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Chapter 1 Introduction to Clinical Supervision

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Many professions have a signature pedagogy (Shulman, 2005a), a particular instructional strategy that typifies the preparation of its practitioners. In medicine, for example, a team of physicians and medical students visit a prescribed set of patients during clinical rounds, discussing diagnostic and treatment issues related to each patient, along with what has happened since the team last discussed that patient. In law, students come to class prepared to be called on at any moment to describe the essential arguments of a particular case, or to summarize and respond to the arguments another student has just offered. During these interactions, their professor engages them in a type of Socratic dialogue.

Clinical supervision is the signature pedagogy of the mental health professions (Barnett, Cornish, Goodyear, & Lichtenberg, 2007; Goodyear, Bunch, & Claiborn, 2005). Like the signature pedagogy of other professions, it is characterized by (a) engagement, (b) uncertainty, and (c) formation (Shulman, 2005a): engagement in that the learning occurs through instructor–learner dialogue; uncertainty because the specific focus and outcomes of the interactions typically are unclear to the participants as they begin a teaching episode; and formation in that the learner’s thought processes are made clear to the instructor, who helps shape those ideas so that the learner begins to “think like a lawyer (Shulman, 2005b, p. 52), a physician, a psychologist, and so on. In this text, we also are concerned with a higher level shift, which is to that of thinking like a supervisor (cf. Borders, 1992).

Shulman (2005a) notes that signature pedagogies are “pedagogies of action, because exchanges typically [end] with someone saying, ‘That’s all very interesting. Now what shall we do?’” (p. 14)

Clinical supervision qualifies as a signature pedagogy against all these criteria; criteria that underscore both supervision’s importance to the mental health professions and its complexity. This text is intended to address that

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complexity by providing the technical and conceptual tools that are necessary to supervise.

We assert that every mental health professional should acquire supervision skills, because virtually all eventually will supervise others in the field. In fact, supervision is one of the more common activities in which mental health professionals engage. For example, in each of the three surveys conducted over a 20-year span (summarized by Norcross, Hedges, and Castle [2002]), supervision was the third most frequently endorsed professional activity (after psychotherapy and diagnosis/assessment) by members of the American Psychological Association’s Division of Psychotherapy. Surveys of counseling psychologists (e.g., Goodyear et al., 2008; Watkins, Lopez, Campbell, & Himmell, 1986) show similar results.

This is true internationally as well. In a study of 2,380 psychotherapists from more than a dozen countries, Rønnestad, Orlinsky, Parks, and Davis (1997) confirm the commonsense relationship between amount of professional experience and the likelihood of becoming a supervisor. In their study, the number of therapists who supervised increased from less than 1% for those in the first 6 months of practice to between 85% and 90% for those who have more than 15 years of practice.

In short, this text is for all mental health professionals. Its focus is on a training intervention that is not only essential to, but also defining of those professions; an intervention that has developed in a complementary way to psychotherapy and so now has more than a 100-year history (Watkins, 2011).

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Foundational Premises One challenge in writing this text has been our recognition that almost anyone who reads it does so through a personal lens that reflects beliefs, attitudes, and expectations about supervision that they have formed through their own experiences as supervisees; perhaps also as supervisors. Such foreknowledge can make the reading more relevant and personally meaningful, but it can also invite critical responses to material that readers find dissonant with their beliefs. We hope readers who have that experience find we have presented material in a manner that is sufficiently objective so that they may evaluate dispassionately any dissonance-producing content or ideas.

