[acb-hsp] Gaps Between MFT and . . . Article

[J.Rayl]

Gaps between Mft Supervision Assumptions and Common Practice: Suggested Best Practices
by Cheryl L. Storm , Thomas C. Todd , Douglas H. Sprenkle , Michael M. Morgan
Supervisors whom we have trained over the years have complained that there is a gap
between their experiences and the supervision literature. Thus, they ask themselves:
"Am I a dinosaur, out of date in the way I practice supervision? Or am I part of
the silent majority of supervisors doing my job based on commonly accepted practices
that are not explicitly discussed in the field?" At first we were surprised by this
gap because the literature seemed to capture our experiences well. However supervisors-in-training,
especially those in a myriad of agencies and institutions outside of educational
settings, kept challenging us to take their feedback seriously. Consequently, we
decided to look further into this issue by reviewing the supervision literature,
the accepted standards, and what appeared to us to be common practice.
As we identified the overarching assumptions that appear in the literature and in
the accepted standards in the field for marriage and family therapy (MFT) supervision,
we became increasingly aware that many of them were not reflected in the common practices
of the majority of supervisors. There are probably numerous reasons for the discrepancy.
Some of the assumptions in the literature are highly idealistic, failing to fit the
"real world" of many supervisors' practices. Some assumptions may not be evident
in practice because innovations reflected in the literature are out of step with
common practice. In addition, the authors of published supervision works tend to
be academicians rather than supervisors practicing in other settings (Sprenkle &
Bailey, 1997). Finally, some assumptions are highly specific to a particular group
of supervisors who share a particular point of view about supervision.
There is also a surprising lack of research support, either quantitative or qualitative,
for many of the basic assumptions that underlie the supervisory enterprise. Indeed,
it would not be overstating the case to assert that the field's belief in the importance
of supervision rests mostly on faith. (After reviewing the individual psychotherapy
supervision literature, Holloway and Neufeldt [ 1995] reached similar conclusions,
so this rather startling conclusion is not unique to MFT.) However, given the rational
and intuitive appeal of our assumptions, this faith is not blind. We began to ask
ourselves: What is the current standard of practice for supervision? After much reflection
and a review of the literature, the research findings, and the common practices of
supervisors, we propose "best practice recommendations" for supervision as an initial
partial answer to this question. Please note that we refer to supervision in a generic
way that encompasses individual, dyadic, and group formats.
COMMON PRACTICE: HOW WAS IT DERERMINED?
When possible we derived the common practice of supervisors from research; in the
absence of research we derived them from consensus among ourselves based on our joint
observations of supervisory practice. Although we have supervised in a variety of
settings and with MFrs in various stages of their careers, we have different supervisory
histories because our experiences tend to occur in a particular context that greatly
influences our observations. One of us predominantly supervises beginning clinicians
who are working toward their MFT master's degrees. One of us supervises experienced
clinicians, often well-known MFr trainers, who have terminal degrees from related
professional fields, such as clinical psychology. One of us supervises MFr doctoral
students who frequently are experienced clinicians and who typically become teachers
and supervisors themselves, and one of us is just beginning his career as a supervisor.
All three of the senior authors are prominent teachers of supervision courses and
have benefited from the combined experiences of hundreds of MFT supervisors, typically
those from nonacademic settings. Thus, our notions about the common practice of supervisors
are our collective agreements about what seems to prevail and underlie these diverse
experiences. We believe that our consensus, coming from different experiences, lends
these conclusions some credibility, but we alert the reader to the bias and subjectivity
built into our conclusions. We further acknowledge that our conclusions are often
generalizations that may oversimplify and leave out the complexity that exists in
the practice of supervision. Hopefully our conclusions will provide a starting point
for extended conversations and research efforts.
GAPS REGARDING GENERAL SUPERVISORY ASSUMPTIONS
Supervisees Perform Better with Supervision Than They Do without It
It is widely assumed that therapists who are supervised perform better than do therapists
who are not supervised. In fact, the entire mental health field is predicated upon
this assumption.
Common practice. Supervision is a core component of clinical educational programs,
the centerpiece of postgraduate training in MFT, and an essential component of state
regulatory laws. Although there is some modest evidence for the effectiveness of
training programs (Avis & Sprenkle, 1990; Liddle, 1991), investigators have not parceled
out the supervision component that is nested within the larger context of training.
Thus, it is not clear what role supervision per se plays in program effectiveness.
Furthermore, there is virtually no research on the effectiveness of supervision that
occurs in postgraduate settings (i.e., individual or group supervision as it is done
in private-practice or agency settings).
