Counseling psychology has demonstrated a long-standing interest and respect for clinical supervision as a unique domain that warrants its own preparation for practice. Counseling psychologists have distinguished themselves in the supervision literature (e.g., Borders et al., 1991; Goodyear et al., 2000), and counseling psychology programs have been much more likely than clinical and school psychology programs to offer supervision coursework (Crook-Lyon, Presnell, Silva, Suyama, & Stickney, 2011; Romans, Boswell, Carlozzi & Ferguson, 1995).
But other health service psychology specialties now have begun to embrace the notion that supervision requires specific preparation. This has been reflected in – and further encouraged by – several important developments in the field. Among these have been
- (a) the 1996 adoption of the accreditation Guidelines and Principles (American Psychological Association [APA], 1996) that required training programs to provide students and interns with at least some training in supervision,
- (b) the identification of supervision as one of the eight core competency domains (Kaslow et al., 2004) and then
- (c) an expert panel’s articulation of supervision competencies (Falender et al., 2004).
Perhaps as a result of this growing attention to the quality of supervision, we now have increasing documentation of the alarming extent to which supervisees in training programs and practice settings report supervision is either inadequate or harmful (e.g., Ellis et al., 2014).
Supervision guidelines spelling out best practices and expected competencies are an important means by which the field can increase the quality of supervision practice. As a result, counseling psychology developed best practices (Borders et al., 2014) and other disciplines (e.g., National Association of Social Workers and Association of Social Work Boards, 2013; National Association of School Psychologists, 2011) have developed guidelines, as have psychologists in other countries (e.g., New Zealand Psychology Board, 2010; Psychology Board of Australia, 2013).
APA’s Board of Educational Affairs, in recognizing that need, convened a task group to develop supervision guidelines that APA then adopted in 2014 (see APA, 2014, 2015). This paper provides an important supplement to those guidelines. It addresses the conceptual and empirical grounding for those guidelines, then reviews the guidelines and makes suggestions based on the empirical literature for ways psychologists can use them to improve supervisory practice. In support of that latter purpose, we present a checklist for psychologists to use to self-assess their supervision competencies.
Conceptual and Empirical Basis for the Guidelines
Perhaps understandably, psychologists’ attitudes about the value of supervision training have been influenced by their own experiences. For example, those who have received clinical supervision training are more likely to affirm the importance of that training (Genuchi, Rings, Germek, & Cornish, 2015; Rings, Genuchi, Hall, Angelo, & Cornish, 2009). This finding suggests that policies requiring formal training of psychologists who supervise result not only in better-prepared supervisors, but also may increase the value attached to training and endorsement of the importance of that training.
Unfortunately, although APA accredited doctoral and internship programs have been required to provide supervision training, the extent and quality of that training has remained variable. Lyon, Heppler, Leavitt and Fisher (2008), for example, found that only 39% of interns (26% of clinical and 73% of counseling psychology interns) reported having completed a graduate course in supervision. Forty-four percent of these respondents reported having supervised a trainee during their internship, generally at counseling centers, but only half of those had completed a graduate course in supervision. In a related study (Crook-Lyon et al., 2011), counseling psychology trainees also reported having received more supervision training than clinical psychology trainees. Even so, trainees judged the major influence on supervision practice to have been the personal experience of having been supervised.
Evidence to support the importance of deliberately preparing competent supervisors has been mounting. Ellis and colleagues (2014) identified supervision that was either inadequate (e.g., failure to meet minimum standards for adequate supervision), or, worse, emotionally or physically harmful to the supervisee (e.g., pathologizing trainees, physically threatening trainees, or making sexual overtures to trainees).
Across two studies with large samples, Ellis and colleagues (2014; Ellis, Creaner, Hutman, & Timulak, 2015) found that 35% and 25% of supervisees, respectively, were currently receiving emotionally or physically harmful supervision. Remarkably, 93% of the participants in one study and 75% of the participants in the other reported currently receiving inadequate supervision, including supervisors’ failure to monitor the supervisee’s clinical work (potentially affecting client welfare) or to use a supervision contract.
Other evidence for inadequate or harmful supervision can be found in studies describing supervision that was multi-culturally insensitive (e.g., Burkard, Knox, Hess, & Schultz, 2009; Singh & Chun, 2010), lacked systematic assessment (Swift et al., 2014), discounted the supervisory relationship (Ladany, 2014), or modeled unethical behavior (January, Meyerson, Reddy, Docherty, & Klonoff, 2014). The risk of harm is magnified by the supervisor’s power to evaluate and serve as a gatekeeper for the profession. In fact, supervisor difficulties performing evaluations and gatekeeping functions (Ladany, 2014; Forrest et al., 2013) lent urgency within the field to define guidelines for supervisors in health service psychology.
In 2002, the Competency Conference identified supervision as a distinct professional competency for counseling, clinical, and school psychologists (Kaslow et al., 2004). Subsequently, a workgroup of supervision experts from counseling and clinical psychology provided a preliminary structure of competencies that supervisors should achieve, prior to commencement of supervision (Falender et al., 2004).
In 2012, the American Psychological Association’s Board of Educational Affairs authorized the formation of a task force, with members from clinical, counseling, and school psychology, charged with writing guidelines for clinical supervision. The work was informed by counseling psychology and international guidelines (APA, 2015). In 2014, the Guidelines for Clinical Supervision of Health Service Psychologists were approved by the APA as policy (APA, 2014) and were published in the American Psychologist (APA, 2015). These guidelines are distinctive in their use of a competency-based approach, rather than a particular (psychotherapy) theoretical approach, and in their applicability to a wide range of training and supervision of health service psychologists (e.g., psychotherapy, assessment, and consultation services).
The guidelines defined competency-based supervision as “a meta-theoretical 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)” (APA, 2014, p. 5). The guidelines are predicated on a number of assumptions about supervision, listed in Table 1 below. The stated objective was that the guidelines would enhance the quality of supervision provided by psychologists, promote the development of supervisee competence, and assure regulators that high quality supervision is valued and provided.
