Early Education and Development

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Reflective Supervision/Consultation and Early

Childhood Professionals’ Well-Being: A Qualitative
Analysis of Supervisors’ Perspectives

Amy Susman-Stillman , Stefanie Lim , Alyssa Meuwissen & Christopher

Watson

To cite this article: Amy Susman-Stillman , Stefanie Lim , Alyssa Meuwissen & Christopher
Watson (2020) Reflective Supervision/Consultation and Early Childhood Professionals’ Well-Being:
A Qualitative Analysis of Supervisors’ Perspectives, Early Education and Development, 31:7,
1151-1168, DOI: 10.1080/10409289.2020.1793654

To link to this article: https://doi.org/10.1080/10409289.2020.1793654

Published online: 10 Aug 2020.

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EARLY EDUCATION AND DEVELOPMENT
2020, VOL. 31, NO. 7, 1151–1168
https://doi.org/10.1080/10409289.2020.1793654

Reflective Supervision/Consultation and Early Childhood

Professionals’ Well-Being: A Qualitative Analysis of Supervisors’
Perspectives
Amy Susman-Stillmana, Stefanie Limb, Alyssa Meuwissenb, and Christopher Watsonb
a
Future Services Institute, University of Minnesota; bCenter for Early Education and Development, University of
Minnesota

ABSTRACT
Research Findings: Supporting the social and emotional well-being of early
childhood professionals is of great importance for the sake of the workforce
as well as the quality of the services they provide. Reflective supervision/
consultation (RS/C) is an ongoing professional development practice that
helps professionals process the emotional experience of working with young
children and families. This qualitative study explores the social and emotional
well-being of early childhood professionals engaging in RS/C practices.
Ninety-seven reflective supervisors across the nation completed an online
survey about their current practice of RS/C. The survey included questions
about why they became reflective supervisors, what helped them learn and
maintain their RS/C skills, and what effects of RS/C they experienced and
perceived in others. Qualitative, inductive analysis of these open-ended
questions revealed RS/C skills and experiences that aligned with four social
and emotional well-being themes: emotional skills, reflective skills, stress-
coping skills, and supportive relationships. Practice or Policy: With the high
rates of turnover and job stress encountered by early childhood profes­
sionals, new strategies are needed to support their social and emotional well-
being. RS/C is a unique professional development practice rapidly increasing
in use and holds promise for building early childhood professionals’ social
and emotional well-being.

The social and emotional well-being of the early childhood workforce is increasingly recognized as key for
implementing effective services (Institute of Medicine (IOM) and National Research Council (NRC),
2015). It affects the quality of interactions with children and families and the ability to successfully provide
the services children and families need (Buettner et al., 2016; IIOM & NRC, 2015; Jennings, 2015; O’Brien
et al., 2012). While high-quality interactions and services for children and families are critical to promote
their healthy developmental outcomes, the social and emotional well-being of the professionals who work
with children and families also matters in its own right (e.g., National Association for the Education of
Young Children, 2011). The early childhood workforce includes myriad professionals from varying
disciplines. It includes those who are responsible for the everyday care and education of children across
different settings like teachers and child care providers, as well as home visitors, early interventionists,
mental health consultants, and those who work in health and social services such as allied health
professionals, child welfare workers and social workers (IIOM & NRC, 2015). Working in the early
childhood field can be immensely rewarding; however, the work also holds multiple challenges. Across
early childhood services, professionals face high caseloads and rigorous documentation and monitoring
standards. Growing numbers of studies describe the low wages (Whitebook et al., 2014), difficult work

CONTACT Amy Susman-Stillman asusman@umn.edu

For submission to Special Issue: Early care and education professionals’ social and emotional well-being
© 2020 Taylor & Francis Group, LLC
1152 A. SUSMAN-STILLMAN ET AL.

