Supervision Alliance Research Articles

Associations Between Supervisory Alliance, Medical Resident Distress, Burnout, and Self-Esteem.

Supervision is considered a collaboration between a supervisor and supervisee and includes perceptiveness, responsiveness of the supervisor, a state of rapport, and specific learning tasks that allow the individual to work towards a goal. The alliance in supervision has been identified as a key ingredient of effective supervision, regardless of the type of treatment, population, or supervision model being used. While it is known that the medical training environment hosts high rates of burnout, little research has examined the role of supervisory alliance in regard to burnout, distress, and self-esteem. This study aimed to apply previous models of supervisory alliance to medical education, and explore associations between educational alliance and trainee self-esteem, burnout, and distress. Participants included 108 medical trainees (response rate = 81%). Medical trainees were recruited from a rural Pennsylvanian teaching hospital and asked to complete a voluntary and anonymous electronic survey. Multiple linear regression was used to examine the association between supervisory alliance and burnout and distress, while controlling for average hours worked and slept. Results suggested that supervisory alliance was associated with burnout, distress, and self-esteem among medical trainees. Given the high rates of depression and burnout among medical providers, it may be helpful to understand the factors that may impact medical trainee's distress and esteem. Future longitudinal research might examine the role of the supervisory alliance over time, and whether strong mentorship and guidance may serve to protect trainees from burnout throughout training and into their career.

The importance, impact and influence of group clinical supervision for graduate entry nursing students.

This paper will report on an evaluation of group clinical supervision (CS) facilitated for graduate entry nursing (GEN) students whilst on clinical placement. The literature suggests educational forums which enable GEN students to engage in critical dialogue, promote reflective practice and ongoing support are an essential element of GEN curricula. The model of supervision employed was informed by Proctor's three function interactive CS model and Inskipp and Proctor's Supervision Alliance. Both emphasise the normative, formative and restorative functions of CS as task areas within an overarching humanistic supervisory approach. The three-function model informed the design of a questionnaire which intended to measure their importance, impact and influence through both structured and open-ended questions. Findings suggest the restorative function of supervision is most valued and is facilitated in an environment where humanistic principles of non-judgement, empathy and trust are clearly present. Also the opportunity to learn from others, consider alternative perspectives and question personal assumptions regarding capability and confidence are a priority for this student group. It is suggested that the restorative function of CS should be prioritised within future developments and models which view this function as a key purpose of CS should be explored.

Constructing an evidence-informed social work supervision model

ABSTRACTThis article aims to pragmatically construct an evidence-informed model of social work supervision from the research findings from social work supervision research. The proposed evidence-informed model consists of five key areas, namely, the construction of social work supervision, supervision of the practitioner, the supervision alliance, the interactional process and the supervision of direct practice. The implications of the proposed evidence-informed social work supervision model for supervisory practice and the international development of social work supervision are also discussed.

Clinical supervision: An exploration of possible mechanisms of action.

Drawing on a sample of 13 supervisors, 32 trainees, and 256 clients from a training clinic, the present study examined the impact of several important relational and personal factors on the supervision process. The different variables that were assessed included client outcome, both supervisee and supervisor emotional intelligence, supervision alliance perceptions, and personality factors. In an initial effort to apply a leadership perspective to supervision, the Leader–Member Exchange Scale was adapted for use as an alternate alliance measure and appeared to hold measurement promise. Contrary to expectation, supervisor agreeableness was inversely related to and predictive of client outcomes: Client outcome was better when low supervisor agreeableness was present. Trainee extraversion and openness to experience predicted significant variance in leader–member exchange and supervisory working alliance perceptions. Our findings bring into focus the significant impact that personality variables can have upon supervision practice and suggest that a leadership perspective has some relevance for supervision study.

Reflections on supervision in psychotherapy

The aim of the author is to share his reflections on supervision as a central topic in therapists' education and training programs. The concept of supervision, its functions and effects on the training process along with the contributions of different theoretical models to its evolution are addressed. Supervision alliance, the roles of supervisor and supervisee, evaluation as a central component and the influence of socioeconomic factors are discussed. The conclusions depict the most interesting paths for development in the near future and the areas where research needs to be further conducted along with the subjects most worthy of efforts in the supervision field.