Table 1. Foundational Assumptions of the Guidelines for Clinical Supervision in Health Service Psychology
- is a distinct professional competency that requires formal education and training
- prioritizes the care of the client/patient and the protection of the public
- focuses on the acquisition of competence by and the professional development of the supervisee
- requires supervisor competence in the foundational and functional competency domains being supervised
- is anchored in the current evidence base related to supervision and the competencies being supervised
- occurs within a respectful and collaborative supervisory relationship, that includes facilitative and evaluative components and which is established, maintained, and repaired as necessary
- entails responsibilities on the part of the supervisor and supervisee
- intentionally infuses and integrates the dimensions of diversity in all aspects of professional practice
- is influenced by both professional and personal factors including values, attitudes, beliefs, and interpersonal biases
- is conducted in adherence to ethical and legal standards
- uses a developmental and strength-based approach
- requires reflective practice and self-assessment by the supervisor and supervisee
- incorporates bi-directional feedback between the supervisor and supervisee
- includes evaluation of the acquisition of expected competencies by the supervisee
- serves a gatekeeping function for the profession
- is distinct from consultation, personal psychotherapy, and mentoring
Note. From: American Psychological Association, Board of Educational Affairs Task Force on Supervision Guidelines. (2014). Guidelines for Clinical Supervision in Health Service Psychology (pp. 9-10). Retrieved from: http://www.apa.org/about/policy/guidelines-supervision.pdf
The guidelines address seven domains: supervisor competence; diversity; the supervisory relationship; professionalism; assessment/evaluation/feedback; problems of professional competence; and ethical, legal, and regulatory considerations. This paper provides the bridge to implementation: empirical support and implementation strategies that will assist trainers and practitioners to apply the APA guidelines in clinical settings.
Organized by domain (APA, 2015), the paper provides a brief summary of empirical support for each, and recommendations for implementation. It also introduces a supervisor self-assessment (Appendix, below) that was developed from the guidelines, focused on supervisors’ knowledge, skills, and attitudes. The self-assessment was designed to provide a structure for individuals and programs to assess and design appropriate training strategies, identify areas of supervision strength that could be built upon, and provide a window on metacompetence (referring here to adopting a reflective approach to what one knows and what one does not know—a difficult task and one that is essential to model to supervisees) (Falender & Shafranske, 2007).
The Supervision Guidelines
Domain A. Supervisor competence
- Supervisors seek to attain and maintain competence in the practice of supervision through formal education and training.
- Supervisors endeavor to coordinate with other professionals responsible for the supervisee’s education and training to ensure communication and coordination of goals and expectations.
- Supervisors strive for diversity competence across populations and settings (as defined in APA, 2003).
- Supervisors using technology in supervision (including distance supervision), or when supervising care that incorporates technology, strive to be competent regarding its use.
Empirical studies (Callahan, Almstrong, Swift, Borja, & Heath, 2009; Wrape, Callahan, Ruggero, & Watkins, 2015) have supported the impact of supervisor competence on supervisees and client outcomes. However, absent an agreed upon definition (Gonsalvez & Calvert, 2014), supervisor competence has not been addressed as an integrated competency, but rather as various separate fragmented competencies, such as psychotherapy theory (i.e., Watkins, 2014), ethics (Barnett & Molzon, 2014), and multicultural competence (Falender & Shafranske, 2007) with primary focus on knowledge and skills. Supervisor competence is an area requiring additional empirical study.
Supervisor self-assessment using the Supervisor Competency Self-Assessment (Appendix, below) and attention to metacompetence, or actively thinking about what one does not know, are proposed as ways to address supervisor competence (Falender & Shafranske, 2007). Modeling, practice, and ongoing feedback have been shown to be associated with supervisor change (Carlson, Rapp, & Eichler, 2012). Other strategies include ongoing supervision training focused on upgrading skill sets (Cummings, Ballantyne, & Scallion, 2015), training on providing feedback after live observation of supervisees (Reddy, Kogan, Iobst, & Holmboe, 2012), and participating in peer consultation groups (Hoge, Migdole, Cannata, & Powell, 2014). Supervisor self-assessment could be supported by authentic and accurate feedback among staff (Johnson et al., 2014).
To create an environment conducive to development of competence, supervisors can model learning from supervisees to increase collaboration and empowerment (e.g., Kassan, Fellner, Jones, Palandra, & Wilson, 2015) and model fluid expertise, moving from expert to learner (Johnson et al., 2014). Enhanced supervision training for evidence-based treatments should be treatment or practice-element-centered and target relationship, monitoring, and outcome assessment (e.g., for child diagnoses; Accurso, Taylor, & Garland, 2011). Techniques to enhance supervisor competence with technology include introduction to research on innovative techniques (e.g., “bug in the eye”; Carmel, Villate, Rosenthal, Chalker, & Comtois, 2016) and on distance supervision (Rousmaniere, Abbass, & Frederickson, 2014). If system-wide change is indicated, transformation leadership, a powerful intervention, can foster a new vision and momentum for change to a competency-based model of life-long learning (Kaslow, Falender, & Grus, 2012).
Domain B. Diversity
- Supervisors strive to develop and maintain self-awareness regarding their diversity competence, which includes attitudes, knowledge, and skills.
- Supervisors planfully strive to enhance their diversity competence to establish a respectful supervisory relationship and to facilitate the diversity competence of their supervisees.
- Supervisors recognize the value of, and pursue ongoing training in, diversity competence as part of their professional development and life-long learning.
- Supervisors aim to be knowledgeable about the effects of bias, prejudice, and stereotyping. When possible, supervisors model client/patient advocacy and model promoting change in organizations and communities in the best interest of their clients/patients.
- Supervisors aspire to be familiar with the scholarly literature concerning diversity competence in supervision and training. Supervisors strive to be familiar with promising practices for navigating conflicts among personal and professional values in the interest of protecting the public.
Multicultural competence is an ethical imperative in supervision, as judgments are influenced by personal and diversity-guided values (Barnett & Molzon, 2014). Factoring into supervision the constellation of diversity and multicultural identities among supervisees/therapists, clients, and the supervisor (e.g., APA, 2003), while grounded in competency benchmarks (Fouad et al., 2009), has less empirical than conceptual support (Falicov, 2014; Miville et al., 2009). Additional empirical exploration is essential.