circumstances/contexts (Kwan, 2019), limited amount of professional supports (Eaves Simpson et al.,
2018), and high rates of turnover (Whitebook et al., 2014; Zabel & Zabel, 2002) they experience.
Although early childhood professionals generally enter the field because they care deeply about
young children and families, it can be challenging for them to maintain a balance between their
work and their well-being. Since the relationship between the practitioner and the child/family is
central to the quality of the service provided (Fifolt et al., 2016; O’Brien et al., 2012), there are real
concerns about whether and how threats to the social and emotional well-being of the early
childhood workforce affect their ability to effectively serve young children and families. Studies
show that the early childhood workforce reports notable levels of stress and depression (Roberts
et al., 2017), burnout (Fifolt et al., 2016; Mor Barak et al., 2009), low self-efficacy (Harrison, 2016),
and vicarious trauma, also referred to as secondary trauma (Osofsky, 2009). This literature repre­
sents a call to better research and implement professional practices which support the well-being of
early childhood professionals.
Reflective supervision/consultation (RS/C) is one tool being used to address the well-being of the early
childhood workforce. Although reflection has been used as a strategy to improve practice in fields such as
education, social work and medicine for some time (Grant & Kinman, 2012; Mamede & Schmidt, 2004;
Watson et al., 2014), a specific approach to reflection, RS/C, arose within the interdisciplinary field of
infant mental health. RS/C is applicable to early childhood professionals engaged in relationship-based
work with families and children who fall into the birth-age 8 range. Other forms of professional
development offered for early childhood professionals, such as coaching or mentoring, generally focus
on modeling or motivating providers to use specific practices. In contrast, RS/C is ongoing professional
development which increases professionals’ capacity to manage the strong emotions inherent in direct
service work and better understand relational dynamics within families and between professionals and
family members with the goal of developing and maintaining effective service delivery (Watson & Gatti,
2012; Weatherston et al., 2010). RS/C is especially important for, but not limited to, early childhood
professionals working with children and families who have experienced trauma. It is a professional
practice that can be useful to all early childhood professionals, as the nature of working with any young
children and their families engenders emotional responses. One of the benefits of RS/C is that it addresses
problems common across early childhood professionals, and can encourage the development of skills
that enhance collaboration within and across disciplines. RS/C is recognized as a professional learning
practice (IIOM & NRC, 2015) and considered best practice by an increasing number of national
organizations, such as the Alliance for the Advancement of Infant Mental Health (Alliance for the
Advancement of Infant Mental Health (AAIMH), 2019), Healthy Families America (U.S. Department of
Health and Human Services, 2018), Head Start/Early Head Start (Head Start Early Childhood Learning &
Knowledge Center, 2018) and Educare (2014).
There are no statistics of which we are aware that describe the increasing use of RS/C within early
childhood fields; however, since 2013, the number of certified reflective supervisors has increased by
over 50% (AIMH, 2019). Furthermore, as the need for professional development supports is increas­
ingly acknowledged, RS/C is rapidly expanding across diverse early childhood fields including home
visiting (Watson et al., 2016), child care (Virmani & Ontai, 2010), early childhood special education
(Watson & Gatti, 2012), and early intervention and allied health professions (Frosch et al., 2018;
Harrison, 2016). As the practice is relatively new to early childhood professionals, there is limited
research that documents the effects of RS/C on workforce outcomes (Heller & Ash, 2016; Low et al.,
2018) or child and family outcomes (Eaves Simpson et al., 2018) and the mechanisms by which these
effects are realized. The purpose of this study is to describe the perspectives of reflective supervisors on
early childhood workforce well-being issues.

ECE Workforce Well-Being

The concept of early childhood professional well-being is emerging and evolving, and is informed by
other practitioner fields. While there is not yet an agreed-upon definition specific to the ECE field, the
 EARLY EDUCATION & DEVELOPMENT 1153

conceptual model of clinician well-being and resilience developed by the National Academy of
Sciences (Brigham et al., 2018) defines well-being as not simply the absence of illness or the lack of
burnout, but a broader concept that entails “alleviating fatigue, moral distress and suffering” and
“promoting personal fulfillment and joy.” Their definition of workforce well-being involves indivi­
duals in contexts and systems, and is the complex product of factors external and internal to the
professional (Brigham et al., 2018).
Recent work by Gallagher and colleagues unpacks early childhood teacher well-being by adapting
Brigham et al.’s (2018) medical professional model to fit the unique circumstances of early childhood
teachers (Gallagher et al., 2019). In their adapted model, Gallagher et al. reflect the multifaceted nature
of teacher well-being, distinguishing between the contextual factors (social and cultural, professional
regulations and policy, organizational factors and leadership, practice environment and conditions)
and the individual factors (teaching role, personal factors, knowledge and competencies) they posit
shape teacher well-being. They depict teacher well-being as shaping the interactions and relationships
that affect child outcomes.
Similarly, the landmark report, Transforming the Workforce for Children Birth through Age 8:
A Unifying Foundation, posits that the foundation of a quality ECE system lies in the support of the
ECE workforce (IIOM and NRC, 2015). Professional well-being is viewed as resulting from profes­
sionals’ knowledge and competencies and the practice environment/working conditions, and directly
affects professionals’ interactions with families and children, and in turn, children’s outcomes (IIOM
& NRC, 2015, p. 359). Professional learning practices such as reflective practice and supportive
supervision are posited to underlie professionals’ knowledge and competencies.
Thus, both the Gallagher et al. model of teacher well-being and the IOM & NRC model of quality
professional practice conceive of workforce well-being as a key aspect of quality service, and include
the professionals’ own knowledge and competencies as key to their well-being. This is in keeping with
research denoting teacher social-emotional competence and well-being as central to a prosocial and
psychologically healthy classroom and to child outcomes (Jennings, 2015; Jennings & Greenberg,
2009). This work also contributes to establishing the importance of ECE professional well-being and
describing specific aspects of well-being. Jennings (2015) offers a set of core competencies for healthy
social-emotional learning that align with individual-level factors of the Brigham et al. (2018) and
Gallagher et al. (2019) models of clinician and teacher well-being: self-awareness, self-management,
social awareness, relationship skills, and responsible decision-making (see also Collaborative for
Academic, Social and Emotional Learning, www.casel.org). An initial study examining relations
between mindfulness and self-compassion and ECE professional behaviors provides support for
their relation with teacher’s provision of emotional support in the classroom and limited support
for teacher’s perspective-taking and self-efficacy (Jennings, 2015). Another investigation of teacher
supports, well-being and experiences revealed that “in general, teachers who reported more profes­
sional supports for wellness and more teamwork among colleagues in their classrooms led classrooms
that scored higher on measures of social-emotional instruction, peer-interaction scaffolding, emo­
tional support of students, and classroom organization” (Johnson et al., 2019, p. 13). There is still
much to be learned about the construct of workforce well-being, but the growing body of evidence on
workforce well-being and high-quality services, coupled with the earlier-cited literature indicating
significant challenges to early childhood professionals’ social and emotional well-being, also warrant
research on how to support it.

