledge of ethics and legal issues relevant to the practice of psychotherapy and the ability to navigate dilemmas and challenges successfully.
- Awareness of the challenges of being a psychotherapist and the importance of engaging in ongoing self-care strategies.
- Commitment to lifelong learning and the ongoing development of clinical competence.
To achieve these goals, and others relevant to successful outcomes in clinical supervision, the following six strategies (or practices) are recommended. The accompanying PowerPoint slides that are referenced below provide additional information beyond the scope of this brief article.
Be a Competent Supervisor
The role of the clinical supervisor is vitally important to the professional development and training of supervisees. How it is conducted can have a direct impact on the quality of clinical services supervisees provide to their current clients as well as on subsequent clients to be treated by the future psychotherapist (Falender & Shafranske, 2004).
Thus, it is essential that supervisors possess needed competence to be a successful supervisor (See slides 7-8).
This includes two very basic forms of competence:
1. competence in the psychotherapy services being supervised and being provided by the supervisee (e.g., CBT with an anxious and phobic adolescent, interpersonal psychotherapy with a depressed geriatric client, group therapy for the treatment of eating disorders), and
2. competence in the art and science of clinical supervision (Barnett, Cornish, Goodyear, & Lichtenberg, 2007).
Supervisors should be psychotherapists who have received formal training in clinical supervision. This would include didactic training, supervision of one’s own supervision, and ongoing professional development and training. At times, the provision of clinical supervision to trainees may be included as a part of a professional’s job description. It is important to ensure that one’s primary credential for fulfilling this obligation is not “I was supervised during my training, so I can be a supervisor” (see slides 38-40).
Utilize an informed consent agreement
As with any other professional relationship, the supervision relationship should begin with the collaborative process of reaching a working agreement on the parameters and goals of the relationship (See slides 9-14). The informed consent to supervision may best be codified in a supervision contract (Falender, 2011; Thomas, 2007). This contract, like any informed consent agreement clarifies many important issues to include (see also slides 15-17):
- Any fees and financial arrangements
- Scheduling and meeting times (along with procedures for modifying this)
- Confidentiality and its limits
- Documentation requirements
- Audio and video recording requirements of treatment sessions
- When documentation and recordings must be provided to the supervisor (e.g., at least 48 hours before each supervision session)
- Emergency contact information and procedures
- Evaluation and feedback procedures (to include with whom evaluations will be shared)
- Case selection and assignment policies
- Requirements of the supervisee to successfully complete the training experience
- Grievance policies and procedures
- How and when the supervisory relationship will end
The supervision contract clarifies each party’s obligations to the other. It should be discussed openly and it should be modified when circumstances change and the situation warrants it.
Assess each supervisee’s training needs from the outset
Rather than beginning by assigning clients to the supervisee and then offering supervision of those cases, it will first be helpful to know which cases might and might not be appropriate to assign to the supervisee and to understand the supervisee’s training needs (See also slide 6).
Therefore, a good place to start is to discuss the supervisee’s previous coursework and training experiences. While it might extremely unusual to have a supervisee complete a written examination on psychotherapy theory and techniques, assessment, diagnosis, ethics, diversity, treatment planning, and the like, it would be very helpful to discuss these and related issues at the outset of the supervisory experience to gauge the supervisee’s level of awareness, understanding, and sophistication in each of these areas. Another strategy that may be helpful is roleplaying to assess the supervisee’s assessment, interviewing, and psychotherapy skills.
Keeping in mind the supervisor’s obligations to those treated by the supervisee as well as to the supervisee him or herself, the assignment of clients should be done based on the supervisee’s readiness to provide the needed services (under the appropriate type and amount of supervision). Not all supervisees can provide all services or work with all clients. At times, the supervisee will need additional education and training before working with certain clients.
This may include:
- Enrolling in academic courses or taking selected continuing education courses.
- Discussing selected readings assigned by the supervisor in supervision sessions.
- With appropriate consent, having the supervisee watch video recordings of treatment sessions to analyze and discuss with the supervisor.
- With appropriate consent, having the supervisee observe other trainees or the supervisor providing treatment and then discuss these observations in supervision.
After assessing the supervisee’s training needs, the type and intensity of supervision should be selected based on this assessment and should change as the supervisee’s training needs change over time. Clinical supervision should not be provided in a ‘one size fits all’ approach and should not be a static process (See also slides 19-21).
Provide timely and meaningful feedback
As was mentioned above, the provision of feedback is one of the issues addressed in the informed consent/supervision contract. All trainees need to have feedback on two levels; ongoing informal feedback to promote learning and enhanced competence, and formal feedback both to the trainee and to her or his training program (Bernard & Goodyear, 2014; Thomas 2007, 2010). Feedback should be provided both verbally and in writing (See slides 24-25). Verbal feedback, while very important, is never sufficient alone.
