8/13/2019 Clinical Supervision Practices of Licensed Psychologists

1/5

8/13/2019 Clinical Supervision Practices of Licensed Psychologists

2/5

178 BRIEF REPORTSTable1Summary ofSuperviseea ndSupervisor Demographics

VariableAgeG enderFemaleMaleRaceWhiteOtherDegreeM APhDOtherDon'tknowLicenseLicensedpsychologistLicensedconsulting

psychologistOtherMajor fieldCounseling/educationalpsychologyClinicalpsychologyOtherYearsin field

n2291418722 351 1 91045

1 4 5

83

84673521 5

Supervisees% M

42.5661.838.297.82.252.245.62.2

63.6

36.4

45.236.018.8 11 .53

SupervisorsSD n7.38 228

7915222 75

241 72351

20

1674 3

5.77 206

34.265.897.82.210.374.115.20.48.7

72.618.7

M SD47.33 7.98

18.79 8.06Differencesin s are due to missing data.

past 5 years, and supervision content. Open-ended questions werecontent analyzed by a licensed counseling psychologist experienced insupervisionprocess.Interrater reliability, established by having anotherlicensed psychologist rate a subset of responses ( = 50), ranged from.70to 1.00(AT=.85).

ResultsSupervisee D emographics

A su mma ryof respondent demographic characteristics ispresented inTable 1(for more detailed inform ation regardingthe results of this study, contact Patricia McCarthy). The re-spondents werefairly experienced and from a varietyofworksettings;54 %wereinpriv ate practice. They provided d irect ser-vicetom aleand femaleadultsandm inorsfor abroad rangeofconcerns, including abuse, health issues, relationship issues,and vocational concerns. The most commonly endorsed theo-reticalo rientations were eclectic (41% ) ,psychodynamic(15%),andsystems(12%).SupervisionActivities

Respondents were asked to report the amount and type offormally scheduled supervision they currently receive. Eighty-eightpercent n =203) reported receiving some type of clinicalsupervision for anaverageof7.35 hourspermonth, includingindividualand group supervision withdesignatedand peer su-pervisors. Eighty percent n = 189)currently had at least one

designated clinical supervisor. Respondents were instructed tochoosea designated rather thanpeer supervisor tocomplete theremainder of the CSQ. Seventy-two percent selected their cur-rentsupervisor,and 28%selected asupervisorfrom withinthelast5years. Abo ut60% chosean individualsupervisor,and 4 0%selected a group s upervisor. They had worked together an aver-age of3.40 years SD =2.69, range= 1 to 14).Fifty-seven per-cent of the respondents were engaged in elective supervisionwith the target supervisor. Criteria for supervisor selection in-cluded clinical expertise (32% ,n =74), personal characteristics(e.g., integrity, intellect,andgender;21 .6% ,n =50), theoreticalorientation (14 .3%,n =33), super visory style(11 .3% ,n =26),reputation (9.1% , n =21 ), licensure level (3.0% , n = 7), andlogistics(e.g.,onlyoneavailable; 2.6% ,n =6).SupervisorCh aracteristics

Supervisor characteristics are summarized in Table 1. Th emajority were active practitioners (94%) . The most commontheoretical orientations in supervision an d clinical practicewereeclectic(32% ), psychodynamic (21% ),and systems (13% ).Almost24 % n =54 ) of therespondents reported that theirsu -pervisors had received supervision training, whereas 5% ( =11 )reportedtheyhadnot. Interestingly,72% n =165)did notknow.SupervisorRolesand Behaviors

Roles. Only 30% n =68) had a supervisor responsible forboth clinical and administrative supervision. Of that group,

