Psychotherapy Supervisors Research Articles

Theory of a Well Mind.

Description In psychiatry residency, we have a didactic within our curriculum that focuses on psychotherapy. This subject culminates in our third year when our program's psychotherapy supervisor asks each of us to create our own personal theory. It allowed us to explore and apply what we had learned up until this point and formulate our own understanding of why people are the way that they are, how people change, and how to facilitate that growth through our theory. Each of us chose to represent our theory in unique ways, reflective of our personalities. One tech-savvy resident used AI and images. Another used a relevant case involving themes of feminism and cultural competency. I represented my theory through poetry. This theory has elements of emotion-focused therapy, attachment theory, and cognitive behavior therapy. Engaging in this style of learning left me with fulfillment and a newfound satisfaction for what I had learned.

Revealing the Unknown: Supervisors’ Perspectives on Using Creative Techniques in Supervision

ABSTRACT Traditionally, psychotherapy supervision takes place as a conversation between the supervisor and a supervisee, but it has been argued that using an array of creative techniques can enhance the supervisory process. However, there has been limited empirical research in this area. This study explored the perspectives of supervisors when using creative techniques in psychotherapy supervision. Using grounded theory procedures, 13 experienced psychotherapy supervisors were interviewed in the United Kingdom and Ireland, and “Attaining Sight” of the supervision issue emerged as a main concern for supervisors. “Revealing the Unknown” was the framework that explained how participants dealt with this concern by using creative techniques in supervision. When the supervision issue was seen more clearly, it helped supervisors cope with their own discomfort and foster a more favorable supervisory encounter. In this article, the implications of using creative techniques in supervision are discussed.

Senior Resident as Junior Supervisor: Case Report of an Apprenticeship Model for Training Psychotherapy Supervisors.

Psychotherapy supervision is an essential component of graduate medical education in psychiatry. However, most psychotherapy supervisors have never had training specific to supervision, and the requisite skills have received little attention in the literature. The authors of this article describe the first year of a pilot project that was aimed at fostering interest and skill in psychotherapy supervision among senior residents. In this model, a postgraduate year (PGY)-4 resident supervised a PGY-2 resident's psychodynamic psychotherapy while receiving supervisory support from a senior faculty member. Feedback from the two residents and the residency program director was positive. The PGY-2 resident reported benefiting from near-peer supervision. The PGY-4 resident continued to supervise residents after graduation and felt well prepared to assume that role. The residency program continued to use this model after the pilot period. Other training programs can replicate this model to nurture the next generation of psychotherapy supervisors.

When the Supervisor Needs a Supervisor: A Case-based Guide for Developing Psychotherapy Supervisors.

Supervision of psychotherapy is recognized as fundamental for attaining competency in psychotherapy. However, there is a lack of training in "best practices" of supervisory skills, and some supervisors may lack contemporary knowledge to support supervisees adequately. Training program leadership challenged by limited time and resources to provide supervisors with the necessary education and support can benefit from additional resources for developing psychotherapy supervisors. The authors present 3 core elements of navigating supervisory challenges: training, open dialogue in supervision, and a formal program-level process. Common issues in psychotherapy supervision are then presented in a case-based format. Reflection questions are included to provide an opportunity to consider a personal approach to the case, while specific guidance based on the literature addresses critical aspects of the case examples. Complex supervisory conflicts can challenge programs, but they are normative to the learning process and promote growth in our supervisors.

Afterword to "When the Supervisor Needs a Supervisor: A Case-based Guide for Developing Psychotherapy Supervisors".

Supervision of psychotherapy is recognized as fundamental for attaining competency in psychotherapy. However, there is a lack of training in "best practices" of supervisory skills, and some supervisors may lack contemporary knowledge to support supervisees adequately. Training program leadership challenged by limited time and resources to provide supervisors with the necessary education and support can benefit from additional resources for developing psychotherapy supervisors. The authors present 3 core elements of navigating supervisory challenges: training, open dialogue in supervision, and a formal program-level process. Common issues in psychotherapy supervision are then presented in a case-based format. Reflection questions are included to provide an opportunity to consider a personal approach to the case, while specific guidance based on the literature addresses critical aspects of the case examples. Complex supervisory conflicts can challenge programs, but they are normative to the learning process and promote growth in our supervisors.

Multicultural Streaming in Group Psychotherapy Supervision: Orientation to and Preparation for Culturally Humble Practice.