Supervisors should never wait until the end of the training experience to inform the trainee (and her or his training program) about their success or lack thereof in the supervised clinical experience. Supervisees need meaningful feedback throughout the training experience so they may make adjustments, engage in needed remediation activities, or just to have their actions reinforced to know that they are making adequate progress toward their agreed upon goals (See slides 33-35).
During the informed consent process the specific criteria to be used for evaluation should be provided to the supervisee, the evaluation form to be provided to the supervisee’s training program should be shared with the supervisee, and the schedule for these formal evaluations should be shared. Additionally, feedback should be seen as an important element of the ongoing supervision process. Supervisors will need to engage in this process to support the supervisee’s professional growth and development as well as to fulfill their obligations as gatekeepers of the profession (Johnson et al., 2008).
Supervisees who are struggling in achieving training goals must receive honest and direct feedback on an ongoing basis and concerns should be shared with their training program. Those supervisees who are not responsive to feedback and remediation efforts should not ‘pass’ the training experience. The implications for the clients they currently do and in the future will treat are too great to allow supervisees with problems with professional competence to move on to the next level of training (Elman & Forrest, 2007).
See yourself as a professional role model
Every clinical supervisor needs to realize and accept that we are role models to our supervisees. How we interact with them, how they observe us interacting with others, how we speak about clients and colleagues -- each of these demonstrate to supervisees what it means to be a psychotherapist, a supervisor, and a professional. This can include demonstrating respect and caring to all individuals with whom we interact, to include our supervisees! It also can include regarding the supervisee as a unique individual to include a focus on self-care, the promotion of wellness, and burnout prevention; and integrating discussions of work-life balance, career planning, and involvement in the profession into ongoing supervision sessions (See slide 36).
We must realize that trainees see us as role models and as they go through this period of developing their professional identity, and are significantly impacted by what we say as well as by what we do. Our impact and influence on trainees’ professional growth and development as well as on their professional identity formation should not be underestimated. Thus, the image supervisors wish to convey to their supervisees should be thoughtfully considered and consciously attended to on an ongoing basis.
Integrate ethics and diversity into every aspect of supervision
A focus on ethical practice and on being multiculturally competent should actively be integrated into all relevant aspects of ongoing clinical supervision. These are not add-ons, but are essential aspects of our clinical work with all psychotherapy clients as well as with all relevant aspects of the supervision relationship and process. Further, this attention to ethics and diversity issues within the supervision relationship can be seen as part of the role modeling and professional identity development described above.
Supervisees should be familiar with the code of ethics of their profession (e.g., APA Ethics Code; ACA Code of Ethics), but the focus should not be on memorization of the code. Rather, the application of ethical principles and standards to challenging and complex situations, utilizing a thoughtful decision-making process is recommended (See also slides 26-28).
Further, a focus on diversity and individual differences should be seen as integral to our work with clients and in the supervision process and relationship (See slides 29-30). Supervisors should seek opportunities to raise these issues with supervisees in a thoughtful and sensitive manner that helps supervisees to understand their central nature in psychotherapy.
Some Final Words
This brief article cannot comprehensively address every issue of importance to being a successful clinical supervisor. A broad literature exists that addresses these issues much more comprehensively. But, it is hoped that this article and the accompanying PowerPoint slides will stimulate some reflection on how each of us are conceptualizing and approaching the clinical supervision process. This may serve as reinforcement for some of the great things each of you are already doing. But, it also may promote some growth and improvement as we endeavor to enhance our competence as supervisors on an ongoing basis.
Cite This Article
Barnett, J. E. (2015, January). Six strategies for successful supervision. [Web article]. Retrieved from http://www.societyforpsychotherapy.org/six-strategies-for-successful-supervision
Barnett, J. E., Cornish, J. E., Goodyear, R. K., & Lichtenberg, J. W. (2007). Commentaries on the ethical and effective practice of clinical supervision. Professional Psychology: Research and Practice, 38, 268-275.
Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Upper Saddle River, NJ: Pearson Education.
Elman, N. S., & Forrest, L. (2007). From trainee impairment to professional competence problems: Seeking new terminology that facilitates effective action. Professional Psychology: Research and Practice, 38(5), 501-509.
Falender, C. A. (2011). Getting the most out of clinical supervision: A guide for practicum students and interns. Washington, DC: American Psychological Association.
Falender, C. A., & Shafranske, E. P. (2004). Clinical supervision: A competency-based approach. Washington, DC: American Psychological Association.
Johnson, W. B., Elman, N. S., Forrest, L., Robiner, W. N., Rodolfa, E., & Schaffer, J. B. (2008). Addressing professional competence problems in trainees: Some ethical considerations. Professional Psychology: Research and Practice, 39, 589–599.
Thomas, J. T. (2007). Informed consent through contracting for supervision: Minimizing risks, enhancing benefits. Professional Psychology: Research and Practice, 38, 221–231.
Thomas, J. T. (2010). The ethics of supervision and consultation: Practical guidelines for mental health professionals. Washington, DC: American Psychological Association.