Issue. Although we are certainly hopeful that supervision contributes to therapeutic
effectiveness, (and we have partially based our careers on this assumption) this
conclusion is empirically unsubstantiated. Therefore, the field could benefit from
basic research on the supervision component within educational programs and postgraduate
supervision, ideally examining clinical effectiveness in cases that are supervised
and changes in supervisees.
Best practice recommendation. Because of the lack of empirical support, we believe
that supervisors, including ourselves, need to be more modest with supervisees, consumers,
and the community at large about their effectiveness and to be realistic about what
supervision can and cannot accomplish. This particularly applies to claims regarding
the effectiveness of supervision, the protection of consumers, the success of their
own preferred therapy approaches and those of their supervisees, and the degree to
which supervisors actually serve as gatekeepers for the profession.
Supervision Protects Consumers because Supervisors Serve as Gatekeepers
Therapists who are in the process of becoming qualified are viewed as ready to treat
clients because of the involvement of qualified professionals (i.e., supervisors)
who oversee the therapy via supervision (Slovenko, 1980). Supervision is assumed
to protect consumers from incompetent, poorly trained, or beginning clinicians who
need assistance because they are in the process of learning. Supervisors are believed
to identify supervisees who are not a good fit for the profession, as well as impaired
or incompetent therapists, and to counsel or usher them out of the profession.
Common practice. Marital and family therapists (and other mental health professionals)
frequently use a consumer-protection argument to advocate state regulation. Although
supervisors are not regulated themselves, there typically is a supervision requirement
for supervisees who are preparing for licensure/certification and an implicit assumption
that supervision is an important component of consumer protection. Supervisors typically
require supervisees to talk with them about issues in their caseloads related to
self-harm or harm to others. One might reasonably infer that there are fewer suicides,
fewer clients abused or exploited by therapists, fewer clients who do harm to others,
and a higher level of service offered. Thus far, these conclusions rest on faith.
In addition, we do not know how many supervisees are denied access to practice nor
the gatekeeping criteria that supervisors use. We do not even know if there would
be agreement among supervisors if criteria were established. At present, there are
no generally recognized and accepted clinical criteria that supervisors use to determine
whether students should graduate from educational programs, be recommended for clinical
membership in the American Association for Marriage and Family Therapy (AAMFT), or
be endorsed for state licensure. Different stakeholders appear to evaluate supervisees
by different criteria. The first author, for example, frequently hears postgraduate
supervisors lament how unprepared for clinical work new therapists are, which indicates
that there is a discrepancy between academic and postgraduate supervisors regarding
what constitutes a well-prepared beginning clinician. Lay people, such as consumers
and politicians, often see supervision as protection from incompetent, unethical,
or impaired therapists, but many of them have given little thought to how this is
achieved.
Issue. We suggest that the field provide evidence for the role of supervision in
consumer protection and determine the extent to which supervisors prevent unqualified
supervisees from gaining clinical credentials, the criteria that they use to make
these difficult decisions, and the methods that they use to carry them out. It would
be helpful to emphasize how different stakeholders define competence and to reach
a consensus regarding what competencies supervisees should attain pre- and postgraduation.
Once criteria are known, supervisors would be more able to serve as effective gatekeepers
and strive to protect consumers. This is a challenge, but it could provide additional
credibility for the process of supervision.
Best practice recommendation. To be maximally effective as gatekeepers and to protect
consumers, supervisors may need to join as a community. For example, pre- and postgraduate
supervisors can find ways to team up in setting criteria for new graduates, or supervisors
can share supervisees' progress as they transfer from one supervisor to another.
Clear Distinctions Can Be Drawn between Supervision, Consultation, and Training
In the literature, supervision, consultation, and training are defined as distinct
endeavors (Sprenkle & Wilkie, 1996). The emphasis in supervision is simultaneously
ensuring the quality of care that clients receive while promoting the professional
development and socialization of partially trained clinicians. Consultation is a
peerlike exchange between therapists and an invited consultant. In training, the
emphasis is on the teaching of theories, skills, and techniques. The definitions
also make an important distinction regarding the degree of clinical responsibility
for clinician's caseloads that supervisors, consultants, or trainers assume. For
example, supervisors are defined as bearing clinical responsibility for clinicians'
caseloads, whereas consultants are not.
Common practice. It is our impression, however, that these sharp distinctions are
often obscured in activities that are labeled "supervision." In common practice,
the terms seem to be used interchangeably. As a result, many supervisors unknowingly
develop supervision contracts, usually loosely defined verbal agreements that are
inconsistent with the formal definition of supervision.