Reflective Supervision/Consultation (RS/C)

RS/C is based on the premise that increased self-awareness and understanding of the reasons why
oneself and others think and act the way we do allows professionals to consider a broader and deeper
range of approaches and strategies for their practice. The space created through the RS/C relation­
ship allows practitioners to step back and reflect on the challenges they face in their work (Parlakian,
2002; as cited in Watson et al., 2014, p. 3). RS/C has theoretical roots in attachment theory, which
1154 A. SUSMAN-STILLMAN ET AL.

posits that supportive relationships are necessary for well-being, as they promote emotion regula­
tion and thus allow for resilience to stress in both children and adults (Brumariu, 2015; Mikulincer
& Shaver, 2008). RS/C is also based in a foundation of mindfulness and self-awareness on the part of
the professional, who is supported in exploring emotional and cognitive responses to his/her work.
It incorporates principles from interpersonal neurobiology, which show that having reflective
partners greatly increases humans’ capacity to process arousing, stressful, or challenging experiences
(Siegel, 2012).
In practice, RS/C consists of regular (e.g., weekly or monthly) meetings with a trained reflective
supervisor or consultant. Meetings may occur one-on-one or for small groups of staff. The focus of the
conversation is the emotions, perspectives, and developmental histories of all involved in a case: the focus
child(ren), the caregivers, and the early childhood professional. The power of RS/C lies in the consistency
of a specific time and space set aside for professionals to process their own emotional reactions to the
work they do, and integrate what they know about their own and others’ feelings and behaviors with
theory and best practice principles (Gilkerson, 2004; Watson et al., 2014). RS/C has been described as “a
relationship-based supervisory approach that supports various models of relationship-based service
delivery” (Heffron & Murch, 2010, p. 5). Thus, RS/C is a professional development practice that can
be used across different early childhood settings and by different early childhood professionals, regardless
of their discipline.

RS/C and Workforce Well-being

The work of supporting young children and families who face multiple challenges is emotionally
taxing and can trigger unresolved issues, fears, or beliefs that often lead to limiting behaviors, stressful
thinking, or difficulty seeing other perspectives. Clinical literature suggests that the time and energy
put into reflecting, especially when one is triggered by their own parenting or other personal
experiences (Eaves Simpson et al., 2018) or when stressed or pressured to act, relieves the pressure
and offers new or clearer avenues for thoughts, feelings and actions. RS/C provides the opportunity for
professionals to learn how to focus on a situation in the moment and be aware of how their own
experiences and the experiences of others affect how they think, feel and act (Tomlin & Viehweg,
2016). When professionals engage in RS/C with regularity, they practice reaching paths to new ideas or
clarity, and by doing so, build the context and skills of social and emotional well-being–supportive
relationships, emotional resilience, cognitive flexibility, and coping skills.
RS/C also benefits professionals by contributing to a healthy work environment, supporting them
in their work and helping them improve their skills (Watson et al., 2014). Evidence is beginning to
accumulate indicating that skills that are targets of RS/C result in improved well-being outcomes for
professionals. For example, social work students with greater reflective skills were more likely to
successfully weather stress and be psychologically healthy (Grant & Kinman, 2012). Early childhood
interventionists who received RS/C reported that multiple dimensions of their professional function­
ing and well-being were positively affected, including their ability to effectively reduce and cope with
job-related stress, manage their own responses to infant and family conflict, and form and maintain
positive relationships with coworkers (Frosch et al., 2018, 2019). Building on the emerging concep­
tualization of early childhood professional well-being and the growing data on RS/C impact, it may be
that some of the most powerful impacts of RS/C are experienced through its effect on emotional and
reflective skills, the ability to cope with stress, and the formation of supportive relationships.

