Title:

The Relationship between Supervision and Clinical Counselors’ Outcome Efficacy

Author:

Nicole A. Adamson, The University of North Carolina at Greensboro

What was the purpose of this literature review?

This brief literature review explores ways in which the supervisory process is related to a counselor’s ability to help clients reach their goals.

Major findings or points:

Outcome efficacy refers to the act of clients reaching their goals.

The following points should be reviewed in order for supervisors to help counselors achieve higher levels of outcome efficacy.

·      Take care to be supportive of supervisees and ensure that they feel safe in supervision sessions.  This can be achieved through setting up clear boundaries and goals for the supervisory process.  Additionally, creative interventions such as bibliosupervision might help establish safety and openness in the supervisory relationship.

• Consistent and intentional supervision is an incredibly important addition to a counselor’s formal training program.  Supervisors should strive to provide systematic, long-term supervision beyond graduation.  The resources that will be required to offer a sufficient caliber of supervision should be accounted for in a mental health organization’s yearly planning.
• Supervision has a formative function (to help counselors develop professionally), a restorative function (to help counselors maintain a sufficient standard of care), and a normative function (to ensure that counselors who work with the public are competent).  The normative function of supervision can potentially cause discomfort and is often overlooked by supervisors.  Thus, it is recommended that supervisors discuss their dual role of mentor and evaluator with counselors, use systematic and objective evaluation criteria, and share the normative function with other qualified professionals (e.g., university supervisors or other colleagues).

Major caveats:

Although supervision is an accepted part of counselor training models, there is limited empirical literature that directly supports the relationship between supervision and counselor outcome efficacy.  The current research has identified some variables that might potentially contribute to outcome efficacy, but a modest amount of interventions has been concretely supported.

What does this research mean for counseling practice, settings, and/or training?

Researchers have considered several supervision variables that might contribute to counselor outcome efficacy.  The empirically-supported variables include the following: offering support; conducting consistent, long-term supervision; and having candid conversations about the functions of supervision.  Supervisors should strongly consider implementing these recommendations. 

Other variables that have not been empirically-supported include the timing of supervision sessions in relation to supervisees’ next counseling session, the possibility of training or modeling ways for counselors to improve therapeutic relationships, and supervision that focuses on specific intervention protocols.  Supervisors should consider their own hypotheses about the importance of such potential variables and develop an intentional supervisory process.

Labels:

supervisory relationship, outcome efficacy, clinical counseling, bibliosupervision, functions of supervision

For Further Reading:

Crits-Christoph, P., Gibbons, M. B. C., Crits-Christoph, K., Narducci, J., Schamberger, M., & Gallop, R. (2006). Can therapists be trained to improve their alliances? A preliminary study of alliance-fostering psychotherapy. Psychotherapy Research, 16, 268–281. doi:10.1080/10503300500268557

Graham, M., & Pehrsson, D. (2008). Bibliosupervision: A multiple-baseline study using literature in supervision settings. Journal of Creativity in Mental Health, 3, 428-440. doi:10.1080/15401380802531052

O’Donovan, A., Halford, W. K., & Walters, B. (2011). Towards best practice supervision of Clinical Psychology trainees. Australian Psychologist, 46, 101–112. doi:10.1111/j.1742-9544.2011.00033.x

Smith, J. L., Carpenter, K. M., Amrhein, P. C., Brooks, A. C., Levin, D., Schreiber, E. A., ... Nunes, E. V. (2012). Training substance abuse clinicians in motivational interviewing using live supervision via teleconferencing. Journal of Consulting & Clinical Psychology, 80, 450-464. doi:10.1037/a0028176

Wheeler, S., & Richards, K. (2007). The impact of clinical supervision on counsellors and therapists, their practice and their clients. A systematic review of the literature. Counselling & Psychotherapy Research, 7, 54-65. doi: 10.1080/14733140601185274

Mapping Expert Counseling Supervisors’ Cognitions

Gülşah Kemer, PhD, NCC

Purpose

The critical role of counseling supervision in counselor growth and effectiveness is considered to be unchallengeable. Thus, many researchers have investigated the complex factors involved in effective counseling supervision. However, within a large body of work, very few researchers have sought to describe the master, or expert, supervisor. An investigation of expert supervisors, specifically their cognitions/thoughts regarding their supervision sessions, was considered to be a crucial avenue for furthering our understanding of effective counseling supervision practices as well as improving supervisor training efforts.

