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Training package for Psychology
Supervisors. A competency based initiative.
Yasmina Nasstasia, Wayne Clarke, Chris Wilcox & Katrina
Delamothe
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Thank
You
Acknowledgements to:
•Hunter and Coast ICTN (Rowena Amin)
•Colleagues from respective Universities including;
Craig Gonsalves, Ros Knight, & Kathryn Nicholson
Perry.
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Module 3:
Understanding your development and role
as a supervisor.
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For some time now…
in the practice of Psychology, Clinical
Supervision has been referred to as a “core
competency”.
Yet,
training of Psychologists in developing
this core competency has been patchy in
Australia, as it has across our profession
internationally.
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We have witnessed a strengthening of the profession.
National Registration has brought with it:
the development of standards,
an increasing emphasis on fitness to practice, and
an intense focus on equipping new graduates for
professional practice.
By ensuring increasing rigor, by way of close supervision, in
the way new Psychologists are entering clinical practice,
the practice of Supervision in this context has become a key
focus - competency is essential.
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With guidelines for the Supervision of new graduates well
developed, the focus has shifted and broadened so that
now the practice and delivery of Supervision generally is
beginning to receive the attention it warrants.
Whilst across the Psychology profession,
Supervision is now an essential element of
practice monitoring generally and professional
development specifically.
There is still no consensus as to what
constitutes effective training in
Supervision.
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The view in the past seemed to be that the skill of
providing good Supervision was learned by some
kind of osmosis…
Supervisors knew how to supervise by having
been themselves supervised.
The majority of Psychologists who provide
Supervision have had little training.
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Consider:
How did you learn to supervise?
How helpful was this?
What if anything was missing?
What would you have liked to be different?
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This set of supervision training modules will, it is
anticipated, produce active, involved and
committed Supervisors, in whatever context,
and across a range of different demands, whose
knowledge and awareness of their role will ensure
that they avoid the pitfalls of the process.
Supervision in Psychology: Current status
“Professional practice supervision is a key element in clinical
governance.
These processes seek to ensure that the individual practitioners
are supported in the development of their:
Practice knowledge,
Skills,
Service delivery,
Accept responsibility for their professional practice and
Are equipped to provide the highest possible levels of care
consistent with evolving evidence relevant to that care.
(NSW Government – Health Allied Health Professional Practice Supervision).
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This Policy statement emphasizes that Supervision
is aimed at enhancing consumer protection, the
safety of care in complex clinical environments, and
the Supervisee’s satisfaction in their role.
It underscores the risk-averse themes within the
public sector generally and the desire to retain
staffing resources.
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“Extensive literature and research indicates that Clinical Supervision
brings a range of benefits to practice outcomes for Allied Health
Professionals. These benefits are together considered so strong, that
Health providers are now recognizing the risks of not supporting and
promoting Clinical Supervision in their health professional workforce
and many are mandating the practice”
(HNELD Pol 13_01)
So, in terms of making Supervision a requisite for continuing
professional practice, Psychologists are ahead of the game, and have
been for some time.
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The Psychology Board of Australia (PsyBA) regards the
experience of Supervision as a component of Continuing
Professional Development (CPD) indicating that it is
”… the means by which members of the profession
maintain, improve and broaden their knowledge, expertise
and competence, and develop personal qualities in their
professional lives ... “
So that CPD encompasses all aspects of Supervision and
ongoing education.
Yet, Supervision and mandatory training for Clinical
Supervisors is not without its detractors, nor is it
without some controversy.
When this policy was first introduced by way of
discussion paper, two Colleges of the Australian
Psychological Society (APS) (Gonsalvez & Milne
(2010)
“were keen to see more evidence of the
effectiveness of Supervisor training”
Another “… wanted to see evidence of the
effectiveness of Supervisor training programs
implemented … in other states”.
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What is the Supervisory process in Clinical
Psychology and what is it meant to
achieve?
At its heart, Supervision is an interpersonal
exchange.
In this respect, whatever the aims of the relationship
professionally and personally, for both the Supervisor
and the Supervisee, the quality of that relationship
stands out as being the single most important
factor in considering effectiveness in Supervision.
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Functions of Supervision.
Across disciplines, Supervision is aimed at the provision
of monitoring, guidance and feedback on matters of
personal, professional and educational development in
the context of the care of patients. (Kilminister & Jolly
(2000)
Three functions have been emphasized in the literature
about Supervision: that, in essence, it has a:
1. Normative aspect (administrative),
2. Formative aspect (educational) and
3. Restorative function (supportive).
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The process of Supervision may take
many forms:
Supervision as a 1:1 process where the Supervisor is
the more experienced practitioner
Within a group setting
Between two clinicians as peer supervision
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Supervision may also have different
purposes
Tutorial or Educational function
Training Supervision
Managerial Supervision
Consultancy Supervision
Peer Supervision
It is important for the Supervisor to consider the nature of the supervisory
contact between the Supervisor and the Supervisee, the parameters for
the Supervisory experience, and the boundaries that obtain to these
needs.
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The most common problem occurs when two distinct roles
merge: for example when a Supervisory experience
becomes a management tool.
Also, what aspects of the Supervisory relationship are
confidential needs to be considered.
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In time PsyBA may require more accountability around Supervision
by means of recording contacts, and thought will need to be given
then to the recording process and what aspects of Supervision can
be transparent, as well as those aspects that cannot.
Sensitivity is required by the Supervisor, who may have multiple
roles with the Supervisee with respect to the risk that Supervision
can be overly directive when there are management imperatives
that need to be conveyed to the Supervisee.
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Supervision that has more to do with bureaucratic
process, rather than aims such as developing practice
knowledge, enhancing skills, and ensuring that service delivery
is profession-directed, is management.
BUT, there needs to be recognition that, inherent in the
Supervision contract, the Supervisor will be seen as having
authority.
In some instances – with 4+2 candidates, or Post-graduate
students on placement – this authority will have a strong,
structured evaluative aspect to it.
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As a general rule,
some evaluation always needs to be built into
Supervision, simply to reflect upon, at each session,
whether the goals of the Supervisee and the Supervisor,
have been achieved,
before Supervision moves on prematurely to the
next issue. (Davys & Beddoe (2010) (p103-104).
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Boundaries
All relationships have their boundaries.
All relationships require boundaries to some degree.
In considering the aims of Supervision, following is a
useful list of general conditions that provide a sense of
how the relationship is constructed and contained:
Specification is required with respect to:
Aims of Supervision
Frequency
Duration
Cost (if any)
Confidentiality (and its limitations)
Accountability to professional or registration bodies and organizational
policy
Interruptions
Issues of safety
Limits to clinical accountability (particularly if the Supervisor is not from the
same profession)
Record keeping
Preparation
Agenda setting
Feedback and review
Processes for dealing with conflict and complaint
Relationship of Supervision to performance management, appraisal and
counselling
Degree of access the Supervisee has to the Supervisor
Missed appointments
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Contracting in Supervision – Vignette
Looking at being open to how the Supervision will work
best for the Supervisee, but also how it will meet the goals
of the Supervisor:
When discussing the Supervision contract, you and James
discussed how he would like to receive feedback. He was keen
to have his work looked at, but also felt that this would potentially
create some difficulty for him. Past experience with Supervision,
meant that James could see that feedback about his work,
constructive criticism and the like, had created discomfort for
him, and contributed to some avoidance.
He thought that it might make him defensive to the point of not
really listening to your feedback. In discussing this, James felt
that the opportunity to be his own critic first might work best for
him, so it was agreed that the format would be that you would
seek James’ own assessment of the material presented to you
before you offered any critique, and that this would be clearly
prefaced by a cue for James, such as “now I will give you my
thoughts on what you have presented” , to ensure that James
was open to input. The decision was to review this structure after
six months to see if it was meeting James’ goals ,and your goals
in terms of the management of the Supervisory relationship.
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Boundaries in context
The context may set up other boundaries, for example,
there may be different constraints around Supervision for
Psychologists employed within Education, than those in
Health.
Particular parameters may also apply to Post-graduate
students on placement. 4+2 Candidates have quite
explicit and rigorous standards which apply to the
Supervision they receive.
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Supervision and Psychotherapy –Vignette
Aimed to draw distinctions between the two, but also to see that
the decision by Supervisor about what is the material for the
Supervision, and what is not, is a difficult one at times:
Your Supervisee reports feeling inadequate in his work with clients
lately. At the same time, he reports that his life is “falling apart” but
implies that this is a ‘no go ‘ area. You notice that, indeed, the
Supervisee seems to be coasting with the clients presented,
allowing some clients to set the running, and at other times moving
clients away from exploring their insights into more general
themes. Upon reflection, you feel that you too are coasting with the
Supervisee, not addressing the difficulties that he is having, not
drawing his attention the possible impact of his personal issues on
his psychotherapeutic work, perhaps fearing that he might “fall
apart” on you.