Present Study
In this paper, we explore reflective supervisors’ perceptions of how RS/C supports the early childhood
workforce, delving into ECE professionals’ well-being. While evidence is beginning to show some
positive impacts of RS/C, at this stage, in-depth qualitative research can elucidate potential relations of
RS/C and aspects of workforce well-being as well as mechanisms through which RS/C may influence it.
 EARLY EDUCATION & DEVELOPMENT 1155

This research will provide a foundation for future quantitative and experimental work that has the
potential to be applied across early childhood professionals in diverse disciplines.
We define the early childhood workforce as inclusive of the myriad professionals that work with
young children and families. In the current study, mental health professionals and home visitors were
most strongly represented, but reflective supervision can and does serve professionals across sectors, such
as early childhood teachers, childcare providers, early interventionists, public health nurses, child welfare
workers and allied health professionals. We report the responses of reflective supervisors who have both
experienced and provided RS/C. Their responses describe the skills and experiences acquired through
participating in RS/C and its impact on their own social and emotional well-being as well as their
perception of effects on those for whom they provide reflective supervision or consultation. We align the
responses with aspects of early childhood professionals’ well-being. We used qualitative responses from
a series of open-ended questions about receiving and providing RS/C. Our inductive analytic process
explored supervisors’ perspectives about social and emotional well-being in RS/C work.

Method
Participants
The data reported in this study are part of a larger study describing the current practice of RS/C and its
impact on ECE professionals in order to identify examples of successes and challenges as its use
increases nationally. This work is being conducted under the auspices of the Reflective Practice Center
at the Center for Early Education and Development at the University of Minnesota, which focuses on
directing research and training on RS/C. This study represents part of our effort to contribute to the
evidence base for RS/C.
Because there is no central repository of reflective supervisors or unified way to contact them,
a snowballing strategy was used to identify reflective supervisors, who are program or clinical super­
visors or specially-trained consultants who provide RS/C to the early childhood professionals and are
part of the early childhood workforce. First, all state infant mental health organizations that could be
identified on the internet were contacted (N = 38). Thirty-one state organizations responded and
provided names of up to 5 reflective supervisors in their state, resulting in 112 identified providers.
These reflective supervisors were sent a survey and also asked to provide names of up to 5 other
reflective supervisors, resulting in 98 additional unique contacts. In sum, 210 reflective supervisors
across the country were identified, and 97 (46%) across 27 states completed the survey.
Reflective supervisors who responded to this survey were a highly educated group of professionals
(67% had masters degrees; 24% had doctorate degrees). Sixty-nine percent had earned a Michigan
Association for Infant Mental Health Endorsement, 5% a California Center for Infant-Family and
Early Childhood Mental Health Endorsement, and 23% reported no endorsement/credential in infant
mental health. Mental health professionals were most strongly represented (58%), followed by the
fields of home visiting (15%), and early intervention or physical/occupational/speech therapy (10%).
The remaining 17% reported working in child care, child welfare, medical care, or other. There was
a range of experience in providing RS/C, with 64% providing for 0–10 years, 23% for 11–20 years, and
13% for over 20 years. Most provided RS/C for 1 or 2 organizations (54%; range = 0–9 organizations,
median = 2 organizations). Ninety-one percent had received their own reflective supervision before
beginning to provide it to others, with most (62%) having 1–5 years of experience receiving before
providing. Seventy-eight percent were receiving their own RS/C at the time they completed the survey.
We did not collect data on other descriptive characteristics of the respondents.

Procedure
Participants were emailed a link to an anonymous online survey on the Qualtrics platform. Those who
completed the survey were entered into a drawing for a 50 USD gift card.
1156 A. SUSMAN-STILLMAN ET AL.

Measure
The survey consisted of 38 questions for RS/C providers covering topics of demographics, training to
become a RS/C provider, and perceptions of the effects of RS/C on self and others. The following open-
ended survey questions were relevant for workforce well-being and were used for the analyses in this
study:

(1) Why did you decide to become a reflective supervisor?

