A Unifying Vision of Psychotherapy Supervision:
Productive and Unproductive Supervision Relations
C. Edward Watkins
Recently, much attention has been given to a unified psychotherapy and its practice; however,focus on supervision of those learning the techniques is lacking. What might be some elements of a unification-informed psychotherapy supervision? What core variables contribute to a productive versus unproductive supervision experience? The Contextual Supervision Relationship Model (CSRM; Watkins, 2016b; Watkins, Budge, & Callahan, 2015) is presented as one potential unifying vision of psychotherapy supervision. The CSRM proposes a common set of variables and pathways that contributes to supervisor-supervisee relationship development and supervisee/patient outcomes. Specific variable/pathway differences between productive versus unproductive supervision relationships are subsequently considered and elaborated upon. What follows might best be thought of as a starting point—perhaps a way to begin thinking more substantively about the implications of a unifying vision of psychotherapy supervision.
Movement toward a unifying perspective has been increasingly evidenced across a host of disciplines and areas of inquiry, some prime examples being in ecological science,biological science, and psychology (Magnavita, 2006; Mayer & Allen, 2013; Melchert, 2016). That certainly has also been the case for psychotherapy, where a growing number of unificationist visions have been proposed (e.g., Henriqus & Stout,2012;Magnavita & Anchin, 2014; Marquis & Elliott, 2015; Millon & Grossman, 2012; Tryon, 2016). Unification may well become the zeitgeist of psychotherapy, a new, defining, and pivotal phase in its evolution (Anchin, 2008, 2012; Magnavita, 2008, 2012a, 2012b).There is increasingly well-documented evidence of the promise and possibility of unification for psychotherapy.
Conversely, any attention to unification and psychotherapy supervision has been virtually non-existent. Articulated trans-theoretical and common factors supervision perspectives are quite rare (Bernard & Goodyear, 2014). The word“unification”with regard to supervision has been mentioned minimally if at all. Yet I contend that unification holds much promise and possibility for psychotherapy supervision and would like to consider how that might be so. Because we have lacked for a common, unifying way of understanding change or its absence across supervision models, I subsequently give consideration to one such unifying vision: The Contextual Super- vision Relationship Model (Watkins, 2016b; Watkins, Budge,& Callahan, 2015; Watkins, Wampold, & Budge, 2015). The way in which the model’s proposed common variables and pathways converge to explain productive and unproductive supervision relationships is highlighted.
Setting the Stage:
What is Psychotherapy Supervision?
Why Does It Matter?
Definition. An empirically-based definition of psychotherapy supervision is:
The formal provision, by approved supervisors, of a relationship-based education and training that is work focused and which manages, supports, develops and evaluates the work of colleague/s [and student trainees]. . . . The main methods that supervisors use are corrective feedback on the supervisee’s performance, teaching, and collaborative goal-setting....Supervision’s objectives are “normative” (e.g., quality control) “restorative (e.g., encourage emotional processing), and “formative” (e.g., maintaining and facilitating supervisees’ competence, capability, and general effectiveness).... (Milne, 2007, p.439).
Supervision is educationally purposed, relationally hierarchical, and evaluative by definition (Bernard & Goodyear, 2014; Page & Wosket, 2015). It may still be the case that “about one half of a professional psychologist’s formal training involves learning through supervision” (Bent, Schindler, & Dobbins, 1991, p. 124).
Significance. Supervision’s primary objectives are: (a) development and enhancement of supervisee conceptual/treatment skills and competencies; (b) development of a defined and defining psychotherapist identity; (c) development of conviction about the very meaningfulness of psychotherapy; and (d) monitoring treatment efforts and safeguarding patient care (American Psychological Association [APA], 2015; Hess, Hess, & Hess, 2008; Watkins, 1997). Supervision appears to be a powerful contributor to training effectiveness, perhaps our most powerful contributor (e.g., Gonsalvez & Milne, 2010). It has been rightly designated as the mental health professions’ signature pedagogy (Bernard & Goodyear, 2014; Goodyear, 2007), its reach international, its scope interdisciplinary (Watkins & Milne, 2014).