The nature of the relationship in
Supervision.
Clinical supervision is now recognized to be:
“ … a designated interaction between two or more practitioners,
within a safe and supportive environment, which enables a
process of reflective, critical analysis of care, to ensure quality
consumer services”
(Clinical Supervision Guidelines for Mental Health Services – Queensland:
available on the AHPRA website).
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Supervision, What’s in it for
you?
1. Supervisee
2. Supervisor
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What’s in it for the Supervisee:
Professional support
An opportunity to off-load and reduce stress
An opportunity to enhance knowledge and increase
competence
An opportunity to experience well-being and enhance
professionalism
What’s in it for the Supervisor:
•An opportunity to give back to the profession
•An opportunity to learn about a fellow professional; the characteristics,
insights and style of working of the supervisee; the particular work context of
the supervisee; the characteristics of a different client group - that of the
supervisee; the assessment skills highlighted with this client group; therapeutic
goals for that client group; interventions that apply to this client group; the
organizational principles and constraints the supervisee works within.
•The opportunity to provide knowledge and foster competence
•The opportunity to promote relevant policies and encourage practice that is
evidence-based – through one’s own practice-based evidence
•The opportunity to promote ethical practice
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What is the supervisor/supervisee
relationship essentially not about:
•Management
•Disciplinary process
•Reportable process … yet
•Individual Psychotherapy
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Supervision is NOT psychotherapy, but
some very similar conditions apply to the
quality of the relationship that is set up between
Supervisor and Supervisee when that relationship is
going well.
Consider the following, with respect to your
own experience of good Supervision:
What seems to apply and what does not?
PSYCHOTHERAPY:
Goals:
Relief of personal symptoms
Self-shifts in attitude
Fundamental changes in personality
Fundamentals:
A working relationship between a trained MH professional and the person
needing help to deal with emotional distress and/or poor functioning
(relationship, work, social relationships)
The professional uses planned interventions according to psychological
principles; therapy is aimed at improving self-awareness; therapists give long
term emotional and practical support; therapy deals with a crisis or crises;
therapies are aimed at improvement, by abolishing specific symptoms
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What is it?
An emotionally charged, confiding relationship:
 Unlike friendship
 Expectation that therapist will be dependable and
trustworthy
 Issues raised may be deeply personal, distressing,
or embarrassing
 Therapist will be empathic, but sufficiently detached
as to not be overwhelmed by what is raised
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What is it?
It has a shared rationale:
 Therapist provides an explanation of the
problems and the intended methods for
dealing with them.
 This makes sense and is acceptable to the
client.
What is it?
New knowledge is provided:
 Arises from the relationship and emerges
as part of the interchange.
 Client obtains new information about
himself, his situation, his problems and
learns of new ways to change or challenge
these things.
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What is it?
Emotional arousal is facilitated:
 The process of learning is not a cold,
intellectual pursuit.
 It encourages emotional expression
 The client gets in touch with his feelings and
this enriches the process
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What is it?
It aims to instill hope:
 Engagement with the professional raises the
client’s hope for a positive outcome.
 Therapist conveys optimism.
 A therapeutic alliance is formed around hope
and optimism.
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What is it?
Success is experienced:
 Course of treatment shifts concern
 Mastery increases and the client no longer
feels powerless and/or a victim.
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What about counselling?
Supervision is not a Counselling relationship either,
but there are elements that are similar.
Consider the following summary of what might
constitute a relationship aimed at providing counsel,
and consider whether Supervision encompasses
some of these elements as well.
What is counselling?
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The aim is to help people make informed decisions about
important matters and to assist in dealing with the impact of the
decisions taken.
Counselling and psychotherapy share many features, but counselling is
distinct in that it is directed at assisting people of make critical decisions about
their lives. These decisions might be about relationships, marriage, parenting
and child management.
In the work place, counselling might relate to educational and/or vocational
choices, or it might arise from workplace issues and be about work practices.
It might have a disciplinary aspect to it, where it is about job performance or
training.
It might be directed at conflict resolution or it it might deal with the effects of
changes in employment or unemployment.
As with Psychotherapy, in Supervision, it is the
relationship which matters most.
For example, those attending workshops some years ago,
conducted by Scott Miller, a visiting US psychotherapist and
researcher, learned that there is no model or proven technique
that guarantees successful outcome in Psychotherapy.
Success hinges on the relationship established between
therapist and client. The same may said of Supervision.
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Let us consider further the nature of
relationships as they occur in therapy and
what we know of them.
At the same time, consider that the same elements
may apply equally to the relationship that is called
Supervision.
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There are often aspects to the therapeutic
relationship which transcend, or perhaps underpin,
the processes of history taking, symptom
consideration and the formation of strategies
These transactional elements relate to:
TRANSFERENCE
&
COUNTERTRANSFERENCE
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These concepts are drawn from the
Psychoanalytic tradition.
They provide a way of thinking about relationship
formation and development generally, but also
specifically, within Supervision.
This is of particular relevance to the Supervisory
relationship because of the power imbalance, and the
traditional nature of Supervision which is hierarchical.
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What is TRANSFERENCE?
A Freudian concept relating to the phenomenon
where an adult patient will re-enact or re-experience their
childhood experiences of their parents and other authority
figures, including siblings, within the therapeutic conversation.
Freud noted that some of his patients attributed all kinds of
things to him that had no foundation in objective fact.
They expressed love or admiration or gratitude which was
strangely out of place, or they expressed resentment, ridicule
or hostility which was not justified by the therapeutic situation.
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What is COUNTER-TRANSFERENCE?
Respects the reality of transference as a matter of course
in most human relationships and acknowledges that the therapist
may experience similar feelings, or make similar ascriptions to his
patients.
So not only it is possible that the patient influences the
therapeutic process with attitudes and behaviour’s
irrationally based on earlier experiences, so might the
therapist with his own.
Unless, he is alerted to the problem and able to face his own
previously unconscious biases.
Working with countertransference in
supervision:
Supervision provides a great opportunity to sensitize the Supervisee to
these components of therapeutic interactions – of all interactions.
Hearing the presentation of a case, the objective and detached ears of the
Supervisor will pick up instances where the transference is occurring.
Processing the case with the Supervisee enables the Supervisor to point out
the reactions to the client that come from the Supervisee’s own
unconscious.
This will alert him to recurrent themes or to “spines” that will be brushed
sometimes by some clients in some situations.
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These two mechanisms can also be found in the
Supervisor/Supervisee relationship.
There are clear elements of this in the Supervisory relationship, even
though it is not a psychotherapy.
Some of the other key similarities are:




It is regular, structured and 1:1 (mostly)
The development of rapport is essential
There is disclosure and shared experiences
Transference and counter-transference typically occur or
emerge, especially because Supervision is often a long-term
relationship
 The power relationship is unequal
For these reasons the Supervisor needs to be alert to the
‘vulnerabilities’ inherent in some aspects of the
Supervisory relationship/process, and needs to be clear
about how to stop the relationship from developing into
some form of psychotherapy.
This might involve:
Being alert to the dynamics and process issues – his/hers as well as
yours
Talking frankly about Supervision NOT being psychotherapy –
recommend psychotherapy to the Supervisee as a helpful process if
clear issues needing this kind of exploration have emerged – but, that
psychotherapy will not to be with you.
Moving session content to less personal areas – presentations,
interview material, knowledge-based discussion etc.
Discussing issues outside of the Supervision with caution if the alarm
bells ringing.
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Parallel Process
Parallel process is a feature unique to the
Supervisory relationship - it might be
noted from time to time. It is particular to
this process because it reflects the
‘supervisory triad’ that is frequently a part
of Supervision - that of the client, the
Supervisee and the Supervisor. Even
though the emphasis is on the dyadic
relationship of Supervisor/Supervisor, the
other stakeholder in the process is the
client, with the Supervisee’s assessment
of, reaction to, and relationship with the
client being the main subject of much of
the Supervision, and the client being one of
the beneficiaries of that process.