(2) What have been the three most helpful things for you in learning/maintaining RS/C provision
skills?
(3) Have you experienced any effects of your participation in RS/C? Please describe.
(4) Have you seen any effects of RS/C for others who receive it? Please describe.

The responses from these 4 questions yielded approximately 29 pages of single-spaced text; 27% of
the text was in response to question 1, 17% in response to question 2, 21% in response to question 3,
and 35% in response to question 4.

Data Analysis
Qualitative analysis using an inductive approach to identifying themes was used to analyze the data
(Miles et al., 2020). Three coders coded the data. One coder held a bachelor’s degree in psychology, had
not worked as an early childhood professional, but was trained to reliability in coding the quality of
reflective sessions. The second and third coders held advanced degrees in developmental psychology.
The second coder had significant experience working with early childhood professionals. The third coder
had taught courses about reflective supervision and had achieved reliability in coding reflective sessions.
A manual coding process conducted in Excel was followed, with a first cycle coding phase where the
first and second coders independently read all responses for an individual question and identified
initial descriptive (“basic topic of a passage” (Miles et al., 2020, p. 65) and process codes (“actions
intertwined with the dynamics of time” (Miles et al., 2020, p. 66). The second step was to discuss their
codes to develop complete definitions and identify areas of agreement and disagreement. Through that
process, as definitions became more clear, codes were revised and in some cases, reduced as there was
duplication (Miles et al., 2020), resulting in a refined set of codes. In the third step, the first two coders
continued the iterative process by reviewing the data and codes to confirm the refined set of codes; any
coding differences were discussed until complete agreement was reached (Miles et al., 2020). The third
coder coded the data separately to confirm the categories and themes and noted a high degree of
confirmation with the refined codes. The first two coders then engaged in second cycle coding (pattern
coding; Miles et al., 2020, p. 79) by linking related codes/categories and abstracting them into themes
(pattern coding, p. 79; Figure 1). Additional second cycle coding was conducted to understand if
characteristics of the respondents (e.g., if they had earned endorsement as a reflective supervisor, or
years in the field) offered unique insights.
For each category, the number and percentage of unique respondents were calculated for the most
prominent sub-themes (Tables 1–4), because some respondents provided multiple responses under
each theme. Out of the 97 who completed the survey, a total of 83 (85.6%) provided responses related
to the workforce well-being themes identified from the four questions analyzed.

Results
Themes
Reflective supervisors described RS/C as a professional development practice that promotes the
ongoing development and maintenance of emotional and reflective skills that build professionals’
resilience and ability to work with children and families who they may experience as challenging.
 EARLY EDUCATION & DEVELOPMENT 1157

Self-efficacy

Emotional awareness Cultivated Emotional Skills

Empathy & compassion

Honoring the process

Perspective-taking
Increased Reflective Skills & Perspective-Taking
Reflective capacity

Maintaining openness & curiosity

Deeper connections w/colleagues

Experienced and Created Supportive
Experienced & used relationships Relationships
Being held in supportive relationships

Cope with stress

Regulate own emotions

Improved Ability to Manage Stress and Job
Improve job satisfaction Challenges

Decrease burnout

Figure 1. Categories and themes.

Table 1. Unique respondents who reported on emotional

skills.
Emotional Skills n %
Self-efficacy 39 61.9
Emotional Awareness 38 60.3
Empathy and Compassion 16 25.4
Total (N = 83) 63 75.9
N = Total number of unique respondents from across all four
questions

Table 2. Unique respondents who reported on reflective skills.

Reflective Skills n %
Honoring the Process 33 53.2
Perspective-taking 27 43.6
Developing Reflective Capacity 24 38.7
Maintaining a Sense of Openness and Curiosity 12 19.4
Total (N = 83) 62 74.7
N = Total number of unique respondents from across all four questions

Reflective supervisors also described the impact of RS/C as powerful and pervasive, positively
affecting not only professional practice but also personal relationships and life in general. Four
themes of how reflective supervisors perceived the impact of RS/C in relation to well-being emerged
from the open-ended responses: 1) Cultivated skills of emotional awareness, empathy and
1158 A. SUSMAN-STILLMAN ET AL.

Table 3. Unique respondents who reported on supportive relationships.

Supportive Relationships n %
Deeper connections with colleagues 14 43.8
Experience and use the power of relationships for personal and professional growth 12 37.5
Being held in supportive relationships 8 25
Total (N = 83) 32 38.6
N = Total number of unique respondents from across all four questions

Table 4. Unique respondents who reported on the ability to

cope with stress.
Ability to Cope with Stress n %
Alleviate Stress 18 43.9
Regulate Own Emotions 12 29.3
Decrease Burnout 11 26.8
Improved Job Satisfaction 10 24.4
Total (N = 83) 41 49.4
N = Total number of unique respondents from across all four
questions

compassion, and self-efficacy; 2) Increased reflective capacity and perspective-taking skills; 3) Built,
experienced and used supportive relationships; and 4) Strengthened the ability to cope with stress,
maintain job satisfaction, and decrease burnout. Below we elaborate upon these themes, with sub-
themes as appropriate, and provide illustrative quotes.

