Jeffrey E. Barnett, PsyD, ABPP
Clinical supervision is an essential aspect of every health service provider’s professional development and training. Serving as a supervisor of a graduate student or trainee can be a very rewarding professional activity. But, what should you be aware of and what are the factors you should consider if offered the opportunity to provide clinical supervision? A number of clinical, ethics, legal, and practical issues are addressed to assist health service providers to enter into this role in a competent and effective manner. Specific issues addressed include understanding supervisor roles and responsibilities, what specific competencies are needed to be an effective supervisor and how to develop them, the qualities and practices of effective and ineffective supervisors; the difference between supervision and mentoring, how to effectively infuse ethics, legal, and diversity issues into supervision; and how to effectively end the supervision relationship. Specific guidance is provided and key resources for those interested in learning more about being a supervisor are provided.
It may come as a bit of a surprise when you receive a call from the training director of a local psychology graduate program asking if you would be interested and willing to supervise one or more of their trainees. Feeling honored and intrigued by the idea, you want to give this serious consideration. After all, it would be great to ‘give back’ to the profession and to assist in the training and development of the next generation of our profession. This also might be an enjoyable and rewarding professional activity that provides a nice balance to all those hours of client treatment in your practice each week. But, if you are like many in practice, this may not be a routine professional activity for you. You may not have supervised a trainee in 5 or 10 years or perhaps you have not provided clinical supervision yet during your career and this would be a new activity for you. Yet, as an experienced clinician you feel that you have much to offer.
Should you accept the invitation? What are the relevant ethics issues and challenges involved in accepting the invitation and supervising the trainee? Are there any legal issues to be aware of and consider? Are there questions to ask and actions to take that will assist you to serve as a clinical supervisor in the best possible way? In the hope that you will say ‘yes’ and take on this important and potentially rewarding new role, this article answers these questions and provides a step-by-step process for preparing for, and engaging in, the role of supervisor of a trainee.
Thinking About Being a Supervisor
In giving consideration to the offer to be a supervisor you may have various thoughts and images running through your mind. Perhaps you picture yourself sitting in your office sipping on coffee with your supervisee across from you, as you listen to your supervisee describe the details of a case and then you provide several key insights that the student takes with her or him and uses to improve the client’s treatment. You might also see yourself offering sage advice about career planning, telling of lessons learned during your years as a practicing professional, with the trainee taking copious notes and nodding emphatically in response to all the great ideas you are sharing.
While these potential images of what serving as a supervisor can look like may possibly convey some aspects of what can occur in supervision, they do not encompass all that supervision is and should be. There is so much more to the role of supervisor and to the supervision process. Whatever thoughts and images you may have about serving in the new role of clinical supervisor, it is important that you see this role accurately, understand its obligations and responsibilities, and that you prepare for it prior to entering this role.
What is Supervision?
Clinical supervision is an important and essential aspect of every psychologist’s professional training. It is, in fact, the profession’s “signature pedagogy” (Goodyear, 2007, p. 273); an essential method that has been integrated into the training of every individual preparing to enter the profession. Further, supervision is one of the primary teaching methods used with all trainees to augment their academic learning and to assist them to develop the clinical skills, professional identity, and values needed to be competent health service providers.
In this article, supervision refers to clinical supervision, as opposed to administrative supervision. Administrative supervision typically implies oversight of support staff such as a receptionist or office manager, in the conduct of their roles to include greeting and interacting with clients, scheduling appointments, processing billing and payments, and the like. In contrast, clinical supervision focuses on providing training in, and oversight of, clinicians-in-training in their assessment and treatment roles with clients.
Supervision is also different from mentoring, although good supervisors may also integrate mentoring into their roles as supervisors. While supervision incorporates roles such as “didactic expert, technical coach, role model, and evaluator” (Johnson, Skinner, & Kaslow, 2014, p. 1073) mentoring is “a role that emphasizes student development and support” (Johnson, 2007, p. 261). But, these roles may overlap significantly and when they do and are applied effectively, this may result in more positive outcomes for the trainee.
The American Psychological Association’s (APA’s) Guidelines for Clinical Supervision in Health Service Psychology (2015) define supervision as follows:
Supervision is 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. (p. 5)
Levels of Supervision
The expectations of you as a supervisor can be quite different depending on the role you are being offered by the training director. It is possible you are being asked to supervise one trainee for one hour each week, multiple trainees one hour per week, or even to serve as the primary clinical supervisor of one or more trainees at a university training clinic or at an internship site. Depending on the role in which you serve, the amount of oversight expected; the amount, frequency, and intensity of supervision provided; and the overall level of responsibility for each trainee’s clinical work may each vary. As will be emphasized, all such expectations and responsibilities will need to be clarified from the outset to ensure a good match between the training director’s expectations of you and your level of interest, availability, and comfort with these expectations.