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The process is one where the Supervisee
unconsciously identifies with the client what might be noted is that he or she
adopts the client’s tone, manner, relating
style and/or behaviour. In effect, it might
be postulated that the Supervisee is telling
the Supervisor what the therapeutic
problem is, or how the intervention is being
received or felt by the client. However,
there may be another dimension to this as
well: McNeill and Worthen (1989) quote an
earlier study in which it was suggested that
parallel process might be seen as a
metaphor in which the patient’s problem in
therapy may be used to express the
Supervisee’s problem in Supervision.
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On the one hand then, parallel process
might relate to an aspect of the
Supervision determined by the material
brought to the session by the Supervisee,
or it might relate to the process of
Supervision itself: in this way, it might be
seen as two aspects of the same process.
Essentially, in broaching the issue, the
Supervisor makes use of what is occurring
in the therapist-client relationship and the
Supervisee-Supervisor relationship to
enable the Supervisee to appreciate the
emotional difficulties he or she is
encountering in receiving assistance in
Supervision, to facilitate an understanding
of the client’s situation in the therapy.
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Identifying the phenomenon is thought to
have the potential for further advancing the
learning and the professional growth
aspects of Supervision. It draws upon that
part of Supervision that is reminiscent of
therapy, as well as upon its didactic
elements. Gains are to be made
potentially from a process which seeks to
highlight and examine the affective
problems that the Supervisee experiences
with his or her clients, and within the
Supervisory relationship, possibly leading
to a more complete understanding of self
for the Supervisee, and enabling the
Supervisee to make greater and freer use
of himself or herself in the work with
clients.
The exploration of parallel process, when it
emerges in Supervision, aims to enhance
the Supervisee’s insight, to add further to
self-awareness, and leads to a greater
appreciation the complexities generally of
the psycho-therapeutic relationship.
Indeed, McNeill and Worthen (1989)
suggest that examination of the process
might be more beneficial to, and better
assimilated by, the more advanced
Supervisee, with the needs of the beginner
more likely to reflect the desire for more
concrete and structured types of
interventions to reduce anxiety and to
enhance basic skills with intervention,
rather than an exploration of the more
esoteric and nuanced aspects of the
supervisory and /or therapeutic
relationship.
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MODULE 3 – Role play
Seek the voluntary involvement
of two participants to play out
the following scenario, to be
followed up with questions
about the process and its future
direction:
One of you will be the Supervisor, the other the Supervisee
presenting a case in which your have been working with a woman
who is in an abusive relationship. Abuse has occurred over the
duration of the relationship and has become physical within the last
year. There are two young children, who have not been assaulted by
the client’s partner, but they are subject to the emotional climate that
culminates, more recently, in an assault. The older child has on one
occasion placed himself between the parents which has resulted in
de-escalation.
You (Supervisee) have been seeing the woman for six sessions, and
you have presented it twice. You display some agitation in
presenting the case and express frustration that the client is not
making plans to leave her partner. The client has missed two
sessions recently and you raise this as part of the current review. As
the Supervisor, you suspect that your Supervisee’s ‘agenda’ is
disrupting what was initially a good alliance with the client and you
comment on this, referring to the recent breaks in contact.
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In seeking to further explore the Supervisee’s agenda, the Supervisor points
out that it is often difficult for individuals to leave abusive relationships. The
Supervisee responds angrily, indicating that he/she views the client’s
behaviour as “hopeless” and indicates that she should be putting the children
first. The Supervisee indicates that he/she is fed up with “holding the client’s
hand” whilst the children continue to live in abject circumstances.
• What responses might the Supervisor make as part of the Supervisory
process?
• What meaning might be made of the Supervisee’s disclosures: how might
this be progressed?
• Is there a role in checking the Supervisee’s education about domestic
violence, resources available, community responses and the like?
• What is likely to now be most helpful for the client?
• Should personal material be further explored with the Supervisee: what
impact might that have on the Supervisory relationship?
• What are the chances that this discussion might increase anxiety rather
than managing it: how can this risk be avoided?
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Quality in Supervision – the art of
being “good enough!”
What are the key ingredients necessary for Supervisees to feel
that their experience of Supervision was “good”?
(Worthen& McNeill (1996))
An experience that strengthens and affirms Supervisee confidence.
Supervisees felt relaxed about presenting material because the
Supervisor provided affirmation and reassurance, so that the
Supervisee was more venturesome and more open about whatever the
material was that was being presented.
The experience of Supervision which increased the Supervisee’s
capacity for seeing the greater complexity within the issues being
presented or being faced in client contact. The feeling expressed was
that there was an increased feeling of coherence in the context of
complex and confusing circumstances clinically: the likely development
of a meta-perspective was enhanced.
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 Supervisees felt, within the experience of Supervision around psychotherapy, an
increased ability to work effectively with their client(s).
 Case conceptualization was felt to have improved, and the formulation of
effective interventions followed.
 Supervisees, as an outcome of good Supervision, developed a new sense of
understanding, whether this related to therapeutic practice, or with respect to
their professional development.
 Supervisees reported developing more of an understanding of themselves, of
their thinking about their client(s) in relation to this, and as it related to the
therapy.
 Supervisees felt a renewed sense of being able to engage with clients,
particularly around therapy and intervention, where there had been struggle.
 Supervisees reported experiencing a sense of renewal as an outcome of this
kind of experience of Supervision, where there was a positive motivation to
persist, to try out new strategies, or simply to face challenging and difficult
situations with their client(s).
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 The effect of good Supervision events was to strengthen the SuperviseeSupervisor alliance. Trust had developed by way of this positive
experience
 Supervisees felt a renewed sense of being able to engage with clients,
particularly around therapy and intervention, where there had been
struggle.
 Supervisees reported experiencing a sense of renewal as an outcome of
this kind of experience of Supervision, where there was a positive
motivation to persist, to try out new strategies, or simply to face
challenging and difficult situations with their client(s).
 The effect of good Supervision events was to strengthen the SuperviseeSupervisor alliance. Trust had developed by way of this positive
experience.
 Supervisees also experienced a growing impetus for continued
advancement in professional development.
 Good Supervision was a motivating experience, where the Supervisee felt
affirmed in having made the career choice for Psychology as a profession,
and motivated to further hone their skills around Psychological Practice.
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A host of researchers and writers about Supervision have set out
the essential elements as markers for success or failure within
the Supervisory relationship:
SUPPORT – when it’s there and when it’s not
TRUST – when it’s there and when it’s not
AVAILABILITY – when it’s there and when it’s not
RESPECT – when it’s there and when it’s not
EXPERIENCE AND KNOWLEDGE – when it’s there and when it’s not
PERSONAL CONNECTION – when it’s there and when it’s not
CHALLENGING – when it’s there and when it’s not
FEEDBACK AND COMMUNICATION – when it’s there and when it’s not
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When is supervision working well?
 Agenda – shaping and directing the session
 Preparation – organized case presentation
 Reading and sharing an article relevant to the process, or to a past
issue.
 Illustration or example(s) drawn from the Supervisor’s experience
 “with-ness” – doing something together
 Supportiveness and non-judgmental approaches
 Helpful self-disclosure can be useful
 Outcome evaluation: did it work, why, how can we show it to have
worked
 Group supervision – case presentation, think-tank approach to clinical
problems
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When is Supervision not working well?
Dysjunction – differences of approach that seem to be
irreconcilable
No choice of supervisor – the feeling of being stuck with each
other.
Contact becomes limited in frequency or duration when there is
poorness of fit.
Supervision which turns into Performance Appraisal or a tool of
management.
Expert or non-expert – difference in perception
The feeling of being overwhelmed especially by the “expertness”
of the very experienced clinician.
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Phases of learning for New
Supervisors (handout)
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What makes a good Supervisee?
One who is committed to establish a solid Supervisory relationship
One is who is clear about and who actions the contract for Supervision
One who responds to empathy and support
One who is seeking greater professional autonomy
One who is positive with respect to continuing professional
development
One who respects and maintains boundaries – all boundaries
One who is comfortable with having sessions recorded, monitored and
reviewed.
One who is punctual and who arrives prepared for Supervision
One who is able to accept feedback.
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What makes a good Supervisee?
See supervision as a positive even if mandated – choose supervision.
Has a genuine desire to learn.
Openly and honestly present their work and know how to present their
work.
Are willing to look inwards to what is happening to you as you do the
work.
Are willing to be accountable for their work.
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Non-disclosure in the
Supervisory Relationship
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Group Exercise/Discussion:
Supervision is facilitated or limited by disclosure. What, as Supervisors,
we told or shown by our Supervisees determines to a great extent
agenda for any supervisory session.
As a group experienced in having been Supervisees, can you reflect on
your experiences and share with the rest of us, situations where you have
not been as open with your Supervisor as you might have been.