8/13/2019 Clinical Supervision Practices of Licensed Psychologists

3/5

BRIEF REPORTS 17976% indicated that thesystem worked well, whereas24% re-ported problems (e.g., "Sometimeshewearstoo many'hats'and issuesgetsidetracked orignored and Sometimes aprob-lem [or 1fear itwillbe],but it hasnever actually seemed thatwhatI say in onecontexthurts m e in theother").Respondents estimated the percentage of tim e their supervi-sorspentineachof fivesupervision roles (cf. Bernard&G ood-year, 1992).Supervisors spentthemajorityoftheir tim eascon-sultants(44%); teacher (20%), evaluator (17%), administrator( 12%) , and counselor/therapist (5% ) roles were less frequent.Morethan29 % n =4 8)reported that ashift to the counselorrole wasappropriate, especially for transference and counter-transferenceissues;23% n= 54)stated that theyortheir super-visorset lim its on thisshift. For example, one reported, "Onlywhen 1invitedit, andthenverylimited. Anoth er stated that Ibelievethatshe and Iboth m aintainasolid bound ary th at stopswith supervision and does not go into therapy. Not all out-comeswere positive (e.g., I was in personal crisis;he was ex-tremelyun com fortable, and said it [acting as counselor] wouldneverhappenagain ").T hirty-nine percentof the respondentsindicatedthat thisshiftnever occurred.About 77% n = 176)of therespondentsreported that theirsupervisors maintained confidentiality;3% n = 7) reportedthatthe ir supervisorsdidnot.Twentypercent n= 46)wereno tsure.Supervisor goals. Frequencieso feight goals were assessedon a5-point Likert scale rangingfrom never( 1 )to usually(5).(Frequenciesoftechniques,assessment procedures, and discus-sion topics were alsoratedon thisscale.) From most toleastfrequentthese goals wereasfollows(m eans rangedfrom 2.05to4.17):adheretoethical standa rds, imp rove supervisee clinicalskills, facilitatesupervisee professional growth,satisfyhis or herown professional needs (e.g., enjoys doing supervision), facili-tate supervisee competencies, adhere to agency policies, andbuild supervisee professional identity. Supervisor personalneedssatisfaction (e.g.,has aneedto feelpowerful)wasrarelyimplemented.Supervisor techniques. The frequenciesof 15techniqueswereassessed.From mosttoleast frequent, they wereasfollows(means ranged from 1.60 to 4.08): support/encouragement,open-ended questions, information giving, advice, interpreta-tion,reflectingcontent,reflecting feelings,self-disclosure, mod -eling, supervisor case presentations, self-involving statements,influence, andclosed questions. Confrontationandhomeworkwererarely used.Assessment procedures. Frequencies of 1 0 supervisor as-sessment procedures were rated (means ranged from 1 .15 to4.42) ,andmostfrequentw ere verbal reportsandcase presenta-tions. Eight procedures were rarely used: case notes, writtenevaluations, role plays, cotherapy, transcriptions, live observa-tion,audiotapes,and videotapes.Discussion topics. Respondents rated the frequency of 21discussiontopics. From most to leastfrequent,these topics wereas follows (means ranged from 1.72to4.04):conceptualizingclient dynamics, selecting treatments, client diagnosis, thera-pist/client dynamics, clientprogress, ethical/legal issues, plan-ningcounselor behavior, counseling boundaries, long-term goalsetting, short-term goal setting, test interpretation, counselorprofessional development, progress as a counselor, unrelated