Clarifying your level of involvement and responsibility from the outset will be important as you may not have the time available to provide the level of supervision that may be desired. It is possible that what is being asked of you as a one-hour-per-week site supervisor is more in line with what is typically expected of a primary internship supervisor who has multiple hours per week available to dedicate to this endeavor. You will also need to understand all expectations for documentation, evaluation of the supervisee, and didactic training, as each of these may take a significant amount of time in addition to the one hour of supervision per week that you provide. It will be important to ensure that you understand all that is being requested of you and that you are able to make the needed commitment to fulfill these obligations. With a good fit between the training site’s expectations and what you comfortably have to offer, this can be a rewarding and gratifying experience for all involved.
Supervision as a Professional Competency
One important question to ask yourself when considering the invitation to supervise a trainee is “am I qualified to be a supervisor?” After all, if not because you are an experienced and skilled clinician who has lots to offer trainees, why else would the training director have contacted you with this offer? While you may in fact be an experienced and skilled clinician who is very successful in your practice, it must be kept in mind that being an effective supervisor necessitates possessing two very distinct types of competence. You must be competent in the treatment areas being supervised (e.g., treatment of children or use of CBT for treating anxiety and depression) and you must be competent as a clinical supervisor as well.
The Ethical Principles of Psychologists and Code of Conduct (Ethics Code, APA, 2010) makes it clear that its enforceable standards apply to psychologists in all their professional roles to include “supervision of trainees” (p. 2). Standard 2.01, Boundaries of Competence, makes it clear that psychologists only take on new professional roles “within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience” (p. 4). Thus, while professional experience is necessary for competence in supervision, it is not sufficient. Supervision is a distinct professional competency with its own unique literature, knowledge base, and skills. It is recommended that all health service providers, regardless of how experienced, competent, and skilled in clinical practice, familiarize themselves with the knowledge and skills relevant to effectively providing clinical supervision. Ideally, this could involve participating in formal education and training before serving in the role of clinical supervisor, to include participating in supervision of one’s supervision as part of this training (Falender et al., 2004), but of course this is not always feasible. Competence may be developed in a variety of ways and as is emphasized in the APA Ethics Code (APA, 2010) this may include relevant professional experience.
Supervision is a distinct professional competency with its own unique literature, knowledge base, and skills.
It should be clear that the fact that one was supervised during their own training is not the sole credential for serving as a supervisor. But, what if there was no course in clinical supervision offered when you were a graduate student? Or what if you did complete such a course but it has now been 5 or 10 years since you completed this education and training? There are numerous excellent books, journal articles, conferences, and continuing education workshops (both in-person and online) that you may utilize to develop and enhance your competence as a supervisor. You may also choose to consult with a colleague who is an experienced and skilled supervisor to receive input and guidance to assist you to develop as a supervisor.
It should also be emphasized that competence is not an all-or-nothing construct. One is not necessarily either competent or incompetent. Rather, competence falls along a continuum and one may actively work to maintain, enhance, or expand their competence or if neglected, our competencies may degrade over time. We may be competent at one point in time and not at another, we may be competent to provide some services and not others, and we may have greater competence in some areas of practice than in others. Competence is a dynamic construct that must actively be worked on throughout our careers. On an ongoing basis throughout our careers we must have an intentional focus on possessing and maintaining the competencies needed to provide effective clinical services (to include supervision).
Even if you do not know everything there is to know about supervision, you still may have the potential to be an outstanding supervisor. But, how will you know how much education and training you need to be competent enough to enter the role of clinical supervisor? Is this something you can decide yourself? Sadly, like health professionals in general, we tend to do a poor job of assessing our own competence and we need the input of experienced and skilled colleagues to assist us in determining the current state of our competence and for recommendations about the type and amount of education and training needed to develop this competence (Dunning, Johnson, Ehrlinger, & Kruger, 2003). We can utilize this colleague’s feedback on our competence and their input when making a decision about readiness to begin providing clinical supervision services to trainees.