Three premises are foundational to what follows:

Clinical supervision works. As we discuss later, the data show that supervision has important positive effects on the supervisees and on the clients they serve. Clinical supervision is an intervention in its own right. It is possible, therefore, to describe issues, theory, and technique that are unique to clinical supervision. Moreover, as with any other psychological intervention, the practice of supervision demands that those who provide it have appropriate preparation. The mental health professions are more alike than different in their practice of supervision, regardless of discipline or country. Most supervision skills and processes are common across these professions. There are, of course, profession-specific differences in emphasis, supervisory modality, and so on. These might be considered the unique flourishes each profession makes on our common signature pedagogy, but we assume there are core features that occur (a) whether

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the supervision is offered by psychologists, counselors, social workers, family therapists, psychiatrists, or psychiatric nurses and (b) regardless of the country in which it is offered (see, e.g., Son, Ellis & Yoo, in press). Therefore, we have drawn from both an interdisciplinary and international literature to address the breadth of issues and content that seems to characterize clinical supervision in mental health practice.

In keeping with our interdisciplinary focus, we most often use the term clinical supervision (versus such alternatives as counselor supervision, psychology supervision, or social work supervision). Figure 1.1 draws from Google’s database of more than 5.2 million scanned books spanning 200 years (available through ngrams.googlelabs.com) and depicts the relative frequency with which clinical supervision and several alternatives have been used as a term in English-language books between 1940 and 2009. Because the black and white rendering of this graphic makes it difficult to differentiate categories, we note that clinical supervision is depicted in the top line, showing it to be the most widely used term. Notable too is the slow linear growth in the use of the term between the mid-1940s and the late 1960s, when the frequency of its use began to increase substantially (interestingly, it also shows some dropoff in the past several years).

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Our Convention on the Use of Key Words

We use counseling, therapy, and psychotherapy interchangeably, because distinctions among

FIGURE 1.1 Occurrence of clinical supervision and related terms in English-language books: 1940–2008

these terms are artificial and serve little function. We also follow the convention first suggested by Rogers (1951) of referring to the recipient of therapeutic services as a client.

We distinguish between supervision and training as well. Training differs from supervision in being “structured education for groups of trainees . . . [and] involves a standardized set of steps” (Hill & Knox, in press, msp. 3). The trainer’s primary role is that of teacher (see our discussion later in this chapter distinguishing the roles of teacher and supervisor).

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Paralleling this training-versus-supervision distinction is the one that we make between trainee and supervisee. We believe that supervisee is the more inclusive term—that is, trainee connotes a supervisee still enrolled in a formal training program and so seems less appropriate for postgraduate professionals who seek supervision. In most cases, we use supervisee.

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Supervision’s Centrality to the professions Supervision’s crucial role in the preparation of professionals has been recognized for thousands of years, as is suggested in the first few lines of the famous Hippocratic Oath:

I swear by Apollo the physician, and Asclepius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation —to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers. (Hippocrates, ca. 400 bc, from Edelstein, 1943; bold ours for emphasis)

In this oath, the veneration being accorded a teacher or supervisor is clear; moreover, the comparison of that teacher to one’s parents suggests the power and influence the neophyte physician cedes to the teacher. To appreciate that power and influence requires an understanding of the nature of the professions (see, e.g., Goodyear & Guzzardo, 2000), especially of the ways in which they are distinct from other occupations. Those distinctions include that (a) professionals work with substantially greater autonomy; (b) professionals need to make judgments under conditions of greater uncertainty (Sechrest et al., 1982), an attribute of the work that Schön (1983) vividly characterized as “working in the swampy lowlands” (p. 42) of practice (this is in contrast to technicians who work from a prescribed protocol on situations that typically are carefully constrained); and (c) professionals rely on a knowledge base that is sufficiently specialized so that the average person would have difficulty grasping it and its implications (Abbott, 1988).

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Because of these qualities of professions, it is generally understood that laypersons would not have the knowledge necessary to oversee them, and so society permits the professions to self-regulate. The implicit contract, however, is that this self-regulation is permitted in return for the assurance that this profession will place the welfare of society and of their clients above their own self-interests (see, e.g., Schein, 1973; Schön, 1983). This self-regulation includes controlling who is admitted to practice, setting standards for members’ behavior, and disciplining incompetent or unethical members.