How do psychotherapy supervisors most effectively integrate issues and concerns about multiculturalism and social justice (MSJ) into the supervisory experience? Concrete examples of how to best address this integration are needed, and this article provides one such example. The authors propose multicultural streaming as one approach to orient supervisees about, and prepare them for, incorporation of MSJ matters into group supervision and to foster their evolving sense of culturally humble practice. This article defines multicultural streaming, presents a plan for its implementation at the group's outset, and identifies implementation guideposts for consideration. A set of cultural humility guidelines adapted for group supervision is also proposed for group facilitation. This perspective is presented with the hope of generating further discussion about integrating MSJ issues into the group supervisory experience.

A Path of Opportunity and Challenge: Perspectives of Psychotherapy Supervisors in India

A Path of Opportunity and Challenge: Perspectives of Psychotherapy Supervisors in India

Singaporean supervisory identity development and its relationship to supervisory experience, counselling experience, and training in supervision

ABSTRACT The relationship between supervisory identity development and supervisory experience, counselling experience, and training in supervision was examined for a group of 29 Singaporean counsellors who attended a workshop on supervision. Analyses indicated that supervisory experience was related to supervisory identity development, whilst counselling experience and supervisory training initially were not. Additionally, participants showed significantly greater scores on the Psychotherapy Supervisor Development Scale (PSDS) following the workshop when compared with PSDS scores prior to the workshop. Thus, workshop supervision training ultimately aided supervisory identity development. The implications of these findings are discussed in relation to the importance of supervisor credentials.

Practising counsellors’ identity salience in clinical supervision

AbstractCounsellors are called to appreciate variety within human experience and culture (British Association for Counselling and Psychotherapy, Ethical Framework for the Counselling Professions, 2018). Similarly, counselling and psychotherapy supervisors who support the ongoing development of supervisees are tasked with understanding supervisees in their own cultural context. Supervisees and supervisors bring their own social and cultural identities into the supervisory space. In this study of 94 supervisees, the researchers sought to explore which social or cultural identity supervisees named as most salient in the supervisory relationship and whether the salient identity was one of minoritised or marginalised status. Gender, religion, race/ethnicity, socioeconomic status, sexual orientation or nationality was often listed as most salient. Further, individuals who identified with a minoritised/marginalised race/ethnicity, nationality or sexual orientation were likely to list that identity as most salient in their supervisory relationship. Implications include the importance of respectful inquisitiveness and supervisor readiness to consider a variety of salient social and cultural identities. Given many of these identities are invisible or ambiguous, supervisors who display cultural humility may be best positioned to provide culturally competent supervision.

Clinicians' Cognitive and Affective Biases and the Practice of Psychotherapy.

Cognitive and affective biases are essentially connected to heuristic shortcuts in thinking. These biases ordinarily function outside of conscious awareness and potentially affect clinical assessment, reasoning, and decision making in general medicine. However, little consideration has been given to how they may affect clinicians in the conduct of psychotherapy. This article aims to illustrate how such biases may affect assessment, formulation, and conduct of psychotherapy; describe strategies to mitigate these influences; and draw attention to the need for systematic research in this area. Cognitive and affective biases potentially influencing clinical assessment, reasoning, and decision making in medicine were identified in a selective literature review. The authors drew from their experiences as psychotherapists and psychotherapy supervisors to consider how key biases may influence psychotherapists' conduct of psychotherapy sessions. The authors reached consensus in selecting illustrative biases pertinent to psychotherapy. Included biases related to anchoring, ascertainment, availability, base-rate neglect, commission, confirmation, framing, fundamental attribution error, omission, overconfidence, premature closure, sunk costs, and visceral reactions. Vignettes based on the authors' combined experiences are provided to illustrate how these biases could influence the conduct of psychotherapy. Cognitive and affective biases are likely to play important roles in psychotherapy. Clinicians may reduce the potentially deleterious effects of biases by using a variety of mitigating strategies, including education about biases, reflective review, supervision, and feedback. How extensively these biases appear among psychotherapists and across types of psychotherapy and how their adverse effects may be most effectively alleviated to minimize harm deserve systematic study.

The Psychotherapy Supervisor as an Agent of Transformation: To Anchor and Educate, Facilitate and Emancipate.

