Therapy-Based Models

Morgan and Sprenkle (2007) noted that early clinical supervisors often had little or no formal training in supervision and tended to merely apply clinical theories to the supervision process. It is generally accepted that the assumptions therapists have of human nature will also impact how they construe all interpersonal behavior, including supervision. Moreover, although there are important differences between therapy and supervision, many of the techniques used in therapy are used in supervision as well (Bernard and Goodyear, 2004, p. 76).

Psychotherapy-based supervision models can feel like a natural extension of the therapy model, often heavily sharing the same concepts, areas of focus, and terminology. Even today, it is still very common practice to apply theories of therapy to supervision. This has to be done thoughtfully and intentionally, however, given that the supervisory relationship is not equivalent to the client–therapist relationship, and the skills and areas of emphasis differ.

Psychodynamic Therapy

Given the prevailing influence of Freudian concepts during the formative years of psychology as a profession, the psychodynamic model heavily influenced the early years of supervision. This approach required the supervisee to undergo psychoanalysis so that the therapist would not be reactive to the client and hinder the therapeutic process. (Although most training programs today do not formally require students to have personal experience with psychotherapy, we highly encourage it. As we frequently tell our students and supervisees, it feels very different in the client chair than in the therapist chair, and often what feels comfortable from the perspective of the therapist is not necessarily what feels comfortable or helpful from the client’s perspective. Although it is possible to become a good therapist without having personal therapy experience, it is akin to expecting someone to become an exceptional basketball coach without ever having played the game—certainly possible, but likely the exception.)

Psychodynamic supervision focuses on client processes from the psychodynamic orientation, viewing the supervisee through the lens of Freudian psychological processes, such as transference and countertransference, defense mechanisms, conflict, and so on. Commenting on the parallels between psychodynamic therapy and supervision, Dewald (1997) noted that both processes need a solid alliance and the feeling of safety, as well as empathic understanding and attunement to the processes of transference and countertransference. Given the similarities, Dewald stated that “if one were a skilled analyst, one would be able to do skilled supervision” (p. 41). However, it is likely that just as good therapists do not necessarily make good clinical faculty members, their ability to make good supervisors is also probably subject to individual differences.

Psychodynamic supervision is broadly classified into three categories depending upon the area of focus: patient-centered, supervisee-centered, and supervisory-matrix-centered (Frawley-O’Dea & Sarnat, 2001):

Person-Centered Supervision

Person-centered supervision is based on the application of Carl Rogers’s (1957) facilitative conditions of psychotherapy to the practice of supervision. Rogers regarded his counseling theory as influencing his supervisory approach and believed that the facilitative conditions of genuineness, warmth, and empathy are essential for effective supervision, just as they are central to psychotherapy. Regardless of theoretical orientation, the underpinnings of most counseling skills training programs in most countries today (e.g., microskills training) rests upon Rogerian foundations and acknowledges the importance of creating an atmosphere of safety, understanding, and authenticity.

Person-centered supervision assumes that the supervisee has the innate ability and resources to develop as a therapist, and the task of the supervisor is to create a collaborative partnership with the supervisee to provide the conditions in which the supervisee can be present to the client’s experience and be fully engaged with the client (Lambers, 2000). The “attitudes and personal characteristics of the therapist and the quality of the client–therapist relationship” are regarded as the prime determinants of the therapeutic outcome in psychotherapy (Haynes, Corey, and Moulton, 2003, p. 118), and in supervision, the working alliance is regarded as the primary vehicle to facilitate the trainee’s learning and growth.

Rogers’s conceptualization of supervision leans more toward the therapy end of the continuum than many other supervision approaches. In an interview with Goodyear, Rogers stated “I think my major goal is to help the therapist grow in self-confidence and to grow in understanding the therapeutic process. And to that end, I find it very fruitful to explore any difficulties the therapist may feel he or she is having working with the client. Supervision for me is a modified form of the therapeutic interview” (Hackney and Goodyear, 1984, p. 283).

Cognitive Behavioral Supervision

As with psychodynamic and person-centered supervision, cognitive behavioral supervision infuses the supervision process with many of the techniques and theoretical concepts of the underlying theoretical orientation. Padesky (1996) asserted that the same processes and methods that characterize the cognitive behavioral therapy (CBT) process can be used to teach and supervise therapists (p. 289), and noted that both therapy and supervision incorporate many similar activities, such as goal setting, checking-in, and eliciting feedback.