The Ruptured Supervisory Alliance and Its Repair: On Supervisor Apology as a Reparative Intervention

In what ways do supervisors repair the ruptured supervisory alliance? In this article, that question is considered, with focus given to one rupture repair intervention: Supervisor apology. Apology/forgiveness theory and research are integrated with current thinking about supervision alliance rupture and repair. Using the recent conflict transformation research of Kirchhoff and colleagues (Kirchhoff, Strack, & Jager, 2009; Kirchhoff, Wagner, & Strack, 2012) as a building block, the 10 elements of apology are examined vis-à-vis the supervisory situation, and the applicability of the concepts of simple and complete apology for supervision alliance rupture repair are presented. Eight statements that link apology and forgiveness with supervision alliance rupture and repair conceptualization are proposed, and a case example that communicates the reparative effectiveness of supervisor apology is described. Supervisor rupture identification and repair is viewed as being an important competency that involves a supporting knowledge base, skill set, and values core.

The Game Analysis of Quality Safety Behavior Subjects in Highway Engineering

This paper point the research at highway engineering quality safety behavior subjects and analyze the characteristics of the parties based on game theory, build game model, Solve mixed strategy Nash equilibrium; And put forward the effective quality management methods of highway safety behavior implement that strengthening the punishment of highway engineering supervision alliance and the effective use of public media regulator.

The supervisory alliance: a half century of theory, practice, and research in critical perspective.

Over the course of psychotherapy supervision history, the supervisor-supervisee alliance has increasingly emerged as a variable of preeminent importance in the conceptualization and conduct of the supervision experience: It has come to be embraced as the very heart and soul of supervision. But after a half century, what evidence do we actually have to justify that highly favorable outlook afforded to the alliance? What do we really know about the supervisory alliance? What do we need to know about it? As we mark the first 50 years of supervisory alliance and look toward its future, I thought it might be useful to examine those questions and provide a current status report about the construct itself In what follows, I (a) describe the two supervisory alliance visions that have been (and remain) dominant in the supervision literature and (b) provide a review of 20 plus years of supervision alliance research. While the supervisory alliance has accumulated solid clinical support, its empirical support appears to be more tentative and less robust. I consider why that is so, identify some missing elements in the alliance research conducted thus far and propose possible remedies to move inquiry in this area forward.

The Supervisory Alliance as Quintessential Integrative Variable

The concept of alliance in psychotherapy supervision is now a half century old. But over the course of its first 50 years, how has the supervisory alliance come to generally be viewed by supervision scholars and practitioners? and What is its specific place now within different visions of supervision? In this paper, I would like to consider those two questions by: (a) describing the two enduring perspectives on the supervisory alliance that have dominated and continue to dominate the supervisory scene; and (b) examining the ways in which the alliance appears to currently be conceptualized and implemented across several distinct views of supervision. Each view of supervision is also presented as containing and actuating its own message and meaning about the role of alliance in supervision, and those messages and meanings are accordingly identified. The supervisory alliance appears to now be widely regarded as being a transtheoretical common factor that binds by means of: (a) bond/rapport; (b) supervision goals; and (c) supervision tasks. Much like the therapeutic alliance in psychotherapy, the supervisory alliance has increasingly come to be seen as the very heart and soul of supervision itself and may indeed be the quintessential integrative variable in psychotherapy supervision.

Towards evidence-based clinical supervision: the development and evaluation of four CBT guidelines

AbstractClinical supervision is central to evidence-based practice (EBP) and continuing professional development (CPD), but the evidence base has made little impact on supervision, a major form of CPD. We unite the two by developing four evidence-based guidelines for cognitive behavioural therapy (CBT) supervision. The guidelines were designed to address the supervision cycle (i.e. collaborative goal-setting; methods of facilitating learning; evaluation and feedback) within the context of the supervision alliance. Guideline development followed the National Institute for Clinical Excellence approach, including a representative stakeholder working group (with local service users and supervisees), a national group of supervisors and supervisor trainers, plus an expert reference group. A total of 106 such participants completed anad-hocguideline evaluation tool, designed to provide a multi-dimensional reaction evaluation of the guidelines. The guidelines were all rated favourably, satisfying the key initial criteria of accuracy and acceptability, and were judged to represent a CBT approach to supervision. It is concluded that the use of the guidelines might help CBT supervisors to better meet demands for CPD (including specialization in supervision) and EBP.

What Is Unique About Supervising Couple Therapists?