Within the mental health professions, three primary mechanisms of self- regulation are (a) regulatory boards, (b) professional credentialing groups, and (c) program accreditation. Supervision is central to the regulatory functions of each, because it provides a means to impart necessary skills; to socialize novices into the particular profession’s values and ethics; to protect clients; and, finally, to monitor supervisees’ readiness to be admitted to the profession. In short, “supervision plays a critical role in maintaining the standards of the profession” (Holloway & Neufeldt, 1995, p. 207).

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Regulatory Boards

State and provincial—and in some countries (e.g., Australia, England, Korea), national—regulatory boards codify the practice of supervision. They often stipulate (a) the qualifications of those who supervise; (b) the amounts of supervised practice that licensure or registration candidates are to accrue; and (c) the conditions under which this supervision is to occur (e.g., the ratio of supervision to hours of professional service; what proportion of the supervision can be in a group format; who can do the supervising; as an example, see the practicum supervision guidelines adopted by the Association of State and Provincial Psychology Boards, www.asppb.net/files/public/Final_Prac_Guidelines_1_31_09.pdf). Somerequire that members of a particular profession who wish to supervise obtain a separate license in order to do so (e.g., Alabama licenses counseling supervisors).

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Professional Credentialing Groups

Independent groups, such as the Academy of Certified Social Workers (ACSW), the American Board of Professional Psychology (ABPP), the National Board for Certified Counselors (NBCC), the American Association for Marriage and Family Therapy (AAMFT), the British Association for Counselling and Psychotherapy (BACP), and the Korean Counseling Psychology Association (KCPA) also credential mental health professionals, usually for advanced practitioners and to certify competence above the minimal level necessary for public protection (the threshold level of competence for licensure is the reasonable assurance that the person will do no harm). Like the regulatory boards, these credentialing groups typically stipulate amounts and conditions of supervision a candidate for one of their credentials must have. In some countries (e.g., Korea), these groups serve as de facto regulatory boards.

Some groups (e.g., AAMFT, NBCC, BACP) also have taken the additional step of credentialing clinical supervisors. In so doing, they make clear their assumption that supervision is based on a unique and important skill constellation.

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Accrediting Bodies

Whereas licensure and credentialing affect the individual professional, accreditation affects the training programs that prepare them. Each mental health profession has its own accreditation body, and their guidelines address supervision with varying degrees of specificity. For example, the American Psychological Association (APA, 2008) leaves it to the individual training program to establish that supervised training has been sufficient. However, other groups are very specific about supervision requirements. For example, any graduate of an AAMFT–accredited program is to have received at least 100 hours of face-to-face supervision, and this should be in a ratio of at least 1 hour of supervision for every 5 hours of direct client contact (AAMFT, 2006). The Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2001) requires that a student receive a minimum of 1 hour per week of individual supervision and 1.5 hours of group supervision during practicum and internship; CACREP doctoral program standards also specify requirements for supervision-of- supervision.

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Fostering Supervisees’ Professional Competence Our remarks thus far speak to the role supervision plays in the professions and to the broader society they serve. This section addresses supervision as a mechanism to ensure that supervisees develop necessary competencies, as well as to the less-direct effects of supervision that occur through supervisees’ exercise of those competencies.

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Integration of Research and Theory with Practice

During their training, novice mental health professionals obtain knowledge from (a) formal theories and research findings, and (b) the practice-based knowledge of expert practitioners. However, there is a third type of knowledge as well—about themselves. For example, they identify aspects of their own personality and interpersonal behavior that affects their work as professionals. Skovholt (2012) refers to this last as an inevitable “loss of innocence” (p. 286).

Clinical supervisors are key to the integration of these several types of knowledge. Supervised practice provides the crucible in which supervisees can blend them, and it is the supervisor who can help provide a bridge between campus and clinic (Williams, 1995), the bridge by which supervisees begin to span what often is a “large theory–practice gulf” (Rønnestad & Skovholt, 1993, p. 396).