It should also be kept in mind that once the decision is made that you possess adequate competence to begin providing supervision to a trainee, you are not done with competence. With the assistance and support of your trusted colleague, you should develop a plan for the maintenance, and further development, of your competence as a supervisor. This should be a part of your personal lifelong learning plan that includes both didactic and experiential components. It is hoped that you will actively engage in these activities on an ongoing basis moving forward.
It should be emphasized that what is expected of you as a supervisor in terms of competence (in addition to responsibilities and oversight) may vary greatly depending on your role. Much more is expected of the primary supervisor at an internship site than of a one-hour-per-week field supervisor. In coordination with the training director, supervision responsibilities will be negotiated and they might be quite narrow (e.g. supervision of the treatment of one depressed client with CBT, supervision of one comprehensive neuropsychological assessment). Thus, depending on one’s role the level of supervision competence needed may vary.
On Being an Effective Supervisor
In considering your suitability for being a supervisor and to assist you to aspire to be the best supervisor possible, it will be helpful to be familiar with the literature on the qualities and actions of both effective and ineffective supervisors. Ladany, Mori, and Mehr (2013) found effective supervisors to possess and demonstrate the following attributes and behaviors: encouraging the supervisee’s autonomy and decision-making, engaging in supportive and encouraging behaviors that promote the supervisory relationship, providing an open forum for discussion, possessing positive personal and professional qualities, sharing clinical knowledge and skills through useful feedback that promotes the supervisee’s growth and development, providing constructive challenge and feedback, and being committed to and actively engaged in the supervision. Qualities of ineffective supervisors tended to be the opposite of each of these. Examples include supervisors being critical and judgmental, having an excessive focus on evaluation, not being fully committed to or engaged in the supervision, lacking sufficient competencies to provide effective supervision, and not promoting the supervisee’s growth and development.
Additional qualities of ineffective supervisors that Ladany (2014) has highlighted include denigrating the supervisory relationship, not maintaining openness to different perspectives and opinions, lacking multicultural competence, modeling unethical behavior, not maintaining healthy and appropriate boundaries, rigidly adhering to one’s theoretical model, micromanaging the supervisee’s clinical work, second guessing the supervisee’s decisions, shaming the supervisee, and using subjective methods to evaluate the supervisee that are inconsistently applied.
In contrast, effective supervisors possess many of the same qualities as effective psychotherapists. They tend to be supportive, empathic, respectful, caring, and emotionally invested in the relationship. As Campoli et al. (2016) describe, effective supervisors are supportive and invested in the supervisee’s professional growth and development, there is bi-directional trust and respect, the supervisor reserves enough time for the supervision to include preparation and supervision sessions, the supervisor meets obligations and fulfills commitments to the supervisee and her or his training program, is approachable and open to their supervisees’ ideas and opinions.
Ellis (2001) draws a further distinction between ineffective supervision and harmful supervision. While neither of these is one’s goal and they both have consequences for the supervisee’s training and professional development, harmful supervision is truly pernicious and must be avoided at all costs. While bad or ineffective supervision does not promote the supervisee’s training and development, harmful supervision is found to result in “psychological, emotional, or physical harm or trauma to the supervisee” (p. 402). Actions that may cause such harm to supervisees may include sexual harassment, egregious boundary violations, and exploiting the supervisee through abuse of the power differential inherent in the supervisory relationship in the service of meeting the supervisor’s own needs (e.g., having the supervisee perform menial tasks for the supervisor, pursuing a personal relationship with the supervisee). All such behaviors should always be avoided and if the risk of any occurring is perceived, seeking immediate consultation with colleagues or one’s personal psychotherapist is recommended and suspending the supervision until such risks can be addressed may be the best course of action.
Questions to Ask and Issues to Consider
Assuming that you are motivated to supervise one or more trainees and you understand what is expected of you to be an effective supervisor, there are a number of questions you should ask the training director or other appropriate representative of the university to be sure all expectations and obligations are understood before you commit to taking on this new role. In essence, these questions ask: “what is expected of me?”, “what is expected of the supervisee?”, and “how will all this operate?” and you may think of additional questions to ask in addition to those that follow. Suggested questions include:
- Under whose license will the trainee be practicing and what are the specific requirements for the extent and nature of the supervision to be provided by me? How will the supervision I provide and my responsibility for the student’s training fit in other supervision provided and the responsibility of others?
- What are the expectations of me for availability between scheduled supervision sessions?
- What back-up coverage arrangements can be made during periods of both planned and unanticipated absences on my part, if needed?