Strategies for enhancing diversity competence include introducing models and studies highlighting how supervisor diversity competence and attitudes directly affect the supervisee and client care (Bertsch et al., 2014; Jernigan, Green, Helms, Perez-Gualdron, & Henze, 2010; Singh & Chun, 2010). Supervisors may use exemplars of training models for diverse populations within a frame of social justice (e.g., refugees, Kuo & Arcuri, 2014; geropsychology, Zucchero, Iwasaki, Lewis, Lee, & Robbins, 2014; community, Carr, Bhagwat, Miller, & Ponce, 2014).
It is essential to proactively assess the emotional climate of the training environment (e.g., graduate program climate scale; Veilleux, January, VanderVeen, Reddy, & Klonofff, 2012) as well as multicultural supervision outcomes (Tsong & Goodyear, 2014). Attentiveness to potential value conflicts between supervisees and clients requires supporting the supervisors’ responsibility to respect and honor multiple diversity worldviews, while upholding the ethical and legal standards of the profession (Wise et al., 2015).
Other strategies could focus on providing specialized training (e.g., affirmative therapy for LGBT populations, Alessi, Dillon, & Kim, 2015; religion, Shafranske, 2014). In the spirit of moving toward a communitarian culture of competence in training (Johnson et al., 2014), emphasis can be placed on supporting leadership and collegial participation in organizational diversity initiatives (Renninger, et al., 2015).
Domain C. Supervisory relationship
- Supervisors value, and seek to create, and maintain a collaborative relationship that promotes the supervisees’ competence.
- Supervisors seek to specify the responsibilities and expectations of both parties in the supervisory relationship. Supervisors identify expected program competencies and performance standards, and assist the supervisee to formulate individual learning goals.
- Supervisors aspire to review regularly the progress of the supervisee and the effectiveness of the supervisory relationship and address issues that arise.
The supervisory relationship is essential to supervision (Bernard & Goodyear, 2014; Falender & Shafranske, 2004; Ladany, Friedlander, & Nelson, 2005; Watkins, 2014). A strong relationship exists between the supervisory alliance/relationship and supervisee self-disclosure. This is critical, as disclosure provides the data for supervision unless video review or live observation is used (Mehr, Ladany, & Caskie, 2010).
A key way to foster the supervisory relationship is to ensure that supervisors value and have the knowledge, skills, and attitudes for establishing the supervisory relationship, identifying and repairing strains and ruptures, which are an inevitable part of the supervision process (Aspland, Lleweylen, Hardy, Barkham, & Stiles, 2008; Safran, Muran, Stevens, & Rothman, 2008), and managing supervisee emotional reactivity (Falender & Shafranske, 2004; Ladany et al., 2005). Attending to and addressing the supervisory alliance provides a model for supervisee work with client alliance strains (Eubanks-Carter, Muran, & Safran, 2015). A supervisory contract is a valuable tool for codifying the supervisory relationship, as it elaborates the expectations, roles, responsibilities and processes (see Domain G).
Domain D. Professionalism
- Supervisors strive to model professionalism in their own comportment and interactions with others, and teach knowledge, skills, and attitudes associated with professionalism.
- Supervisors are encouraged to provide ongoing formative and summative evaluation of supervisees’ progress toward meeting expectations for professionalism, appropriate for each level of education and training.
Professionalism, a core competency for psychologists (Fouad et al., 2009), can be defined by observable behaviors (Grus & Kaslow, 2014). Professionalism is reflected in traits from which professional behaviors and actions should emanate:
(1) accountability—responsibility, commitment, and appropriate deportment;
(2) ethical engagement—knowledge of ethical standards, moral reasoning, honesty, integrity, trustworthiness, and courage;
(3) self-reflection—openness, self-awareness, and self-care;
(4) professional identity—view of self as a psychologist and a healer and sense of responsibility to the profession;
(5) pursuit of excellence—commitment and self-motivation with respect to professional development and lifelong learning;
(6) humanism—care, compassion, respect for others’ dignity and choices, and cultural competence;
(7) civility—polite, respectful and considerate behavior and communication for the good of the community, seeking common ground in the face of differences;
(8) collaborative orientation—work with others, teamwork, and communication;
(9) collegial connections—incorporate and use relational mentors and competence constellation colleagues; and
(10) social responsibility—altruism, advocacy on behalf of others, fair and ethical stewardship of resources, and service to the community. (Kaslow, personal communication, April 30, 2016)
Supervisees are impacted by both demonstrations of, and lapses in, professional behavior (Van Mook et. al., 2009). The impact of these on trainee development has been codified in the term “hidden curriculum,” referring to learning that occurs by trainees’ observations of actions and communications (Gabbard et. al., 2012). Positive role modeling supports the development of professionalism, whereas problematic modeling does the opposite (Larkin, 2003). Research, specific to psychology supervisees, is needed in this area.
Professionalism and ethics are acquired through supervisor modeling. For example, in a related field, medical residents rated clinical supervision as the best way to assess knowledge, attitudes, and values of professionalism and ethics. Faculty direct observation of supervisee work with patients and team members was the best way to assess skills. Generally, role modeling was the most effective way to teach professionalism (Marrero, Bell, Dunn, & Roberts, 2013).
Domain E. Assessment/Evaluation/Feedback
- Ideally, assessment, evaluation, and feedback occur within a collaborative supervisory relationship. Supervisors promote openness and transparency in feedback and assessment, by anchoring these in the competency development of the supervisee.
- A major supervisory responsibility is monitoring and providing feedback on supervisee performance. Live observation or review of recorded sessions is the preferred procedure.
- Supervisors aspire to provide feedback that is direct, clear, and timely, behaviorally anchored, responsive to supervisees’ reactions, and mindful of the impact on the supervisory relationship.
- Supervisors recognize the value of and support supervisee skill in self-assessment of competence and incorporate supervisee self-assessment into the evaluation process.