Reflective Supervisors Perceived RS/C as Helping to Cultivate Emotional Skills (Emotional

Awareness, Empathy and Compassion, and Self-Efficacy)
Improvements in self-awareness and self-efficacy were expressed most frequently by respondents
(Table 1).

Self-Efficacy. One emotional well-being skill discussed by professionals from their RS/C practice was
growth in their sense of competence. Early childhood professionals described the ability to “sort out
complex situations” and “make good decisions” when participating in RS/C. The experience of RS/C
was reported to reduce the pressure professionals put on themselves to be the “all-knowing” expert,
allowing these professionals to engage in collaborative work with children and families while main­
taining a sense of self-efficacy even when their efforts did not “fix” things. Early childhood profes­
sionals found RS/C practices to be “professionally enhancing” for their careers.
Providing RS/C allows me to feel a deep sense of genuine care for my supervisees, while also holding a deep care
and foundation of the clients we serve. I feel grounded and balanced when I need to address an issue with
a supervisee; I can do it from a place of care and shared discovery vs. administrative discipline.

Emotional Awareness. Respondents described various ways in which their participation in reflective
supervision supported growth in their emotional awareness. They reported becoming more astute in
identifying and discussing their own emotional reactions and responses and how greater emotional
awareness allowed them to “gain more insight into professional and personal motivations and rationale
for actions and choices made.” Along with greater comfort in discussing and processing their emotional
reactions and responses, they felt more “in-tune” with themselves. They were also more likely to
acknowledge the connection between their emotional responses and how those affect their interactions
with families and responses to families’ situations.
[I] Notice my own feelings in every moment and how they are impacting my attention, urges and responses.
 EARLY EDUCATION & DEVELOPMENT 1159

They also recognized the challenges of emotional awareness, and the importance of using difficult
emotions as a window into important emotional growth. As one respondent reported, one of the most
helpful things in learning/maintaining RS/C skills was to “lean into strong emotions, confusing
interactions, challenging situations, etc . . . as opportunities for reflection rather than something to
avoid, resist, blame others, or complain about.”

Empathy and Compassion. Respondents reported that their sense of empathy and compassion for
others and for themselves increased as a result of participating in RS/C. Some also linked it to their
practices, such that their own increased empathy and compassion enabled them to be more humble
and compassionate with their families/clients and with themselves, observing “self-talk being more
open and less critical” and realizing it was ok to “cut myself some slack”.
It has helped me to learn how to use myself and awareness of what I am thinking and/or feeling to be more
accepting of clients and colleagues and quite frankly, myself.

Reflective Supervisors Reported that RS/C Supported the Development of Reflective Skills that
Promote Professionals’ Well-Being
The development of reflective skills underscores the changes, or shifts, these early childhood profes­
sionals were making in their approaches to thinking about the children and families with whom they
work. Professionals recognized that those shifts enabled them to engage in more effective ways of
thinking and acting. Four themes of reflective practices emerged from the open-ended responses:
honoring the process; maintaining a sense of curiosity; developing reflective capacity; and perspective-
taking (Table 2).

Honoring the Process. Part of the fabric of RS/C practice is the process of exploration of an issue from
multiple angles. For many, this is a shift in supervisory experiences, and introduces a new mind-set for
working through the emotional aspect of working closely with vulnerable families. Respondents
reported being “more thoughtful, less quick to judge, willing to slow down,” and “less defensive,
becoming open and receptive” to a reflective process that entails not rushing to solutions, and
promotes ongoing reflection.
I love supervising. When training others, I often say, “Taking the time, makes time . . . time slows down when we
pay attention to expanding our shared awareness and understanding about the person’s cases.”

Perspective-Taking. The ability to understand a situation from other perspectives contributes toward
more flexible thinking and understanding. Respondents see the value in taking the perspectives of
others; they find that they are less likely to be “stuck” in one way of thinking, more likely to “discover”
other perspectives, and better able to understand the complexities of a particular situation. Thus, they
have an easier time constructively reframing and responding to a situation.
When working with educational coaches, I have noticed that they ‘notice’ others more.

It opens up creativity for me–just having someone try to understand my perspective makes me want to turn and
look to the other perspectives in the story. It really works.

