The Ambiguous Nature of Clinical Supervision and its Impact on the Development of the Novice Supervisor

Pica (1998) described the ambiguous nature of clinical training and its impact on the development of student clinicians. That paper, which has become influential of graduate curricula, training, and research (Bailey et al., 2024; Bettney, 2017; Booy et al., 2025; Burgess et al., 2013; Everson, 2013; Pickard et al., 2023; Richardson et al., 2018; Witte et al., 2009), concluded that a certain amount of ambiguity is needed to develop the confidence to manage the stressors associated with working in this field as a practicing clinician. Almost three decades later, the author examines similar processes of ambiguity that the novice supervisor faces in supervision of individual and group psychotherapy. If these ambiguities are not effectively navigated, they have the potential to hinder supervisory growth.

Supervisory ambiguity begins with deciding how to structure supervision. How will student clinicians receive it? Will it maximize their learning? Is the supervisor trying to take some of the workload off oneself, or conversely, reduce the demands for student clinicians in order to make for a less stressful supervisory experience? Will it speak evenly to student clinicians at varying levels of experience?

Historically, clinical supervision has utilized developmental and orientation-specific models. Developmental supervisory models focus on training student clinicians according to their expected level of growth and experience (Stoltenberg & McNeil, 2012), while orientation-specific models train student clinicians within the supervisor’s theoretical framework (Aasheimi, 2016; Prasko et al., 2024; Sarnat, 2016). 

A content analysis by Simpson-Southward et al. (2017) identified a lack of consistency among supervisory models and limited research to support the effectiveness of any particular model of clinical supervision. Falender (2018) commented on the need for a competency-based supervisory model to address the lack of organization in clinical supervision training. A more recent mixed-methods survey of supervisors and supervisees pointed to the potential of a decision-making framework that could provide a more uniform supervisory model (Haft et al., 2024).

That being said, the ambiguous nature of clinical supervision can never be eliminated, even with a universal training approach. There is no way to account for every situation that will unfold when supervising a wide array of students, across a variety of training sites, and with clients experiencing diverse and evolving life circumstances. This can make for a trying experience for those new to the role of clinical supervisor.

Structured versus Unstructured Approaches in Supervision

The author defines structured supervisory models as those that apply a distinct format, including assigned readings, structured case presentations, and planned individual and group exercises. A structured form of supervision makes things clearer for both student clinicians and the supervisor, eliminating some uncertainties that may develop across the course of training.

Ambiguity may arise more frequently in less structured supervisions, where the format may develop according to the individual or group process. Role plays may occur spontaneously within the felt experience of the student clinician or the group. Case presentation formats might be left to the discretion of the student clinician, creating a normative level of anxiety that mirrors the uncertainty of clinical situations as they organically unfold.  

Age, Experience, Cultural, and Gender Considerations in Supervision

Independent of structure, ambiguities can arise when discussing and working with student clinicians of different ages, levels of prior clinical experience, and intersectional identities.

Adams et al. (2023) found that student clinicians desired more time devoted to discussions about their clients’ cultural backgrounds as it relates to symptom presentation. But if so, how much? And how might it be addressed?

A survey conducted by Griffin et al. (2026) found that Black doctoral psychology students reported that White supervisors needed greater familiarity with, and attention to, cultural concerns in supervision. They desired a supervisory space that felt safe enough to discuss aspects related to race and racism. A study on transgender and gender expansive clinical supervisees also emphasized the importance of feeling seen and safe among those in positions of power (Maroney et al., 2025). Ambiguity may arise in how supervisors effectively foster this sense of safety across supervisees with differing identities and lived experiences, particularly as supervisors must remain consistently aware of how their own cultural experiences and biases may influence the supervisory relationship.

With an eye toward promoting a safe environment for discussions of culture and identity, supervisors must consider how to structure and facilitate these conversations in ways that promote reflection and growth. This can become particularly complex when navigating differing identities, perspectives, and lived experiences among supervisees, whether in individual or group supervision. Supervisors must remain attentive to interpersonal dynamics and be prepared to address comments or assumptions that may reflect bias or have an unintended impact on others.

Navigating Clinical Crises and Training Site Conflicts in Supervision

Clinical crises present a unique source of ambiguity in supervision. Supervisors are often required to make timely clinical decisions with limited information, whether a case is new, a previously stable client experiences an unexpected crisis, or concerns have not yet fully emerged in supervision. These situations require supervisors to rapidly integrate available information and provide clear forms of guidance.

Ambiguities may also present at the training site. This may be related to the student clinician’s behavior or performance, an ethical concern, the development of a medical/mental health issue prompting a leave of absence, a lack of required clinical or supervisory hours, or a mismatch between the student clinician and the training site. The supervisor needs to speak to the needs and concerns of the student clinician, while maintaining the relationship with the training site. There is no manual to guide these sometimes difficult situations.

Reactions to Particular Student Clinician Types in Supervision

There is no way of knowing what types of student clinicians one will be assigned. The potential for ambiguity may become particularly salient when working with diverse trainee presentations, including student clinicians presenting as defensive, hostile, avoidant, obsessive, or dependent.