Issue. Because supervision is a universally accepted requirement for professional
advancement in the field, it seems imperative that supervisors practice according
to a generally understood and endorsed definition of supervision. Confusion can be
highly problematic for everyone. For example, supervisors may frequently target supervisees'
clinical cases, neglecting supervisees' overall professional development. As another
example, it is common practice for doctoral student supervisors-in-training to supervise
other students but to have the evaluation of their supervisees be the sole responsibility
of faculty so that the doctoral student supervisors-in-training are essentially doing
consultation, not supervision. We recommend that the field proactively revisit the
definition of what constitutes supervision. Supervisors may use the terms supervision,
consultation, and training interchangeably because the current distinctions between
these activities fail to capture real world differences. The definitions may need
to be revised or supervisors simply may need to be familiarized with the differences
between the activities.
Best practice recommendation. We have found it helpful to clearly define what responsibilities
we are personally and professionally agreeing to assume when we take on the role
of supervisor and to have the specifics of the supervision process spelled out in
a written, formal contract that is periodically reviewed. As we distinguish supervision,
we think it is important to attend to supervisees' overall professional development,
which includes their progress toward clinical competency and becoming respected professionals
who can function effectively in all respects in an organization.
Supervisors Inherently Have Clinical Responsibility for Supervisees' Cases
Supervisors are assumed to have integral knowledge of supervisees' entire caseloads
and to be proactively guiding the therapy process.
Common practice. In our experience, supervisors frequently erroneously assume they
are less responsible for their supervisees' cases than they are. Two typical examples
illustrate the problem. In the first situation, supervisor and supervisee agree to
focus on a few ongoing cases, ignoring the remainder of the supervisee's caseload.
In the second situation, a supervisor and supervisee agree to meet every 2 weeks
for 1 hr, when the supervisee is conducting 30 sessions per week. Unfortunately the
supervisors in these examples may still be held accountable for all of the supervisees'
cases.
Issue. For many supervisors, there seems to be a gap between the degree of responsibility
that they believe they are assuming and the degree of responsibility for which the
legal context will hold them accountable. Although supervisors can not monitor every
move the supervisee makes, they are responsible for ethically and legally practicing
supervision that is consistent with the standard of care for supervision. There seems
to be consensus that supervisors should have an agreement that supervisees inform
them regularly about any risky clients, should have specific procedures outlined
for the handling of emergency cases, and should be accessible to provide appropriate
guidance (Engleberg & Storm, 1990).
Best practice recommendation. Because of the public and legal view that supervisors
are overseeing supervisees' entire caseloads, it appears that the best practice is
to abide by the consensus and to insist that supervision is frequent and extensive
enough that supervisors can responsibly oversee supervisees' caseloads. An alternative
approach is to limit the number of cases that the supervisees see; however, this
may require significant changes in regulatory laws and supervisees' professional
contexts before it can be easily done.
GAPS REGARDING CONTEXTUAL SENSITIVITY
Supervisors Must Be Proactive in Promoting Contextual Sensitivity
With the feminist critique and growing awareness of cultural influences, supervisors
are expected to attend to issues concerning gender, ethnicity, sexual orientation,
race, socioeconomic status, religion/spirituality, and so on in therapy and in the
supervisory context.
Common practice. Because supervisors in the field have been predominantly male, whereas
supervisees have been usually female (Nichols, Nichols, & Hardy, 1990), the effect
of gender on supervision was the first contextual influence to be addressed. The
extensive literature has, for the most part, focused on the experiences and needs
of women supervisees (e.g., Wheeler, Avis, Miller, & Chaney, 1989). Because there
were significantly more female supervisors in 1990 than there were in 1980 (Nichols
et al., 1990), we are beginning to see some attention to men being supervised by
women and to same-sex supervision (Turner & Fine, 1997). Supervisors are increasingly
dealing with supervisors' and supervisees' values and biases regarding gay/lesbian
clients (Long, 1996) and are determining whether gay/lesbian supervisors and supervisees
should be open about their sexual orientation to each other (Gautney, 1994; Schrag,
1994). Although race, class, and ethnicity, along with gender are always present
within any supervisory relationship, race, class, and ethnicity are being much more
slowly addressed in the field than is gender (Lappin & Hardy, 1997). It appears that
most supervisors now notice their supervisees' contextual influences (and how they
are similar or different from their own and their supervisees' clients) and agree
that it is important for them and for their supervisees to be contextually sensitive.
Issue. When differences are visible and spoken about openly, contextual influences
are more easily addressed, but when supervisees or supervisees' clients do not bring
up contextual influences, supervisors have told us they frequently wonder whether
they should. Other supervisors are confused about how to address contextual influences
when supervisors, supervisees, and clients appear to be of the same gender, culture,
race, sexual orientation, and so on (AAMFT, 1994). We think that there is a need
to develop specific supervisory methods to promote contextual sensitivity in supervisees,
provide supervisory guidelines for when to focus on contextual influences and when
not to focus on them, and to address more complex issues, such as dealing with diversity
that is less visible.