Consider also you motives for holding back on information, for not
declaring your own thoughts and feelings, and/or for your doubts about
the Supervisory process at that time. What was happening at that time in
the Supervision? What made you decide to leave information out of the
content of the session?
Non-disclosure in the Supervisory
Relationship
Exploration of non-disclosure with respect to
what Supervisees share with their Supervisor
further exposes, and adds weight to, important
elements in the Supervisory relationship already
outlined.
Ladany et al. (1996) suggest that the power
imbalance, together with the evaluative nature or
implications of Supervision, and the way that
these are played out, acknowledged and
confronted, is at the heart of the matter.
72
73
The power imbalance may influence the
Supervisee’s willingness to be open, to
experience confidence, or to demonstrate and
feel trust in the process.
Because evaluation is explicit or implied, the
Supervisee may seek to minimize any negative
impression that he or she might make, at the
same time attempting to maximize the potential
to be viewed – and judged– positively.
74
The choice of what is disclosed in
Supervision is up to the Supervisee.
No matter how full and complete the
presentation of a case, or a session with
a client, information about the
Supervisee himself or herself, his or her
own processes, his or her reactions to
the therapy, are for him or her to share –
or not - with the Supervisor.
75
Indeed, as Ladany et al. (1996) hypothesise that
“… Supervisees would leave more things unsaid
in Supervision than clients would in therapy
because of the evaluative consequences and the
involuntary nature of Supervision” (p10-11).
Withholding information may be the only way
that the power imbalance can be redressed, so
that it may be the Supervisee’s only means to
exert some control in this skewed relationship.
76
In a study of more than 100 by Ladany et al. (1996),
Supervisees, detail the wide range of forms that non-disclosure
can take.
They examine the reasons given by Supervisees for their
decision to hold back in the supervisory conversation, and they
provide some useful suggestions for how the Supervisor might
encourage more openness in Supervision.
A total of 13 categories were identified to describe aspects of
the alliance, or the circumstances of the interaction, where
Supervisees withheld information from Supervision.
• Negative reactions to Supervisor - unpleasant; disapproving; critical thoughts
• Personal issues - thoughts about self; privacy about context of own life and ‘nonpublic’ issues
• Clinical mistakes – perceived errors or feelings of inadequacy as a therapist
• Evaluation concerns – uneasiness/uncertainty about Supervisor’s assessment
• General client observations – comments about client behaviour, diagnosis,
interventions
• Negative reaction to client – disapproving or critical thoughts about the client
• Countertransference – therapist’s identification with the client, reaction to the client
• Client-therapist attraction – feeling drawn to the client, interested in a sexual or
personal sense
• Positive reactions to Supervisor – perceived approval from Supervisor, with a desire
to maintain this kind of contact
• Supervision setting concerns – feeling unsupported in the placement
• Supervisor appearance – disapproval of dress, language and aspects of
Supervisor’s presentation
• Supervisee-Supervisor attraction – drawn to the Supervisor in a sexual or physical
sense
• Positive reactions to client – approving thoughts or comments
(Reflect upon which of these emerged from the Group exercise)
77
These categories are listed in descending order of the frequency
reported, and possible importance, from the responses of
Supervisee’s participating in the Ladany et al (1996) study.
Of main significance was the Supervisee’s negative reaction to the
Supervisor.
Some of the perception had to do with the feeling that that the
Supervisor lacked skill or expertise
In other instances, Supervisees indicated that the power imbalance
led to a reluctance to challenge or question the Supervisor
Fear of being seen negatively, or of committing “political suicide’ was
often reported.
Deferring to the Supervisor ,or to self-consciously acting to reduce
the risk of being negatively evaluated, were also cited.
78
79
Personal issues were not disclosed by a large number
Supervisees. Some of this may have related to
perfectionism, some to concerns around career choice.
However, as the study authors point out, Supervision is
not psychotherapy, and some degree of reticence to
introduce personal matters into Supervision might be
quite an “appropriate” and a “healthy” choice (p18).
It is where this might have implications for client
contact and/or psychotherapy that this category of nondisclosure might be an issue that the Supervisor might
sense and further explore with the Supervisee.
80
Clinical errors and the concerns about evaluation seem
to be linked, and occurred in this study in equivalent
number. The difficulty is that concerns about the
adequacy of performance, the desire to promote a
positive appearance in Supervision, and the nondisclosure of clinical errors or mistakes may exert a
negative impact on client care.
Undisclosed aspects of client’s presentation, the client’s
behaviour during a session, and/or the Supervisee’s
specific reactions to clients, were of significance where
diagnostic implications, or decision-making about the
direction of intervention were involved in the Supervisory
process. This was critical where the Supervisee’s
inability or empathise with or connect to the client
compromised interaction and/or therapy.
81
Ladany et al. (1996) also provide an analysis of the reasons behind the decision
of Supervisees to withhold information: 10 were clearly identified:
• Perceived unimportance – information thought to be irrelevant, unnecessary or
not worth discussing
• Too personal – private, undesirable to discuss about self in Supervision
• Negative feelings – embarrassment, shame or discomfort related to raising a
topic
• Poor alliance with the Supervisor – negative feelings about SupervisorSupervisee interaction
• Deference – considered by Supervisee to be no part of their role, it might hurt
or offend, it might cause a negative reaction in the Supervisor
• Impression management – concern about being perceived, viewed, or labelled
negatively
• Supervisor agenda – perceived orientation, views, beliefs of the Supervisor
• Political suicide – negative consequence perceived or feared with respect to
future activities
• Pointlessness – a perception that raising an issue would change nothing, or
that the issue is out of the control of the Supervisor or Supervisee
• Supervisor is not competent – Supervisor perceived as being inadequate or
unavailable
Ladany et al (1996) propose that a poor
alliance, either at the time or in the context
of the Supervisory relationship was a main
in theme in determining that Supervisee’s
made the choice not to disclose content that
might have had some relevance to the
session of Supervision.
The notion of mutual trust, liking, and caring
between the Supervisor and Supervisee
seemed to be the key components.
When these conditions were not present, it
is proposed that Supervisees will disclose
less information.
82
83
In terms of how the non-disclosure occurred, the authors
determined that there were three principal mechanisms
used.
The most common was taking a passive approach: if the
Supervisor did not raise an issue, or ask a question, the
information was not spontaneously volunteered.
A diversionary approach was employed as another strategy:
the Supervisee launched into a discussion of something
else as a way to avoid disclosing information.
The least used strategy was a more direct approach:
Supervisees indicated that they did not wish to discuss,
elaborate or go further into issues raised in the Supervision.
An important finding in the Ladany et al (1996) study was
the extent to which non-disclosure in Supervision was
counterbalanced in some way by Supervisee’s sharing this
information with others.
This was often peers and work colleagues who were
perceived as being important to the Supervisee’s function
as a therapist.
This suggests that informal Supervision may occur
involving those who have considerably less Supervisory
experience than the nominal Supervisor.
It points to a need to share and to express, and a desire to
do so in a less pressured, less evaluative and more open
context.
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85
Group Exercise-Discussion
Having considered the nature of non-disclosure in
Supervision
– the content and the reasons for this conscious or
unconscious decision made by Supervisees –
consider what you, as a Supervisor, need to look out for
and what steps you might take to maximize openness
and trust in Supervision relationships.
Ladany et al. (1996) have drawn some suggestions for Supervisor consideration or
action to limit the extent of non-disclosure:
• Supervisee anxiety about evaluation and the evaluative aspect of Supervision needs to be
addressed, normalised, and acknowledged as part of the Supervision process.
• Supervisors need to reflect upon their approach to Supervision to counter the effects of nondisclosure: Supervisees are more likely to be disclosing if the process is perceived to be open
and collaborative
• Deference may reflect the Supervisee’s heightened awareness of the power differential and
may be particularly salient for beginning Supervisees.
• Discussions in Supervision are often one-side or involve feedback: this may be more critical
and ego-threatening than positively reinforcing
• Supervisors may need to indicate that some personal issues may relate to Supervision
around client contact, and suggest that discussion may be important to the Supervisee’s
growth as a therapist
• Revelation of mistakes made by the Supervisor in discussion with the Supervisee will
increase the chances of mistakes being shared more openly in the Supervision
• Foster in the Supervisee that all aspects of the client’s presentation, behaviour during the
contact and the Supervisee’s reaction to these and to other aspects of client presentation
have a potential bearing on the course of the assessment of, and the intervention with, that
client
• The largest number of complaints against Psychologists involve inappropriate sexual
intimacies. Supervisors need to be aware that the dynamics of both psychotherapy and
Supervision hold this potential: they need to be alert to the potential for damage to client
outcome, as well as to the damage that might apply to either or both participants in
Supervision.
