Legal aspects of clinical supervision 1: Employer vs employee

In order to implement clinical supervision some major issues need to be clarified. This article looks at clinical supervision in terms of the relationship between the employer and the employee. It discusses clinical supervision as a contractual requirement and a voluntary system and examines some of the related problems. The implementation of clinical supervision may be limited by the significant cost of training. Possible frameworks for setting up a system for supervision are suggested. Employers need to be adequately informed about the clinical supervision process so that it can become both effective and flexible. The second article in this series will consider legal issues relating to professional accountability, patients' rights, and records and record keeping. These two articles refer to information generated from a workshop held at Prince Philip Hospital, Llanelli, in which practitioners looked at some of the legal issues relating to clinical supervision.     

Competence in competency-based supervision practice: Construct and application.

Providing competent clinical supervision is challenging for the practitioner both in determining supervisee competencies and in conducting the corresponding supervision. Competence, an ethical principle that informs the practice of psychology, refers to requisite knowledge, skills, and values for effective performance. Similar to other health care professions, psychology is increasingly moving towards competency-based approaches in education, training, and performance appraisal. In this article, the authors review perspectives on competence as a construct and define competency-based clinical supervision, with particular attention to the nature of ethical, legal, contextual, and practice issues that arise from the establishment of a standard of competency-based supervision practice. The authors conclude with a discussion of challenges faced in clinical supervision and recommendations for best practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical dilemmas in clinical supervision. 2: Need for guidelines

In this, the second half of this two-part article, the authors focus on ethical dilemmas in clinical supervision. Referring to the case vignettes included in the first part of this article (Vol 7(15): 920-3), the authors highlight how ethical dilemmas can arise and then provide some discussion on how they might be handled. As a result of the discussion, the authors conclude that there is a clear need for a specific set of guidelines to be produced that would help safeguard best practice within clinical supervision and ensure it remains an opportunity to help and support nurses in reflecting on their dilemmas, difficulties and successes (Cutcliffe and Proctor, 1998a). This would prevent supervision from becoming another form of management monitoring which might inadvertently prevent the resolution of intra- and interpersonal issues affecting the care of clients.     

Clinical supervision: the art of being supervised

Clinical supervision has been described as being of paramount importance to the development of nursing (Bishop 1994). It is now accepted that clinical supervision is an integral part of nursing practice (Waterworth et al 1997). This article summarises the pre-requisites for successful supervision and emphasises the role of the practitioner in the scheme (UKCC 1996). The author suggests how supervisees can influence the type and quality of their supervision.     

Focus supervision: Management format for supervision practices.

Although supervision practices have received some attention from clinicians and researchers, they have also created new challenges for clinical practicum supervisors and coordinators. Because graduate-level trainees have learned more about supervision, they expect more from their supervisors; conversely, supervisors have sought limits on their comprehensive roles. This article outlines a supervision model consisting of 2 tiers: general and focus supervision. General supervision covers the global range of clinical cases, whereas in focus supervision, trainees address specific clinical skills and topics. The process of designing and implementing this model is described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of psychotherapy supervision on client outcome: A critical examination of 2 decades of research.

The supervision of counselors-in-training has become an important area of psychotherapy research. Through supervision, one expects that trainees will gain the knowledge and clinical skills needed to work effectively with clients. Much research has been dedicated to understanding trainee skill development through supervision, but relatively few studies in the literature have addressed whether clinical supervision leads to improved client outcome. The current article presents a review of 2 decades of research into the question of whether clinical supervision improves client outcome. Ten studies conducted between 1981 and 1997 are reviewed in detail. Caveats and criticisms, as well as suggested directions for future research, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A transtheoretical model of clinical supervision.