topics, counselor personal issues, administrative issues, and thesupervisor'scases. Rarely discussed were supervision bound-aries,thesupervision relationship, thesupervisor's personalis-sues, and gossip.Helpful/unhelpful supervision. Respondents described howtheir supervisors dealt with issues beyondthe supervisor's ex-pertise. Mostfrequent was referral to another professional or torelevantliterature (57% ,n= 137).About9 % n= 20) reportedthat their supervisor deniedth eissueorpretended competence.Respondents also described the most and leasthelpful aspectsof their supervision. Helpfulaspects included the supervisor'sfacilitative characteristics(e.g., empathy, trustworthiness, gen-uineness, and regard; 4 4 . 2 % , n = 102), clinical expertise(38.1% ,n =88), promotion of supervisee professional develop-ment(34.6% ,n =80),andtheoretical orientation (either similarto or different from the supervisee's; 4.8% ,n = 11). Interest-ingly,thesehelpfulaspects paralleled the criteria used to selecttheirsupervisors. Com m ents included She accepts me person-ally.Ifeel verysafediscussingm yfearsandlimitations"; Hisunderstanding ofhuman behaviorand feelings and his confi-dence in me and in the process of therapy ; and Expertisecombined with gentle, respectfulguidance."Responses about least helpful aspects were more idiosyn-cratic: interpersonal conflicts(10.4% , n= 24 ), supervisor lackoftimeorunavailability(10 .4% ,n=24), theoretical/conceptu-alizationdisagreements(8.2% ,n =19),d isorganized(8.2% ,n =19),too nondirectiveorvague(6.1% ,n = 14), personality con-flicts(6.1% ,n - 14),too much time spentonadm inistrativeissues(5.6% ,n = 13),lack ofexpertise (3.9% ,n =9), and toomuchdiscussion ofsupervisor's w ork (3.0% ,n =7).Comm entsincluded Not enough useful information and techniques ; Heneverconfrontsand Ithinkitm ightbehelpful occasion-ally ; His perfectionistic expectations . . .h is method of hav-ingm eredo work without help ; Sheis notalwayspredictableas to what kindof'mood'she is in ; and Sometimes I thin k hefeelscompelled to com e up w ith a new idea or some advice, tof u l f i l l his mandate to be 'supervising', when all that's reallyneededis asound ing board or affirmation.Tests of Group Differences

Multivariateanalysesofvariance indicatednosignificant in-teractions ormaineffectsdue togender, experience,ordegree.Therefore, noun ivariate analyses were conducted.Discussion

DoesSupervision Vary as aFunction of Experience?There were surprisinglyfew significantdifferencesdue to ei-theryearsofexperienceordegree. Perhapsdifferencesweresub-tle or were not detected by the questions asked on the CSQ.Furthermore, yearsofexperienceanddegreelevelareonlytwoaspects ofdevelopmentand may not be asstrongly related tosupervisionpracticesforpost-degree ind ividu alsastheyare fornovices. Additionalresearch isneeded to examine supervisiondifferencesat allpointsin theprofessionallifespan.In comparison with novices, the present sample reportedmore autonomy. Their supervisors were mostoftenin the less

8/13/2019 Clinical Supervision Practices of Licensed Psychologists

4/5

180 BRIEF REPORTSdirectiveconsultant role,whereas novices prefer a more direc-tiveteacherrole (Bernard&G oodyear, 1992).They also reliedon self-report; novices' supervisors are more likely to includebehavioral assessments. Furthermore, 17%of the present sam-ple reported that peer supervisionwastheir only sourceof su-pervision, whereas peer supervision would be adjunctivefornovices. Inthis study, supervision seemed client focused (e.g.,discussion most frequently concerned client issues and casemanagem ent). Little time was spent on the person of the su-pervisee or the supervisory relationship. Perhaps supervisionwith novices contains more of these elements. Additional re-searchis necessary to test this hypothesis.

Kurpius eta l.(1 9 9 1 ) cited evidencefrom 1981that a prepon-deranceo fstudenttrainees'supervisorsa rem en, implying thatm enare m ore competent than w omen and should be given m orepower.Theyspeculated that trainees might not choose femalesupervisors whengiven the opportunity. Th e present findingssuppo rt the preponderance of male supervisors in a postdegreesample (ab out two thirds); however, m ore fem ale than male re-spondents had female supervisors (43.6%vs . 18.4%).Because70% of therespondents selected their supervisors,it islikelythatgender played some sort of role in their choices. Research isneeded to assessth eextenttowhichsexrole stereotypingm aybeafactor.

