Workforce Development / Training / Supervision
Stephanie L. Haft, M.A.
Predoctoral Psychology Intern
UCSF Zuckerberg San Francisco General Hospital
San Francisco, California
Catherine Callaway, M.A.
PhD Candidate
University of California, Berkeley
Berkeley, California
.jpg "Nancy H. Liu, Ph.D. photo")
Nancy H. Liu, Ph.D.
Associate Clinical Professor
University of California at Berkeley
Berkeley, California
Background: Clinical supervision is understood to be a critical process that socializes trainees to the practice of psychotherapy. It is currently recognized as a core competency within health service psychology training (Falender, 2018). There is less guidance however, on supervision problems—when they arise and how they are recognized, understood, and addressed. In this exploratory study, we examine variability in supervisor and supervisee responses to vignettes of supervision dilemmas with the purpose of developing a framework for how dilemmas might be managed. First, we examine quantitative responses on how supervisors and supervisees rate the frequency and harmfulness of supervision scenarios. Second, we identify themes in responses to supervision dilemma vignettes.
Methods: A total of 94 participants (29 supervisors, 65 supervisees, 75% female, 79% White) completed an online survey which randomly presented four of eight supervision dilemma vignettes. Participates rated the frequency and harmfulness of the scenario, and wrote in their immediate, short-term, and long-term responses from the perspective of the supervisee or supervisor. Responses were analyzed using descriptive and inferential statistics as well as qualitative content analysis (Mayring, 2014).
Results: Of the eight scenarios, the two that were rated as the most common supervision dilemmas overall were the supervisor giving no critical feedback and supervisee-supervisor disagreement on case conceptualization. A significant difference emerged on frequency ratings for the supervisee being late on documentation, with supervisors rating this as significantly more frequent than supervisees (p=.019). The supervisee becoming defensive on cultural sensitivity issues was rated as most harmful to the client, the supervisor giving no critical feedback was rated as most harmful to the supervisee, and the supervisee being late on documentation was rated as most harmful to the supervisor. Content analysis identified ten themes pertaining to responses to dilemmas. For the four vignettes assessing supervisee response, the most common themes for addressing dilemmas were problem-solving, seeking support outside of the supervisory relationship, and inaction. For the four vignettes assessing supervisor response, the most common themes for addressing dilemmas were problem-solving, establishing the rationale for a requested change, and having a broader discussion about the supervision process.
Conclusion: Supervisors and supervisees were mostly consistent in their ratings of the frequency and harmfulness of supervision dilemmas. Responses to vignettes from the perspective of the supervisee or supervisor indicated heterogeneity in priorities and actions to address problems within clinical supervision. Understanding themes in responses to common supervision dilemmas can guide the development of a framework for improved training in supervision competencies, informed by both supervisor and supervisee perspectives.