The purpose of this article is to introduce a transtheoretical model of clinical supervision for professional psychology. The various stages and processes of change inherent in the transtheoretical psychotherapy model (Prochaska & DiClemente, 1982, 1984, 1986; Prochaska & Norcross, 2007) are assessed and applied to clinical supervision. Specifically, relevant literature is examined; supervisee stages of change (SSC) and supervisor processes of change (SPC) are introduced and discussed; and existent models of supervision are contextually compared to the proposed transtheoretical model. Strategies and recommendations for implementing and researching a transtheoretical approach to clinical supervision are also provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opening the dialogue: Implications of feminist supervision theory with male supervisees.

There is a lack of scholarship examining the implications of feminist-informed theories of clinical supervision to guide practice with male supervisees. A critical discussion is needed to better understand the intersections of feminist supervision theory and masculine psychology lest ineffective supervisory interventions occur. The present article begins with a critical review of the intersections of male psychological theory and feminist supervision theory. A hypothetical case vignette is then presented to highlight a number of potential implications for supervisors working with male supervisees informed by feminist supervision theory. The article concludes with directions for future training and research, as well as limitations of the arguments presented. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of Handbook of psychotherapy supervision.

Reviews the book, Handbook of psychotherapy supervision by C. Edward Watkins Jr. (see record 1997-08923-000). This book offers a forum for some of the most influential thinkers of our time to discuss what is probably the most critical aspect of learning how to become a therapist: clinical supervision. The book is well organized, comprehensive, and informative. In it, the elusive nature of teaching how to conduct psychotherapy is explored and clarified from a variety of perspectives and across myriad contexts. Overall, the book provides a wealth of information in an organized and readable fashion. Nonetheless, the topics explored include some areas that were not covered adequately. For example, the book would have been further enhanced had the subject of supervisory failures been given more attention, as we know that learning from past errors often provides the most valuable teaching opportunities. Despite a few minor criticisms, the book serves as a wonderful reference for practitioners, students, and teachers of psychotherapy. While extremely useful for the beginning supervisor, the book is also a valuable resource for seasoned supervisors who wish to expand or challenge their ways of thinking about supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical supervision: the Cartmel NDU experience

Much has been written about clinical supervision, but there is little published evidence to demonstrate its effectiveness. This article describes the introduction and development of clinical supervision in a mental health nursing development unit, charting the consequent change of culture to one in which nurses were able to pioneer innovative models of care.     

Core competencies in suicide risk assessment and management: Implications for supervision.

The recent publication of core competencies in suicide risk assessment and management (Suicide Prevention Resource Center, 2006) and the American Psychiatric Association's (2003) practice guidelines have raised concerns about how best to address these issues in clinical supervision of trainees. This article reviews the identified core competencies, addresses implications for supervision of trainees, and provides a general framework for applicable strategies for the supervision process to facilitate clinical skill development and refinement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Real-time training: Transfer of knowledge through computer-mediated, real-time feedback.

In this article, the author describes an interactive, computer-mediated method/technology for promoting transfer of knowledge, theoretically grounded in cognitive science, that responds specifically to needs outlined by Binder (1993; 1999) and Berger (2004) for integrating cognitive psychology principles and interactive, computer-mediated methods with psychotherapy training. The article provides a context for understanding the process known as Real-Time Training (RTT; Rosenberg, 2000a) by reviewing expertise research literature as applied to clinical training, describing the conceptual framework underlying the development of RTT, reviewing live and computer-mediated supervision methods for clinical training, providing preliminary research validation of RTT, and discussing clinical training and supervision implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical training and expert testimony: Comment.

Comments on the original article by R. Jeffrey (see record 1965-06327-001) regarding expert testimony by psychologists in two separate court cases. The current author opines that it is a highly questionable practice for the American Psychological Association to approve programs in clinical psychology when many of these universities cynically or indifferently designate the entire responsibility for training and supervision in psychodiagnostics and psychotherapy to others, outside the university, whose competence is often unknown. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The experience of shame in psychotherapy supervision.