What follows is a discussion of several student clinician personality types that may be particularly challenging for some supervisors to work with, creating unexpected stress and uncertainty for the supervisor. The discussion is based on the author’s clinical experience and research by Grant et al. (2012), which touched upon supervisee scenarios that created uncertainty, avoidance, and reactivity in supervisors, as well as the need to seek consultation.  

The Student Clinician Who Presents as Overly Confident

This student clinician presents as above the need for supervision. This may be due to having previously worked in the field, an inflated sense of self-worth, anxiety, or simply defending against underlying feelings of inadequacy. McWilliams (1994) discussed a group of individuals who were more prone to psychological reactivity due to early forms of developmental arrest. Unconsciously, these individuals may protect themselves from feeling vulnerable by adopting an overly confident self-projection. Likewise, Halewood and Tribe (2003) reported a proneness to narcissistic injury among a group of clinical trainees who had experienced difficult caregiving relationships.

Although the factors underlying an overly confident presentation may vary considerably across student clinicians, such dynamics may be important for the supervisor to consider. The ambiguity lies in determining how to respond without either reinforcing the student clinician’s defensiveness or unnecessarily challenging their sense of competence. Student clinicians should be met with an empathically firm approach that sets boundaries in a reflective discussion without triggering emotional injury.

The Overly Anxious Student Clinician

This student clinician’s anxiety is palpable to the supervisor and fellow supervisees. Richardson et al. (2018) discussed a subset of student clinicians who enter and proceed through training with a more heightened level of anxiety and perfectionistic tendencies. This particular student clinician may talk incessantly or ask repetitive questions that can create frustration or anxiety within the group, become overly frustrated from a lack of structure, or conversely avoid presenting case material and responding to others during case presentations. The effective supervisor recognizes these behaviors and may use individual supervision to explore how the student clinician’s anxiety and associated behaviors are perceived by others, including the supervisor.

Empathic confrontation may help elicit greater self-awareness when a  student clinician’s anxiety begins to interfere with the supervisory process. Grant et al. (2012) warned of the potential for supervisors to default into avoidant behaviors themselves. The ambiguity lies in determining how to address the trainee’s anxiety without inadvertently reinforcing it or becoming overly accommodating. Addressing these dynamics may be particularly challenging for supervisors who are naturally anxious or prone to people-pleasing, making it important that they be mindful of their own reactions.

The Student Clinician with Theoretical Rigidity

This student clinician may have firmly defined their theoretical orientation and have difficulty connecting with feedback that lies outside their established conceptual framework. They may be perceived as dismissive of such material either from the supervisor or fellow student clinicians. This can be particularly challenging for supervisors invested in teaching multiple perspectives on testing or psychotherapy. In a group supervision, others may similarly become frustrated and look to the supervisor to address the dynamic. Failing to address the dynamic may undermine the supervisor’s credibility, while intervening too forcefully may contribute to defensiveness or conflict that disrupts trust within the group.

The supervisor must therefore find a way to increase the student clinician’s awareness of their behavior. One way to approach this might be to reflectively engage in a discussion on the role that lifelong learning plays in developing the competence needed to become the most effective psychologist. Assigning Taylor and Neimeyer’s (2015) article on lifelong learning may prove useful in this regard.

Concluding Remarks

Just as student clinicians grow through encounters with ambiguity on their path toward becoming effective clinicians, novice supervisors must similarly learn to navigate supervisory ambiguity as they develop into effective supervisors. For the novice supervisor, ambiguity can emerge unexpectedly and in many different forms. A stance of humility and commitment to lifelong learning may help novice supervisors navigate these challenges and foster ongoing professional growth and supervisory competence.

That being said, the paper closes with tips to help manage supervisory ambiguity by discussing ways to increase knowledge, validation, confidence, and mental clarity. The following are some key steps that make for the development of an effective clinical supervisor.

A first step might be to identify a supervisory model that speaks to the supervisor both as a person and as a professional in order to spark a certain level of comfort, confidence, and passion within the supervisory  model.

A second step might include staying abreast of current trends in clinical supervision. This may include holding subscriptions to journals devoted specifically to this topic.Keeping abreast with what is happening in the field not only keeps the supervisor relevant but can help boost and maintain their confidence given a commitment to an ever-evolving knowledge base.

A third step toward managing ambiguity relates to being prepared for uncertainty and conflict. This includes proactively envisioning ways of handling clinical, student, and training site situations that may suddenly unfold.

A fourth step relates to actively building relationships with training site directors. Establishing openness, trust, and familiarity can facilitate collaboration and provide valuable support and solution-focused communication when challenges arise at the training site.

A fifth step pertains to identifying a seasoned colleague who can serve as an ongoing mentor/consultant. This allows for validation, the potential recognition of transference reactions with diverse student clinicians, and other practical solutions to problems that may arise.

Lastly, remember that the process of clinical supervision, though trying at times, can be quite rewarding particularly when it is designed and approached in a manner that consistently promotes knowledge, confidence, validation, and mental clarity. The impact that an effective supervisor can have on a student clinician can stay with them for the rest of their lives and influence how they supervise in the future.