Best practice recommendation. Sharing by supervisors and supervisees of their contextual
influences within supervision, supervisors proactively asking about contextual influences
regularly in all cases, and supervisors being curious about how contextual influences
are affecting therapy and supervision promotes contextual sensitivity in supervisors
and supervisees. This can create a context of permission for those influences that
are less evident to emerge.
Until Recently, Supervision Practices Were Assumed to Be Similar Across Professional
Settings
Although there has been considerable literature devoted to training in various contexts
(Liddle, Breunlin, & Schwartz, 1988), until recently there has been surprisingly
little written on the supervision process per se within the three primary supervisory
contexts of educational institutions, privately contracted supervision, and agencies.
Thus, there seems to have been an underlying assumption that supervision practices
can easily be adapted to a variety of professional settings without supervisors needing
to know much about the context or to change the supervision process in any significant
way.
Common practice. In our experience, supervisors outside of educational settings are
painfully aware that their supervision practices are different than those practices
held up as the standard, and less than onethird of supervisors work within educational
settings (Nichols et al., 1990). The ideal image of supervision portrays live and
taped supervision, with ample opportunity for supervisors to structure it in a variety
of ways. The actual practices of supervisors seem to be much more context dependent
and to reflect some of the differences between the professional contexts of educational
programs (Storm & Sprenkle, 1997), privately contracted supervision (Todd, 1997a),
and agencies (Cook, 1997).
Issue. We propose that there be more discussion by experienced supervisors from a
variety of settings in the field regarding the influence of the professional setting
on supervision, the challenges each setting poses for supervision, and what constitutes
the best supervision practices for a given context.
Best practice recommendation. We have found it to be useful to recognize the ways
in which professional settings shape the meaning of supervision, create opportunities
and constraints for supervision, and define supervisory practice. Based on this information,
supervisors are in a better position to select the best supervisory practices for
their particular setting.
GAPS REGARDING ETHICS
Supervisory Ethical Decision Making Involves More Complexity
Supervisors must consider their responsibility to supervisees and their gatekeeping
role for the profession in addition to their responsibility for delivering quality
care to their clients and their ethical responsibilities to the profession and the
community. This must be accomplished one step removed from the practice of therapy.
Thus, supervisory ethical decision making is often more complex than clinical ethical
decision making.
Common practice. In our experience, beginning supervisors seem to believe that if
they are well-versed in MFr ethics, this information will easily transfer to the
supervisory context, automatically making them ethical supervisors. As they gain
experience, supervisors gain awareness that this belief is only partially valid as
they recognize that the complexity involved in supervision requires additional ethical
knowledge.
Issue. Although the assumption and common practice appear to converge over time for
most supervisors, we feel it would behoove the field to more strongly encourage supervisors-in-training
to recognize the complexity that is inherent in supervision ethics from the start
and to seriously consider the unique ethical responsibilities of supervisors.
Best practice recommendation. The best ethical practice seems to be for supervisors
carefully to consider their responsibility to supervisees and their gatekeeping role
for the profession in addition to their responsibility for delivering quality care
to their clients, the profession, and the community.
Supervisors Should Avoid Multiple Relationships
Ethical standards clearly discourage multiple relationships that have the potential
for exploiting supervisees or contaminating the objectivity of supervisors (AAMFT,
2001). If supervisors and supervisees engage in multiple relationships, the underlying
belief appears to be that the "power" differential between supervisors and supervisees
places supervisees at risk and jeopardizes supervisors' ability to fulfill their
evaluative role.
Common practice. As noted by Ryder and Hepworth (1990), multiple relationships abound
in supervision. Most supervision involves some attention to the impact of supervisees'
personal life on their work (Aponte, 1994), which results in a wide range of practice
regarding where supervisors draw the line between therapy and supervision. After
a hotly contested debate in the field about this issue (Freidman, 1994; Peterson,
1993; Tomm, 1993), the resolution appears to be that supervisors are wise to avoid
becoming therapists for their supervisees, but they have wide latitude to focus on
the interface of their supervisees' personal and professional lives. Many supervisors
encourage, rather than avoid, other nonsexual multiple relationships with supervisees,
such as coauthoring a paper or attending meetings together because they believe these
relationships are desirable in mentoring therapists. However, the onus is on supervisors,
not on the supervisees, to ensure that no harm comes from these relationships, and
supervisors should recognize that doing so is much more difficult than assumed.
Issue. Although the field has recognized the difficulty in determining when multiple
relationships are desirable and when they are problematic in supervision, supervisors
have little to guide them in making this decision. We believe that supervisors could
benefit from having guidelines that focus on constructive multiple relationships.