86
“Supervisors could disclose their own mistakes and struggles to
make it safe for supervisees to disclose. They could normalize
mistakes by sharing their own humanness and growth,
communicating that mistakes will not erode their impression of the
supervisee.” Ladany et al. (1996) (p 22).
Finally, Ellis (2010) provides an excellent snap-shot of the processes
involved in learning about and providing Supervision. The article ends
with Ellis providing some twenty “do’s” of Clinical Supervision. There is a
strong emphasis on :
• Constructing a relationship that empowers the Supervisee,
• One that encourages openness in the interaction, and transparency in
its evaluative aspects.
• Encouraging the Supervisor to use his own processes
“ …we do not have to do Supervision in isolation” (p111).
87
References
Davys, A & Beddoe, L (2010). Best Practice in Professional Supervision. London. Jessica Knight
Ellis, M V (2010). Bridging the Science & Practice of Clinical Supervision: Some Discoveries, Some Misconceptions
The Clinical Supervisor 29(1), 95-116
Falender, C A & Shipanske, E P (2007). Competence in Competency-Based Supervision Practice: construct and application
Professional Psychology: Research and Practice 38(3), 232-240
Gonsalvez, C J & Milne, D L (2010). Clinical supervisor training in Australia: a review of current problems and possible solutions
Australian Psychologist. 45(4), 233-242
Hawkins, P & Shohert, R (2000). Supervision in the Helping Professions. Philadelphia. Open University Press.
Kilminster, S M & Jolly, B C (2000). Effective supervision in clinical practice: a literature review. Medical Education 34, 827-840
Ladany, N; Hill, C E; Corbett, M M; & Nutt, E A (1996). Nature, Extent, and Importance of What Psychotherapy Trainees Do Not
Disclose to Their Supervisors. Journal of Counseling Psychology 43(1), 10-24
McNeill, B M & Worthen, V (1989). The Parallel Process in Psychotherapy Supervision
Professional Psychology: Research and Practice 20 (5), 329-333
Milne, D E; Sheikh, A I; Pattinson, S & Wilkinson, A (2011). Evidence-based Theory for Clinical Supervisors: a systematic review of
11 controlled studies The Clinical Supervisor 30(1), 53-71
NSW Government Health (2013). Allied Health Professional Practice Supervision. Doc HNELHD Pol13_01
NSW Government Health (2010). Continuing Professional Development for Psychologists HNEH Pol 10_02
Rogers, C (1957). The necessary and sufficient conditions of therapeutic change. Journal of Consulting Psychology. 21, 95-103
Schindler, N J & Talen, M R (1996). Supervision 101: the basic elements of teaching beginning supervisors.The Clinical
Supervisor14(2), 109-120
Worthen, V & McNeill, B W (1996). A phenomenological Investigation of “Good Supervision Events”. Journal of Counselling
Psychology 43(1).
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89
Module 5:
Supervising for the development of
competencies in working with
difference.
90
“ … do not neglect diversity issues and the “-isms”.
Unfortunately, diversity and multicultural issues are all too often
overlooked. Diversity and the –isms are often viewed as
background instead of foreground as supervisors work with
supervisees and those supervisees’ work with clients” (Ellis,
2010).
“… all people are multicultural and thus all interactions are crosscultural” Hage et al. (2006).
91
Group exercise
Reflection No 1.
Reflection No. 1
Following opening quotes:
“ … do not neglect diversity issues and the “isms”. Unfortunately, diversity and multicultural
issues are all too often overlooked. Diversity and
the –isms are often viewed as background
instead of foreground as supervisors work with
supervisees and those supervisees’ work with
clients.”
“… all people are multicultural and thus all
interactions are cross-cultural”
How does this fit with your experience of
having received and given Supervision?
According to this quote, each one of is a
multicultural being: have you ever been
recognized as being so: was this a positive
or a negative experience?
92
The practice of Clinical Psychology is
fundamentally about working with and
understanding difference.
This entails coming to an understanding of the unique features of the
client, their history, particular strengths, weaknesses and
preoccupations, their presentation and how they construes the
problems central to his/her arrival, or to the referral seeking the
assistance that Clinical Psychology promises.
93
The Discipline of Psychology, from where we as clinicians come from,
tries to establish, by using the rigor of scientific investigation, the
communalities of human development and experience.
People are its primary subject matter, a subject matter that it seeks to
explore and investigate in order to equate, to establish norms and
develop normal expectations, to describe what is usual and to reflect
back these principles, relationships - even laws - to explain, and to
assist prediction in human behaviour.
94
To learn about Psychology and psychological practice is to internalize
some of this wisdom, at least in part.
To practice as a Psychologist is to develop an ever-more reliable set
of these values, as an internal gauge, used as a complex but actually
quite personal and individual ‘psychometric tool’, active in the
processes of assessment, evaluation and intervention with
clients.
Clinical Psychological practice relies on this wisdom, but its focus is on
departures from the norm, on variance, on the unusual aspects of
experience and on aberrations in cognition, emotion, behavior and
experience. Often the differences we seek as clinicians to examine
are subtle and not readily disclosed.
95
Individual and Cultural Diversity – Microeffects: Impact at the practitioner level.
In the consideration of Individual and Cultural Diversity (ICD), attention is drawn
to those more prominent, more evident differences:
Race
Gender
Age
Religion
Disability
Ethnicity
Sexuality
Socio-economic status
All which create sharper and more “visible” divisions, which may be the source
of the experience of marginalization, disempowerment and stereotyping, in our
clients and in ourselves.
96
97
Group reflection exercise:
What are the differences that have shaped me and
how has this influenced the way I view myself, other
people and the world?
Consider, race, culture, class, gender, sexuality,
religion, and disability.
How have these differences influenced the way
others have seen me?
Cultural issues abound. Some differences are
evident in the physical appearance, the dress and/or
the language of the other. Supervisors, in the work
of supervision, need to highlight the differences in
culture that might be experienced less evidently, for
example, within and between organizations within
our society.
Most of all, the Supervisor needs to attune the
Supervisee to the cultural differences that apply to
family life – his or hers is different from yours: yours
is different from his: and the client’s experience is
different to you both.
98
99
It can be challenging for the newly-trained Psychologist to
confront his or her own biases.
Self-evaluation may not have been much experienced in four or more years
of studying Psychology, which emphasized objectivity and a dispassionate
approach.
Rather than the practitioner being the objective and detached product of
science that the research-based teachings of Psychology might encourage
us to be, the practitioner must recognize, be conscious of, and to some
extent embrace, his or her uniqueness.
The novice Supervisee will progressively be brought to recognize that
we are, each of us, a product of diverse influences.
Our individuality and functionality as clinicians are products of many of
the same factors, including those embodied in the study and application of
diversity and difference, that result in very different personal outcomes for
our clients.
100
Supervision offers an opportunity to assist the
Supervisee to raise awareness around some of
these issues around differences, not only with the
clients that he or she sees, but also with differences
as they play out in his or her development as a
clinician.
101
How might you start a
conversation with your
Supervisee about the
differences that have shaped
them? Example: asking your
Supervisee to talk about some
of the differences that have
shaped his or her development
as a clinician: talk about the
differences between us, as
Supervisor and Supervisee.
It is indeed challenging to realize that we are all biased.
We all view the world through our own particular lens that has
been shaped, rightly or wrongly, by the social milieu and socialization
experiences that we have been raised within.
As clinicians, Psychologists take account of race and ethnicity in our
interactions with our clients, but we would recoil to having that
described as being, at any level, racist.
But this being the case,
we might also be regarded as being sexist, homophobic,
ageist, and
that we hold views around social class and status, simply
because these factors are embroidered into our formulations, our
diagnoses, and are reflected in the interventions we enact with our
clients.
102
Self-awareness and self-monitoring are essential components in
the delivery of psychological services.
In this respect we cannot effectively provide supervision to others,
which facilitates and develops skills around dealing with diversity in our
Supervisees in their work, unless we have an unself-conscious
awareness of those differences that go to describing our own selves
as people and as clinicians.
We might be happy to be described as being a ‘Behavioural
Psychologist’, but less happy to be described as being ‘old’.
103
For the Clinician, self-awareness, some degree of self-acceptance
are components in the vital equipment we take with us to our
interactions with our clients.