Method

Expert supervisors’ cognitions and cognitive categories were investigated through a mixed-method approach called concept mapping. Concept mapping was considered to be a good fit for the present study because it allowed expert supervisors to craft the content of the full study by first providing their cognitions/thoughts while they are preparing, conducting, and evaluating their supervision sessions through an online survey; second, assigning those cognitions into cognitive groups and rating their priority level while working with easy and challenging supervisees; and finally reshaping the results through discussion in a focus group session. A total of 18 expert supervisors participated in the study. A final number of 195 statements/cognitions were summarized into 25 cognitive categories.

Results

Expert supervisors’ cognitions and cognitive categories represented many different supervision components. There were traces of the supervision models at the cognition/statement level, but none of the cognitive categories were named after these models. This result seemed to support the idea that supervision models are simplistic descriptions of supervisory process; the experts’ cognitive maps were more complex and nuanced than the models.

Cognitive categories/areas of expert supervisors’ thinking were Supervisor’s Goal Setting/Agenda Setting, Supervisor’s Reflective Process, Additional Supervisor Reflections about Working with a Challenging Supervisee, Planning and Managing Supervision Interventions, Conceptualizing the Work, Choice Points/In-Session Decisions, Needing Immediate Attention, Helping the Supervisee Attend to and Pick up on Important Things in His/Her Counseling, Assessing the Intrapersonal and Cognitive Experiences of the Supervisee, Supervisee’s Professional Behaviors, Supervisee Development, The Client and The Counseling Session, Administrative Considerations, Systemic Considerations, Supervisee in Relationship to the Client, Supervisee’s Intervention Skills, Supervisee’s Conceptual Skills, Supervisee’s Reflective Process, Parameters of Evaluation, Supervisee’s Response to Feedback, Collaboration with the Supervisee, Supervisor’s Experience of the Working Relationship, Supervisor’s Assessment of and Reflection on His/Her Work, Supervisee’s Receptivity to Supervision, and Understanding the Client.

Based on the conceptual similarities among these cognitive categories, five separate but related regions appeared. These regions were Assessment of the Supervisee and His/Her Work, Supervisory Relationship, Supervisor Self-Assessment and Reflection, Conceptualization of Supervision and Intervening, and Administration Considerations.

Moreover, expert supervisors presented more importance or higher priority to almost all of the cognitive categories while they were working with challenging supervisees when compared to easy supervisees. Expert supervisors’ ratings also indicated that “Supervisee Development,” “The Client and the Counseling Session,” and “Supervisor’s Goal Setting/Agenda Setting” cognitive areas were in the higher importance/priority list for both easy and challenging supervisees.

Lastly, even though the present study did not investigate cognitive processing abilities of supervision experts, results provided preliminary findings for the study of expertise in counseling supervision. In the same line with some of the previous findings in counseling and other areas of expertise, expert supervisors’ cognitions in this study involved self-monitoring, self-reflection, desire to be genuine and collaborative with their supervisees, and intentional use of self/interventions.

Implications

Results of the present study have implications for both counseling supervisors and supervisor training programs. Supervision practitioners may consider cognitive categories – in a broader view, the regions of expert supervisors’ thinking – as important components of their practices while they are working with their supervisees. Moreover, supervisor training programs may use strategies in their curricula to trigger these areas of thinking in supervisor trainees’ practices with their supervisees. In particular, the most notable of the regions were supervisors’ self-assessment and reflective thoughts, because very few researchers have mentioned or explored supervisor reflectivity. Thus, supervisors may pursue the chances of self-reflective practice as well as transparency not only for their own self-awareness and improvement, but also modeling reflective practice and transparency to their supervisees.

Limitations

As in all other studies, the results of the present study must also be considered within the context of its limitations. First, generalizability of the present study results is limited to the expert supervisors involved in this study. Thus, a more culturally diverse group of expert supervisors and their thinking may lead to further information. Second, there may be other potential variables which influenced expert supervisors’ knowledge and practices of supervision (e.g., years of experience as a supervisor, their training, and their range of supervisees varied) that were not considered here.

Labels: Expert counseling supervisors, supervisor cognitions

Labels: Expert counseling supervisors, supervisor cognitions