Ethical Practicesof SupervisorsSeveralof the present resultsreflect ethical concerns raisedby Kurpiuset al.(1991 ) .They argued that supervisees havearight to clarification of supervisor credentials. Although morethan 9 9 % of the respondents k new their supervisors' clinicalcredentials,72% did notknow whether their supervisorhad any

supervisiontraining. K urpius et al.( 1 9 9 1 ) recommended thatsupervisors provide a professional self-disclosure statem ent.Another aspect of informed consent isconfidentiality.Onefifthofthe participants were not sure whethertheirsupervisorsmaintainedconfidentiality, whereas3%reported that theyd idnot. S upervisors should specify limits to confidentiality as partof informed consent.The second ethical concern raised byKurpiuset al.( 1 9 9 1 )was accou ntability. Several of the results suggest that the qu alityofsupervision washigh.Forexample, about75% of the super-visorsheld doctoral degrees, they had been in the field an aver-ageof 19years, and most were active practitioners. Dual roleconflictsp artially were avoided in that 70%wereno t responsi-ble for both administrativean d clinical supervision. Supervi-sors rarely moved into atherapist role. The most frequent su-pervisorgoals were ethics, im provem ento fclinical skills,andsupervisee professional developm ent. Few respondents reportedthat their supervisors primarily gratified their ow n needs or wastedtime"in supervision. Most of the supervisors had sup-portive styles,characterizedby the Rogerian facilitative condi-tionsfound to be"ideal"supervisor ch aracteristics(Carifio&Hess, 1987).Most knew their limits, referringsuperviseesasnecessary.However, some of the findings could be problem atic. First,only24 %knewthat th eir supervisorshad anytrainingin super-vision (e.g., continuing education). Second, Kurpius et al.( 1 9 9 1 ) argued that supervisors should regularly review theireffectivenessbysoliciting supervisee feedb ack. Such reviewsap-pearto occurinfrequently;4 8% reported that the relationshipbetween supervisor and supervisee was rarely discussed, and27% indicated that it was never discussed. T hird, respondentslistedtransferenceand countertransferenceas one of the mostfrequent topics and self-report as the prim ary assessment pro-cedure. R eview of actual work rarely occurred. Although expe-rienced practitioners mightbem ore skilleda trecognizing andaddressing these dynamics, theycan operate "unconsciously"and,to that extent, mightbe"unsupervised."Ideally,supervi-sorswouldassess behavior sam ples.Another potential ethical issue is gender role stereotyping.

Limitso f th eStudySeveral limits suggest caution in generalizing the results. A45% response rate, although comparable to ratesofother sur-veys (e.g., Borders &Hamilton-Usher, 1992), represents onlya portion of the practitioners surveyed.Therespondents werealmost exclusively Wh itean dwerefrom onemidwestern state.

Furthermore, about 50% were master's-level licensees. Al-thoughtheir responses werenot significantly different from thedoctoral-level licensees included in this study, they m ayhavelimited generalizability because most psychologists in theUnited States havedoctorates. A shorter version of the CSQ,containing items that appear to have generated the most infor-mativeresults, co uldbesentto across section ofpsychologists.Anotherl imitisrelianceon self-report. Although this methodmaybevalidforsupervisee demographics,it isquestionableforassessing supervisor dem ographics and supervision process. Be-cause half of the sample respondents reported that they eithercurrentlyprovided supervision or had some supervision train-ing,their responsesmay bemore valid because they knowsu-pervision from "bothsides." Nevertheless, behavioral analysesareneeded.Ifself-report methodsareused,bothsuperviseesand supervisors should be surveyed. Finally, the present studyfocused on supervisionprocess rather than outcome. As Bor-ders(19 89 )stressed, client outcome should be the ultim ate con-cern.AdditionalResearch Recommendations

Several questions sho uld beaddressed:Are there qualitativedifferences between individualswh oelecttoreceive clinicalsu-pervisionand those who do not (e.g., in th is study, a dispropor-tionatenumberofmalepractitioners chosenot toreceive super-vision)?Issupervision differentwhen supervisors areassignedversusselected or trained versus untrained? What are the rela-tionshipsbetween supervision practices and supervisee satisfac-tion,change, and client outcome? We hope that answers to thesequestionswilllead to im provem ents in supervision and in theprovisionof psychological services.References

ACES adopts standards for counseling supervisors. (1989, Spring).ACES Spectrum,pp.7-10.Allen,G .,Szollos,S., &W illiams,B. (1986).Doctoral students' com-parative evaluations of the best and worst psychotherapy supervision.Professional Psychology:Researchan dPractice,1 7,91-99.