Practice is absolutely essential if supervisees are to develop professional skills. This is Peterson’s (2002) point when he tells the joke about a New York City tourist who, lost, stops a cabbie and asks, “How can I get to Carnegie Hall?” The cabbie’s response is, “Practice, practice, practice!” Peterson notes that this joke’s punch line is significant in that the cabbie does not say, “Read, read, read!”

However, practice alone is an insufficient means to attain competence: Unless it is accompanied by the systematic feedback and guided reflection (the operative word being guided) that supervision provides, supervisees may gain no more than the illusion that they are developing professional expertise. Dawes (1994) asserts:

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Two conditions are important for experiential learning: one, a clear understanding of what constitutes an incorrect response or error in judgment, and two, immediate, unambiguous and consistent feedback when such errors are made. In the mental health professions, neither of these conditions is satisfied. (p. 111)

Dawes’ assertions about the two conditions necessary for experiential learning are compelling. Yet we believe his assertion that neither condition is met in the mental health professions is overstated. We predicate our writing of this text on the assumption that supervision can satisfy these and other necessary conditions for learning.

It is true a supervisor (by whatever name) may be unnecessary for attaining many motor and performance skills. In these domains, simply performing the task may provide sufficient feedback for skill mastery. Learning to type is one example. Learning to drive an automobile is another (Dawes, 1994): When driving, the person who turns the steering wheel too abruptly receives immediate feedback from the vehicle; the same is true if he or she is too slow applying the brakes when approaching another vehicle. In these and other ways, experience behind the wheel gives the person an opportunity to obtain immediate and unambiguous feedback. Driving skills are therefore likely to develop and improve simply with the experience of driving.

However, psychological practice skills are of a different type. These skills require complex knowledge for which experience alone is rarely able to provide either of the two conditions that Dawes stipulated as necessary for experiential learning to occur. Practitioner skill development requires intentional and clear feedback from another person, such as is available through supervision. Research data confirm that unsupervised counseling experience does not accelerate the clinical progress of trainees (Hill, Charles, & Reed, 1981; Wiley & Ray, 1986), a conclusion complemented by that of educational psychologists who examined the broader domain of instruction (see especially Kirschner, Sweller, & Clark, 2006).

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Competence to Supervise Whereas the literature gives a great deal of attention to fostering the competence of new professionals, a great deal less attention has been given to the development of competence in the supervisors themselves. Milne and James (2002) comment that this has been something of a paradox that the field must address.

Developing supervisor competence implies systematic training. It was disappointing, therefore, to see that internship supervisors responding to the Rings, Genuchi, Hall, Angelo, and Cornish (2009) survey gave only lukewarm endorsement for the two items, “Supervisor has received supervision of his or her supervision, including some form of observation (audio or video) with critical feedback,” and “Supervisor has completed coursework in supervision.” In contrast, Gonsalvez and Milne (2010) note that “expert opinion is unanimous in identifying the need for supervisor training, often in forceful terms” (p. 234). It is increasingly rare to encounter people who believe that being an effective therapist is a sufficient prerequisite to being a good supervisor; analogous, we believe, to assuming that if a person is a good athlete, she or he inevitably will make a good coach or sports announcer.

Research literature that focuses on the effectiveness of supervisor training is still small and developing. Importantly, though, it does document positive outcomes. We summarize that research in Chapter 12 .

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Availability of Training for Supervisors

In the early 1980s, several authors (e.g., Hess & Hess, 1983; McColley & Baker, 1982) comment on what seems the limited availability of supervision training for mental health professionals. Fortunately, circumstances have changed quite significantly since then (except, perhaps in the case of psychiatry; e.g., Rodenhauser, 1996). Accrediting bodies (i.e., APA, CACREP, and AAMFT) have been important in this shift, through their stipulations that students in doctoral programs they accredit should receive at least some preparation to supervise.