The objective of this review was to answer the question, What do supervisors actually do in promoting transformative change in the beginning therapist supervisee? New therapist trainees, lacking treatment skills and a sense of "therapist identity," are prone to experience self-doubt, feel anxious and demoralized, and think of themselves as impostors. Psychotherapy supervision can be helpful and encouraging to beginning therapists in their process of development. Using Mälkki and Green's concepts of liminality, edge emotions, and boundary confusion as framework, the author examines the pivotal role of the supervisor in striving to create a transformative supervision space. The author identifies and elaborates on three transformative streams of supervisory action-to anchor and ground, to educate and facilitate, and to liberate and emancipate. The constituents of each action stream are also identified. Psychotherapy supervisors serve foremost as agents of transformation, their chief objective being to actuate and actualize a transformative process of therapist development. The crucial processes by which supervisors achieve that transformative objective reside in the three streams of supervisory action. Accordingly, psychotherapy supervision is best conceptualized as a transformative learning pedagogy.

Becoming a Competent Psychotherapy Supervisor: How Do I Get There From Here?

Becoming a Competent Psychotherapy Supervisor: How Do I Get There From Here?

The complexities of power in feminist multicultural psychotherapy supervision.

The goal of the present study was to understand how current feminist multicultural supervisors understand and implement their feminist multicultural principles into clinical supervision. We addressed this aim by answering the following research question: How do self-identified feminist multicultural psychotherapy supervisors conceptualize and practice feminist supervision that is explicitly multicultural? The perspectives of 14 participant supervisors were obtained by using semistructured initial interviews, follow-up interviews, and feedback interviews and were investigated via a feminist constructivist grounded theory design and analysis. Most participants identified as counseling psychologists (n = 12), women (n = 11) and temporarily able-bodied (n = 11); but they identified with diverse racial/ethnic, sexual, spiritual/religious, generational, and nationality statuses. A 7-category empirical framework emerged that explained how the participants anticipated and managed power in supervision. The core category, the complexities of power in supervision, explained how participants conceptualized power in supervisory relationships. The 6 remaining categories were bringing history into the supervision room, creating trust through openness and honesty, using a collaborative process, meeting shifting developmental (a)symmetries, cultivating critical reflexivity, and looking at and counterbalancing the impact of context. Limitations of the study, implications for research, and suggestions to use the theoretical framework to transform supervisory practice and training are discussed. (PsycINFO Database Record

Psychotherapy Supervision: Conflicting Roles and Competing Tasks

Psychotherapy Supervision: Conflicting Roles and Competing Tasks

상담 수퍼바이저 교육과 훈련 요소 연구 : 수퍼바이저 발달 요인과 수퍼바이저 역량 요인 중심으로

상담 수퍼바이저 교육과 훈련 요소 연구 : 수퍼바이저 발달 요인과 수퍼바이저 역량 요인 중심으로

A survey of CBT supervision in the UK: methods, satisfaction and training, as viewed by a selected sample of CBT supervision leaders

AbstractInternationally, clinical supervision has been increasingly recognized as a core competency and an essential requirement for clinical training. Over the past 10 years, frameworks for supervision competencies have been developed and promulgated in several countries, notably the UK, USA and Australia. But what is the current status of the actual practice of CBT supervision in the UK? We conducted an internet survey with a purposive sample of n=110 accredited British Association for Behavioural and Cognitive Psychotherapy (BABCP) supervisors and trainers (a 44% response rate), selected for their assumed expertise. The results were consistent with past surveys of Townend et al., indicating that the most frequently reported supervision methods tended to reflect many of the recommendations in widely disseminated supervision competency frameworks and recognized best practice statements. Overall, these CBT supervision leaders reported using an impressively wide range of methods, including much more frequent use of role-play, therapy recordings, and direct observation than reported in the Townend et al. surveys or in observational studies. Although satisfied in their supervisory role, respondents indicated the need for improved CBT supervisor training resources, with significant interest in developing competence instruments and group supervision methods. In conclusion, at least for this small sample of CBT supervision leaders in the UK, practice reflects international progress, but training resources are sought to maintain momentum.

Measuring the Effectiveness of a Genetic Counseling Supervision Training Conference.

