Essential Knowledge for Clinical Supervisors
This post will include information and skills dealing with research on role induction practices, quality of clinical supervision, psychodynamics of 
alliance, and progress measurement. Since the information and skills for all these topics is complex, I will do my best to keep it as clear as possible. This information aims to improve existing clinical supervision practices.
Reducing anxiety of less experienced supervisees by role induction strategies
- First of all clarify both supervisee and supervisor roles, expectations, behaviors, skills, rights, responsibilities, and clinical development.
- Support supervises via clear information on process and skills training about cognitive, behavioral and emotional processes, skills, and clinical expectations.
- Include lowering anxiety and improving competence as ongoing clinical supervision activities. Measure them!
- Work directly on supervisees self-awareness capacities.
- Clinical and psychological development issues may exist; adjust clinical supervision to fit these parameters.
- Improvement in supervisees clinical competence and psychological health are ongoing goals.
- Important variables that impact success or failure are supervisor competence and supervisee openness to growth and emotional regulation patterns.
- Keep the quality of supervision in mind, and participate in mutual evaluation and openness to feedback. For best results keep supervisee input about the supervisor as anonymous as possible. Otherwise, supervisee anxiety will increase.
- Recall that ethics requires that there be a reasonably detailed supervision contract.
- Effective clinical supervision often translates into effective psychotherapy, which leads to improved client progress, better job satisfaction and self-esteem.
The Importance of clinical, evidence-based and psychodynamic training
- Perhaps the single most important aspect of effective clinical supervision is the quality of the alliance. This is a parallel process with the therapy itself.
- With improved training in psychodynamic alliance-building skills comes client self-reports of experiencing a stronger therapeutic alliance in therapy. Keep in mind the training is cognitive, behavioral, and affective in nature. It is experienced!
- Research is mixed about the differences in alliance quality regarding psychodynamic training vs other training (CT, CBT, humanistic, interpersonal, etc.). The study noted suggests that improved emphasis on psychodynamics skills and processes ends with a better therapy alliance, which is consistent with better outcomes for clients. Although other studies refute this finding, it does appear to be logical that a training program specializing in psychodynamic therapy would produce better outcomes for psychodynamics, thus perhaps a better clinical alliance.
- Manualized psychodynamic therapy training also showed substantial improvement in the clinical alliance and the amount of psychodynamic skills being used in therapy.
Comparative quality of clinical supervision and its implications
- Research including over 300 clinicians concluded that 69-79% received inadequate clinical supervision.
- What is more concerning is that the same research noted that 25-40% of clinicians received harmful clinical supervision.
- At other measurement times 51-55% of clinicians noted that they received exceptionally helpful clinical supervision. Last I heard a 50% range is a grade of F. We need to work on improving this reality!
- Research also supports that there are great differences between supervisee perceptions vs objective criteria used effectively to measure comparative quality of clinical supervision. So the indication is to use both – supervisee anonymous evaluation and direct observation and measurement of clinical performance.
- 86-92% of clinicians did receive some form of clinical supervision but both the regularity and quality varied.
The reality of using progress monitoring measures for clinician development
- The use of clinical progress monitoring measures regarding client clinical change improves outcomes. However they are used rarely.
- Clinicians noted that the use of such measures in therapy required technical expertise, additional costs, time in the session, some
increased anxiety, and was sometimes accompanied by negative responses from clients, other clinicians, and managers.- There were few differences in use and barriers between agency clinicians and private practice clinicians.
- Since the benefits of progress monitoring in clinical practice is well established and is often part of evidence-based endorsements for therapies, it is important to increase the use of progress monitoring.
- Furthermore, the lack of progress monitoring may have negative impacts on clients and third-party payments for therapy.
For more information refer to Ellis, M. V., Hutman, H., Chapin, J. (2015). Reducing supervisee anxiety…Journal of Counseling Psychology, 62, No. 4, 608-620. Hilsenroth, M. J., Kivlighan, D. M., Slavin-Mulford, J. (2015). Structured supervision of graduate clinicians in psychodynamic psychotherapy…Journal of Counseling Psychology, 62, No. 2, 173-183. Ellis, M. V., Creaner, M., Hutman, H., Timulak, L. A comparative study of clinical supervision… Journal of Counseling Psychology, 62, No. 4, 621-631. Ionita, G., Fitzpatrick, M., Tomaro, J., Chen, V. V., Ovington, L. (2015). Challenges in using progress monitoring measures…Journal of Counseling Psychology, 63, No. 2, 173-182.
Anthony R. Quintiliani, PhD., LADC
From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton Sangha
Author of Mindful Happiness
art, science, engineering, and humanities. He saw art as science and science as art – most clinicians recognize these combinations in their own clinical work. I will simply note a list of documented attitudes, values and behaviors that DaVinci mastered. Here is the list. Courage may be needed to move off your comfort-path.
have. Criticism stifles creativity and open conversation. How might you use their suggestions in creative ways?
may help us return to the true self and an authentic life. The wisdom of these ancient teachings may open up the light in our dark nights of the soul. Living the foundations of The Perfections may liberate our deep hope for the better. Correctly taking and giving with patience and effort can enter our regular meditation practice. We may see more clearly what is important, as well as what path to take in any given challenge. Living our life with The Perfections in mind, body, and behavior expands hope for ourselves and for others. How might you creatively introduce The Perfections to your client (only with permission – they are Buddhist)?
cognitions and emotions from the past, we need to move to the present moment and be there in calmness and safety. Of course other interventions are required when psychosis, intoxication, or extreme emotional dysregulation occur; meditation is not the recommended response in these conditions. One of the best ways to introduce your clients to meditation is to simply allow a gentle focus on the breath, just as it is. Relaxation-focused manipulation of the deep breath, especially for client with untreated trauma and polyvagal complications, may lead to the opposite effect – stimulating anxiety. Once your client can focus gently on her/his breath and benefit from brief exposures, he/she may be ready for brief meditations.
hold your head in a relaxed and level position. Now loosen your jaw and notice. Practice releasing any tension that you may be carrying in your throat. Let it go very gently, and open up your throat. Now bring attention to the area of your heart center, and imagine a warm, glowing, gentle inner light there. Notice the feeling. Allow it to nurture you. To end simply be with your natural breath; after a few breaths, allow it to bring you to full attention. This meditation is over.
positive thoughts and emotions. When we get stuck in negative cycles of thinking, feeling and doing our right brain and limbic area dominate. A very old mindfulness belief is that you are not your thoughts, your emotions, or your behaviors; these parts of you are simply associated with your life experiences. When a client learns to defuse a though it means they have changed its linguistic structure and removed it from being cemented into their CABs, or cognition-affect-behavior cycles. In all good therapies, especially Cognitive-Behavioral Therapy and various mindfulness therapies (MBCR, DBT, MBCT, MBRP, ACT), helpers often work on truth-analysis of unhelpful, repetitive, negative thoughts patterns – especially those embedded into CABs cycles of ineffective experiences. Self-medication, isolation, and avoidance are commonly associated with these realities. Sometimes this work includes meta-cognitive analysis regarding your thoughts about your thoughts or the patterns of your thoughts. The clear logic is that the words we often tell ourselves in times of stress or fear are NOT often true. Of course, if indeed you are seriously endangered best to allow your limbic brain area to save your life. The list below will note various approaches used to defuse thoughts from our experience of being, our CABs cycles.
example: “I am so worthless” helps solidify your brain plasticity about personal meanings and images. Try this: “Sometimes I feel worthless” or “When really bad things happen, I can feel worthless” or “My unpleasant feeling can relate to feeling less worthwhile.”