Some organizations also have specified levels and type of training for those mental health professionals who do move into supervisory roles. For example, the Association for Counselor Education and Supervision (ACES) endorses Standards for Counseling Supervisors (ACES, 1990), a variant of which later was adopted by the Center for Credentialing and Education as the basis for its Approved Clinical Supervisor credential. AAMFT, too, has a supervisor membership category that requires specified training.

Regulatory boards also are beginning to require that mental health professionals who provide supervision receive supervision training. For example, psychologists licensed in California who want to supervise must to participate in one 6-hour supervision workshop during every 2-year licensure cycle; at this writing, several other state and Canadian provincial psychology boards either mandate some level of supervision training or are considering doing so (Janet Pippin, personal communication, September 13, 2011). Sutton (2000) reports that 18% of counselor licensure boards require a course or its equivalent for persons providing supervision, and another 12% require training in supervision.

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Similar trends in supervision training are evident in other countries as well. For example, programs accredited by the Canadian Psychological Association are to provide supervision training. In Britain, supervision training is readily available to qualified professionals through a number of freestanding training “courses” (i.e., programs), and the National Health Service’s Improving Access to Psychological Therapies (IAPT) group developed a proposal to create structures to permit briefer (e.g., 5–7 day) supervision training (IAPT, 2011); to inform that training, it also commissioned the development of a document to identify supervision competencies (Roth & Pilling, 2008). Korean counselors and psychologists often can obtain supervision training in their academic programs, although not universally (see Bang & Park, 2009).

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The Competence Movement and Its Implications for Supervisor Training

Regulatory boards always have been concerned that the practitioners they certify for practice are competent. A relatively recent development, however, has been the attention being given to operationalizing, training for, and assessing competencies. The emergence of what has been called “the competence movement” (Rubin et al., 2007, p. 453) roughly coincides with the increasing demands for accountability seen in higher education in, for example, U.S. accreditation and in Europe’s Bologna Process (Adelman, 2008). Essential to that movement is some common working definition of competence. It is useful, then, to consider the definition put forth by Epstein and Hundert (2002):

the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served; [it relies on] habits of mind, including attentiveness, critical curiosity, awareness, and presence. (p. 227)

Their definition of medical competence has been sufficiently useful to have been embraced as well in the mental health professions (see, e.g., Rubin et al., 2007). It makes clear that competence is not merely a disparate collection of knowledge and skills, but rather something that requires the exercise of judgment. It seems highly similar to Aristotle’s concept of phronesis, or practical wisdom, which “concerns how individuals ‘size up’ a situation and develop and execute an appropriate plan of action” (Halverson, 2004, p. 94).

The 2002 Competencies Conference (Kaslow et al., 2004) was something of a watershed in U.S. psychology. Although competencies had been an

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explicit aspect of the National Schools of Professional Psychology’s training model (Peterson, Peterson, Abrams, & Stricker, 1997), this conference signaled broad embrace of competencies. Important to note is that there was clear consensus among conference attendees that supervision is a core competence of psychologists. In fact, a task group of supervision experts attending that conference articulated competencies they believed supervisors should attain and demonstrate (Falender et al., 2004).

However, all conceptions of competence are grounded in expert opinion, and these opinions can differ across groups of experts or across time within a group of experts, and so are inherently value laden. Understandably, then, authors have varied some in the focus and specificity with which they have addressed competencies (see, e.g., Falender et al., 2004; Roth & Pilling, 2008; Tebes et al., 2010).

Deist and Winterton’s (2005) assertion that competence is a fuzzy concept seems borne out to some extent in these several conceptions of supervision competence. This is not to say that these conceptions are contradictory or unimportant; in fact, despite its fuzziness, we absolutely embrace the importance of competence as a central focus of this text.

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Defining Supervision We assume that anyone reading this text is bringing some understanding of what supervision is. However, an important next step is to provide a more formal definition, and then to address the aspects of this definition.

In parsing the term, it is possible to infer that its practitioners exercise super vision. In fact, supervisors have the advantage of a clarity of perspective about counseling or therapy processes precisely because they are not an involved party. Levenson (1984) speaks to this when he observes that, in the ordinary course of his work as a therapist, he spends considerable time perplexed, confused, bored, and “at sea,” but, “When I supervise, all is clear to me!” (p. 153).