- Supervisors seek feedback from their supervisees and others about the quality of the supervision they offer, and incorporate that feedback to improve their supervisory
The creation of competence standards has outpaced competence assessment (Larkin & Morris, 2015). For example, training in corrective feedback by physician supervisors was associated with behavior change and high satisfaction (Perron et al., 2013). In a psychology study, supervisors who did not give corrective feedback wished they had (Hoffman, Hill, Holmes, & Freitas, 2005). Providing feedback represents a high priority for empirical research.
Implementation strategies related to assessment, evaluation, and feedback include supervisors incorporating idiopathic assessment of individuals’ acquisition of competencies (Larkin & Morris, 2015), tracking developing competencies (Santos et al., 2015), using an assessment protocol to track and provide feedback (Piazza-Waggoner, Karazsia, Hommel, & Modi, 2015) or providing collaborative feedback empowering supervisees and clients (Minieri, Reese, Miserocchi, & Pascale-Hague. 2015). Training in formative (Cummings et al., 2015) and summative feedback are central supervisor competencies. Another relevant strategy involves using client outcome data in supervision (Swift et al., 2014), as this practice is associated with enhanced client outcomes.
Domain F. Problems of professional competence
- Supervisors understand and adhere both to the supervisory contract, and to program, institutional, and legal policies and procedures related to performance evaluations.
- Supervisors strive to address performance problems directly.
- Supervisors strive to identify potential performance problems promptly, communicate these to the supervisee, and take steps to address these in a timely manner allowing for opportunities to effect change.
- Supervisors are competent in developing and implementing plans to remediate performance problems.
- Supervisors are mindful of their role as gatekeeper and take appropriate and ethical action in response to supervisee’s performance problems.
An estimated 4% to 10% of supervisees manifest competence problems, and peers often recognize them first (Veilleux et al., 2012). Therefore, use of competency monitoring by supervisors for early identification of competence problems is essential, but (to date) has been addressed only through the lens of supervisees (Kamen, Veilleux, Bangen, Vanderveen, & Klonoff, 2010). Supervisors typically are reluctant to address supervisee competence issues (Johnson et al., 2008), given negative consequences that may result. Additional research is essential.
It is important to address aspects of the training environment that inhibit, rather than foster, collaborative learning experiences (Shen-Miller et al., 2015) and provide skills for effective conversations (Jacobs et al., 2011). It is important to identify competence problems early and give formative feedback that is behaviorally anchored. Transforming professional competence problems into competence and broader ethical frameworks can facilitate faculty and supervisors in approaching these as a team. This provides increased opportunity for early notice of competence problems and increased opportunities to address these (Johnson et al., 2008). If such input and associated guidance does not result in sufficient progress, it is essential to progress to a remediation plan (Johnson et al., 2008) that is guided by the APA template for remediation (APA, n.d.) and the setting’s personnel practices.
Domain G. Ethical, legal, and regulatory considerations
- Supervisors model ethical practice and decision-making and conduct themselves in accord with the APA ethical guidelines, guidelines of any other applicable professional organizations, and relevant federal, state, provincial, and other jurisdictional laws and regulations.
- Supervisors uphold their primary ethical and legal obligation to protect the welfare of the client/patient.
- Supervisors serve as gatekeepers to the profession. Gatekeeping entails assessing supervisees’ suitability to enter and remain in the field.
- Supervisors provide clear information about the expectations for, and parameters of, supervision to supervisees preferably in the form of a written supervisory contract.
- Supervisors maintain accurate and timely documentation of supervisee performance related to expectations for competency and professional development
Modeling ethical practice is a powerful part of the supervisor’s role (Marrero et al., 2013). Many supervisees perceive that supervisors commit ethical infractions (Ladany, Lehrman-Waterman, Molinaro, & Wolgast, 1999) and lack knowledge of supervision ethics (January et al., 2014). In the group supervision context, this has been found to be a central concern. Central topics, such as informed consent about evaluation and confidentiality, were generally reported as not discussed in the sample studied; group members were often not recused from supervision if they personally knew clients under discussion (Smith, Riva, & Cornish, 2012). Survey data revealed that supervisees may take a single ethics course early in their training, even prior to clinical experience, so they may not always understand the complexity of identification and implementation of what they learned in that course (Domenech Rodriguez et al., 2014) or its extrapolation to the clinical and supervision contexts.
Supervision that intentionally addresses ethical events in clinical work fosters ethical sensitivity (e.g., Moffett, Becker, & Patton, 2014). Addressing ethics early in practicum supervision (Wise & Celluci, 2014) and throughout the course of supervision ensures that ethics are not simply viewed as relevant for risk avoidance, but rather that addressing the topic serves as a proactive, positive factor. The use of supervision contracts is essential (e.g., Association of State and Provincial Psychology Boards [ASPPB], 2015), as they structure the ethical and legal parameters of supervision and criteria for successful completion. Although an essential part of supervision, they are often given too little attention. Integrating attention to personal value systems, multiculturalism, and professionalism with ethics is a central competence (Wise et al., 2015).
The APA Supervision Guidelines herald a major shift away from learning to supervise through the personal experiences of having been supervised to a more systematic, competency-based framework. They provide a framework and design criteria for supervisors to self-assess and purposefully enhance their supervision practices. A competency-based approach requires consideration of practice domains, strategies, and the knowledge, skills, and attitudes of supervision.
Sequential supervision training should begin during graduate work and include coursework regarding essential components, models, and research opportunities to supervise, with supervision-of-supervision, followed by observation and assessment to gauge supervision competence (Falender, Ellis, & Burnes, 2013). Following this consensus on the definition of competency-based supervision, research on implementation and outcomes for clients and supervisees with empirically supported measures are essential. Dissemination of implementation strategies for the guidelines is only a preliminary step. Transformation to competency-based supervision (Kaslow et al., 2012) requires planful execution, training, and implementation of the various aspects of supervision practice. In concert with the ASPPB Supervision Guidelines (2015), the transformation subsumes training, supervision, and regulation.