- What is the general range and type of clients (e.g., age range, diagnoses, treatment modalities) treated at the clinic?
- Are there a specific number of clinical hours, client mix, and hours of supervision that are expected for the student?
- What is the procedure to follow if my supervisee is assigned a client whose treatment needs fall outside my areas of clinical competence?
- Is there a specific evaluation form to be used to evaluate the supervisee’s performance, how often must it be completed, and to whom is it submitted?
- Is it expected that I will provide clients for the student to treat in my practice or will the student be treating clients at a university clinic or some other setting?
- If at the university practice setting, will I need to be present when services are being provided and must supervision be provided at that site?
- Is the student required to have her or his own liability insurance and does the university also carry liability insurance that covers the clinical services the supervisee provides?
- How long will the supervision experience last and what procedures are followed if clients are in need of ongoing treatment when the supervisee’s training experience ends?
- What information can you share with me about the supervisee’s education and clinical training experiences thus far?
- What are the documentation requirements, both for the student and for myself, how is the record keeping system accessed, and where are records stored?
- Who do I contact if I have concerns about the supervisee’s progress and appropriateness for entry into the profession?
- What procedures are in place for addressing and resolving disagreements and grievances between supervisor and supervisee?
- Will a written agreement be provided that addresses each of these issues, to be reviewed and agreed to by both parties prior to offering supervision to any students?
Once these issues have been resolved to your satisfaction so that you know what is expected of you, and assuming that all stated expectations of you can reasonably be met based on your abilities and available time, you are ready to begin moving forward in your new role as clinical supervisor. You should also confirm with your malpractice insurance carrier that the provision of clinical supervision is covered by your policy.
Assessing Your Supervisee’s Training Needs from the Outset
After your new supervisee contacts you and introduces her or himself to you, you likely will schedule the initial supervision session. It is vital that expectations for this initial supervision session be clarified during this initial conversation. Often, supervisees want to begin by telling their new supervisor about the clients they have been assigned, what their plans are for these clients in treatment, and what they have done thus far with these clients. In fact, new supervisors may feel some pressure to dive right in and start the supervision process, providing suggestions and guidance for moving forward with each client’s treatment.
Unfortunately, beginning the supervision process and relationship in this way will likely prove to be a significant mistake. Prior to being able to provide supervision, you need to have a good understanding of your supervisee’s training needs. For, without this understanding, how can you know what type and amount of supervision is needed? It is hoped that before meeting with the supervisee for the first time you will receive information from the training director about the student’s previous education, training, and relevant experience. At the initial meeting with your new supervisee, you can each share about and discuss your background, training, experience, and goals.
If you are to be a one-hour-per-week site supervisor, it is hoped that the primary supervisor at the supervisee’s training program will have conducted a comprehensive assessment of the supervisee’s knowledge and skills. Unless this is your supervisee’s first training experience, she or he will have received evaluations from previous supervisors that can be of help to you in better understanding strengths and weaknesses, as well as the supervisee’s ongoing training needs. Additionally, the training site will likely have conducted ongoing assessments of the supervisee’s knowledge and skills relevant to serving in a supervised clinical role. Based on this information you can have a better idea of how to proceed with supervision and if any didactics or additional training may be needed prior to initiating supervision.
If you are to be a primary supervisor in a graduate program or at an internship you may decide to conduct a comprehensive assessment of each trainee’s current knowledge and skills.
Engaging in this process prior to jumping into the supervision of actual clients’ assessment and treatment can have several benefits. Perhaps most importantly, it helps to ensure that the supervision to be provided actually meets the supervisee’s training needs and appropriately addresses any noted areas of deficiency or weakness. This, of course, is beneficial to the trainee as well as to her or his clients. Conducting this initial assessment also provides a baseline of supervisee functioning in the various areas that will be supervised and that will be evaluated over time. Thus, its results will be useful for gauging the supervisee’s progress over the course of the supervision process. An additional benefit of this process is that showing an interest in the supervisee and in her or his training, supervision needs, growth, and development is an excellent way to begin the supervisory relationship. It will hopefully set the tone for a collaborative ongoing relationship with open discussion and commitment to work toward mutually agreed upon goals.
But, it should be kept in mind that one must be practical in terms of the amount of time you have to offer each supervisee and the limits of your agreed upon role. If such assessments of the supervisee’s training needs have already been completed, there likely is no need for you to repeat this process. Obtaining a report on this assessment from the training program, reviewing it, and maintaining awareness of its implications as you proceed with supervising the trainee should be sufficient for most supervisors.