Theory. Supervision perspectives are traditionally clustered into three groups: Psychotherapy-focused, developmental, and social role/process (Bernard & Goodyear, 2014; Watkins & Milne, 2014). Psychotherapy-focused supervision perspectives center around the learning of a particular form of psychotherapy (e.g., Jungian, existential), with the supervision then being informed by and organized around the specific psychotherapy being learned (e.g., Dewald, 1997; Farber, 2014).Developmental supervision perspectives give primary emphasis to the stages of supervisee development, the issues that accompany those stages, and the importance of supervisors responding in a matching, developmentally-informed way (e.g., Ronnestad & Skovholt, 2013; Stoltenberg, Bailey, Cruzan, Hart,&Ukuku,2014).Social role/process perspectives give primary emphasis to supervisees’ learning needs, how those needs evolve during supervision, and the roles that supervisors can accordingly enact that best match those evolving needs (e.g., Bernard, 1997; Holloway, 2014). Created specifically with supervision in mind, the developmental and social role/process visions are foremost meta-visions and can be readily incorporated into any psychotherapy-focused supervision perspective. Complementing these first generation models, a second-generation of psychotherapy-focused, developmental, and social role/process perspectives (e.g., common factors models) has emerged over the last fifteen-year period. Supervision continues to evolve, advance, and diversify (Bernard & Goodyear, 2014; Watkins & Milne,2014).
Evidence. Psychotherapy supervision has generally lagged far behind psychotherapy in its research (Hill & Knox, 2013; Milne et al., 2012).Being triadic in nature (i.e., patient-supervisee-supervisor) and often involving graduate student supervisees as participants (where a supervision versus no supervision comparison group would be unethical to form), supervision research has long been recognized as quite difficult to conduct (Hill & Knox, 2013; Russell, Crimmings, & Lent, 1984; Wampold & Holloway, 1997), its annual output paling in comparison to that of psychotherapy research (Inman & Ladany, 2008; Ladany & Inman, 2012). The current state of supervision research has even been likened to psychotherapy research in the 1950s and ’60s, where issues of measurement and effectiveness remain of most pressing concern (Milne et al., 2012). As Milne et al. (2012) have stated, “. . . we are currently about ‘half-way there’, working on the ‘search for scientific rigour’...”(p.144).
Despite this state of affairs, supervision research advances have clearly been made, and recent reviews nicely capture that reality (Hill &Knox, 2013;I nman, Hutman, Pendse, Devdas, Luu, & Ellis, 2014; Tangen & Borders, 2016; Watkins, 2014a, 2014b). While concerned with a host of potential variables, supervision research is understandably much concerned with supervisee and patient outcome. Does supervision effect changes in supervisees? Are patients in turn positively impacted? Although supervision’s true acid test may lie in effected patient changes (Ellis & Ladany, 1997; Lichtenberg, 2007), actually showing supervision patient change empirically has proven to be a most problematic proposition (cf. Wampold & Holloway, 1997). Research thus far has been limited, mixed in findings, and any definitive conclusions about supervision-patient outcome effectiveness remain elusive (Hill & Knox, 2013; Wheeler & Richards, 2007; Watkins, 2011a). But in the last approximate ten-year period, rigorous research about this issue has finally begun to emerge (e.g., Bambling, King, Raue, Schweitzer, & Lambert, 2006; Rieck, Callahan, & Watkins, 2015; Rousmaniere, Swift, Babins-Wagner, Whipple, & Berzins, 2016; Wrape, Callahan, Ruggero, & Watkins, 2015) and holds much promise for future study. Conversely, showing supervision supervisee change has proven far easier to accomplish. Supervision indeed appears to have a number of highly favorable outcomes for supervisees, including strengthening of the supervisee-patient relationship, enhanced self-awareness, enhanced sense of self-efficacy, enhanced treatment knowledge, and enhanced skill acquisition and utilization (Goodyear & Guzzardo, 2000; Hill & Knox, 2013; Holloway & Neufeldt, 1995; Inman et al., 2014; Inman & Ladany, 2008; Lambert & Ogles, 1997; Wheeler & Richards, 2007; Wilson, Davies, & Weatherhead, 2016): “…the evidence of supervisor [and supervision] impact has been well established” (Bernard & Goodyear, 2014, p.301).
