Psychotherapy Supervision Developments and Innovations for the New Millennium: Contributions from the Cutting Edge

Psychotherapy supervision, which has been more than a century in the making, can be defined as a “distinct professional activity” (Falender & Shafranske, 2004, p. 3), “an intervention” (Bernard & Goodyear, 2014, p. 9), or “a pedagogical method” (Gordan, 1996, p. 1) in which a senior professional (supervisor) serves as mentor or guide to a junior professional (supervisee) who is in the process of learning and practicing psychotherapy. Supervision is designed to enhance supervisees’ professional functioning, involves evaluation of that professional functioning by the supervisor, and is a hierarchical monitoring process (supervisor to supervisee) that serves to protect both patients and profession (Milne, 2007; Milne & Watkins, 2014; Thomas, 2010).

In psychotherapy education, supervision may well be our “single most important contributor to training effectiveness” (Gonsalvez & Milne, 2010, p. 233)—unparalleled in its power and potential to prepare budding therapists for practice and assist more advanced therapists further develop their treatment skills. During the last few decades attention to and interest in supervision have grown: Its educational stature has increasingly ascended, it has become solidly and firmly established as a substantive area of practice and inquiry, and its relevance and reach have increased internationally (Bernard & Goodyear, 2014; Borders & Brown, 2005; Hess, Hess, & Hess, 2008; Milne, 2009; Watkins, 1997; Watkins & Milne, 2014). The educative power and preeminence of supervision in the teaching and learning of psychotherapy appears to be appreciated as never before, and all indications suggest that this sweeping embrace of supervision can be expected to continue unabated in the years and decades ahead (cf. Bernard, 2005; Gonsalvez, 2008; Hess, 2011; Roth & Pilling, 2008; Szecsody, in press; Watkins, 2012b).

Psychotherapy supervision is a primary means (if not the primary means) by which we teach, transmit, and perpetuate the traditions, practice, and culture of psychotherapy. Furthermore, supervision is also a professional service that (a) many practitioners will provide at some point during their careers, and (b) merits its own specific training attention if it is to be done well (Fleming, 2012; Watkins, 2012a). Psychotherapy supervision, broadly and routinely embraced as an educational sine qua non, looms large in the “the making” of psychotherapy practitioners.

During the last generation of supervision study and practice, a number of substantive changes occurred in the landscape of psychotherapy supervision that forever altered it. Some of the most exciting and revolutionary changes transpired in the last decade. The focus of this journal issue will be on several recent supervision developments and innovations. In what follows, two specific questions will be addressed:

What are some of the most recent, cutting edge supervision developments and innovations that most merit our attention?

Why do they seem so significant for supervision now and in the future?

Matters that will be given accent—supervision competencies/best practices, evaluation, research, supervisor training, and technology, have been chosen because of either (a) the significant impact they already have had on the supervision field or (b) the possibility of significant and enduring impact they appear poised to deliver. The topics under review are transtheoretical in reach, and all presentations will reflect that. In the subsequent pages, you will be treated to a cornucopia of supervision innovations and possibilities. The contributors and their contributions include the following.

1. Topic: Best practices in clinical supervision. DiAnne Borders, Ph.D., Department of Counseling and Educational Development, University of North Carolina, Greensboro. In her paper, Borders: (a) addresses the importance of the best practices concept for supervision practice; (b) identifies how it is different from yet complementary to the concept of competencies; and (c) provides an overview of the Association of Counselor Education and Supervision’s (ACES) best practices document and discusses its trans-discipline supervisory relevance.

Why this paper matters: As complement to competency delineation efforts (e.g., Falender, Cornish, Goodyear, Hatcher, Kaslow, Leventhal, Grus, 2004; Roth & Pilling, 2008, 2010; Psychology Board of Australia, 2013; Turpin & Wheeler, 2011), recent effort has also been advanced toward identifying the best practices of clinical supervision. These practices, in contrast to competencies, reflect a different standard for consideration—capturing what supervisors are to do when providing supervision services. As Borders describes, “competencies outline required declarative knowledge, or what a competent supervisor needs to know, while best practices provide the basis for procedural knowledge, describing when and how declarative knowledge is applied, or what a supervisor does during supervision.” But what do such best practices actually “look” like? Shaped and formalized under Border’s (2012) direction, no more comprehensive a work has been produced in answer to that question than the ACES best practices document, and her paper gives voice to that seminal document and its significance for best practices consideration.