Developing the Supervision Contract
Just as your supervisee must engage in a comprehensive informed consent process with each client, you and your supervisee should participate in a similar process regarding your work together. Thomas (2007) describes in detail the supervision contract, its need, and its components. Key components of the supervision contract recommended by Thomas (2007) include information about the supervisor’s relevant background, training, and experience, theoretical orientation, and approach to treatment; the supervisory methods the supervisor plans to use; the supervisor’s responsibilities and requirements; the supervisee’s responsibilities; potential supplemental requirements; confidentiality policies; documentation of supervision; financial policies (clarifying if any payment is involved); risks and benefits; feedback and evaluation; complaint procedures and due process; professional development goals; how verification of completed hours will be provided; and the duration and termination of the supervision contract.
Of course, each of these sections will include a range of relevant details. The ultimate issue is to ensure that both parties are in agreement from the outset regarding their rights, responsibilities, and obligations. While the supervision contract may be similar in its intent to the informed consent agreement between clinician and client, some of its elements are by necessity different. For example, key issues to include in the supervisee’s responsibilities include how the supervisee represents her or himself to clients, how the supervisor wishes to be contacted in between supervision sessions and under what circumstances this should occur, and how the clinical services provided by the supervisee should be documented (e.g., in writing, audio recordings, video recordings) and how much in advance of each supervision session these materials should be provided to the supervisor for review. A number of sample supervision contracts are readily available and may be modified for your own use as a supervisor. Examples are provided by Bernard and Goodyear (2014) and Thomas (2007).
A number of models of supervision exist and you should utilize the model that fits best with the education and training you have received in supervision. See for example, the APA Psychotherapy Supervision Series in the Resources section at the end of this article. Regardless of the model selected, Barnett and Molzon (2014) recommend taking a developmental approach to the provision of supervision with new supervisees. This involves altering the nature, type, frequency, and intensity of supervision experiences as the supervisee’s training needs change over time. Each of these steps should be followed by open discussion with feedback provided and recommendations for needed remediation or additional training being given. There should be a continuous process of observation, discussion, feedback provided, recommendations made, and ongoing follow-up and monitoring of outcomes. Of course, it should be kept in mind that based on the results of the assessment of the supervisee’s training needs that either the training program or you may conduct, a number of the steps in the process described below may not be needed or relevant. In fact, for many advanced trainees, you may quite appropriately begin toward the end of the developmental continuum.
For very new and inexperienced trainees, you may wish to begin by engaging in role plays with the supervisee to simulate clinical experiences that are likely to occur once clients are being treated. You can then have the supervisee observe you provide a particular clinical service, followed by providing the service together, and then with you observing the supervisee provide the service. The observation of the supervisee can begin with active feedback being provided live during the session, and as the supervisee develops competence and comfort, greater autonomy can be provided to the supervisee.
With continued progress and development, or to start with more advanced and skilled trainees, you can move forward to having treatment sessions video recorded for your subsequent viewing, rather than being present during each session. Over time, it should be possible to more intensively supervise certain more complex or challenging cases by use of video recording analysis, review, and discussion, with other cases being supervised using the supervisee’s written documentation of the other cases and open discussion of the treatment provided.
With continued progress and development . . . you can move forward to having treatment sessions video recorded for your subsequent viewing, rather than being present during each session.
It should be noted that this is not a rigidly linear process and depending on the referrals your supervisee receives and challenges that arise in each client’s treatment, it may be helpful to revert back to a more active form of supervision for a period of time. This should be a flexible process that is implemented to best meet the supervisee’s training needs and of course, most importantly, each client’s treatment needs. And again, it is important to consider the part you play in the supervisee’s overall training to include if you are providing one hour of supervision each week as opposed to being a primary site supervisor. One must be realistic about what supervision services you can provide and if more is needed than you have contracted to provide you may need to provide this feedback to the training director who may then consider alternative arrangements to better meet the supervisee’s training needs.
A final point to emphasize regarding the actual supervision process is to ensure that you understand your legal obligations as a supervisor. While trainees are technically practicing psychology without a license, providing clinical services as part of an externship, internship, or postdoctoral fellowship is an authorized exemption under licensing laws, as long as it is done so under the direct supervision of a licensed psychologist as authorized by the training program. You should clarify your legal responsibility for each supervisee. If you are a primary internship supervisor you may be taking on legal responsibility for the clinical services the supervisee provides. This responsibility will have implications for how closely you supervise the trainee. But, if you are providing one hour of supervision per week it is likely that the training director or a primary clinical supervisor maintain this responsibility. But, this is something to clarify at the outset of your involvement as a supervisor.