Best practice recommendation. We believe that supervisors can make sound decisions
about when to engage in multiple relationships in supervision if they embrace the
idea that it is their responsibility, not that of their supervisees, to prevent harm
and if they carefully weigh the possible enhancements and complications of these
relationships.
GAPS REGARDING PHILOSOPHY
An Underlying Philosophy of Supervision Is Important
Having supervisors articulate a personal model of supervision has been a major requirement
of AAMFT since 1977.
Common practice. At this point, it is generally conceded that it is important for
supervisors to articulate a personal philosophy of supervision. This consensus has
been strengthened by the postmodern emphasis on being transparent about one's assumptions.
However, much of the existing literature has tended to focus on models of training,
rather than on models of supervision, or it has made little distinction between supervision
and training. (See, e.g., references on training from various perspectives in Liddle
et. al., 1988.) Only recently has the supervision literature discussed the implications
of most major MFr models for supervision. (See, e.g., references on supervising from
various perspectives in Todd & Storm, 1997.) It is still rare for a substantial body
of literature to be available for any particular model of supervision, with the exception
of the solution-focused model (e.g., Marek, Sandifer, Beach, Coward, & Protinsky,
1994; Selekman & Todd, 1995; Triantafillou, 1997).
Issue. Because most supervisors regard themselves as integrative in their supervision
(Wetchler, 1988), they cannot always easily develop a set of assumptions that is
coherent and consistent. Being an integrationist may warrant closer scrutiny. At
one extreme are the well-articulated, highly consistent integrative models of supervision,
such as those described by Rigazzio-DiGilio (1997). At the opposite extreme, many
supervisors actually may be somewhat closer to "unsystematically eclectic."
Best practice recommendation. We recommend that supervisors who are combining ideas
from several models move toward a higher degree of integration. We suggest that the
articulation of a supervision philosophy include considerations such as supervises
preparation for supervision and other contracting issues, notions about supervises
"resistance," and appropriate handling of personal issues. In addition to theoretical
consistency, it can be useful to pay attention to the theoretical fit of particular
supervisory structures and supervision formats to achieve goals that are important
within a given model of supervision. For example, Stewart (1997) argues that case
report may be a better fit than live supervision for narrative supervision.
Supervision Is Isomorphic to Therapy
One of the most influential ideas in the supervision literature has been the concept
of isomorphic relationships among different levels of systems, such as the supervisory
system recapitulating some important dynamic between parents and children and family
and therapist (White & Russell, 1997). In a similar vein, aspiring supervisors have
been advised to look to their model of therapy as a guide for their model of supervision
(Heath & Storm, 1985).
Common practice. There seems to be little doubt that these twin foci have been influential
in shaping how supervisors think about supervision. These ideas have been reassuring
to new supervisors and have often produced useful ideas about supervision.
Issue. Conversely, this emphasis on isomorphism and the parallels between therapy
and supervision models may have tended to eclipse a focus on important differences
between supervision and therapy. Mead (1990) also cautions against adopting any narrow
model of supervision, favoring a much more generic model instead.
Best practice recommendation. We recommend that all supervisors more closely examine
the differences between therapy and supervision. Some issues are paramount for particular
models; for example, the handling of personal issues in psychodynamic and Bowenian
approaches, the use of paradox and other indirect techniques in the Haley strategic
approach, and the role of education and insight that is deemphasized in many therapy
models but that is more important in supervision.
Theoretical Orientations of Supervisors Are Major Contributors to Their Effectiveness
Many supervisors feel strongly about the theoretical orientation they prefer in therapy
and believe that it is their skill in applying these ideas that is their primary
contribution to supervisees. As noted earlier, the idea of isomorphism has further
promoted the idea that these therapy ideas are replicated in supervisors' philosophies
of supervision.
Common practice. There is no evidence that one theoretical approach to supervision
is generally better than any other orientation. In fact, we were not able to find
any studies that compare models of supervision, and there are very few that look
at the impact of a clearly articulated model. Triantafillou's (1997) study of a solution-focused
approach to supervision is a rarity in this regard. However, we are quite confident,
based on comparative studies of therapy models, that comparative studies of supervisory
models would not yield consistently significant differences. The largest meta-analysis
of MFT outcome research has demonstrated that there are only superficial differences
in the results achieved by the various therapy models (Shadish, Ragsdale, Glaser,
& Montgomery, 1995). Therefore, it seems reasonable to assume that there is no demonstrably
superior model of supervision because they tend to be based on therapy models that
are themselves not demonstrably superior.
Issue. Rather than asking, "What is the best approach to supervision?" we should
be asking questions such as: "To what extent does supervision enhance the `common
factors' demonstrated by research to positively affect therapy (e.g., building strong
therapeutic alliances with clients)?" However, what are "common factors" in the supervision
experience? In a Delphi study of supervisors' perceptions of the essential ingredients
of effective supervision, White and Russell (1995) took a first step in this direction.