Genetic counselors who receive formal training report increased confidence and competence in their supervisory roles. The effectiveness of specific formal supervision training has not been assessed previously. A day-long GC supervision conference was designed based on published supervision competencies and was attended by 37 genetic counselors. Linear Mixed Model and post-hoc paired t-test was used to compare Psychotherapy Supervisor Development Scale (PSDS) scores among/between individuals pre and post conference. Generalized Estimating Equation (GEE) model and post-hoc McNemar's test was used to determine if the conference had an effect on GC supervision competencies. PSDS scores were significantly increased 1week (p<0.001) and 6months (p<0.001) following the conference. For three supervision competencies, attendees were more likely to agree they were able to perform them after the conference than before. These effects remained significant 6months later. For the three remaining competencies, the majority of supervisors agreed they could perform these before the conference; therefore, no change was found. This exploratory study showed this conference increased the perceived confidence and competence of the supervisors who attended and increased their self-reported ability to perform certain supervision competencies. While still preliminary, this supports the idea that a one day conference on supervision has the potential to impact supervisor development.

Setting the stage for an evidence-based model of psychotherapy supervisor development in clinical psychology.

In Canada and in the United States, psychotherapy has been defined as a core professional competency within mental health professions, and more specifically in clinical and counselling psychology (Canadian Psychological Association, 2002; Falender et al., 2004). However, how supervisors develop competencies in psychotherapy remains an understudied area (Barker & Hunsley, 2013; Belleville & Viau-Quesnel, 2014; Watkins, 2012b). Given that (a) psychotherapy supervisors do not spontaneously acquire skills necessary for supervising effectively (Hoffman, 1994), (b) experience alone does not adequately prepare one to become a psychotherapy supervisor (Worthington, 2006), and (c) the development of specific competencies are necessary for the ethical and professional practice of psychotherapy (Watkins, 2012b), it is crucial that we increase our understanding of makes for the effective teaching of effective supervision (Hunsley & Barker, 2011, p. 144). This study aims to provide a critical assessment of the existing literature using a BES methodology to inform future research and the development of Canadian training and practice guidelines in this area.A Proposed Definition of Psychotherapy Supervisor DevelopmentOne of the major challenges in this area of research has been a lack of a clear conceptualisation of what psychotherapy supervisor development is and how it works. A definition is an important starting point for any assessment of the research literature by delineating the construct; that is, what constitutes psychotherapy supervisor development and what does not. Given that a systematic review tries to identify, appraise, select, and synthesize all high quality research evidence on a given research question, a sound definition provides a clear frame of reference to orient and anchor its execution. This is especially necessary in this case, because whereas there have been numerous reviews in the area of clinical/ psychotherapy (at least 32 by the mid-90s) and more since then (Ellis, Ladany, Krengel, & Schult, 1996; Milne & James, 2000; Milne, Sheikh, Pattison, & Wilkinson, 2011), only a few have focused on psychotherapy supervisor development per se (see Barker & Hunsley, 2013). This distinction is crucial, because it is the difference between reporting on what works for delivery of clinical/psychotherapy versus how a supervisor becomes effective at delivering what works.To help us formulate a valid and useful definition for the construct of supervisor development, we are guided by Milne (2007), who noted four criteria necessary for a useful definition: (a) precision (e.g., it has an essential meaning that makes it distinct); (b) specificity (e.g., it defines a concept clearly and completely); (c) operationalization (e.g., it is stated in a form that permits measurement); and (d) corroboration (e.g., it receives adequate support from research). A reasonable starting point for formulating a definition of psychotherapy supervisor development was recently proposed by Watkins (2012a):The process of growth involved in being and becoming a psychotherapy supervisor, its unfolding and evolution over time; the factors (e.g., openness, defensiveness) that facilitate or fracture that growth process; the developmental issues (e.g., independence vs. dependence) that potentially affect and permeate that process; and the tailoring of supervisory interventions to match of needs. (p. 46)This definition represents a synthesis of Watkins' review of 30 years of literature on the subject of psychotherapy supervisor development and incorporates concepts from all four extant developmental models that describe how supervisors develop their skills and professional identities (Hess, 1987; Roenhauser, 1994; Stoltenberg & McNeill, 2009; Watkins, 2012a).However, when Milne's (2007) criteria are applied to Watkins' (2012a) definition of psychotherapy supervisor development, several gaps and limitations become apparent:(a) The process of growth involved in being and becoming a psychotherapy supervisor is not defined precisely in behavioural terms, that is, what is meant by growth and development? …