Providing Evaluation and Feedback
Evaluation of the supervisee and providing the supervisee with ongoing feedback in a manner that assists the supervisee to continue learning and developing professionally are essential supervisor responsibilities. Ongoing feedback is vital for the supervisee’s ongoing learning, skill development, and professional development. In addition to providing your supervisee with ongoing regular feedback, each training program will require that you conduct more formal periodic evaluations of the supervisee’s performance and functioning.
The training program will hopefully provide you with a copy of the evaluation form they want used. You should ensure your familiarity with the performance criteria prior to your first meeting with your supervisee as the frequency, nature, scope, and details of how you will be evaluating your supervisee should be included in the supervision contract and discussed as part of the initial informed consent to supervision (Thomas, 2007). It should also be made clear with whom you will be sharing the evaluation results (such as the director of the training program) so that the supervisee doesn’t erroneously think that the evaluation results are private and shared just between the two of you. By sharing the evaluation form and its criteria with the student as part of the initial informed consent discussions and including it in the supervision contract, this will help ensure that there is agreement from the outset on all expectations and the likely consequences should the supervisee not be able to fulfill these criteria and expectations (Thomas, 2007).
Many training programs will require the formal evaluation form to be completed and forwarded to the training director on a quarterly basis. But, it is important that you provide your supervisee with ongoing feedback and not wait until there is a significant concern present before sharing this with the supervisee. Each supervisee should be provided with ongoing feedback and opportunities to remediate. It may also be helpful to take the approach that this is a learning process and that what is most important for the supervisee is to be open and receptive to feedback and learning as opposed to some absolute measure of competence or skill. It is the supervisee’s growth and development over the course of the supervision experience that are key. Thus, the supervisee’s freedom from defensiveness, responsiveness to feedback, self-awareness and insight, professionalism, and ability to learn and develop as a health service professional-in-training that are most important in the evaluation and feedback process. But, supervisors play an important role in creating a safe environment in which trainees will openly share about their mistakes, difficulties, and concerns, to promote an optimal learning experience. Too much focus on evaluation and feedback provided in a harsh or negative manner can result in supervisees withholding valuable information and thus, limiting the learning process.
In addition to offering the supervisee with timely opportunities to remediate any deficiencies you may note, and in addition to the general goal of promoting the supervisee’s ongoing learning, growth, and development, evaluation and feedback are important as they pertain to your role as a gatekeeper for the profession. While this primarily is the responsibility of the training director or primary site supervisor, each supervisor plays a least a small role in gatekeeping responsibilities. Gatekeepers play a role in deciding who is professionally competent enough to move on to the next level of training, and for those at the end of their training, who is fit to enter independent (unsupervised) practice as a licensed health service provider (Bernard & Goodyear, 2014). Thus, it is important that you not just pass on a supervisee of questionable competence or readiness, counting on the next supervisor to step in and make the decision not to move this trainee forward.
Each supervisor has a responsibility to our supervisee’s current clients, but also to all future clients this supervisee may treat. While this is not likely to be the most pleasant aspect of serving as a supervisor for you, it clearly is one of the most important. It is hoped that you will be able to integrate ongoing evaluation and feedback into the supervision process, while still being a supportive and encouraging presence for your supervisee. While striking this balance may be challenging, your obligations as a supervisor necessitate fulfilling both of these important roles.
Infusing Ethics, Legal Issues, and Diversity into Supervision
Ethics, legal, and diversity issues are so important that they should be infused into all aspects of supervision and should not be treated as separate or add-on issues. There are multiple ways of addressing these issues. Initially, you can initiate discussion of these issues during supervision sessions as they are relevant to the interactions and relationship between you and your supervisee. For example, if you and your supervisee are of different gender, race, ethnicity, culture, religion, age, ability, etc., it is important to have open discussions about how these differences may possibly impact the interactions between the two of you and your understanding of each other.