Levenson (1984) also reports finding that theoretical and technical difficulties were surprisingly clear to him. Moreover, he maintains that people he supervised and who seemed confused most of the time that they were supervisees reported that they attained a similar clarity when they were supervising. He speculates that this is “an odd, seductive aspect of the phenomenology of the supervisory process itself” (p. 154) that occurs at a different level of abstraction than therapy. Perhaps this is the perspective of the “Monday-morning quarterback.”

The Merriam-Webster (n.d.) online dictionary reports, however, that the etymological definition of supervision is simply “to oversee,” from the Latin word supervises, and that the first known use of the term in English occurred in about 1645. To provide oversight is a key function of supervisors in virtually any occupation or profession. Yet as important as this is, it is an insufficiently precise description of what occurs during the

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clinical supervision of trainees and practitioners in the mental health professions.

Definitions of supervision offered by various authors differ from one another as a function of such factors as the author’s discipline and training focus. Our intent is to offer a definition that is specific enough to be helpful, but at the same time broad enough to encompass the multiple roles, disciplines, and settings associated with supervision.

We have offered, with only the slightest of changes, the following working definition of supervision since the first edition of this text (Bernard & Goodyear, 1992):

Supervision is an intervention provided by a more senior member of a profession to a more junior colleague or colleagues who typically (but not always) are members of that same profession. This relationship

is evaluative and hierarchical, extends over time, and has the simultaneous purposes of enhancing the professional functioning of the more junior person(s); monitoring the quality of professional services offered to the clients that she, he, or they see; and serving as a gatekeeper for the particular profession the supervisee seeks to enter.

The earlier version of this definition has been informally adopted as the standard in both the United States and the United Kingdom (see, e.g., Milne, 2007). In this edition, we make two changes to that definition:

1. Whereas the definition we use in prior editions asserts that supervision is a relationship between two people of the same profession, this revised definition acknowledges that this is not always true.

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2. Whereas the final clause stipulates that supervisors serve as gatekeepers for those entering the profession, the revised version acknowledges that gatekeeping can occur at other points as well.

Because this definition is succinct, it merits further explication. Each of the following sections addresses a specific element of this definition.

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Supervision Is a Distinct Intervention

Supervision is an intervention, as are teaching, psychotherapy, and mental health consultation. There are substantial ways in which supervision overlaps with and draws from these other interventions (see, e.g., Milne, 2006), yet still remains unique. Table 1.1 summarizes what we believe to be the most salient similarities and differences.

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Teaching versus Supervision. Teaching is central to supervision, and the supervisee’s role of learner is suggested in the title of the classic supervision book, The Teaching and Learning of

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TABLE 1.1 Supervision versus Teaching, Counseling, and Consultation

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Similarities Differences

Teaching • Both have the purpose of imparting new skills and knowledge.

• Both have evaluative and gatekeeping functions.

• Whereas teaching is driven by a set curriculum or protocol, supervision is driven by the needs of the particular supervisee and his or her clients.

Counseling or Therapy

• Both can address recipients’ problematic behaviors, thoughts, or feelings.

• Any therapeutic work with a supervisee must be only to increase effectiveness in working with clients.

• Supervision is evaluative, whereas counseling is not.

• Counseling clients often have a greater choice of therapists than supervisees have of supervisors.

Consultation • Both are concerned with helping the recipient work more effectively professionally. For more advanced trainees, the two functions may become indistinguishable.

• Consultation is a relationship between equals, whereas supervision is hierarchical.

• Consultation can be a one- time event, whereas supervision occurs across time.

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• Consultation is more usually freely sought by recipients than is supervision.

• Supervision is evaluative, whereas consultation is not.