Using the Inventory of Countertransference Behavior as an observer-rated measure

This study examined the use of the Inventory of Countertransference Behavior (ICB) as an observer-rated measure of countertransference (CT). The ICB was originally designed for use by direct psychotherapy supervisors who assess their supervisees, but this limits its use in research and with practitioners who are not in supervision. To increase the use of the ICB as an observer-rated scale, we developed clarifying statements and examples of in-session therapist behaviors for each of its 21 items, creating an Inventory of Countertransference Behavior-Observer (ICB-O). Two separate teams of observers rated therapist CT using the ICB-O while listening to audiotaped recordings and reading transcripts of four psychotherapy dyads' sessions. Our analyses indicate that the ICB-O can be used reliably as an observer-rated measure of CT, and that differences emerged in the development of positive CT over time. We also obtained ratings of client insight and clients' and therapists' ratings of quality of sessions, and present variations in these ratings, including CT, when the treatment was classified as either more or less successful. We end the paper by presenting ways in which the ICB-O can be used in supervision, training, and research.

A Response to “Thinking About Our Work: Supervision”

A Response to “Thinking About Our Work: Supervision” J. Scott Rutan1 issn 0362-4021 © 2015 Eastern Group Psychotherapy Society group, Vol. 39, No. 1, Spring 2015 53 1 Private practice. Correspondence should be addressed to J. Scott Rutan, PhD, 71 Waban Hill Road, Chestnut Hill, MA 02467. E-mail: scottrutan@scottrutan.com. In his article, Dr. Stone focuses on supervision of group therapy, with specific emphasis on setting clear goals. I applaud Dr. Stone for calling our attention to the need to be thoughtful about teaching and practicing the art of supervision, which is the foundation of our work. It is often overlooked, such that Anne Alonso (1985) termed it the “Quiet Profession.” I will comment on supervision from a somewhat broader perspective, not focusing exclusively on the supervision of group therapy. Ours is an apprenticeship trade. We learn under the watchful eyes of our supervisors. Fundamentally, supervision is the loaning of experience to neophyte therapists. Venturing into the world of emotional healing can be daunting when we begin. There are powerful emotions—eruptions of old countertransferences, the seduction of projective identifications, receiving sexual and angry transferences. These can be bewildering and frightening to new therapists. In group therapy, the swirl of emotions is only intensified. A supervisor should have specific goals in mind, and they differ according to the level of experience of the supervisee. These may or may not match the goals of the neophyte therapist, though, as Moga and Cabaniss (2014) state, they need to be made clear to the supervisee. An initial supervisory goal is to help the supervisee become able to bear strong affect without having to act. Affect, certainly in the psychodynamic tradition, is a main avenue of change, and it is imperative that therapists become comfortable with a wide range of emotions and a wide level of intensity of those emotions. For example, some young therapists are made very anxious when their patients express sexual feelings toward them. A supervisor can helpfully point out that most feelings 54 rutan in therapy are often addressed to “Dear Occupant,” meaning that they are transference feelings invited by the role of the therapist. Another early goal is to help the supervisee understand and use theory to guide in technique. Early in the process, this will likely be helping the supervisee use the supervisor’s preferred theory. It is hoped that in later stages, the supervisor will help supervisees learn the theories that most naturally fit with them. In the psychodynamic tradition, helping the supervisee hear “process” and believe in the unconscious are two of the most important skills to impart. Then the task is to learn how to feed back to the patients what has been heard in a way that maximizes patient growth. The supervisory relationship is an intimate and complicated one. Supervisees are in a vulnerable position, often encountering painful aspects of their own personalities . In addition, most of the time, supervisor and supervisee work in the same setting and have multiple types of connections, including personal. The supervisor must be acutely aware of the boundaries of the supervisory relationship. Often the supervisory relationship is even more complicated, as when the supervisor is new in the role, or when there are personality conflicts, or when supervision occurs across professional disciplines. There are many types of supervision. There is supervision of specific modalities, for example, supervision of individual therapy, couple therapy, family therapy, or group therapy. There are different configurations for supervision. Much supervision of individual therapy occurs in dyadic settings, whereas often, supervision of group therapy occurs in groups. There are even peer supervisory groups (Kassan, 2010). Good supervision provides the supervisee with a cognitive frame by which to understand the patient, an ability to elicit and allow the full emotions of the patient, an ability to value the patient no matter how distasteful his or her defenses might be, a keen sense of professional ethics, the ability to “hear” the unconscious themes in each hour, and, finally, an ability to maintain a professional boundary that protects both patient and therapist. REFERENCES Alonso, A. (1985). The quiet profession: Supervisors of psychotherapy. New York: Macmillan. Kassan, L. D. (2010). Peer supervision groups: How they work...