They found that a strong supervisor-supervisee relationship that emphasizes warmth,
support, humor, and genuineness is a prerequisite for supervision deemed successful
by supervisees.
Best practice recommendation. We believe that supervisors should give major emphasis
to the supervisory relationship (rather than overvaluing technique), making use of
"common factors" that enhance this relationship. These include the qualities of warmth
and support, empathic listening, acting genuinely, and expressing humor and optimism.
These factors are crucial in the best practice of supervision because it is important
for supervisees to trust the supervisory process to feel safe in revealing vulnerabilities,
uncertainties, and mistakes, and to openly discuss personal issues.
Supervision Should Be Tailored to Supervisees'Developmental Level
The idea has been widely accepted that supervisees' needs and the appropriate focus
of supervision change across several developmental stages. In fact, it is largely
regarded as axiomatic: Beginning therapists have different needs and require a different
supervisory focus than more experienced therapists (Flemons, Green, & Rambo, 1996).
Further, many supervisors seem to believe and the literature calls for supervisors
to tailor their supervision to the specific developmental level of supervisees (Rigazio-DiGilio,
1997; York, 1997).
Common practice. In considerably simplified form, developmental models essentially
suggest supervision that is more directive and technique focused for beginning supervisees,
whereas advanced supervisees need a more collaborative, conceptual style of supervision.
Despite its wide acceptance, there is little research evidence to support the notion
of stages or the assumption that supervision should vary according to supervisees'
developmental levels. In fact, results from some studies question, and even contradict,
the notion of developmental stages and note a lack of longitudinal data to show that
supervisees' needs change over time (Fisher, 1989; Wark, 1995). For example, Fisher
(1989) found that beginning and advanced supervisees report no differences in their
supervision needs, in the supervision they received, or in the supervisory behaviors
that each group perceived as helpful. Three major reviews (Holloway, 1992; Stoltenberg,
McNeill, & Crethar, 1994; Watkins, 1995) of extensive research in the individual
psychology literature at best found only limited support for the developmental assumption.
Issue. The developmental approach is a helpful, intuitively appealing way to organize
supervision, but supervisors may not actually conduct supervision differently with
beginning supervisees than they do with those who are more advanced. Supervisees
may not develop along discernable stages, and supervision tailored to stages may
not be better than supervision that is not.
Best practice recommendation. Because there does not appear to be a universal developmental
sequence for supervisees, we propose that supervisors individualize their supervision
to the specific needs of each supervisee. Supervisees appear to be the best source
for information about how to tailor supervision for them.
GAPS REGARDING SUPERVISORY RELATIONSHIPS
Supervision Is a Private Endeavor between Supervisors and Supervisees
Historically, most supervisors and supervisees view themselves as engaging in an
intense personal relationship in which supervisees trust their supervisors with their
professional failings, fears, and struggles, and supervisors respond with guidance,
support, and mentoring.
Common practice. Supervisors and supervisees may assume that more privacy exists
than actually occurs. Because of changes in the profession, our observation is that
privacy within the supervision relationship seems to be diminishing. The percentage
of supervisors who are doing supervision within their private practices has dropped
dramatically (Nichols et al., 1990). Supervisees are more frequently obtaining supervision
within their work environments from supervisors who confer with other supervisors.
Issue. We recommend that the field take note of the degree of privacy that seems
to exist in supervision. It may not be possible to treat supervision as the intense
personal relationship recommended if it is a less private endeavor. Supervisors may
need to find new ways to create a safe supervisory environment that invites supervisees
to bare their struggles when confidentiality is limited.
Best practice recommendation. Supervisors and supervisees alike appear to need clarity
regarding the degree to which the supervisory relationship is private. Perhaps the
best practice is for supervisors and supervisees to be as personal and intense as
is appropriate for the particular context. We have found explicit contracting regarding
privacy and confidentiality in supervision can be helpful, and keeping our behavior
consistent with our contracts is important.
Contemporary Supervisors Are Collaborative and Use Corresponding Methods
Power issues in supervision, once ignored, are now counteracted by an emphasis on
collaboration with the advent of postmodernism in MFT. In recent years, the literature
on supervision has been emphasizing collaboration and a flattening of the hierarchy
in supervision as well as innovative methods that are consistent with postmodern
ideas, such as the use of reflecting team supervision.
