Wednesday, December 11, 2013

Rehabilitation Counseling Supervision:  Past, Present, and Future

Katie A. Wachtel, The University of North Carolina at Greensboro

What is the purpose of this literature review?
            There has been significant controversy regarding whether rehabilitation counseling (RC) should be considered a specialization of the counseling profession or its own unique profession.  Proponents of the belief in RC as a unique profession have argued that this should include specialized definitions, models, standards, and practices for supervision.  However, despite this belief, supervision has been largely ignored in both the research and practice of RC.  Recent revisions to RC ethical standards and research findings in the area of RC supervision, summarized below, may prove impactful on the way in which rehabilitation counselors conceptualize and practice supervision.

Major findings or points: 
A review of the literature indicated that prior to 1995 there was no distinct definition or model for supervision within the rehabilitation context, despite arguments that the nature of RC warrants distinctive supervision interventions.  Maki and Delworth (1995) proposed a definition and model unique to RC; however, ethical guidelines for RC supervision were not established until 2002.  Requirements of specialized training in supervision, use of a variety of evaluation methods, documentations of sessions, and multicultural competence were added in the 2010 revision of the ethical guidelines.
            Despite the adoption of ethical standards related to supervision in RC, minimal research has been conducted in this area, and the few researchers who have examined supervision have found that clinical practices in supervision may still be lacking.  Researchers have found that a majority of research on supervision in RC has been conducted using trainees so that little is known about supervision practices post graduation.  Supervision continues to be an important part of professional development and can protect against a decrease in counseling skills; however, many supervisees in professional settings report only receiving supervision on an as-needed basis.  Similarly, supervisees and supervisors alike consistently report confusion between administrative supervision and clinical supervision.  Supervisees overwhelmingly report only receiving supervision as part of team meetings and report slight to moderate satisfaction with administrative supervision, but less than satisfactory feelings regarding clinical supervision.  In addition, individuals who report lower satisfaction with supervision are often those reporting more frequent supervision.  A majority of supervisors report little to no formal training in supervision.  Based on these findings, it appears that clinical practice of supervision in RC is overall not perceived as effective and steps may need to be taken to improve supervision in professional RC settings.
What does this research mean for counseling practice, settings and/or training?
            Although ethical standards for RC supervision have been established and revised, a majority of supervisors and supervisees continue to report dissatisfaction with supervision practices.  It may be important to stress formal training of supervisors using the models developed specifically for RC to assist supervisors in better understanding and implementing supervision practices.  Supervisees may benefit from the adoption of ethical standards in that they will allow supervision to encompass specific expectations and goals.  This can help to add structure and understanding to the supervision process, which may assist both the supervisee and supervisor in feeling more positively about the experience.

Rehabilitation counseling, supervision

For Further Reading:
Blackwell, T. L., Strohmer, D. C., Belcas, E. M., & Burton, K. A.  (2002).  Ethics in rehabilitation counselor supervision.  Rehabilitation Counseling Bulletin, 45, 240-247.
Glosoff, H. L., & Matrone, K. F. (2010). Ethical issues in rehabilitation counselor supervision and the new 2010 Code of Ethics. Rehabilitation Counseling Bulletin, 53(4), 249-254. doi:10.1177/0034355210368729
Herbert, J. T., & Trusty, J. (2006). Clinical supervision practices and satisfaction within the public vocational rehabilitation program. Rehabilitation Counseling Bulletin, 49, 66-80.
Maki, D. R., & Delworth, U. (1995). Clinical supervision: A definition and model for the rehabilitation counseling profession. Rehabilitation Counseling Bulletin, 38, 282-294.
McCarthy, A. K. (2013). Relationship between supervisory working alliance and client outcomes in state vocational rehabilitation counseling. Rehabilitation Counseling Bulletin, 57, 23-30.
Schultz, J. C., Ososkie, J. N., Fried, J. H., Nelson, R. E., & Bardos, A. N. (2002). Clinical supervision in public rehabilitation counseling settings. Rehabilitation Counseling Bulletin, 45, 213-222.
Thielsen, V. A., & Leahy, M. J. (2001). Essential knowledge and skills for effective clinical supervision in rehabilitation counseling. Rehabilitation Counseling Bulletin, 44, 196-208.