CBT-oriented supervisors typically negotiate an agenda with the supervisee at the beginning of each session and continuously assess and monitor the supervisee’s progress. Behavioral practice may be stressed during both counseling and supervision sessions, including through such means as behavioral rehearsals and role playing. CBT-focused supervisors rely heavily on Socratic questioning and challenging the supervisees’ misconceptions. Other areas of focus include establishing a strong working relationship, skill analysis, and assessment; setting supervision goals and strategizing and implementing methods to achieve the goals; follow-up evaluation and generalization of learning; and, at times, assigning homework to the supervisee (e.g., Liese & Beck, 1997; Rosenbaum and Ronen, 1998). Cognitive behavioral supervision also emphasizes the use of the trainee’s observable cognitions and behaviors, especially regarding reactions to the client (Hayes et al., 2003).

Systemic Supervision

Systemic supervision, based upon the theoretical perspective of systemic family systems therapy (e.g., Haley, 1987; Watzlawick, Weakland, and Fisch, 1974), is characterized by focusing importance and attention on the similarities between family systems and supervisory systems. Consequently, issues such as structure and boundaries take on special importance in supervision.

Within the systemic model, which is widely used by marriage and family therapists and supervisors, among others, it is believed that there should be a close correspondence and theoretical consistency between therapy and supervision (e.g., McDaniel, Weber, & McKeever, 1983). This close correspondence between therapy and supervision is referred to as isomorphic translation (Rigazio-DiGilio Daniels, & Ivey, 1997, p. 224) or parallel processes. One implication, grounded in structural family therapy, is that supervision should maintain clear boundaries between the supervisor and supervisee, similar to the clear boundaries a marriage and family therapist would want to maintain with families in therapy.

The systemic supervision process, as with systemic therapy, is also premised upon collaboratively establishing clear, meaningful, and effective goals (e.g., Haley, 1987; Watzlawick, Weakland, & Fish, 1974). This “coconstructive process” is based upon the emerging and evolving relationship between supervisor and supervisee (Milne, 2009, p. 30). Haley (1987) and Liddle, Breunlin, and Schwartz (1988) stress the importance of a successful first session to serve as the foundation for both successful therapy and clinical supervision.

A key principle is that as the structure of the supervision process is constructed and solidifies, this emerging structure becomes the vehicle through which the supervisee will learn and develop. Mirroring typical family therapy, the supervisor takes on an active, directive, and collaborative role (Liddle et al., 1997, p. 413). Papadopoulos (2001) notes, similar to Yalom and Leszcz's (2005) seminal distinction between a process and content orientation, that systemic supervision distinguishes between information and data. One of the primary tasks of supervision is to help the supervisee realize that not everything heard in session is helpful to the therapeutic process and to learn to “discriminate between information and data and to increase their effectiveness in eliciting appropriate information” (pp. 406–407).

Developmental Supervision

Developmental models of supervision are based on the assumption that clinicians in training pass through predictable stages of development as they gain increased knowledge and skill. The task of the supervisor is to identify the stage of the supervisee and to tailor the focus and approach of supervision in accordance, with the general assumption that a beginning therapist needs more structure and guidance, whereas a more advanced clinician benefits from a more collaborative and conceptual focus. The stages of growth and learning are qualitatively different from each other, and each stage of development requires different approaches and emphases in supervision. Developmental supervision models became particularly prominent in the 1980s, prompted especially by the work of Cal Stoltenberg (1981) and Ursula Delworth (Stoltenberg & Delworth, 1987).

Influential developmental psychologist Lev Vygotsky (e.g., Vygotsky, 1978) regarded it as important for supervisors to provide tools and models designed through carefully “scaffolding” their supervisees’ training experiences to meet their developmental needs. He coined the term “zone of proximal development” (ZPD) to describe the difference between what learners can do on their own and what they can do with assistance. Development occurs though the use of scaffolding offered by someone with more knowledge and experience who provides increasingly challenging experiences as the learner acquires greater mastery. The supervisor helps to elicit and clarify what the supervisee already knows, building upon these strengths and drawing out the supervisee’s understanding. Milne (2009) likens the scaffolding process to the metaphor of taking a journey with a guide. The supervisee must exert effort and take some chances, thereby contributing to what is undertaken and achieved, but the process works best with a supervisor who behaves like an experienced guide who can draw on the experience of already having traveled the path (p. 131).

Developmental models such as Stoltenberg and Delworth’s (1987) focus on tailoring the supervision process to meet the supervisees’ current level of development, based on the premise that supervisees go through predictable stages of development. As the supervisee develops competence or mastery, the supervisor gradually moves the scaffolding to encourage the supervisee to apply the learning to the next and more difficult stage.