Implications for Training
There are a number of barriers to implementing the guidelines in the field of psychology generally, and more specifically in counseling psychology. A prevailing attitude has been that supervision is not a distinct professional competency. A lack of systematic graduate-level training in supervision, outside counseling psychology, is concerning. Evidence for the provision of supervision within counseling psychology is far more positive, but still illustrates that some graduates never receive any formal training until internship, if at all. The cost of supervision training and optimal practice reflect the lack of value attached to the supervision process within the profession. Finally, there is a general lack of empirical studies regarding the effects of quality clinical supervision on supervisee and client outcomes.
The development of the supervision guidelines illustrates the change process that is occurring in health service psychology, building upon counseling psychology literature and momentum to more fully embrace a competency-based approach to education, training, and credentialing. As part of the change process, the guidelines are intended to foster a process of educating supervisors, supervisees, administrators, and the profession that competence in clinical supervision is acquired through systematic acquisition of knowledge, skills, and attitudes.
Accountability for training outcomes is a national focus, and the development of supervisor competencies will aid in the support of program attention to learning outcomes of their students and supervisees. Specific steps for implementation of the guidelines provided here include: acknowledging that supervisor competence is an essential part of the training trajectory, dedicating time and a commitment to training for both supervisees and supervisors, including supervisor competence in performance review; allowing time for supervisor consultation to share challenges, difficulties, and successes with supervisees; and normatively providing supervision-of-supervision to beginning supervisors and supervisees. These changes should lead to improvements in training of all health service psychologists, even the terrain of supervision training in the graduate school pipeline, and provide a format for more systematic investigation of the impact of excellent quality supervision on supervisee development and client outcomes.
Cite This Article
Falender, C. A., Grus, C., McCutcheon, S., Goodyear, R. K., Ellis, M. V., Doll, B.,…Kaslow, N. J. (2016). Guidelines for clinical supervision in health service psychology: Evidence and implementation strategies. Psychotherapy Bulletin, 51(3), 6-16.
Accurso, E. C., Taylor, R. M., & Garland, A. F. (2011). Evidence-based practices addressed in community-based children’s mental health clinical supervision. Training and Education in Professional Psychology, 5(2), 88-96. doi: 10.1037/a0023537
Alessi, E. J., Dillon, F. R., & Kim, H. M. (2015). Determinants of lesbian and gay affirmative practice among heterosexual therapists. Psychotherapy, 52(3), 298-307. doi: 10.1037/a0038580
American Psychological Association. (1996). Guidelines and principles of accreditation. Washington, DC: Author.
American Psychological Association. (2003). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58(5), 377-402. doi: 10.1037/0003-066X.58.5.377.
American Psychological Association. (2015). Guidelines for clinical supervision in health service psychology. American Psychologist, 70(1), 33-46. doi: 10.1037/a0038112
American Psychological Association. (n.d.). Competency remediation plan template. Retrieved from http://www.apa.org/ed/graduate/competency-remediation-template.doc.
American Psychological Association, Board of Educational Affairs Task Force on Supervision Guidelines. (2014). Guidelines for clinical supervision in health service psychology. Retrieved from: http://www.apa.org/about/policy/guidelines-supervision.pdf
Aspland, H., Lleweylen, S., Hardy, G., Barkham, M., & Stiles, W. (2008). Alliance ruptures and rupture resolution in cognitive-behavioral therapy: A preliminary task analysis. Psychotherapy Research, 18(6), 699-710. doi: 10.1080/10503300802291463
Association of State and Provincial Psychology Boards. (2015). Supervision guidelines for education and training leading to licensure as a health service provider. Retrieved from http://c.ymcdn.com/sites/www.asppb.net/resource/resmgr/Guidelines/Final_Supervision_Guidelines.pdf
Barnett, J. E., & Molzon, C. H. (2014). Clinical supervision of psychotherapy: Essential ethics issues for supervisors and supervisees. Journal of Clinical Psychology, 70(11), 1051-1061. doi: 10.1002/jclp.22126
Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Boston, MA: Pearson.
Bertsch, K. N., Bremer-Landau, J. D., Inman, A. G., DeBoer Kreider, E. R., Price, T. A., & DeCarlo, A. L. (2014). Evaluation of the critical events in supervision model using gender related events. Training and Education in Professional Psychology, 8(3), 174-181. doi: 10.1037/tep0000039
Borders, L. D., Bernard, J. M., Dye, H. A., Fong, M. L., Henderson, P., & Nance, D. W. (1991). Curriculum guide for training counseling supervisors: Rationale, development, and implementation. Counselor Education and Supervision, 31, 58-82.
Borders, L. D., Glosoff, H. L., Welfare, L. E., Hays, D. G., DeKruyf,, L., Fernando, D. M., & Page, B. (2014). Best practices in clinical supervision: Evolution of a counseling specialty. Clinical Supervisor, 33(1), 26-44. doi: 10.1080/07325223.2014.905225
Burkard, A. W., Knox, S., Hess, S. A., & Schultz, J. (2009). Lesbian, gay, and bisexual supervisees’ experiences of LBG-affirmative and nonaffirmative supervision. Journal of Counseling Psychology, 56(1), 176-188. doi: 10.1037/0022-0184.108.40.206
Callahan, J. L., Almstrom, C. M., Swift, J. K., Borja, S. E., & Heath, C. J. (2009). Exploring the contribution of supervisors to intervention outcomes. Training and Education in Professional Psychology, 3(2), 72-77. doi: 10.1037/a0014294
Carlson, L., Rapp, C. A., & Eichler, M. S. (2012). The experts rate: Supervisory behaviors that impact the implementation of evidence-based practices. Community Mental Health, 48(2), 179-186. doi: 10.1007/s10597-010-9367-4
Carmel, A., Villate, J. L., Rosenthal, M. Z., Chalker, S., & Comtois, K. A. (2016). Applying technological approaches to clinical supervision in dialectical behavioral therapy: A randomized feasibility trial of the bug-in-the-eye (BITE) model. Cognitive and Behavioral Practice, 32(2), 221-229. doi: 10.1016/j.cbpra.2015.08.001
Carr, E. R., Bhagwat, R., Miller, R., & Ponce, A. N. (2014). Training in mental health recovery and social justice in the public sector. The Counseling Psychologist, 42(8), 1108-1135. doi: 10.1177/0011000014555200
Crook-Lyon, R. E., Presnell, J., Silva, L., Suyama, M., & Stickney, J. (2011). Emergent supervisors: Comparing counseling center and non-counseling-center interns’ supervisory training experiences. Journal of College Counseling, 14(1), 34-49.