Common practice. Despite this emphasis on collaboration, it is important to ask how
widespread and consistent is this practice and whether supervisees, the "consumers"
of supervision, are reassured by this emphasis. Historically, supervisors seem to
have underemphasized the power that is inherent in the evaluative and gatekeeping
roles of supervisors, a role that supervisees rarely forget. Even those supervisors
who subscribe to more collaborative relationships are dealing with a larger context
that places supervisors at the top of a hierarchy and holds them accountable as experts
who guide and evaluate their supervisees. The degree of emphasis on flattening the
hierarchy also seems to depend significantly on context. Postmodern ideas appear
to be embraced most wholeheartedly in academia, although, even in academic settings
implementation is not easy because of the importance of grades for students. In contrast,
in agency settings, it is not uncommon for supervisors to have clinical and administrative
responsibility for supervisees, which makes it difficult to flatten the hierarchy
or ignore the issue of power (Cook, 1997). Similarly, it may be easier to emphasize
collaboration in a private supervision setting (Todd, 1997a) when supervisees already
have terminal degrees, or when supervising supervisors (Storm, Todd, McDowell, &
Sutherland, 1997).
Issue. Literature on the topics of power, hierarchy, and collaboration has shown
an increasing awareness of the complexity of this issue. We think that the field
could benefit from the development of additional postmodern methods that fit the
constraints and opportunities for supervision that occurs outside of educational
settings. This probably requires more collaboration between supervisors from academia
and those from other settings.
Best practice recommendation. We agree with Fine and Turner (1997), who advocate
making power issues transparent, rather than assuming that it is possible to make
them disappear. We believe that a postmodern view can be best practiced when the
constraints and opportunities of the context and expectations of supervisees are
carefully considered.
Most Issues and Potential Problems in Supervision Can Be Avoided or Minimized
Careful contracting, including provisions for evaluation, feedback from supervisees,
and conflict resolution can help to avoid or minimize problems.
Common practice. Supervision contracts remain informal and feedback, if requested
at all, is usually haphazard. Beyond this, however, is a more basic issue of trust
by supervisees, who are very aware of differences in power in supervision (Storm
et al., 1997; Todd, 1997b). Surveys of supervisees reveal clear supervisee preferences
for particular qualities of supervisors and the importance of the supervisory relationship
(Wetchler, 1989; Wetchler & Vaughn, 1991; White & Russell, 1995). Unfortunately supervisees
do not consistently disclose concerns to their supervisors (Ladany, Hill, Corbett,
& Nutt, 1996), and supervisors are often inaccurate about how they are viewed by
supervisees (Dellorto, 1990). Although supervisors clearly need feedback, supervisees
do not sense that supervisors are open to such feedback, and issues of power and
evaluation make it seem risky to offer it (Todd, 1997b).
Issue. The American Association for Marriage and Family Therapy has attempted to
stipulate supervisory responsibility for the supervisory climate, requiring prospective
supervisors to describe how they "create a supportive learning environment and foster
the development of creativity of the therapist rather than fostering imitation of
the supervisor" (AAMFT, 1999, p. 16). Other authors (see, e.g., Atkinson, 1997) recommend
that supervisors invite a frank and open discussion about the learning environment,
essentially doing a candid "full disclosure" in their initial supervisory contract.
Although these recommendations are a good start, it seems crucial for supervisors
to find ways for supervisees to register complaints that supervisees will actually
utilize, to obtain honest supervisee feedback regarding their supervision, and to
use supervisee feedback to address irresponsible or exploitative behavior by supervisors.
Best practice recommendation. We propose that supervisors proactively seek and respond
to supervisee feedback by paying attention to characteristics of the relationship
or the supervisory context that make it difficult for supervisees to be candid in
their feedback.
GAPS REGARDING METHODS AND INTERVENTIONS
Supervisors Prefer Live Format and Team Structure
The impression created by the literature is that supervisors not only prefer the
format of live supervision and the structure of team supervision to all other alternatives,
but that they are also the most common format and structure. A visual review of any
bibliography on supervisory methods indicates that most articles are on some aspect
of live or team supervision.
Common practice. There has been a dramatic increase in the use of live supervision
since the 1980s (Nichols et al., 1990). However, surveys of supervisory practice
indicate that live supervision lags behind case consultation and videotape supervision
as the formats that are most frequently used by the majority of supervisors (Nichols
et al., 1990; Wetchler, Piercy, & Sprenkle, 1989). Although supervisors in educational
programs believe that supervisees should have a variety of supervision experiences
during their training (Henry, Sprenkle, & Sheehan, 1986), videotaped supervision
is the most common, followed by live supervision (Carlozzi, Romans, Boswell, Ferguson,
& Whisenhunt, 1997). It appears that team supervision lags behind other structures
and that supervision tends to occur primarily in dyads or groups. (Team supervision
refers to a group of therapists that works with a case together with one member in
the room with the clients and the other members behind a one-way mirror.) This is
probably because AAMFT and state regulation requirements emphasize the importance
of individual and group supervision. It appears that live and team supervision are
predominantly used in training settings.