Developmental models of supervision typically define progressive stages of supervisee development (e.g., from novice to expert), and describe specific characteristics, tasks, and skills expected for each stage. Developmental supervision depends upon the supervisor accurately identifying the supervisee’s current stage of development and adapting the supervision focus and approach to appropriately meet both the competencies and the interpersonal needs of the supervisee. The supervisee is ideally both supported (which provides a sense of security) and challenged to stimulate growth and learning.

Heppner and Roehlke (1984) studied supervisees over a 2-year period to examine the implications of supervisee development on the supervision process. Beginning-level practicum students reported valuing support combined with skills training, essentially wanting to know the “right way” to conduct therapy. As supervisees gained more experience, they gained more of an appreciation for conceptualizations and a deeper understanding of the therapy process. Beginning practicum students identified issues of support and self-awareness as “critical incidents,” whereas the most advanced trainees (doctoral interns) tended to report more critical issues around personal issues and defensiveness affecting therapy.

Although developmental models are intuitively appealing to both supervisors and supervisees, in actual practice, supervisors appear to provide the same sort of supervision to all supervisees regardless of their level of experience (Sumerall et al., 1998). Fortunately, supervisees seem not to mind. In a study of 100 supervisees, Ladany, Marotta, and Muse-Burke (2001) found no differences in supervisee preferences based on level of clinical experience and asserted that the concept of developmentally different levels of supervision may be “based more on clinical lore than on research” (p. 215).

Common Factors Approach

Despite the many different supervision models that exist, there is no evidence to suggest that any one model of supervision is in any way superior to any other (Morgan and Sprenkle, 2007). Goodyear and Bradley (1983) examined the similarities and differences between the five most dominant clinical supervision theories at the time (rational emotive, behavioral, client-centered, developmental, and psychoanalytic), and stated they were “struck with the extent to which supervision techniques must be similar across supervisors, regardless of theory” (Goodyear & Bradley, 1983, p. 63). Noting the absence of superiority of any one model, Sprenkle (1999) argued for the need to examine the aspects of supervision that transcend the various different approaches. With increased experience, clinical supervisors seem to focus less on the differences between theoretical approaches and to gravitate toward the common factors in their practice. Less experienced supervisors tend to differ in ways based on their theoretical orientation, whereas more experienced supervisors share much more of their emphases in common (Goodyear and Robyak, 1982).

Morgan and Sprenkle (2007) note that whereas the common-factors approach in psychotherapy emerged from empirical studies on clinical outcomes, there is not yet a comparable body of research in supervision from which the common factors of supervision can be drawn. However, they suggest that this does not negate the potential benefits of identifying important elements shared by supervision models (p. 6). And, as there is a lack of empirical support for adopting one theoretical model to the exclusion of others (Storm, Todd, Sprenkle, and Morgan, 2001), it seems only reasonable to focus on the common factors. “We believe that it is unlikely that any one model, common factors or otherwise, will ever emerge as the best way to supervise everyone under every situation. Human beings and the process of supervision are too complex to brook such hubris. But there are likely a set of elements that most good supervision will have in common” (Morgan & Sprenkle, 2007, p. 7).

The results of the review by Morgan and Sprenkle (2007) identified a number of general supervision domains:

The literature also finds commonalities regarding a variety of areas to which supervisors must attend during supervision. These include the following responsibilities:

A third element widely regarded as important to supervision is the quality of the supervisory relationship, which was almost universally described as a critical element. This seems to apply whether the relationship is collaborative or more hierarchical and directive. However, the research from a variety of studies seems to suggest that supervisees prefer to have a high degree of support from their supervisors, regardless of how directive or collaborative the relationship is (p. 10).

The review of literature on common factors suggests four frequently identified supervision roles, as follows:

Good supervision involves flexibility and the ability to work from within multiple supervisory roles (Morgan & Sprenkle, 2007, p. 12). It should also be noted that although many theoretical models exist, as with the application of psychotherapy, practice is often very eclectic. Probably resulting from the fact that formal training in supervision is often the exception and not the rule, surveys indicate that the most popular supervision model actually used is simply to draw upon one’s own supervision experiences (Falender and Shafranske, 2004). Although drawing from one’s own experience can be a valuable and important component of the practice of supervision, it is doubtful that anyone would argue that is the method of choice for any professional activity, ranging from flying a plane to performing medicine to offering supervision. Given the importance and influence of supervision, hopefully formal training in supervision will soon become the norm and the expectation.

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