Some degree of comfort and skill in dealing with difference and
diversity, as well as sensitivity to, and awareness of, our own
vulnerabilities - our blind-spots and ‘buttons’ which may be pressed is a necessary skill, requisite in providing therapy: it is just as much a
factor in the provision of Supervision.
104
As the more experienced, even worldly, Psychologist providing
Supervision to a professional colleague, whether that colleague is a
novice or a peer, we must not display complacency.
Because of the differences in experience between the two participants,
there is a power imbalance, at least early in the Supervisory
relationship, and that must be acknowledged.
This imbalance may make it difficult for both parties to explore other
aspects of difference and diversity that characterize the relationship.
105
106
Hawkins and Shohert (2007) examine the power imbalance in
the context of dealing with diversity within Supervision, and
describe role power, cultural power and personal power.
Role power is inherent in the Supervisor, and depending on
context, may bring with it legitimate power, reward or coercive
power.
Cultural power derives from the dominant social and ethnic
group, in Australia that is white, Anglo-Saxon, heterosexual and
able-bodied.
Personal power is particular to the individual, and may derive
from authority of their expertise, their presence and/ or their
personality.
This will become more difficult if the more apparent differences cannot be
discussed, and their impact on the Supervision acknowledged, explored and
effectively minimized.
Supervisor-Supervisee alliance is essential towards facilitating this open
discussion.
Being open about difference as it exists between the participants in the
Supervision will make it easier to acknowledge and discuss diversity, cultural
difference and the like as it exists within the Supervisee-client dynamic.
107
108
How do we facilitate that awareness within ourselves?
What experiences have you had with people from a
different cultural background?
Were you aware of any prejudices?
What if any were directed towards you?
It is essential that the Supervisor, perhaps through the
processes of his or her own Supervision, is equipped with a
clear understanding of his or her own status within these broad
considerations of individual and cultural diversity.
This refers not just to having an awareness and an acceptance
of his or her own differences, and those factors within his or her
own development that have created those differences, but also
that the Supervisor is attuned to his or her own reactions to
divergence or difference in others.
109
In terms of appreciating and understanding the value systems of
clients who are culturally different, it is important to learn about our
client’s values and to not impose our values.
We also need to be willing to learn about socio-political forces that
have affected our clients and to consider applicability of psychology
treatments for different groups.
As members of organizations, Psychologists need to think about how
diversity-friendly their organisation are, and how they can instil the
celebration of difference in our psychology community.
110
Group discussion:
Consider racism, sexism or homophobia among your colleagues:
•What do you do when there is racism, sexism or homophobia among
your colleagues?
•Would you be likely to confront the colleague?
•What would you want to ask or tell them?
•What about if this was your Supervisee?
111
Individual and Cultural Diversity - Macroeffects: impact within Psychology as a
profession.
The American Psychological Association (APA) (2000)
has set out a range of standards relating to the
consideration and inclusion of factors, encompassed
within the ICD descriptors, for education and training of
Psychologists, the provision of clinical services by
Psychologists, and the research undertaken by
Psychologists.
112
Such Guidelines are needed to take account of “… the different
needs for particular individuals and groups historically
marginalized or disempowered within and by Psychology (my
emphasis) based on their ethnic heritage and social group
identity or membership”.
This is a very important issue, reflecting on how Psychology
has been practiced, at least in the USA, in that it recognizes
that the past failure to consider cultural diversity has effectively
further marginalized the very people that our profession has
sought to assist. Within the profession, this failure has even
unwittingly marginalized some of our colleagues.
(Vignette)
113
Diversity – Vignette
Looking at how non-acknowledgement can unwittingly affect us professionally:
An indigenous Psychologist working in the generalist agency in which you are both
employed, where you are her senior but not her manager, raises in Supervision some
concerns about how she feels she is being pigeon-holed. She indicates that, although
she is employed as a Generalist, the way the agency has been allocating cases, has
resulted in her having an exclusively indigenous caseload. She has become a
Specialist of sorts, although this is not her role, or her skill.
She is in a bind because she feels strongly about the lot of her people, but she feels
that her culture is being over-emphasised without this ever being openly discussed in a
way that she can take issue with it. She does not want to be disloyal on one hand, but
she wants the opportunity to work with the same range of problems that the agency
covers. All of her clients tend to be among the poorest and most dysfunctional, but she
feels that if she makes a complaint about her professional development, it will be taken
that she wants to avoid these clients and to be given an easier role in the agency
114
APA further asserts that, in the work that
Psychologists undertake, they are in a position to
provide leadership as agents of pro-social change,
advocacy, and social justice.
As a profession, Psychology is in a position to
promote societal understanding, affirmation and
appreciation of multiculturalism and draw attention to
the damaging effects of individual, institutional and
societal racism, prejudice, and all forms of
oppression based on stereotyping and
discrimination.
115
The six founding principles for the development of
these Guidelines are worth considering, in a
summary form, as they seem also to apply to the
sensitivity to, and focus on, dealing with difference
and diversity in the Supervisory process.
116
117
The ethical conduct of Psychologists is enhanced by knowledge of
differences in beliefs and practices that emerge from socialization
Understanding and recognizing the interface between individuals’
socialization experiences can enhance the quality of education,
training, practice and research
Recognition of the intersection of racial and ethnic group membership
with other dimensions of identity enhances the understanding and
treatment of all people.
Knowledge of historically derived approaches that have viewed cultural
differences as deficits, helps Psychologists to understand the underrepresentation of ethnic minorities in the profession.
Psychologists are uniquely able to promote racial equity and social
justice.
Psychologists recognize that organizations can be gatekeepers or
agents of the status quo rather than leaders in a changing society with
respect to multiculturalism.
Culture: is defined as the belief systems and value orientations that
influence customs, norms, practices and social institutions, including
psychological processes (language, care taking practices, media, and
educational systems) and organizations. Inherent in this definition is the
recognition that all individuals have a cultural, ethnic and racial heritage.
Culture is also described as an embodiment of a worldview, through
learned and transmitted beliefs, values and practices. It encompasses
a way of living informed by the historical, economic, ecological, and
political forces on a group.
118
Five levels at which aspects of culture can be seen
are set out in Hawkins and Shohert (2007) (P106)
with each influenced by the levels beneath it:
• Artefacts: the rituals, symbols, art, building, policies
etc.
• Behaviour : the patterns of relating and behaving;
the cultural norms
• Mind-sets: the ways of seeing the world and framing
experience
• Emotional ground: the patterns of feeling that shape
making of meaning
• Motivational roots: the fundamental aspirations that
drive choices
119
Race: has no consensual definition, with the biological basis of
race having been, at different times, the source of heated
debate in Psychology.
The definition of race therefore, is considered to be socially
constructed rather than biologically determined, so that it is a
category to which others assign individuals based on perceived
physical characteristics, such as skin colour or hair type, and
the generalizations and stereotypes made as a result. In the
American literature concerning race, one sees this frequent
references to People of Color (POC).
120
Ethnicity: in a like fashion to the concepts of race and culture,
APA indicates that “ethnicity” does not have a commonly
agreed upon definition. APA Guidelines refer to ethnicity as the
acceptance of the group mores and practices of one’s culture
of origin and the concomitant sense of belonging. APA notes
that individuals may have multiple ethnic identities that operate
,with different salience, at different times.
121
122
Multiculturalism and Diversity: these are terms that have been used
interchangeably to include aspects of identity stemming from gender,
sexual orientation, disability, socio-economic status and age (my
emphasis).
Mulitculturalism is the term used in American culture, whereas in
Australia, the term “diversity” would more commonly be used to
encompass these factors. Indeed, APA indicate that “multiculturalism
in an absolute sense, recognizes the broad scope of dimensions of
race, ethnicity, language, sexual orientation, gender, age, disability,
class status, education, religious/spiritual orientation and other cultural
dimensions” (P2).
It stresses that all of these are critical aspects of an individual’s
ethnic/racial and personal identity, and urges that Psychologists be
cognizant of issues related to all of these dimensions of culture.
The Guidelines:
Guideline 1: Psychologists are encouraged to recognize that, as cultural beings, they may
hold attitudes and beliefs that can detrimentally influence their perceptions of and
interactions with individuals who are ethnically and racially different from themselves.
Guideline 2: Psychologists are encouraged to recognize the importance of multicultural
sensitivity/responsiveness, knowledge, and understanding about ethnically and racially
different individuals.
Guideline 3: As educators, Psychologists are encouraged to employ the constructs of
multiculturalism and diversity in psychological education.
Guideline 4: Culturally sensitive psychological researchers are encouraged to recognize
the importance of conducting culture-centred and ethical psychological research among
persons from ethnic, linguistic and racial minority backgrounds.