Developing Reflective Capacity. Reflective supervisors report observing in themselves and in their
supervisees “a deepening of reflective functioning and capacity.” Reflective capacity is multifaceted
and includes the ability to consider the mental states, thoughts and emotions of self and others; the
appreciation that mental states are connected to behaviors; the recognition that people can have
mental states different from their own, and that even when sharing a mental state, the resulting
behaviors may vary from individual to individual (Tomlin & Viehweg, 2016, p. 20). Professionals
1160 A. SUSMAN-STILLMAN ET AL.

found that when they have deeper understanding of others and their experiences, they are better able
to regulate their own emotions and build meaningful relationships.
For instance, I see a better capacity to be alert to enactments and to bring confusing clinical situations to be
examined (vs. numbing, avoiding or demonstrating defensive overconfidence).

I can now, most of the time, reflect ‘in action’ rather than always after a home visit. It’s almost second nature now
to not be so freaked out because I don’t know what to ‘do’. It has helped me to evaluate the reflective capacity of
parents I work with.

Maintaining a Sense of Openness and Curiosity. RS/C was reported to provide an outlet for practi­
tioners to discuss ideas and feelings that are often thought to be “off-limits,” “unprofessional” or
inappropriate ways to think or feel about families. Yet, these ideas and feelings, if not explored, can
result in limiting beliefs, relationships and behavior. Respondents credit participation in RS/C as
a reason for why supervisees became less inhibited in voicing negative or challenging emotions and
more likely to maintain a sense of curiosity and wonder about the family and their circumstances.
They [my supervisees] try to ‘fix’ the problem a lot less now and they allow their curiosity to flow through their
intentional conversations with teachers and children.

Yes, helping providers to look beyond the 'what' of a parent or child’s actions to see the 'why.'

Reflective Supervisors Discussed that RS/C Helped Them and Supervisees Experience the
Transformative Power of Relationships
Reflective supervisors describe the positive power of relationships and the ongoing personal and
professional benefits they and their supervisees experienced as a result because they were able to
build, experience and use supportive relationships (Table 3). Respondents voiced the deeper con­
nection they experience with their colleagues and the feeling of being held in these relationships and
being better able to support each other in the work. They noted that they experience and use the
power of relationships for personal and professional growth. Respondents valued their experiences
with RS/C and frequently voiced the desire to provide for others in RS/C what was provided for
them.

Deeper Connections with Colleagues. Respondents reported that RS/C supervisors and supervisees
developed meaningful relationships and found the increased connectedness with like-minded collea­
gues and sense of community beneficial.
The participants in group RS become bonded with each other and the power of the relationships they form
continues long after the training ends.

Experienced and Used the Power of Relationships for Personal and Professional Growth. RS/C
supervisors offered examples of how their RS/C relationships served as the medium in which they
process challenges and enhance their personal and professional capacities. They reported feeling safe
and supported in their agencies, felt supported in their growth and development, and had greater
comfort sharing more personal experiences. Being in trusting RS/C relationships fostered deeper work.
Other people can help you see the big picture, when you are stuck in the weeds; in group we look at what is hard
for us, and wonder ‘why’ this particular thing, or client is difficult for us.

I have seen professionals grow internally and within the external relationships, truly see their own value in the
relationships they have with others and how powerful those relationships are in the healing, growing and
changing capacities of ourselves and those we work with.
 EARLY EDUCATION & DEVELOPMENT 1161

Being Held in Supportive Relationships. They also describe how participating in supportive RS/C
relationships allowed them to “know each other on a much deeper level” and “have more ability to
support each other every day.”
My long-term group is composed of women who did not have easy entrees into life. Our group is a safe place for
them and will continue to be “from the cradle to the grave.”

RS/C Providers Described Improved Ability to Manage Job and Personal Challenges
Practitioners provided examples of how RS/C improved their ability to cope with stress, regulate their
emotions, improve job satisfaction, and decrease burnout (Table 4).

Alleviate Stress. RS/C was reported to help providers recognize their stress and their reactions to it.
With an environment to release stress, they “notice reduced stress in their work”.
Definitely. Being heard and having someone try to understand helps me calm down, think more clearly, ease my
fears and untangles my confusion.

Yes, specifically, without RS/C, I tend to become depleted and lose patience and empathy for my students as well
as my supervisees.

Regulate Own Emotions. Professionals discussed often experiencing strong emotional reactions when
working with vulnerable young children and families and as a result, getting swept up in the families’
challenges and feeling emotionally out of control. RS/C provided a context for helping professionals
practice their own emotional regulation, “learn to better manage strong affect” and “become calmer
and more able to sustain reflective function and capacity while under stress.”
I’m well aware of my triggers with certain families. It [RS/C] helps with anxiety about being so overwhelmed by
the problems families face.