Cummings, J. A., Ballantyne, E. C., & Scallion, L. M. (2015). Essential processes for cognitive behavioral clinical supervision: Agenda setting, problem-solving, and formative feedback. Psychotherapy, 52(2), 158-163. doi: 10.1037/a0038712
Domenech Rodríguez, M. M., Erickson Cornish, J. A., Thomas, J. T., Forrest, L., Anderson, A., & Bow, J. N. (2014). Ethics education in professional psychology: A survey of American Psychological Association accredited programs. Training and Education in Professional Psychology, 8(4), 241-247. doi: 10.1037/tep0000043
Ellis, M. V., Berger, L., Hanus, A. E., Ayala, E. E., Swords, B. A., & Siembor, M. (2014). Inadequate and harmful clinical supervision: Testing a revised framework and assessing occurrence. The Counseling Psychologist, 42(4), 434-472. doi: 10.1177/001100013508656
Ellis, M. V., Creaner, M., Hutman, H. B., & Timulak, L. (2015). A comparative study of clinical supervision in the Republic of Ireland and the United States. Journal of Counseling Psychology, 62(4), 621-631. doi: 10.1037/cou0000110
Eubanks-Carter, C., Muran, J. C., & Safran, J. D. (2015). Alliance-focused training. Psychotherapy, 52(2), 169-173. doi: 10.1037/a0037596
Falender, C. A., Cornish, J. A. E., Goodyear, R., Hatcher, R., Kaslow, N. J., Leventhal, G., . . . Sigmon, S. T. (2004). Defining competencies in psychology supervision: A consensus statement. Journal of Clinical Psychology, 60(7), 771-785. doi: 10.1002/jclp.20013
Falender, C. A., Ellis, M. V., & Burnes, T. (2013). Response to reactions to major contribution: Multicultural clinical supervision and benchmarks. The Counseling Psychologist, 41(1), 140-151. doi: 10.1177/0011000012464061
Falender, C. A., & Shafranske, E. P. (2004). Clinical supervision: A competency-based
approach. Washington, DC: American Psychological Association.
Falender, C. A., & Shafranske, E. P. (2007). Competence in competency-based
supervision practice: Construct and application. Professional Psychology: Research and Practice, 38(3), 232-240. doi: 10.1037/0735-7028.38.3.232
Falicov, C. J. (2014). Psychotherapy and supervision as cultural encounters: The
multidimensional ecological comparative approach framework. In C. A. Falender, E. P. Shafranske, & C. J. Falicov (Eds.) Multiculturalism and diversity in clinical supervision: A competency-based approach (pp. 29-58). Washington, DC: American Psychological Association. doi: 10.1037/14370-002
Forrest, L., Elman, N. S., Huprich, S. K., Veilleux, J. C., Jacobs, S. C., & Kaslow, N. J. (2013).
Training directors’ perceptions of faculty behaviors when dealing with trainee competence problems: A mixed method pilot study. Training and Education in Professional Psychology, 7(1), 23-32. doi: 10.1037/a0032068
Fouad, N. A., Grus, C. L., Hatcher, R. L., Kaslow, N. J., Hutchings, P. S., Madson, M.
B., . . .Crossman, R. E. (2009). Competency benchmarks: A model for
understanding and measuring competence in professional psychology across training levels. Training and Education in Professional Psychology, 3(4 Suppl), S5-S26. doi: 10.1037/a0015832
Gabbard, G. O., Roberts, L. W., Crisp-Han, H., Ball, V., Hobday, G., & Rachal, F. (2012). Professionalism in Psychiatry. Arlington, VA: American Psychiatric Publishing.
Genuchi, M. C., Rings, J. A., Germek, M. D., & Cornish, J. A. E. (2015). Clinical supervisors’ perceptions of the clarity and comprehensiveness of the supervision competencies framework. Training and Education in Professional Psychology, 9(1), 68-76. doi: 10.1037/tep0000064.
Gonsalvez, C. J., & Calvert, F. L. (2014). Competency-based models of supervision: Principles and applications, promises and challenges. Australian Psychologist, 49(4), 200-208. doi: 10.1111/ap.12055
Goodyear, R. K., Cortese, J. R., Guzzardo, C. R., Allison, R. D., Claiborn, C. D., & Packard, T. (2000). Factors, trends, and topics in the evolution of counseling psychology training. The Counseling Psychologist, 28(5), 603-621. doi: 10.1177/0011000000285001
Grus, C. L., & Kaslow, N. J. (2014). Professionalism: Professional attitudes and values in psychology. In W. B. Johnson & N. J. Kaslow (Eds.), The Oxford handbook of education and training in professional psychology (pp. 491-509). New York, NY: Oxford University Press.