Supervisors also are role models for our supervisees. So, by initiating these discussions and thoughtfully and openly participating in them, you are modeling these behaviors for your supervisee. It is hoped that this will help encourage your supervisee to have similar discussions with her or his clients when relevant. As a role model, you also can model not just professionalism at all times, but also ethical practice. Regardless of how many discussions of ethics occur in supervision (and these are certainly important to have), how you conduct yourself with your supervisee can have a significant and lasting impact on your supervisee. Thus, how you address confidentiality, boundaries, and related issues with your supervisee, and how you implement them through these interactions, will model acceptable and expected behavior to her or him. For example, how you engage in self-disclosure with your supervisee, how you utilize touch, and how much you share about your own clients will model for your supervisee how a health service provider conducts her or himself.
It will also be important to ensure that your supervisee has an appropriate focus on relevant ethics, legal, and diversity issues with each of her or his clients. You should be sure to inquire about the presence of such issues and integrate a focus on them throughout the course of supervision of each client’s treatment. Thus, you may most appropriately ask how individual differences might necessitate modifying the informed consent process or may possibly be impacting the supervisee’s reactions to a particular client, how touch or self-disclosure might appropriately be utilized with a certain client to help better achieve agreed upon treatment goals, and if questions about possible abuse or neglect have been asked and attended to in compliance with relevant state law.
Hopefully, it is readily apparent how these three issues may interact with each other. For example, when contemplating the use of touch or self-disclosure, the presence of individual differences might impact this decision and how the use of such interventions might need to be modified to be most appropriate for the individual client. Even if a certain intervention or behavior is generally consistent with the parameters of the Ethics Code and one’s licensing law, you still must ensure its appropriateness for each individual client, taking into consideration all relevant individual differences.
A focus on individual differences is essential to the development of each supervisee’s competence. Not only is multicultural competence an essential aspect of one’s overall competence, it is an essential aspect of each health service provider’s professional identity. Learning to see clients through a multicultural lens that acknowledges and respects all individual differences, and that addresses the role of these differences in each client’s treatment needs, are ongoing goals for the supervision process. This begins first with the interactions between you and your supervisee and then continues with your active focus on these issues throughout the course of supervision.
Ending the Supervisory Relationship
Just as how the supervision relationship was initiated is so important, so too is how it is ended. Typically, you will know from the outset when the supervision relationship will end, such as if it will last for one semester or one academic year. But, even knowing this in advance does not remove the need to address this ending in a thoughtful manner. Further, even with the best of intentions there may be other situations that can arise that may necessitate the ending of the supervision relationship. These can include both supervisor (e.g., changing jobs and moving from the area, no longer having the time or ability to continue serving as a supervisor) and supervisee (e.g., withdrawing the training program or taking a leave of absence) circumstances.
Not only is multicultural competence an essential aspect of one's overall competence, it is an essential aspect of each health service provider's professional identity.
It is hoped that how the ending of the supervision relationship will be handled was addressed in the initial informed consent discussions and that it was clearly articulated in the supervision contract (Thomas, 2007). If at all possible, the ending of the supervision relationship should be planned for and discussed openly, to include any reactions the supervisee may be having to the impending end of the relationship. The process should be occurring on two levels; the pending ending of the supervision relationship and the termination or other resolution of each client’s treatment by the supervisee. How you address the ending of the supervision relationship with your supervisee will model for her or him how to appropriately and effectively discuss similar issues with their clients.
Rather than thinking of termination as the ending of the relationship, current thinking on this process indicates that it is more appropriate to instead focus on consolidation (Maples & Walker, 2014). This accentuates that this is an important phase of the relationship, not a singular event that occurs once the professional service is complete. Consolidation also implies reviewing and reinforcing progress achieved and gains made over the course of the relationship, as well as working to prepare the supervisee (or client) to continue on their current positive path after the relationship ends. It is hoped that they will take with them from the relationship all they have learned and to then build on this as they continue moving forward in their growth and development.
It is possible that even though the supervisee’s time working at a clinical site may be ending, her or his clients’ treatment needs may still be present. Discussions of transfer to new psychotherapists should occur well in advance of the student’s departure from the site and contact with training site or program administrators will hopefully have occurred at the beginning of the training experience so both you, your supervisee, and your supervisee’s clients are familiar with the policies and procedures in place for ensuring that each client’s ongoing treatment needs are met.
Summary and Recommendations
It is wonderful that you have decided to share your experience, expertise, and knowledge with a current graduate student. Serving as a clinical supervisor is an important and potentially very rewarding professional activity. While there is much to learn about being an effective supervisor, and the learning process will hopefully never stop, it is hoped that you will find this to be such a meaningful and valuable experience that you continue in this role for years to come.