Wilkinson, A. D., & Wagner, R. M. (1993). Supervisory leadership styles and state vocational rehabilitation counselor job satisfaction and productivity. Rehabilitation Counseling Bulletin, 37, 15-25.
Implications of Research on Metaphors in Supervision
Alwin E. Wagener
Facilitating the development of counselors in supervision is important and challenging. It requires awareness of supervisees’ developmental levels and challenges and supervisory approaches and interventions to assist them. One intervention that has been explored is the use of metaphors in supervision. Though empirical support is limited, there are findings relevant to supervision, summarized below.
Before describing implications of supervision research in counseling, a description of metaphors and brief defining of terminology is required. Metaphors in this context are not solely linguistic devices. Instead, they are recognized and supported by cognitive research as playing an important role in organizing thoughts and emotions, learning new information, and integrating new understandings. Two types of metaphors are described.  Conventional metaphors are the metaphors commonly used and easily understood (e.g. love is a journey), while unconventional metaphors are those not in common use and often requiring some explanation (e.g. love is an apple). Unconventional metaphors may involve combinations of conventional metaphors to create new links with what is being described, such as “love is a canoe journey and you don’t rock the boat”. With that foundation, the following implications can be understood.
·      The introduction of metaphors in supervision may increase both detail and depth of conversations about clients and experiences as a counselor.
·      Telling stories with strong metaphoric themes to supervision groups and initiating a discussion relating the metaphor to counseling may be useful for encouraging supervisee self-reflection.
·      Having the supervisee create a metaphoric drawing of the client and/or counseling experience he or she wants to process in supervision and then spending time processing that drawing has the potential to increase counselor development and bring out important client issues that might not otherwise be recognized or discussed.
·      When supervisees create unconventional metaphors, they often are working on emotional-cognitive integration or developing new perspectives.
·      If supervisees do not create unconventional metaphors, this may indicate that emotional-cognitive integration or developing new perspectives is not happening, which may or may not be appropriate for the situation or developmental level of the supervisee.
·      The co-creation of metaphors between supervisor and supervisee may help in the development of a working alliance by creating a shared language.
These implications are extrapolated from the articles attached to this manuscript. They have preliminary, qualitative, and theoretical support but lack generalizable, empirical support. Therefore, future research is needed to increase understanding of the use of metaphor in supervision. 

For Further Reading
Gelo, O. C. G., & Mergenthaler, E. (2012). Unconventional metaphors and emotional-cognitive regulation in a metacognitive interpersonal therapy. Psychotherapy Research, 22, 159–75. doi:10.1080/10503307.2011.629636
Guiffrida, D. A., Jordan, R., Saiz, S., & Barnes, K. L. (2007). The use of metaphor in clinical supervision. Journal of Counseling & Development, 85, 393–400. doi:10.1002/j.1556-6678.2007.tb00607.x
Long, P., & Lepper, G. (2008). Metaphor in psychoanalytic psychotherapy: A comparative study of four cases by a practitioner-researcher. British Journal of Psychotherapy, 24, 343–364. Retrieved from
Råbu, M., Haavind, H., & Binder, P.-E. (2013). We have travelled a long distance and sorted out the mess in the drawers: Metaphors for moving towards the end in psychotherapy. Counselling and Psychotherapy Research, 13, 71–80. doi:10.1080/14733145.2012.711339
Robert, T., & Kelly, V. (2010). Metaphor as an instrument for orchestrating change in counselor training and the counseling process. Journal of Counseling & Development, 88, 182–189. Retrieved from
Sommer, C., Ward, J., & Scofield, T. (2010). Metaphoric stories in supervision of internship: A qualitative study. Journal of Counseling & Development, 88, 500–508. Retrieved from
Stone, D., & Amundson, N. (1989). Counsellor supervision: An exploratory study of the metaphoric case drawing method of case presentation in a clinical setting. Canadian Journal of Counselling, 23, 360–371. Retrieved from
Tay, D. (2012). Applying the notion of metaphor types to enhance counseling protocols. Journal of Counseling & Development, 90, 142–150.
Young, J. S., & Borders, L. D. (1998). The impact of metaphor on clinical hypothesis formation and perceived supervisor characteristics. Counselor Education and Supervision, 37, 238–256. Retrieved from
Young, J. S., & Borders, L. D. (1999). The intentional use of metaphor in counseling supervision. The Clinical Supervisor, 18, 137–149. Retrieved from