8/13/2019 Clinical Supervision Practices of Licensed Psychologists

5/5

BRIEF REPORTS 181Bernard, J. M., & Goodyear, R. K. (1992).Fundamentals ofclinicalsupervision.NeedhamHeights,MA:Allyn&Bacon.Borders, L. D.(1989) . A pragmatic agenda for developmental supervi-sion research.C ounselor Education a nd Supervision, 29,16-24.Borders, L.D.,&Hamilton-Usher,C. H.(19 92). Post-degree supervi-sion: Existing and preferredpractices.JournalofC ounseling and De-velopment, 70 ,594-599.Carifio, M. S., & Hess, A. K. (1987).Who is the ideal supervisor? Pro-fessional Psychology:Researchan dPractice,18,244-250.Fitzgerald, L. E, &Osipow,S. H.(19 86).An occupational analysisofcounseling psychology: How special is the specialty? American Psy-chologist,4 1,535-544.Kenfield, J. ( 1 9 9 1 ) .The nature of supervision among experienced fe -male psychologists.U npublished manuscript, Universityof Minne-

sota,Minneapolis.Kurpius,D.,G ibson,G .,Lewis,J.,&Corbet,M .( 1 9 9 1 ) .Ethical issuesin sup ervising counseling practitioners. CounselorEducationand Su-pervision,31,48-55.

McCarthy, P.R.,DeBell,C., Kanuha, V.,&McLeod,J.(1988).Mythsof supervision: Identifying the gaps between theory and practice.CounselorEducationa nd Supervision,28,22-28.Robiner, W . N., & S chofield, W. (19 90). References on supervision inclinical and counseling psychology. Professional Psychology: Re -searchand Practice, 21,297-312.Zins,J. E.,Murphy,J.J.,&Wess,B. P.(1989) .Supervision in schoolpsychology: Currentpracticesandcongruence w ith professionalstan-dards.SchoolPsychologyReview,18,56-63.Zucker, P.J.,& Worthington, E.L.,J r. (1986). Supervision of internsand postdoctoral applicants for licensure in university counselingcenters.Journalof CounselingPsychology, 33 ,87-89.

Received January27, 1 9 9 3RevisionreceivedAugust5, 1 9 93

AcceptedSeptember9, 1993

A M E R I C A N P S Y C H O L O G I C A L A S S O C IA T IO NS U B S C R I P T I O N C L A I M SI N F O R M A T IO N Today sDate:.

Weprovidethisform to assist members,institutions,andnonmemberindividualswithanysubscriptionproblems.Withtheappropriateinformation wecanbeginaresolution.Ifyouuse theservicesof anagent, please doNOTduplicateclaimsthroughthem anddirectlyto us. PLEASE PRINTCLEARLYAND IN INKITPOSSIBLE.

PRINT FULLNAME OR KEY NAME OF INSTITUTION MEMBER ORCUSTOMERNUMBER (MAYBE FOUND ON ANYPAST ISSUELABEL)

DATE YOUR ORDER WASMAILED(OR PHONED)

_CHECK CHARGECHECK/CARDCLEARED DATE:_CITY STATE/COUNTRY

YOUR NAME ANDPHONENUMBER

TITL

(Ifpossible,send acopy,frontand back, ofyourcancelledchecktohelpus in ourresearchof your claim.)

ISSUES: MISSING DAMAGED

VOLUMEOR YEAR NUMBER OR MONTH

Thank you. Once a c laim is received an d resolved delivery of replacement issues routinely lakes4 6weeks. (TOBEFILLEDOUTBYAPASTAFF) DATE RECEIVED:.ACTION TAKE N:_STAFF NAME:

DATEOFACTION: _I NV. NO. DAT E:LABEL NO. DATE:Sendthisformto APASubscriptionClaims, 750FirstStreet,NE ,Washington, DC20002-4242

PLEASEDO NOT REMOVE. APHOTOCOPYMAY BEUSED.