Conviction. We as supervisors believe in the power of supervision. We tend to hold fast to the conviction that, by means of supervision, meaningful transfer occurs: The supervisee’s treatment skills/competencies and conceptual understandings, developed and enhanced via supervision, will then be carried forth into the treatment situation and beneficially applied (Goodyear & Guzzardo, 2000; Lichtenberg, 2007). My subsequent focus will be on the supervision relationship as an agent of change and ideally an agent of transfer.
Productive and Unproductive Supervision
Relationships: A Unifying, Contextual Model
The matter of (what has been termed) good, effective, productive, or beneficial supervision has long been and continues to be of much concern in psychotherapy supervision (e.g., Carifio & Hess, 1987; Wilson et al., 2016); that has similarly been the case for unproductive, unbeneficial, ineffective, even harmful supervision (Ellis, 2001; Ladany, Mori, & Mehr, 2013). For my purposes here, I define productive or beneficial as ‘that which contributes to or stimulates the development of the supervisee and/or patient”, with unproductive or unbeneficial being defined conversely.
Beneficial or productive supervision often appears to involve a host of constructive relational/educational characteristics, features, and qualities, some of the most significant identified as including: empathic, flexible, respectful, supportive, sensitive, accepting, collaborative, appropriately self-disclosive, and appropriately challenging (Kilminster, Cottrell, Grant, & Jolly, 2007; Rodenhauser, Rudisill, & Painter, 1989; Wilson et al., 2016). Unbeneficial or unproductive supervision often appears to involve the very opposite of those very same features, including being unempathic, disrespectful, inflexible, non-collaborative, and non-supportive (Ellis, Berger, Hanus, Swords, & Siembor, 2014; Ellis, Cre- aner, Hutman, & Timulak, 2015; Magnuson, Wilcoxon, & Norem, 2000). Over three decades ago, Worthington (1987) opined that “A good theory of lousy supervisor behaviors is missing” (p. 203). Although slow progress is being made (Ellis, Berger et al., 2014), that missing theory still largely remains the case: “Part of the solution may come from continuing to identify those variables that predict the occurrence of harmful and inadequate supervision”(Ellis,Bergeretal.,2014,p.462).
Psychotherapy supervision can clearly be for better or worse. But what are the critical variables that make “for better” or “for worse” increasingly likely? Might there be a unifying model that; (a) identifies those seemingly helpful and unhelpful supervision variables and; (b) explains the resulting beneficial and unbeneficial nature of the supervision experience? I propose the Contextual Supervision Relationship Model (CSRM) as one such model (Watkins, 2016b; Watkins, Budgeetal., 2015; Watkins, Wampold et al.,2015).
Channeling Wampold. The CSRM is a supervisory extrapolation of and largely parallels Wampold’s contextual psychotherapy relationship model (Budge & Wampold, 2015; Imel & Wampold, 2008; Wampold, 2001, 2007, 2010; Wampold & Budge, 2012; Wampold & Imel, 2015). Wampold’s psychotherapy model accentuates the synergistic nature of both common and specific factors, each set of factors being necessary and dependent on the other. His critical model components are: (a) the importance of therapist–patient relationship (bond)formation; and (b) three relationship pathways that stimulate patient change. Those three change pathways are: (a) the therapist–patient real relationship; (b) creating expectations through explanation and providing some form of expectation-consistent treatment; and (c) the patient’s active involvement in healthy actions. Where treatments are composed of the bond and three pathways, they are increasingly apt to be effective—with the outcomes being symptom reduction and better quality of life (Wampold & Imel, 2015). The model provides a unifying perspective on what trans-theoretically renders treatment effective and ineffective. For more detailed description of Wampold’s contextual model, see Wampold and Imel (2015).
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