Providing the Light: Supervision of Counselors who work with Trauma
Tamarine M. Foreman

“What is to give light, must also endure burning.” -Viktor Frankl

            Viktor Frankl’s quote illuminates the challenge supervisors face as they supervise counselors working with clients who have experienced the trauma of abuse, neglect, and violence.  As supervisors, we are ethically obligated to ensure supervisees are not emotionally or physically impaired and are capable of providing services to clients without doing harm. The following information provides suggestions on how to best support and supervise counselors working with clients who have experienced trauma.  
Creating a Safe Space
            Supervisors can create a space for supervision that is safe, non-evaluative, supportive, and educational.  It is best when different supervisors provide clinical and administrative supervision.  If this cannot be done, it is recommended that clinical and administrative supervision be conducted in separate sessions. 
Educate Supervisees
            Supervisors need to educate supervisees about the risks of working with clients who have experienced trauma.  Those risks include experiencing compassion fatigue, which entails the physical and emotional exhaustion from providing counseling services over time; vicarious traumatization which encompasses changes to how a counselor perceives their self as capable, others as fair and just, and the world as safe; and burnout which is a result of working with difficult clients and leads to feelings of being overwhelmed. Supervisors can also educate the supervisee that observing the resilience and healing of clients facilitates personal and professional growth.
Inquire about the Supervisee’s Thoughts and Emotions
            Supervisors need to ask supervisees about their personal experience of working with specific clients who have experienced trauma.  Ask supervisees about their thoughts and feelings before, during, and after the session. Supervisors can also ask if the supervisee is having any intrusive or unwanted thoughts or images (e.g., nightmares, reoccurring images related to client stories, worries about one’s own safety or safety of loved ones, or suspicion of other people’s motives).
Pay Attention to Common Themes
            Supervisors need to pay attention to common themes counselors share in supervision, either through the same client story or a collection of the types of stories being shared. Paying attention to common themes provides insight into how the supervisee is being impacted.  Supervisors can also pay attention to any changes in supervisees’ behavior or reactions to clients or specific types of clients. 
            Be aware if the supervisee shows signs of distress or has difficulty maintaining self-care practices.  It is equally important for supervisors to be aware of their own limitations, model healthy boundaries, and practice self-care.  Recall the airline stewardess who emphasizes the importance of putting your own oxygen mask first before helping others.  
Implement Mindfulness
            Supervisors can employ the use of mindfulness, breathing exercises, and stories to support the wellness of supervisees.  The use of mindfulness and breathing exercises can assist supervisees in developing self-awareness skills in the present moment of supervision that may transfer to facilitating counseling sessions.
            Supervisors can also seek out additional training in trauma theory and improve their knowledge about therapeutic interventions designed to assist traumatized clients.

For Additional Information about trauma, please look into reading the following books:
Hill, M. (2004).  Diary of a country therapist.  New York: Hayworth Press.

McCann, I. L., & Pearlman, L. A. (1990). Psychological trauma and the adult survivor: Theory, therapy, and transformation. New York: Brunner/Mazel, Inc.

Pearlman, L. A. & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference
            and vicarious traumatization in psychotherapy with incest survivors. New York:
            W.W. Norton.