2. Topic: The importance of learning objectives in psychotherapy supervision. Deborah Cabaniss, M.D., Diana Moga, M.D., and Melissa Arbuckle, M.D., Department of Psychiatry, Columbia University Center for Psychoanalytic Training and Research. In their paper, Cabaniss, Moga and Arbuckle (a) describe their program of study about learning objectives; (b) provide recommendations for how practitioners can most meaningfully make learning objectives a central part of the supervisory process; and (c) indicate needed directions for future study and practice.

Why this paper matters: Over the past 15 years, Cabaniss and her colleagues have programmatically studied and made the compelling case for using learning objectives in psychotherapy education (e.g., Cabannis, 2008, 2012; Cabannis & Arbuckle, 2011; Moga & Cabaniss, in press; Rojas, Arbuckle, & Cabaniss, 2010). As Cabaniss et al. state in their paper here, “Use of objectives in psychotherapy supervision will enhance the supervisee’s experience of supervision; help supervisors to direct learning in supervision; help supervisors, supervisees, and program directors to know whether trainees are attaining goals; and help programs to alter supervisory techniques.” Where such learning objectives are lacking, confusion, anxiety, disorganization, and compromised learning may well be the result for supervisees (Cabaniss, 2008; Rojas et al., 2010). But as Cabaniss et al. make clear, it does not have to be that way; they indicate, instead, that learning objectives can be used as anchoring ground and organizer for the entirety of the supervision process, and they show what needs to be done to make that so.

3. Topic: Making evaluation more accurate and meaningful for psychotherapy supervision. Craig Gonsalvez, Ph.D., School of Social Sciences and Psychology, University of Western Sydney, Australia, and Trevor Crowe, School of Psychology, University of Wollongong, Australia. In this paper, Gonsalvez and Crowe: (a) describe their program of study into supervision evaluation and identify its implications for supervision practice; (b) provide recommendations for how practitioners can most meaningfully make evaluation count in supervision; and (c) indicate needed directions for future study and practice.

Why this paper matters: Evaluation is a central defining feature of supervision. But if there is one problematic aspect to supervision, it is evaluation, and that reality has been well recognized (Ellis & Ladany, 1997; Ellis, D’iuso, & Ladany, 2008). Gonsalvez and his colleagues (e.g., Gonsalvez, Bushnell, Blackman, Deane, Bliokas, Nicholson-Perry … Knight, 2013; Gonsalvez & Freestone, 2007) have long been engaged in a multisite research initiative to investigate how to make supervision evaluation more accurate and meaningful. As Gonsalvez and Crowe point out in their paper, “Supervisor evaluation of psychotherapy competence is a complex and daunting challenge because a large diversity of psychotherapies, each founded on different theoretical assumptions and principles, offer diverse conceptualisations of what might constitute best-practice.” What then is a supervisor to do? The Gonsalvez/Crowe paper takes up that question, provides a well-informed and thought-provoking overview about supervision/evaluation issues, and presents a highly incisive perspective on how to make evaluation more useful for supervision practice.

4. Topic: Training supervisors for competent supervision practice. Janine Bernard, Ph.D., Department of Counselor Education, University of Syracuse.

In her paper, Bernard (a) describes a novel form of supervisor training; (b) provides substantive foundation for her educational program; and (c) presents supervision examples of its implementation.

Why this paper matters: Bernard has been substantively contributing to the supervision literature for decades and effectively training supervisees and supervisors for competent practice (see Bernard, 1979, 1997; Bernard & Goodyear, 2014). Yet as she rightly points out in her current paper, how to best train supervisors remains a pressing issue in the field: “Despite a rich professional literature … that provide[s] insight into the [supervisee] learning process, there has been less focus on pedagogy to achieve supervisor competence.” Innovative approaches to providing such training are sorely needed. Bernard’s paper provides one well informed, informative perspective on how to begin filling that void. Her unique approach privileges supervisor education, draws on actively involving the supervisor trainee in a rich learning process of directed note taking, reflection, and feedback, and shows much promise in studiously making the supervisor-training experience matter and matter greatly.