Psychotherapy (Ekstein & Wallerstein, 1972). Teaching and supervision also have in common an evaluative aspect reflected in their gatekeeping functions, regulating who is legitimized to advance further into training or into the workplace.

Teaching, however, typically relies on an explicit curriculum with goals that are imposed on everyone uniformly. However, even though the focus of supervision at its broadest level might seem to speak to common goals (i.e., to prepare competent practitioners), the actual intervention is tailored to the needs of the individual supervisee and the supervisee’s clients. Eshach and Bitterman’s (2003) comments about the challenges in preparing physicians to address the needs of the individual—and therefore about the need for an educational context that is flexible and adaptive to the needs of the trainee and the person she or he is serving—apply just as well to the training of mental health practitioners (and, notably, have the characteristics of a signature pedagogy).

The problems are often poorly defined. . . . The problems that patients present can be confusing and contradictory, characterized by imperfect, inconsistent, or even inaccurate information. . . . Not only is much irrelevant information present, but also relevant information about a case is often missing and does not become apparent until after problem solving has begun. (Shulman, 2005a, p. 492)

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Counseling versus Supervision. There are elements of counseling or therapy in supervision—that is, supervisors often help supervisees examine aspects of their behavior, thoughts, or feelings that are stimulated by a client, particularly as these may act as barriers to their work with the client. As Frawley-O’Dea and Sarnat (2001) observe, maintaining “a rigidly impenetrable boundary between teaching and ‘treating’ in supervision is neither desirable nor truly achievable” (p. 137).

Still, there should be boundaries. Therapeutic interventions with supervisees should be made only in the service of helping them become more effective with clients; to provide therapy that has broader goals than this is ethical misconduct (see, e.g., Ladany, Lehrman-Waterman, Molinaro, & Wolgast, 1999; Neufeldt & Nelson, 1999), as we discuss in Chapter 11 .

It also is worth noting that clients generally are free to enter therapy or not, and usually have a voice in choosing their therapists. However, supervision is not a voluntary experience for those who have committed to a training program, and they often have scant voice in whom their supervisor is to be. Given this circumstance, it is salient to note that Webb and Wheeler (1998) found in their study that supervisees who had chosen their own supervisors reported being able to disclose to their supervisors more information of a sensitive nature about themselves, their clients, and the supervisory process than supervisees who had been assigned a supervisor.

Page and Woskett (2001) differentiate supervision from counseling according to their respective aims (in counseling, to enable a fuller and more satisfying life, versus in supervision, to develop counseling skills and the ability to conceptualize the counseling process); presentation (clients present material verbally, whereas supervisees present in multiple ways,

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including not only verbally, but via audio and videotape, live observation, etc.); timing (clients choose the pace, whereas supervisees often must have new understanding or skills in time for their next counseling session); and relationship (in counseling, regression may be tolerated or even encouraged, whereas that is not so in supervision; although some challenging of boundaries is expected in counseling, there is no such expectation in supervision).

The single most important difference between therapy and supervision, however, may reside in the supervisor’s evaluative responsibilities. This can create challenges to supervisors, which we discuss in Chapters 10 and 11 .

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Consultation versus Supervision. For more senior professionals, supervision often evolves into consultation —that is, the experienced therapist might meet informally on an occasional basis with a colleague to get ideas about how to handle a particularly difficult client or to regain needed objectivity. We all encounter blind spots in ourselves, and it is to our benefit to obtain help in this manner.

Consultation, however, is more likely than supervision to be a one-time-only event, and the parties in the consultation relationship often are not of the same professional discipline (e.g., a social worker might consult with a teacher about a child’s problem; Caplan, 1970). Two other consultation– supervision distinctions echo distinctions already made between therapy and supervision. One is that supervision is more likely imposed, whereas consultation typically is freely sought. More significantly, whereas evaluation is one of the defining attributes of supervision, Caplan and Caplan (2000) observe that consultation

is non-hierarchical. Our consultants reject any power to coerce their consultees to accept their view of the case or to behave in ways the consultants may advocate. . . . consultants have no administrative power over the consultees or responsibility for case outcome. (pp. 18–19)

In summary, specific aspects of teaching, therapy, and consultation are present as components of supervision. Supervision should be thought of as an intervention composed of multiple skills, many of which are common to other forms of intervention. Yet their configuration is such as to make supervision unique among psychological interventions. Moreover, there is at least one phenomenon, that of parallel or reciprocal processes (e.g., Doehrman, 1976; Searles, 1955), that is unique to supervision and distinguishes it from other interventions (parallel processes are discussed in Chapter 3 ).