This article is intended to be a helpful introduction to the key issues to consider and attend to in your efforts to prepare for this new role and as you carry it out. While no one article can provide each new supervisor with all needed information to ensure competence as a supervisor, this article can serve as a good first step in the learning process. The references cited and the resources section that follows it each provide a wealth of additional materials that should be of value to you as you continue this process. So, welcome to this exciting new professional role. It is hoped that you will become actively engaged in learning more about clinical supervision and work to enhance your supervision competence on an ongoing basis, as you share your knowledge, experience, wisdom, and guidance with our profession’s next generation of health service providers.
Jeffrey E. Barnett, PsyD, ABPP, is a licensed psychologist and Associate Dean and Professor of Psychology at Loyola University Maryland. He maintains a part-time private practice in Towson, Maryland, and has been in practice over 30 years. He is a past Chair of the Ethics Committees of the American Psychological Association, the American Board of Professional Psychology, and the Maryland Psychological Association. His scholarship and the presentations he regularly gives focus on ethics, legal, and professional practice issues for health service professionals.
American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Retrieved from http://www.apa.org/ethics
American Psychological Association. (2015). Guidelines for clinical supervision in health service psychology. American Psychologist, 70, 33–46.
Barnett, J. E., & Molzon, C. H. (2014). Clinical supervision of psychotherapy: Essential ethics issues for supervisors and supervisees. Journal of Clinical Psychology: In Session, 70(11), 1051–1061.
Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Upper Saddle River, NJ: Merrill.
Campoli, J., Cummings, J., Heidt, C., O’Connell, M. E., Mossière, A., & Pierce, A. (2016, June).
Top 5 components of "good enough" supervision. [Web article]. Retrieved from http://societyforpsychotherapy.org/top-5-components-good-enough-supervision
Dunning, D., Johnson, K., Ehrlinger, J., & Kruger, J. (2003). Why people fail to recognize their own incompetence. Current Directions in Psychological Science, 12, 83– 87.
Ellis, M. A. (2001). Harmful supervision, a cause for alarm: Comment on Gray et al. (2001) and Nelson and Friedlander (2001). Journal of Counseling Psychology, 48(4), 401-406.
Falender, C. A., Erickson Cornish, J. A., Goodyear, R., Hatcher, R., Kaslow, N. J., Leventhal, G., ...Grus, C. (2004). Defining competencies in psychology supervision: A consensus statement. Journal of Clinical Psychology, 60(7), 771–785.
Goodyear, R. K. (2007). Toward an effective signature pedagogy for psychology: Comments supporting the case for competent supervisors (pp. 273-273). In J. E. Barnett, J. A. E.
Cornish, R. K. Goodyear, & J. W. Lichtenberg, Commentaries on the ethical and effective practice of clinical supervision, Professional Psychology: Research and Practice, 38(3), 268-275.
Johnson, W. B. (2007). Transformational supervision: When supervisors mentor. Professional Psychology: Research and Practice, 38(3), 259–267.
Johnson, W. B., Skinner, C. J., & Kaslow, N. J. (2014). Relational mentoring in clinical supervision: The transformational supervisor. Journal of Clinical Psychology: In Session, 70(11), 1073-1081.
Ladany, N. (2014). The ingredients of supervisor failure. Journal of Clinical Psychology: In Session, 70(11), 1094–1103.
Ladany, N., Mori, Y., & Mehr, K. E. (2013). Effective and ineffective supervision. The Counseling Psychologist, 41(1), 28-47.
Maples, J. L., & Walker, R. L. (2014). Consolidation rather than termination: Rethinking how psychologists label and conceptualize the final phase of psychological treatment. Professional Psychology: Research and Practice, 45(2), 104-110.
Thomas, J. T. (2007). Informed consent through contracting for supervision: Minimizing risks, enhancing benefits. Professional Psychology: Research and Practice, 38(3), 221–231.
Additional Resources Books and Videos
American Psychological Association Clinical Supervision Essentials Series. (2016 and 2017).
Eleven books that each address the fundamentals of supervision of psychotherapy provided under different theoretical orientations. Available at http://www.apa.org/pubs/books/browse.aspx?query=series%3aClinical+Supervision+Essentials+Series
American Psychological Association Psychotherapy Supervision Video Series. (2016 and 2017). Eleven videos demonstrating the fundamentals of supervision of psychotherapy provided under different theoretical orientations. Available at http://www.apa.org/pubs/videos/browse.aspx?query=subject%3aPsychotherapy+Supervision