5. Topic: Advancing supervision research by means of the fidelity framework. Derek Milne, Ph.D., Newcastle University, Newcastle upon Tyne, England. In his paper, Milne (a) describes the fidelity framework; (b) indicates how it can be meaningfully used in clinical supervision research; and (c) provides useful example to that effect.

Why this paper matters: The current state of supervision research has been compared to psychotherapy research in the 1950s and 1960s: “…. we are currently about ‘half-way there’, working on the ‘search for scientific rigour’…” (Milne, Leck, James, Wilson, Procter, Ramm … & Weetman, 2012, p. 144). But if we are to move beyond “halfway there,” how might we begin to set that process in motion? Milne and his colleagues (Culloty, Milne, & Sheikh, 2010; Milne et al., 2012) have proposed that the fidelity framework—effectively employed in health behavior research—can be used to advance research in clinical supervision. In his paper here Milne reconceptualizes the outcome evaluation issue in supervision. He persuasively presents the fidelity framework as being “a supervision-specific, systematic agenda for evaluating clinical supervision …” and proposes that it has the potential to foster an “evolutionary leap” in supervision research. His provocative paper clearly helps to see how the possibility of evolutionary leap could readily be made into supervision actuality.

6. Topic: Using technology competently to enhance competent supervision practice. Tony Rousmaniere, Ph.D., University of Alaska, Fairbanks, Alan Abbass, M.D., Dalhousie University, Jon Frederickson, Ph.D., Washington School of Psychiatry, Inés Henning, Ph.D., International Psychoanalytic University, Berlin, and Svenja Taubner, Ph.D., International Psychoanalytic University, Berlin. In this paper, Rousmaniere, Abbass, Frederickson, Henning, and Taubner (a) consider some of the most exciting technological developments to emerge for psychotherapy supervision in recent years; (b) provide examples of how videoconference-based supervision can be viably used in practice; and (c) describe an international program in which videoconference-based supervision has played and continues to play a prominent role.

Why this paper matters: The rapid escalation of technological developments in psychotherapy and psychotherapy training, including videoconferencing, has been both exciting and dizzying. And such rapid technological developments show no signs of slowing down. In their paper, Rousmaniere et al—all afficianados of and experts in technological advances in treatment and training (see Abbass, Arthey, Elliott, Fedak, Nowoweiski, Markovski, & Nowoweiski, 2011; Rousmaniere, 2014; Rousmaniere & Frederickson, 2013; Taubner & Henning, 2013)—make effort to help us better navigate those fast developing technological waters in supervision. As they make clear, “technology is greatly enlarging the availability of psychotherapy training throughout the world.” They show us just how that is so, providing instructive supervision case examples and description of a joint Chinese and American psychoanalytic training program. Their paper bears testament to the power of technology to “enlarge and enrich” the supervisory experience and is good reading for stimulating further thought about how to make those desiderata become reality.

7. Topic: Pressing needs and impressing possibilities in supervision practice and research. Ed Watkins, Ph.D., Department of Psychology, University of North Texas. In conclusion, I provide a summary review piece about pressing needs and impressing possibilities for psychotherapy supervision across four critical areas (a) supervision training and practice; (b) measurement; (c) difference and diversity; and (d) research.

Why this paper matters: In looking back at supervision’s history, what continue to be some of the most pressing needs? What are some ways in which supervision has recently advanced? I examine those two questions by considering how supervision now compares with supervision from approximately two decades ago (Watkins, 1995, 1998). As I state in my review here, “In supervision’s continued advance, the varied [identified] needs … call for, even demand, our studious attention and action in the years and decades ahead; through their being better addressed, the immense promise and possibility of clinical supervision stand to be more fully realized ….” My review ideally serves as both a celebration of good works done and roadmap for charting future direction in supervision study.

While this issue reflects the multi-disciplinary nature of psychotherapy supervision (with psychology, psychiatry, counselor education, and social work represented), each contribution is unequivocally transdisciplinary in its supervision message and implications. Although such varied terms as “psychotherapy supervision,” “clinical supervision,” or “counseling supervision” will be used across the subsequent articles, all authors will be referring to the same educational process: The supervision of psychological treatment services. Perhaps if there is one binding question that suffuses this journal issue, it would be this: How can we as supervisors make supervision a best practices endeavor in every respect? That question is ably addressed across all papers that follow, and the answers that the authors provide are highly instructive and eminently progressive in message and meaning.