Hoffman, M. A., Hill, C. E., Holmes, S. E., & Freitas, G. F. (2005). Supervisor perspective on the process and outcome of giving easy, difficult, or no feedback to supervisees. Journal of Counseling Psychology, 52(1), 3–13. doi: 10.1037/0022-0220.127.116.11
Hoge, M. A., Migdole, S., Cannata, E., & Powell, D. J. (2014). Strengthening supervision in systems of care: Exemplary practices in empirically supported treatments. Clinical Social Work Journal, 42(2), 171-181. doi: 10.1007/s10615-013-0466-x
Jacobs, S. C., Huprich, S. K., Grus, C. L., Cage, E. A., Elman, N. S., Forrest, L.,… Kaslow, N. J. (2011). Trainees with professional competencies problems: Preparing trainers for difficult but necessary conversations. Training and Education in Professional Psychology, 5(3), 175-184. doi: 10.1037/a0024656
January, A. M., Meyerson, D. A., Reddy, L. F., Docherty, A. R., & Klonoff, E. A. (2014). Impressions of misconduct: Graduate students’ perception of faculty ethical violations in scientist-practitioner clinical psychology programs. Training and Education in Professional Psychology, 8(4), 261-268. doi: 10.1037/tep0000059
Jernigan, M. M., Green, C. E., Helms, J. E., Perez-Gualdron, L., & Henze, K. (2010). An examination of people of color supervision dyads: Racial identity matters as much as race. Training and Education in Professional Psychology, 4(1), 62-73. doi: 10.1037/a0018110
Johnson, W. B., Barnett, J. E., Elman, N. S., Forrest, L., Schwartz-Mette, R., & Kaslow, J. (2014). Preparing trainees for lifelong competence: Creating a communitarian training culture. Training and Education in Professional Psychology, 8(4), 211-220. doi: 10.1037/tep0000048
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(6), 589-599. doi: 10.1037/a0014264
Kamen, C., Veilleux, J. C., Bangen, K. J., VanderVeen, J. W., & Klonoff, E. A. (2010). Climbing the stairway to competency: Trainee perspectives on competency development. Training and Education in Professional Psychology, 4(4), 227-234. doi: 10:1037/a0021092
Kassan, A., Fellner, K. D., Jones, M. I., Palandra, A. L., & Wilson, L. J. (2015). (Re)considering novice supervisor development through a social justice lens: An experiential account. Training and Education in Professional Psychology, 9(1), 52-60. doi: 10.1037/tep0000041
Kaslow, N. J., Borden, K. A., Collins, F. L., Jr., Forrest, L., Illfelder-Kaye, J., Nelson, P. D., & Rallo, J. S. (2004). Competencies conference: Future directions in education and credentialing in professional psychology. Journal of Clinical Psychology, 60(7), 699-712. doi: 10.1002/jclp.20016
Kaslow, N. J., Falender, C. A., & Grus, C. (2012). Valuing and practicing competency-based supervision: A transformational leadership perspective. Training and Education in Professional Psychology, 6(1), 47-54. doi: 10.1037/a0026704
Kuo, B. C. H., & Arcuri, A. (2014). Multicultural therapy practicum involving refugees:Description and illustration of a training model. The Counseling Psychologist, 42(7), 1021-1052. doi: 10.1177/0011000013491610
Ladany, N. (2014). The ingredients of supervisor failure. Journal of Clinical Psychology, 70(11), 1094–1103. doi: 10.1002/jclp.22130
Ladany, N., Friedlander, M. L., & Nelson, M. L. (2005). Critical events in psychotherapy supervision: An interpersonal approach. Washington, DC: American Psychological Association.
Ladany, N., Lehrman-Waterman, D., Molinaro, M., & Wolgast, B. (1999). Psychotherapy supervisor ethical practices: Adherence to guidelines, the supervisory working alliance, and supervisee satisfaction. The Counseling Psychologist, 27(3), 443-475. doi: 10.1177/0011000099273008
Larkin, G. L. (2003). Mapping, modeling, and mentoring: Charting a course for professionalism in graduate medical education. Cambridge Quarterly of Healthcare Ethics, 12(2), 167-177. doi: 10.1017/S0963180103122062
Larkin, K. T., & Morris, T. L. (2015). The process of competency acquisition during doctoral training. Training and Education in Professional Psychology, 9(4), 300-308. doi: 10.1037/tep0000091
Lyon, R. C., Heppler, A., Leavitt, L., & Fisher, L. (2008). Supervisory training experiences and overall supervisory development in predoctoral interns. Clinical Supervisor, 27(2), 268-284. doi: 10.1080/073252220802490877
Marrero, I., Bell, M., Dunn, L. B., & Roberts, L. W. (2013). Assessing professionalism and ethics knowledge and skills: Preferences of psychiatry residents. Academic Psychiatry, 37(6), 392-397. Retrieved from http://ap.psychiatryonline.org
Mehr, K. E., Ladany, N., & Caskie, G. L. (2010). Trainee nondisclosure in supervision: What are they not telling you?. Counselling & Psychotherapy Research, 10(2), 103-113. doi: 10.1080/14733141003712301
Miville, M. L., Duan, C., Nutt, R. L., Waehler, C. A., Suzuki, L., Pistole, M. C., . . . Corpus, M. (2009). Integrating practice guidelines into professional training: Implications for diversity competence. The Counseling Psychologist, 37(4), 519-563. doi: 10.1177/0011000008323651
Minieri, A. M., Reese, R. J., Miserocchi, K. M., & Pascale-Hague, D. (2015). Using client feedback in training of future counseling psychologists: An evidence-based and social justice practice. Counselling Psychology Quarterly, 28(3), 305-323. doi: 10.1080/09515070.2015.1055236
Moffett, L. A., Becker, C. J., & Patton, R. G. (2014). Fostering the ethical sensitivity of beginning clinicians. Training and Education in Professional Psychology, 8(4), 229-235. doi: 10.1037/tep0000054
National Association of Social Workers and Association of Social Work Boards. (2013). Best practice standards in social work supervision. Retrieved from http://www.socialworkers.org/practice/naswstandards/supervisionstandards2013.pdf
National Association of School Psychologists. (2011). Supervision in School Psychology (Position Statement). Bethesda, MD: Author.
New Zealand Psychologists Board. (2010). Guidelines on supervision. Wellington, New Zealand: Author. Retrieved from www.psychologistsboard.org.nz/best-practice-documents-and-guidelines2.