Saakvitne, L., & Pearlman, L. A. (1996). Transforming the pain: A workbook on vicarious traumatization. New York: W.W. Norton.

For Additional Information about supervision related to trauma, please look into reading the following articles:

Knight, C. (2004). Working with survivors of childhood trauma: Implications for clinical supervision. The Clinical Supervisor, 23, 81–106. doi:10.1300/J001v23n02

McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3, 131-149. doi: 10.1007/BF00975140

Warren, J., Morgan, M., Morris, L. B., & Morris, T. M. (2010). Breathing words slowly: Creative writing and counselor self-care—The writing workout. Journal of Creativity in Mental Health, 5(2), 109–124. doi:10.1080/15401383.2010.485074
Wells, M., Trad, A., & Alves, M. (2003). Training beginning supervisors working with new trauma therapists: A relational model of supervision. Journal of College Student Psychotherapy, 17, 19–39. doi:10.1300/J035v17n03

Measuring the Supervisory Relationship: A Critical Review of Instruments
By: Jodi L. Bartley
The University of North Carolina at Greensboro

The supervisory relationship is an important component of supervision (Borders & Brown, 2005; Ladany & Muse-Burke, 2001); however, it is a complex, and multifaceted construct, and thus it can be difficult to measure. Below is a summary description of seven instruments that can be used by supervisors and supervisees to measure the supervisory relationship in both clinical practice and clinical research settings.

Supervisor (SPRS-R) and Trainee (TPRS-R) Personal Reaction Scales – Revised
·      Authors: Holloway and Wampold, 1984
·      Intended Audience: Supervisors (SPRS-R) and Supervisees (TPRS-R)
·      Number of Items: 12 items each, anchored on 5-point Likert scales from 1 = not characteristic of my present feelings to 5 = highly characteristic of my present feelings.
·      Scales: Evaluation of Other, Evaluation of Self, and Level of Comfort (for both versions)

Barrett-Lennard Relationship Inventory for Supervisory Relationships (BLRI-S)
·      Authors: Schacht, Howe, and Berman, 1988
·      Intended Audience: Supervisees
·      Number of Items: 40 items anchored on a 6-point Likert scale from 1 = I strongly feel it is not true to 6 = I strongly feel it is true.
·      Scales: Regard, Unconditionality, Empathic Understanding, Congruence, and Willingness to be Known

Working Alliance Inventory/Supervision (WAI/S Supervisor and Supervisee Forms)
·      Author: Bahrick, 1990
·      Intended Audience: Supervisors and Supervisees
·      Number of Items: 36 items anchored on a 7-point Likert scale ranging from 1 = never to 7 = always.
·      Scales: Bond and Goals/Tasks.

Supervisory Working Alliance Inventory (SWAI Supervisor and Trainee Versions)
·      Authors: Efstation, Patton, and Kardash, 1990
·      Intended Audience: Supervisors and Supervisees
·      Number of Items: 23 items (supervisor version) and 19 items (supervisee version), written on 7-point Likert scales ranging from 1 = almost never to 7 = almost always.
·      Scales: Client Focus, Rapport, and Identification (supervisor version); and Rapport and Client Focus (supervisee version).

Supervisor Relating Style Inventory (SRSI)
·      Authors: Lizzio, Wilson, and Que, 2009
·      Intended Audience: Supervisees
·      Number of Items: 12 items, written on a 7-point Likert scale ranging from 1= not at all to 7 = very characteristic.
·      Scales: Support, Challenge, and Openness

Supervisory Relationship Questionnaire (SRQ)
·      Authors: Palomo, Beinart, and Cooper, 2010
·      Intended Audience: Supervisees
·      Number of Items: 67 items, written on a 7-point Likert scale ranging from strongly disagree to strongly agree.
·      Scales: Safe Base, Structure, Commitment, Reflective Education, Role Model, and Formative Feedback.