Notes that shame is a complex and powerful experience that is difficult for therapists to address. The purpose of this article is to help therapists on both sides of the supervision dyad have a better understanding of shame and its defenses. In order to elucidate the inevitable shame that arises in supervision, this article first describes the nature of shame, beginning with its early manifestations in interpersonal relationships with primary caregivers. It also includes a short section on the adaptive nature of shame. Because individuals develop characteristic ways of coping with it, it is suggested that shame may be concealed from oneself and others through withdrawal, avoidance, attack on self, and attack on others. These characteristic reactions to shame are discussed in detail because they influence how shame is manifested. Four vignettes illustrate how each defensive reaction may be manifested in supervision, and suggestions for minimizing the adverse impact of shame are proffered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical supervision for nurse lecturers

This article builds on a previous one which discussed the use of de Bono's thinking tool, 'six thinking hats' in the clinical, managerial, educational and research areas of nursing (Lewis 1995). This article explores clinical supervision and describes how the six thinking hats may be used as a reflective tool in the supervision of nurse lecturers who teach counselling skills.     

Developmental models of supervision: It is development—Response to Holloway.

This article is a response to Holloway's critique of developmental models of psychotherapy supervision. Our position is that developmental models of supervision can benefit from taking guidance from and drawing parallels to more general models of human development. It should not be assumed, however, that these models of supervision are direct translations of other models. The metaphor of development has proven useful in a number of domains of human activity. We argue that this analogy is also useful in conceptualizing the training process in counseling and psychotherapy by providing a detailed framework through which changes in trainees over time and optimal supervisory approaches can be examined. Although Holloway's impression of the state of research on developmental models of clinical supervision is that there exists little evidence in support of the models, other authors have noted considerable consistency between the constructs of these models and the published research. We support Holloway's suggestion for improving research methodology in this area, and we note additional directions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is it ever acceptable to deceive a patient?

This article describes a dilemma in clinical practice. The critical incident illustrates how a patient was deceived in hospital and how this was simply accepted by the majority of the ward staff. The situation is analysed by the student nurse involved, who found it difficult to accept, and a call is made for nurses to challenge decision-making processes based on inequalities of power.     

Clinical applications of telehealth in mental health care.

This article introduces the concept of telehealth and examines how telehealth expands both provider and patient access to health care. Current clinical applications are presented including equipment, research, and examples of direct clinical care. The article focuses on store-and-forward and video teleconferencing technologies providing information about the equipment and research pertaining to the clinical use of the equipment. The status of behavioral telehealth programs in the United States is reviewed and two case examples are provided. The first example discusses a direct patient care system and the second a remote clinical supervision system. The article concludes with suggestions for determining the value of adding telehealth to existing clinical practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training graduate students to be clinical supervisors: A survey of Canadian professional psychology programmes.

Recognising the need for training in clinical supervision, the Canadian Psychological Association (CPA) requires that accredited professional psychology programmes offer graduate students training in supervision. To fill a gap in the existing supervision literature, we surveyed training directors (or designates) of CPA accredited clinical and counselling programmes to understand how this training standard is currently being met in the area of clinical supervision. Responses were obtained from 20 of 28 programmes (71.4% response rate). Approximately 50% of respondents indicated that their programmes required some coursework related to clinical supervision, with wide variability, however, in the number of hours of coursework provided to students (range 3 to 39). Most courses included lectures and group discussion, but also often provided students with practical experience in clinical supervision provision. Only 25% of programmes required a practicum in which students gained experience in clinically supervising other students, although an additional 40% of programmes offered an elective practicum in which students gained some training in clinical supervision. Most programmes (~71%) identified strategies for improving training in clinical supervision (e.g., improving course work, requiring practical experience), but also identified challenges to offering clinical supervision training (e.g., availability of skilled supervisors, insufficient time to devote to supervision, student competency). Based on the findings, we offer some recommendations for how training in clinical supervision could be improved in Canadian professional psychology programmes as well as describe some important directions for future research in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)