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.
– even from ourselves. We feel something is very wrong in this moment, and we allow separateness to pull us into a frenzied effort to escape pain and suffering. At such times our most deeply hidden negative self-views strengthen and dominate. We will do almost anything to escape the aloneness and self-alienation. Endless impulses to seek what is wrong and forget what is right take over our emotional lives. It is at such times of strong emotional challenge that we need to take refuge in the Buddha, the Dharma, and the Sangha. Tara Brach’s creation of the RAIN process is a huge leap in a sane direction. According to Brach, RAIN helps us overcome tendencies to activate the “second arrow” of suffering; our second arrows are caused by unhelpful thoughts, feelings, emotions, body sensations, and behaviors related to the “first arrow.” The first arrow is the original event or experience that caused our pain and suffering. Often our reactivity to it makes matters worse – we suffer more in our own minds and bodies. Below I will review the RAIN process and make additional comments on its usefulness and versatility in ongoing self-care and emotional self-regulation. The practice of RAIN skills is appropriate for all people – helpers and helpees.
we learn to care more about others and less about ourselves. The self-centered ego gives way to compassionate tolerance. Buddhist practices and meditations may improve our interpersonal relations, both intimate and distant. Today our world, nation, regions, and families are locked in bitter conflict; the entitled view of “my ideas are right” holds sway and prevents any forward movement for negotiated co-existence of different ideas and people. If we hope to save ourselves as well as our world, we MUST practice more interpersonal mindfulness. Such practices of random acts of kindness, general compassion, taking in suffering and giving out joy, tolerance, openness to differences, general gratitude and others all support more inter-personally cooperative thoughts and behaviors. Such thoughts and behaviors will improve self, dyads, relationship, family, community, race, ethnic group, religion, state, nation, and world. The need for this shift is highly urgent! We must change our being from greed, aversion, and hate to generosity, inclusivity, and love. If not our species and our world may fail.
happening right now in this present moment. What, exactly, is it that is upsetting me? What, exactly, is it that may lead to mutual satisfaction here now? Begin your changes by starting with yourself. Notice what conflictual inner self-messages continue to play and re-play themselves over and over again in your own mind. Begin by listening to your own inner conflicts, and work at listening and reflecting deeply on both sides of this dynamic. Work on a solution, even if it is not a perfect one. First practice more radical acceptance with your own inner conflicts, then gently move to outer conflicts – begin gently with significant others. Practice, practice, practice and practice more. There cannot be a winner! Once you feel the sensations and emotions of successful compromise, begin to practice beyond intimate circles and into your general world environments. It is all about sharing your love and acceptance of self with others, and being for the betterment of others. On this path also practice good self-care.