Issue. One of the primary issues thus becomes how to train supervisors in the formats
and structures that they are most likely to use in their professional settings. Each
format (i.e., live, taped, and case consultation) and each structure (i.e., teams,
dyads, and groups) has unique advantages and disadvantages within particular professional
settings. Formats and structures interact with supervisors' and supervisees' preferred
theoretical ideas, styles, methods, and values. As a result, using them in varied
combinations may promote maximum learning. However, supervisors, as recommended in
1988 by Kniskern and Gunman, still need to determine what format and structure works
best with which supervisee who is learning what competencies at what point in time?
Do certain formats and structures actually promote particular types of learning as
believed?
Best practice recommendation. We have found that the best supervisory formats and
structures are dependant on such factors as the theoretical preferences of participants,
learning goals of supervisees, professional setting in which supervision occurs,
and so on, and can be selected accordingly. Supervisors will select the best formats
of supervision if they appreciate the opportunities and constraints of each.
Raw Data Are Privileged Over Other Sources of Supervision Information
Generally, supervision standards emphasize access to direct observation of therapy,
also referred to as raw data, and often require a certain percentage of supervision
to be based on it for supervision hours to count. Until recently, self-report has
been viewed as a back-up data source, rather than as a preferred or primary source.
Common practice. Because supervisees and supervisors view self-report via case consultation
as more practical in terms of time and logistics and as more helpful for supervisee
development than is raw-data supervision, supervision tends to be based more on self-report
during case consultation (Wetchler & Vaughn, 1991).
Issue. We believe the field could benefit from reevaluating its position on raw data
by reconsidering the benefits of case consultation as proposed by McCollum and Wetchler
(1995) and Stewart (1997) and by scrutinizing more closely the privileged status
of live supervision. To privilege both types of data, supervisors may need to educate
the therapeutic community about the value of each and work to change existing standards.
Best practice recommendation. We have found it helpful to recognize that both raw
data and self-report sources of information add value to the supervision process,
albeit in differing ways; each has constraints and limitations, and each influences
the supervision process in specific ways (Carlozzi, Romans, Boswell, Ferguson, &
Whisenhunt, 1997). We suggest that supervisors continually reexamine the value of
differing sources of information in supervision for the fit with their philosophies
of supervision and not become too wedded to one source over others.
CALL FOR ACTION
Over the years, AAMFT has clearly been the leader in setting the standard for MFT
supervision practice. This role has included the creation of extensive criteria for
the designation of qualified supervisors, the process, content, and characteristics
of supervision, and the role of the supervisor. Despite this emphasis, we believe
that we are witnessing erosion of the quality of supervision and deemphasis on supervision
as a result of provisions of many state laws. Some states only require that a "qualified
supervisor" have additional years of clinical experience, some require some degree
of supervisory experience, but only rarely is there any requirement for didactic
preparation or supervision of supervision. Because AAMFT is now relying heavily on
state regulation as the route to clinical membership, regulation requirements may
be undercutting the role of the approved supervisor and the standards so carefully
built. We are concerned that if current trends continue, few professionals will be
motivated to become approved supervisors. If we believe that having well educated
supervisors who provide quality supervision is important in training future clinicians
and for consumer protection, it is important to counter this trend. Assuming that
AAMFT is not going to roll back the clock, we believe that it would be timely for
supervisors to advocate stronger provisions in state laws that require supervisory
training. We join with AAMFT in inviting our colleagues to be politically active
to ensure that supervisory training requirements are strongly enforced. This seems
critical to us if the best supervision practices, whatever they are, are to endure.
CONCLUSION
We hope that this article stimulates discussion about the standards of practice of
supervision. We are less concerned that readers agree with our assumptions, generalizations
about supervision, and/or suggested best practices for supervision than we are that
we, as a field, address any gaps between the literature and standards and the common
practice of supervision. We look forward to working with our supervisory colleagues
in sharpening the definition of the standards of practice for supervision.
-1-
Questia, a part of Gale, Cengage Learning. www.questia.com
Publication Information:
Article Title: Gaps between Mft Supervision Assumptions and Common Practice: Suggested
Best Practices. Contributors: Cheryl L. Storm - author, Thomas C. Todd - author,
Douglas H. Sprenkle - author, Michael M. Morgan - author. Journal Title: Journal
of Marital and Family Therapy. Volume: 27. Issue: 2. Publication Year: 2001. Page
Number: 227+. © 2001 American Association for Marriage and Family Therapy. Provided
by ProQuest LLC. All Rights Reserved.
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"But they that wait upon the LORD shall renew their strength; they shall
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