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Typically a Member of the Same Profession

The widely acknowledged purposes of supervision are to facilitate supervisees’ development and to protect clients. It is possible to accomplish these purposes when the supervisory dyad is composed of members of two different disciplines (e.g., a marital and family therapist might supervise the work of a counselor). In fact, almost all supervisees will be supervised by someone outside their immediate profession.

However, supervision also serves a professional socialization function missing in cross-disciplinary supervision dyads. Ekstein and Wallerstein (1972) speak to this when they note that it is possible for a training program to prepare its supervisees with all the basic psychotherapeutic skills, but that “what would still be missing is a specific quality in the psychotherapist that makes him [or her] into a truly professional person, a quality we wish to refer to as his [or her] professional identity” (p. 65). Crocket et al. (2009) found that supervisors who were providing interdisciplinary supervision reported many positive features of this arrangement, but also note the difficulties of working from different ethics codes and of having too-limited knowledge of the professional culture of the supervisee. Kavanagh et al. (2003) found that Australian public mental health workers perceived that the extent of supervision they received was related to its impact on them, but only when the supervisor was of the same profession.

In a cautionary tale concerning the use of members of one profession to supervise neophyte members of another profession, Albee (1970) invokes the metaphor of the cuckoo: The cuckoo is a bird that lays its eggs in the nests of other birds, which then raise the offspring as their own. His case in

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point was U.S. clinical psychology, which had used the Veterans Administration system as a primary base of training in the decades following World War II. From Albee’s perspective, the clinical psychology fledglings were put in the nest of psychiatrists, who then socialized them into their way of viewing the world. Albee asserts that one consequence is that clinical psychology lost some of what was unique to it, as its members began incorporating the perspectives of psychiatry.

Notably, Gabbard (2005) expresses concern about social workers and psychologists supervising psychiatry residents. He acknowledges that they can be excellent therapists, but then observes that:

Children become what their parents do more than what their parents say. The same can be said of psychiatric residency training. If their professional role models treat psychotherapy as a marginal endeavor taught by allied professionals, residents will assume that psychiatrists are not really psychotherapists. (p. 334)

In short, counselors and psychotherapists are supervised by people from different professions and often receive excellent training from them. Our point is not to argue against that practice, but rather to suggest that for the sake of professional identity development, it is important that the majority of supervision be done by someone who is in the profession that the supervisee is preparing to enter.

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Supervision Is Evaluative and Hierarchical

We mentioned previously that evaluation stands as one of supervision’s hallmarks, distinguishing it from both counseling or therapy and consultation. Evaluation is implicit in the supervisors’ mandate to safeguard clients, both those currently being seen by the supervisee and those who would be seen in the future by the supervisee if he or she were to finish the professional program.

That supervisors have an evaluative function provides them with a tool, giving them an important source of interpersonal influence. For example, although most supervisees have a very high degree of intrinsic motivation to learn and to use feedback to self-correct, evaluation can provide supervisees with an additional, extrinsic motivation to use supervisory feedback.

However, despite its importance as a component of supervision, both supervisor and supervisee can experience evaluation with discomfort. Supervisors, for example, were trained first in the more non-evaluative role of counselor or therapist. Indeed, they may well have been attracted to the field because of this feature of counseling. The role of evaluator therefore can be not only new, but uncomfortable as well.

The role of evaluator also affects the trainee’s perception of the supervisor. Stude