Supervisory Relationship Measure (SRM)
·      Authors: Pearce, Beinart, Clohessy, and Cooper, 2013
·      Intended Audience: Supervisors
·      Number of Items: 51 items, written on a 7-point Likert scale anchored from 1 = strongly disagree to 7 = strongly agree.
·      Scales: Safe Base, Supervisor’s Professional Commitment to Supervision, Trainee Contribution, External Influences, and Supervisor’s Emotional Investment.

            There are benefits and drawbacks to each of the measures; therefore, choosing one for research or practical purposes depends on a person’s intentions. If the intention is to use the measure in clinical research or to use it in clinical practice settings as part of a more comprehensive evaluation, the SRQ (for supervisees) and/or SRM (for supervisors) are recommended. These measures were developed specifically for the supervisory relationship, they are reliable and valid, and they include more items (67 and 51, respectively). In this way, they could provide a nuanced investigation of the relationship.
            On the other hand, if a person intends to use a measure for brief, more practical purposes, one of the shorter measures is recommended. The SRSI includes only 12 items and could be administered to supervisees after sessions to help supervisors gain insight into their balance of support, challenge, and openness in the relationship. The Working Alliance Inventories (the WAI/S and SWAI) are both a bit longer than the SRSI; however, they can be used with both supervisors and supervisees to gain perspective into the alliance of the supervisory relationship. The SPRS-R and TPRS-R are shorter measures like the SRSI; however, they are a bit outdated and were created based on characteristics of the therapeutic relationship. If the intention is solely to understand how a supervisee perceives the supervisor’s use of facilitative conditions, the BLRI-S is recommended.
Taken together, then, it is important that supervisors and clinicians identify their purpose for using the instruments and choose accordingly. Further research is needed to examine the construct of the supervisory relationship and the multiple aspects of that relationship. New research in this area could offer numerous implications for the effectiveness of supervisory practice as it relates to the strength of the supervisor-supervisee relationship.

FOR FURTHER READING  (*Measures reviewed)
*Bahrick, A. S. (1990). Role induction for counselor trainees: Effects on the Supervisory Working Alliance. (Doctoral dissertation). Retrieved from
Borders, L. D., & Brown, L. L. (2005). The new handbook of counseling supervision. Mahwah, NJ: Lawrence Erlbaum.
*Efstation, J. F., Patton, M. J., & Kardash, C. M. (1990). Measuring the working alliance in counselor supervision. Journal of Counseling Psychology, 37, 322-329. doi:10.1037/0022-0167.37.3.322
*Holloway, E. L., & Wampold, B. E. (1984). Dimensions of satisfaction in the supervision interview. Paper presented at the Proceedings of the American Psychological Association Convention, Toronto, Canada.
Ladany, N., & Muse-Burke, J. L. (2001). Understanding and conducting supervision research. In L. J. Bradley & N. Ladany (Eds.), Counselor supervision: Principles, process, and practice (3rd ed.) (pp. 304-329). Philadelphia: Brunner-Routledge.
*Lizzio, A., Wilson, K., & Que, J. (2009). Relationship dimensions in the professional supervision of psychology graduates: Supervisee perceptions of processes and outcome. Studies in Continuing Education, 31, 127-140. doi:10.1080/01580370902927451
*Palomo, M., Beinart, H., & Cooper, M. J. (2010). Development and validation of the Supervisory Relationship Questionnaire (SRQ) in UK trainee clinical psychologists. British Journal of Clinical Psychology, 49, 131-149. doi:10.1348/014466509X441033
*Pearce, N., Beinart, H., Clohessy, S., & Cooper, M. (2013). Development and validation of the Supervisory Relationship Measure: A self-report questionnaire for use with supervisors. British Journal of Clinical Psychology, 52, 249-268. doi:10.1111/bjc.12012
*Schacht, A. J., Howe, H. E., & Berman, J. J. (1988). A short form of the Barrett-Lennard Relationship Inventory for supervisory relationships. Psychological Reports, 63, 699-706. doi:10.2466/pr0.1988.63.3.699