Guideline 5: Psychologists strive to apply culturally-appropriate skills in clinical and other
applied psychological practices.
Guideline 6: Psychologists are encouraged to use organizational change processes to
support culturally informed organizational (policy) development and practices.
123
Addressing Diversity in Clinical
Practice and Supervision
Hawkins and Shohert (2007) provide a model intercultural sensitivity
(P108), and suggest that clinicians may progress through these stages on
the way to becoming more culturally effective in their work with clients:
•
•
•
•
•
•
Denial: where one sees one’s own culture as the only real one
Defence: against cultural differences, where one sees one own culture
as the only good one
Minimization: in which elements of one’s own cultural world view are
experienced as universal
Acceptance: in which there is recognition that one’s own culture is just
one of a number for equally complex world views
Cognitive adaptation: where one can look at the world ‘through different
eyes’
Behavioural adaptation: where the individual can adapt their behaviour
to different cultural situations and relationships
124
125
Fouad et al (2009) list as one of the key Foundational
Competency Domains, working with individual and cultural
diversity, often noted in the literature as ICD.
The model distinguishes between the aims and expectations in
the teaching and supervision, when the Supervisee is in the
learning phase of his or her career, in the phase where practice
takes place by way of internship, and when the Supervisee is in
independent practice.
126
The focus is the development of self, as a Psychologist, and
recommends that the Supervisor’s attention be drawn to
establishing with the Supervisee a sense of how he or she has
been shaped by individual and cultural diversity.
Attention is drawn to knowledge, awareness and understanding
of one’s own dimensions of diversity and the attitude of the
experience of diversity in the other.
It recommends that the Supervisor look for indicators that the
Supervisee monitors and applies knowledge of self, as a
cultural being, in the processes of assessment, treatment and
consultation.
127
.
For example, white, Western people tend to
regard their own culture as a kind of
international norm.
For Psychologists the risk in this is either
that they regard themselves as being
culturally neutral or, when working with
someone from a different ethnic background,
they may assume that their work with the
client is correct any perceived cultural
divergence.
Guidelines are listed as a means by which the Supervisor
might gauge the extent to which the development of skills,
within interactions where ICD factors are at play, are being
fostered by means of the Supervisory process.
For example, in terms of being able to relate effectively
and meaningfully as a professional Psychologist to
individuals, groups or communities, Fouad et al (2009) list,
as a behavioural indicator, that the Psychologist needs to
demonstrate the ability to:
“… effectively negotiate conflictual, difficult or complex
relationships … with individuals and groups that differ
significantly from (himself or herself)”.
128
129
Hawkins and Shohert (2007) suggest that there are
three ways of responding to culture:
• the Universalist, denies the importance of culture and
emphasises the role of individual pathology;
• the Particularist takes the opposite view and sees all
difference as cultural;
• the Transcendentalist, takes the view that “both the
client and the therapist have vast cultural experiences
that deeply influence their worldviews and behaviour”
(P105).
Which are you?
130
Group exercise 1
Culture: consider how questions around differences might be included:
Your Supervisee presents a case of a CALD (culturally and linguistically
diverse) client comes in for treatment of depression. He speaks excellent
English. Should culture be included in the case formulation and case
assessment and how?
What questions can we as Supervisors ask our Supervisees to consider?
ooOOoo
For these and other like skills to be encouraged and developed within the
Supervisee, they must be present in the Supervisor.
131
Group exercise 2
For Sexuality:
Your Supervisee presents the case of a gay male who has presented for
treatment of depression. Should sexuality be included in the case formulation
and case assessment: how ?
What questions can we as supervisors ask our supervisees to consider?
How would you guard against racial and sexual stereotyping in counselling
relationship with clients?
How would you do this with Supervisees?
----For these and other like skills to be encouraged and developed within the
Supervisee, they must be present in the Supervisor.
132
If we are to recognize rather than deny cultural difference, of any
kind, we need to create a language across that difference. Within
the Supervisory process, as with the therapeutic relationship
presented by the Supervisee, understanding difference is not
enough: if we do not complete the circle by including our own
difference, we risk being absent from the process.
Hawkins and Shohert (2007) indicate that his involves not just
exploring and understanding the cultural factors, experiences and
assumptions that we bring to the relationship – therapy or
Supervision – but also being aware that some aspects of culture
bring with them power.
Thus dealing with difference involves both understanding culture as
it applies to all three participants – Supervisor, Supervisee and
client – and recognizing the inherent power imbalance that will exist
a as these factors are explored and exposed.
General models for Supervision for
Competency with Difference
An example of how standards might be achieved in that part of the
Supervisory relationship directed at ensuring cultural competence in
the Supervisee.
This is a developmental model, focused around the stages of growth of
overall competence within the Supervisee.
It is essential that Supervisors explore racial, gender-related, ethnic
and cultural dynamics within the Supervision. Spiritual beliefs and
socio-economic issues, even political allegiances, should be added to
this mix.
133
There is in fact a supervisory triad of the client, the Supervisee,
and the Supervisor that always needs to be considered, although it
is the dyadic relationship between Supervisor and Supervisee.
It is necessary for the Supervisor to build a strong working alliance
with the Supervisee so that multicultural issues, which are often
contentious or sensitive in nature, can be discussed frankly.
Adopting a developmental approach simply takes account of the fact
that the needs of the inexperienced Supervisee are quite different from
the needs of the advanced trainee, or the experienced Supervisee,
and require, of the Supervisor, different and changing strategies.
134
Building cultural awareness in the Supervisee is emphasized as a
necessary first step to facilitating the development of skill in
implementing sensitively directed, multicultural interventions in the
Supervisee.
The inclusion of discussion about the likely impact of the Supervisee’s
own culture, whatever that might mean, on the perceptions and
reactions of their clients generally is part of this process.
 How was it for you to sit with a client (… of a different
culture, specified)?
 Did the (… identified cultural differences …) between
the client and yourself affect your connectedness
with him/her?
 Can you identify any multicultural issues that may
affect you working with this client?
135
A four stage model is outlined:
At the first level in the model, where Supervisees are described as having high
motivation for client work, but anxiety and limited insight, they are described as
being likely to have little knowledge of multicultural factors
At the second developmental stage within the model Supervisees are described
as striving more autonomy in their work with clients.
At the third level of this model focused on building competency around
multicultural issues, the Supervisee is likely to have reached an awareness that
the interactions with clients can be limited by his/her own biases, and by the
experience of conflicting values within the therapeutic conversation.
In the fourth and final stage of the model there is a sense that an awareness of
self-other has been achieved, it is acknowledged, and it is incorporated by the
Supervisee in client work.
136
137
Hawkins and Shohert (2007) provide a general
model for the provision of Supervision in which
seven differing focal activities are described, with
the authors recommending that Supervision move
between the suggested modes over the course of
the supervisory experience (Chapter 7).
They have adapted their model to consider how
this might apply to the Supervisor’s focus on
working with the Supervisee where attending to
cultural difference, of any kind, needs to be
addressed.
138
Mode 1: Focus on the client and what and how they
present.
The client’s world is understood by way of the experiences he
brings to and expresses in therapy. Cultural material may be
brought explicitly or implicitly, with the task of the Supervisee
to understand the extent to which the client’s experience is
strongly derived from his culture, as opposed to what is more
characterised by personality variables. The Supervisee will
need to be attentive to the client’s non-verbal signs, and it is
an opportunity for the Supervisor to increase the Supervisee’s
awareness of his or her own tendency to give meaning to
these signs through the medium of his or her own culture.
139
Mode 2: Exploration of the strategies and interventions
used by the Supervisee.
This mode provides the Supervisor with the opportunity to
examine interactions and interventions that are born of the
Supervisee’s own cultural experience. It acknowledges that
this unconscious bias can be sharply evident in interventions
that do not take full account of the cultural experiences and
expectations of the client. The Supervisor, detecting this kind
of error, might suggest that the Supervisee become more fully
acquainted with the messages of the client’s cultural
background in order to make more culturally sensitive
interventions.
140
Mode 3: Focusing on the relationship between the client and
the Supervisee.
In this mode, the focus is on neither the Supervisee nor the client,
but rather on the system that their meeting together has created.
Questioning by the Supervisor is aimed at encouraging the
Supervisee to see the relationship as a whole, rather than from his
or her own perspective. It is an opportunity to examine
transference and counter-transference, but to so with culture in
focus.