Perron, N. J., Nendaz, M., Louis-Simonet, M., Sommer, J., Gut, A., Baroffio, A., . . .van der Vieuten, C. (2013). Effectiveness of a training program in supervisors’ ability to provide feedback on residents’ communication skills. Advances in Health Science Education, 18(5), 901–915 doi: 10.1007/s10459-012-9429-1
Piazza-Waggoner, C., Karazsia, B. T., Hommel, K. A., & Modi, A. C. (2015). Considerations for assessing competencies in pediatric psychology. Clinical Practice in Pediatric Psychology, 3(3), 249-254. doi: 10.1037/cpp0000109
Psychology Board of Australia (2013) Guidelines for supervisors and supervisor training providers. Retrieved from http://www.psychologyboard.gov.au/Standards-and-Guidelines/Codes-Guidelines-Policies.aspx
Reddy, S. G., Kogan, J. R., Iobst, W. F., & Holmboe, E. S. (2012). The ABIM’s clinical supervision practice improvement module and its effect on faculty supervisory skills. Academic Medicine, 87(11), 1632-1638. doi: 10.1097/ACM.0b013e31826c43ba
Renninger, S. M., Phillips, J. C., Magnus, K., Armstrong, S. K., Cahill, B., Herman, M., . . .Vajk, F. (2015). Outcomes of an organizational diversity initiative: Diversifying trainers to diversify psychology. Training and Education in Professional Psychology, 9(3), 229-234. doi: 10.1037/tep0000089
Rings, J. A., Genuchi, M. C., Hall, M. D., Angelo, M., & Cornish, J. A. E. (2009). Is there consensus among predoctoral internship training directors regarding clinical supervision competencies? A descriptive analysis. Training and Education in Professional Psychology, 3(3), 140-147. doi: 10.1037/a0015054
Romans, J. S., Boswell, D. L., Carlozzi, A. F., & Ferguson, D. B. (1995). Training and supervision practices in clinical, counseling, and school psychology programs. Professional Psychology: Research and Practice, 26(4), 407–412. doi: 10.1037/0735-7028.26.4.407
Rousmaniere, T., Abbass, A., & Frederickson, J. (2014). New developments in technology-assisted supervision and training: A practical overview. Journal of Clinical Psychology, 70(11), 1082-1093. doi: 10.1002/jclp.22129
Safran, J. D., Muran, J. C., Stevens, C., & Rothman, M. (2008). A relational approach to supervision: Addressing ruptures in alliance. In C. A. Falender & E. P. Shafranske (Eds.), Casebook for clinical supervision: A competency-based approach (pp. 137-157). Washington, DC: American Psychological Association. doi: 10.1037/11792-007
Santos, M., Baughcum, A. E., Burton, E. T., Cadieux, A., Curran, J. L., Gaffka, B. J., . . . Ward, W. (2015). Fellowship training in pediatric obesity: Key components. Professional Psychology: Research and Practice, 46(6), 400-408. doi: 10.1037/pro0000050
Shafranske, E. P. (2014). Addressing religiousness and spirituality as clinically relevant cultural features in supervision. In C. A. Falender, E. P. Shafranske, & C. J. Falicov (Eds.). Multiculturalism and diversity in clinical supervision: A competency-based approach (pp. 181-207). Washington, DC: American Psychological Association Books.
Shen-Miller, D. S., Schwartz-Mette, R., Van Sickle, K. S., Jacobs, S. C., Grus, C. L., Hunter, E. A., & Forrest, L. (2015). Professional competence problems in training: A qualitative investigation of trainee perspectives. Training and Education in Professional Psychology, 9(2), 161-169. doi: 10.1037/tep0000072
Singh, A., & Chun, K. Y. S. (2010). “From the margins to the center”: Moving towards aresilience-based model of supervision for queer people of color supervisors. Training and Education in Professional Psychology, 4(1), 36-46. doi: 10.1037/a0017373
Smith, R. D., Riva, M. T., & Cornish, J. A. E. (2012). The ethical practice of group supervision: A national survey. Training and Education in Professional Psychology, 6(4), 238-248. doi: 10.1037/a0030806
Swift, J. K., Callahan, J. L., Rousmaniere, T. G., Whipple, J. L., Dexter, K., & Wrape, E. R. (2014). Using client outcome monitoring as a tool for supervision. Psychotherapy, 52(2), 180-184. doi: 10.1037/a0037659
Tsong, Y., & Goodyear, R. K. (2014). Assessing supervision’s clinical and multicultural impacts: The Supervision Outcome Scale’s psychometric properties. Training and Education in Professional Psychology, 8(3), 189-195. doi: 10.1037/tep0000049
Van Mook, W. N. K. A., De Grave, W. S., van Luijk, S. J., O’Sullivan, H., Wass, V., Schuwirth, L. W., & van der Vleuten, C. P. M. (2009). Training and learning professionalism in the medical school curriculum: Current considerations. European Journal of Internal Medicine, 20(4), e96-e100. doi: 10.1016/j.ejim.2008.12.006
Veilleux, J. C., January, A. M., VanderVeen, J. W., Reddy, L., & Klonoff, E. A. (2012). Differentiating amongst characteristics associated with problems of professional competence: Perceptions of graduate student peers. Training and Education in Professional Psychology, 6(2), 113-121. doi: 10.1037/a0028337
Watkins, C. E. (2014). The competent psychoanalytic supervisor: Some thoughts about supervision competences for accountable practice and training. International Forum of Psychoanalysis, 23(4), 220-228. doi: 10.1080/0803706X.2012.712219
Wise, E. H., & Cellucci, T. (2014). Using the ethical context to enhance practicum training. Training and Education in Professional Psychology, 8(4), 221-228. doi: 10.1037/tep0000055
Wise, E. H., Bieschke, K. J., Forrest, L., Cohen-Filipic, J., Hathaway, W. L., & Douce, L. A. (2015). Psychology’s proactive approach to conscience clause court cases and legislation. Training and Education in Professional Psychology, 9(4), 259-268. doi: 10.1037/tep0000092
Wrape, E. R., Callahan, J. L., Ruggero, C. J., & Watkins, C. E. (2015). An exploration of faculty supervisor variables and their impact on client outcomes. Training and Education in Professional Psychology, 9(1), 35-43. doi: 10.1037/tep0000014
Zucchero, R. A., Iwasaki, M., Lewis, M. M., Lee, J., & Robbins, M. J. (2014). Social justice training within geropsychology: Nontraditional pedagogies to cultivate a competent workforce. The Counseling Psychologist, 42(7), 946-971. doi: 10.1177/0011000014540342