What is unique about supervising couple therapists? To answer this question I highlight three important therapeutic processes in CT and their accompanying supervisory implications. The first process, the attending to values and beliefs about the meaning of coupling to couples and therapists and its influence on CT, is facilitated by supervisors who help supervisees uncover values and beliefs about coupling. The second process, developing the therapeutic alliance which has a unique complexity in CT, is facilitated by the processing of the therapeutic alliance in supervision and discovering ways of strengthening it. The final process, attending to emotion prevalent in CT, is facilitated by supervisors who assist supervisees in becoming comfortable with the expression of emotion and work with it constructively in CT. After briefly describing each process and why it is viewed as important in CT, I suggest ways supervisors can assist supervisees' becoming more proficient in them. An abbreviated supervision illustration ends each section.

The Supervisory Alliance

SUSAN GILL (ED.): The Supervisory Alliance. Jason Aronson, Northvale, NJ, 2001, 242 pp., $45.00, ISBN 0-7657-0307-6. Psychotherapy supervision has always occupied a core place in the education of psychoanalytic therapists even if it has remained relatively neglected in the psychoanalytic literature. As analytic theory and practice have changed, especially toward a more collaborative and less conception of the therapeutic relationship, the relationship has also become a subject of renewed interest and academic attention. How do we conceptualize the parallel couples of therapist-trainee/patient and supervisor/supervisee? How do we reconcile traditions of didactic and administrative authority with a desire to promote a facilitating environment for mutual inquiry? How do we understand and resolve impasses in supervision, and deal with problems of secrecy, countertransference enactment, shame, and interpersonal binds? What are the similarities and necessary differences between therapeutic relationships and relationships? CSW, PhD, and psychoanalytic institute Susan Gill's compendium of essays, The Supervisory Alliance, revisits and attempts to reformulate traditional conceptions of psychotherapy supervision in the light of neoclassical, object-relational, and intersubjective models of psychotherapy. The Supervisory Alliance is divided into two large sections, the first about facilitation of learning in psychotherapy supervision, and the second about working with countertransference in supervision. Each section is multi-authored, and like many such volumes it suffers from considerable unevenness in sophistication, relevance, and coherence in design. Stanley Teitelbaum sets a historical context for the other essays by describing a move away from a purely didactic view of supervision (in which the was expected to have super vision) toward an experiential perspective that democratizes the process. Modern views of supervision are far less and more nurturing, aiming to facilitate the creation of an internal supervisor who relieves anxiety and fosters creative thought. Teitelbaum describes various obstacles to an open alliance in supervision, including the impulse of some supervisors to interpret the supervisee's character, or to compete with the supervisee for intellectual and clinical authority. Some essays are outstanding for their synthesis of theoretical perspective and clinical example. Lawrence Epstein describes a paradigm he calls collusive selective inattention to negative impacts of the relationship. Bound by a traditional authoritarian tilt of the supervisor-supervisee contract, both parties can fall into a pattern of unhelpful enactment that is prolonged by their mutual reluctance to speak about their dilemma. The supervisee is reluctant to challenge authority, and the may become increasingly entrenched in trying to manage the therapy case rather than attend to the emerging impasse in supervision. Epstein wisely notes having learned through experience that the supervisory impulse, which makes supervisors want to seem brilliant, helpful, or admired by the supervisee, can itself become a major impediment to a successful relationship. The resolution of such impasses in the relationship facilitates resolution of parallel impasses in the therapy that is under supervision. He recommends balancing the supervisor's attention between the case material and the needs of the supervisee. Sydney Arkowitz uses the metaphor of perfectionism to explore obstacles in the relationship. …

The Four Pillars of Psychotherapy Supervision

Effective supervision is essential for monitoring, improving, and advancing the field of psychotherapy. The two primary goals of supervision involve protecting the welfare of the client and fostering the professional development of the supervisee. The four pillars of effective supervision include developing a positive working alliance in supervision, providing directive guidance as needed, using a Socratic dialogue to explore key issues that arise in psychotherapy, and customizing the supervision to match the needs of the trainee. The present manuscript explores these guidelines and provides several recommendations for effective supervision.

Perspectives on supervision in cognitive therapy

Supervision is often a neglected clinical area. Frequently, supervisors view supervision as an epiphenomenon of clinical work rather than a central feature. This article emphasizes the importance of supervision in cognitive therapy. Teaching novice professionals to skillfully apply cognitive conceptualizations and interventions is a challenging and difficult task. It is argued that fostering a learning alliance in supervision forms the basis for acquisition of pivotal cognitive therapy competencies. Various impediments to productive learning alliances are discussed and ways to obviate these obstacles are suggested. Further, issues related to technical interventions, relationship processes, and case conceptualizations are discussed. Finally, ways to augment trainees' skills in these fundamental areas are delineated.