Unconscious prompts by the client about a desire to explore
unspoken issues of culture may emerge. Some aspects of the
power differential created by cultural differences, as it exists
between the Supervisee and the client, might also become more
evident.
141
Mode 4: Focusing on the Supervisee.
In this mode, the Supervisor addresses the Supervisee’s own
issues, and the extent to which these impact on client-based
activities. It is founded on the Supervisee’s emerging
awareness of his or her own prejudiced attitudes and feelings.
Supervision in this mode is not psychotherapy directed at the
eradication these biases. In the process, the Supervisee is
encouraged to see that these are part of his or her growth and
development.
Consciously appreciated and taken into account by the
Supervisee, they may be more a strength to framing
interventions, than a vulnerability or a liability with clients from
a different cultural background.
142
Mode 5: Focusing of the Supervisory relationship.
Exploration of the way the relationship with the client is
mirrored within the Supervisory relationship is possible in
this mode of Supervision practice.
In respect of the power differential that exists between the
Supervisee and his or her Supervisor, this may provide a
useful experience for the Supervisee as he or she
experiences what it might be like in therapy for a client
from a non-dominant culture.
143
Mode 6: The Supervisor focusing on their own
process.
The Supervisor needs to be attuned to the changes and
reactions he or she experiences within the Supervision:
this can be lost when the focus on role, and the processes
associated with that role, are at the forefront of
awareness.
Reactions to the material being presented in a
Supervision session may be related to the interaction of
the Supervisor and the Supervisee as described in Mode
5, but it may also be that the Supervisor is picking up the
unspoken reactions that the Supervisee has to the client,
some of which may contain an element of tension or
discord around cultural issues.
Mode 7: Focusing on the wider contexts in which work happens.
Finally, to progress the Supervision, the aim of the Supervisor is to
integrate the above-mentioned aspects of Supervision around culture.
This process of integration also needs to take account of where the client
work takes place and the context of Supervision – they may not be the
same. Where cultural difference is involved in the Supervision, it needs to
be acknowledged that the world of the client may be seen and interpreted
differently by the Supervisee and the Supervisor. Similarly, the Supervisee
needs to become attuned to the texture of his or her cultural learning,
some of which may have been reinforced as part of professional
development. Consideration of the formation of culturally based attitudes
and values, and how they may impact on intervention, needs to be
factored into Supervision. Aspects of the client – Supervisee relationship
may be mirrored in the Supervisor – Supervisee relationship, and this may
be brought into sharper focus when the issue of difference, between the
Supervisee and his or her client, is in focus.
144
145
An example:
Spirituality and Religion
Group Exercise
– Reflection No. 2
146
I want to now put a deeply personal question to you: I want you to think about
how you answer this with respect to the public nature of your disclosure and who
is with you to-day in the audience. Think about what you are prepared to say
about yourself; you may need to self-censor; you may feel some caution about
how others might construe your disclosure.
In a few words, what can you say about your own spiritual beliefs, your religious
practices, or your religious or spiritual affiliations?
(Note down the answers with the intention of getting some idea of the diversity
represented in this group)
For those who had to self-censor, who had some caution about what they might say
openly, please reflect upon this as we embark on the next part of this presentation
Consider the reasons for this for you
Consider as we talk about spirituality and religion as a multicultural concern, how similar
disclosures might be difficult for our clients in therapy, or our colleagues in Supervision.
Consider also how, if this is a difficulty with respect to religion and spirituality, how similar
disclosures – about ethnicity, social class, sexuality – might prove to be just as difficult
for our clients, for our colleagues in Supervision
There has been a tendency, in Psychology, to represent religious beliefs and
behaviours negatively. It seems that this is largely because of the contradictions
and confusions between the way in which the spiritual dimensions of the human
condition are expressed and considerations of behaviours and ascriptions that
relate to mental illness.
Yet “… behavioural research … has linked clients’ spirituality and religiosity
with improved mental health outcomes”
Multiculturalism is often used as code for differences in the community where
religion, and to a lesser extent, spirituality, are concerned. Immigration in
particular, has introduced a great deal of diversity of religious traditions into the
cultural life of Australia.
Where once Christianity was the dominant religious culture, orchestrating most
of the behaviours related to religious traditions, a plurality now best describes
religious life in Australia.
For this reason, Psychologists working with clients, and Psychologists paired in
Supervision
147
Religion and spirituality are not interchangeable
terms.
For the purposes of this discussion:
Spirituality refers to the meaning and purpose of one’s
life, a search for wholeness and a relationship with a transcendent
being.
Religion, or religious involvement, is a means of
expressing one’s spirituality, and generally refers to participation in
an organized system of beliefs, rituals and collective traditions.
Focus on spirituality and religion, for the Supervisor and the
Supervisee, encapsulates basic considerations that obtain to any
other aspect of diversity and difference as it relates to working with
clients, and to the work of two professionals who come together to
examine that work in Supervision.
148
A model for working in Supervision with Spirituality and
Religion
Discrimination Model:
Intervention skills – the Supervisee’s skill in delivering an intervention conceptualization
skills – the Supervisee’s ability to understand and synthesize information about the client,
distinguishing between the essential and the non-essential
Personalization skills – the personal traits of the Supervisee which contribute to the
therapeutic relationship, including personality, cultural background, personal values and
aspects of self.
Three key Supervisory roles:
As teacher, the Supervisor may instruct, model, provide feedback and evaluate.
As counsellor, the Supervisor encourages reflection, assists the Supervisee in examining
their own thoughts and their own internal schema of reality.
As consultant, the Supervisor provides an objective resource to the Supervisee, always
encouraging the Supervisee to trust their own perceptions, thoughts and insights.
149
The implementation of the model involves the Supervisor identifying the
focus area and what needs to be discussed at that point of Supervision,
depending on what, and how, the Supervisee is presenting, and then
determining which of the Supervisory skills is indicated for properly
addressing that focus.
The Discrimination Model might work in Supervision in the following way:
if the Supervisee seems to be struggling with a client’s repeated
reference to biblical material, the Supervisor must determine whether the
Supervisee is unsure who to integrate the religious themes with the other
themes that the client is presenting (conceptualization), or if the
Supervisee is struggling to do what is needed (intervention), or if the
Supervisee feels discomfort to the point of being unable to act
(personalization).
150
Intervention Skills:
On the basis of what has emerged from the assessment, the
Supervisor and the Supervisee can determine interventions,
techniques or other questions that may need to be answered, derived
from, or related to, the religious and spiritual traditions that have been
unearthed. Polanski (2003) gives examples of what these might be:
loving-kindness meditations from Buddhist traditions; contemplative
prayer from Christian traditions, suggesting that these might be used
as adjuncts to other interventions initiated by the Supervisee, or
emerging from the Supervisory conversation.
The aim of Supervision within the focus on intervention is to teach the
Supervisee new skills or to enhance existing skills, imparting
information about the assessment process, and formulating with the
Supervisee questions or techniques that are derived from the
information gleaned with respect to religious or spiritual beliefs and
affiliations. Supervision might be the moment when such
interventions are rehearsed.
151
Conceptualization Skills:
When religion and spirituality are being considered, the basic
conceptualization skill needed by the Supervisee – and the Supervisor – is
that spirituality actually exists, and that spiritual experiences make a
difference to the individual’s behavior.
The task of the Supervisee, in concert with the Supervisor, is to sort out
what is essential in the exploration of spiritual and religious themes with
the client.
Guilt may be central theme: religion may be the source of this guilt just as
it may be a source of strength for the client.
In the Judeo-Christian traditions, the image of God as a parent prevails,
so that clients raised in this tradition may have a construct of God based
on their experiences with their parents.
152
Personalization Skills:
This set of skills relates to the Supervisee’s ability to effectively
and ethically address the client’s spiritual and religious beliefs out
of an awareness of his or her own.
The spiritually competent Supervisee (and Supervisor) engages in
self-exploration of his or her beliefs in order to increase sensitivity,
acceptance and understanding of the impact of his or her own
belief system within therapy.
Personalization skills of this kind may be challenging for the
Supervisor to address: his or her experience as a result may range
from the highly satisfying to the deeply uncomfortable, and some
awareness and anticipation of this is advised.
153
154
Polanski (2003) concludes:
“The Supervisor’s position of power suggests that
his or her attitudes toward spirituality and counselling
will set the tone for how these issues are addressed
in Supervision and may, consequently, influence the
way the Supervisee addresses these issues with
clients. Demonstrating a readiness to address these
issues with Supervisees is essential for the
Supervisors to ensure appropriate client care and to
enhance the professional development of the
counsellors”. (p139)
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