Decrease Burnout. Some providers specifically made the link between the relief RS/C provides,
a reduction in symptoms of burnout, including emotional, physical, and mental exhaustion, and “a
renewed sense of energy” for the work.
It’s SOOOO soothing . . . I am so much less tangled up about a case or a supervisee after an RS/C session! It
sustains my ability to work. I’m less avoidant of difficult things in my work. Manage the secondary trauma way
better.

It has helped me not feel so burdened by the weight of issues of my clients. It helps with burnout, knowing that
I have a time set aside to talk about my frustrations freely. And then, it helps make some sense out of them.

The shift from a burden to interest is often visibly apparent in the face and body language of the recipient, and
sometimes it is articulated with expressions of eagerness to get back to the work.

Improve Job Satisfaction. Reflective supervisors reported that the improved support for staff led to
their reporting “better job satisfaction and general well-being and a positive impact on clients.” Others
link RS/C and job satisfaction to “greater longevity in the workforce”.
I’ve had at least 3 providers who walked into my office saying immediately that they saw no need in this [RS/C]
because they were going to quit their jobs anyway. A year and a half later and no one has left their jobs.

Layered Analysis
Layered analysis explored whether characteristics of the reflective supervisors–whether or not
they held an infant mental health endorsement and years of experience – yielded unique insights
1162 A. SUSMAN-STILLMAN ET AL.

into the perceptions of the relation between RS/C and well-being. Respondents who held an
endorsement offered more comments related to well-being than respondents who were not
endorsed, particularly in relation to emotional awareness, honoring the process, openness and
curiosity, alleviating stress and regulating their own emotions. Respondents who were not
endorsed offered more comments about job satisfaction. When analyzing the categories and
themes from the perspective of years in the field (broken down by less than or more than 20, as
20 years was the mode in this sample), similar to the results for those who were endorsed,
respondents who had more years of experience offered more comments related to alleviating
stress, regulating their own emotions, emotional awareness, empathy and compassion, and
decreasing burnout, while those with fewer years of experience made more comments about
job satisfaction. Cultivating emotional skills through RS/C was particularly salient for respon­
dents who were endorsed or who had more years of experience.

Discussion
With the high rates of burnout and turnover, the early childhood field is at a particularly critical
juncture in relation to supporting and maintaining the early childhood workforce. Attention to the
psychological well-being of the early childhood workforce is essential; workforce supports are critical
to help early childhood professionals develop and maintain a sense of well-being in the face of
challenging work and to provide quality services to children and families. At this time, there is
evolving theory and accruing evidence to guide the field toward the development of effective work­
force supports and best practices to promote early childhood workforce well-being. This study showed
that RS/C providers perceive RS/C to be a powerful professional development practice. In response to
open-ended questions asking about why they became a reflective supervisor, what helped them learn
and maintain their RS/C skills, and what effects they have experienced and witnessed in others, they
generated answers around themes of key aspects of early childhood professionals’ well-being –
emotional resilience, reflective functioning, authentic, trusting relationships, and coping with stress.
These themes remained consistent across different characteristics of RS/C providers, although there
were some categories of the RS/C experience that resonated more strongly for certain groups based on
endorsement and experience. Overall, however, the results of this study indicate that RS/C providers
perceive RS/C to be a promising strategy for promoting key aspects of psychological well-being in the
diverse set of disciplines that comprise the early childhood workforce. This study adds to the literature
by describing and providing qualitative data regarding the social and emotional well-being skills that
the early childhood workforce may acquire as a result of participating in RS/C.
It is important to note that RS/C represents a unique kind of professional experience for early
childhood professionals. Much of the professional learning for early childhood professionals tends to
focus on caregiving, parenting or teaching practices that promote children’s general health, learning
and social-emotional development, supporting special populations of children (e.g., children with
special needs, or who are learning English), or enhancing parent knowledge or skill. RS/C, with its
focus on building and supporting a reflective mind-set, is an important reminder that quality in ECE
services depends not only on the interventions that are delivered, but on the well-being of the
workforce as well–how the circumstances and challenges around the work and the relationships
with children and families are perceived, processed, and addressed by the professionals themselves.
Work with children and families experiencing challenges and stress requires emotional intelligence,
which has been defined as “being able to motivate oneself and persist in the face of frustrations: to
control impulse and delay gratification; to regulate one’s moods and keep distress from swamping the
ability to think; to empathize and to hope” (Goleman, 1996, p. 34). One of the unique aspects of RS/C,
compared to other kinds of professional development, is its focus on processing the emotional
experience of the professional working directly with children and families. The reflective practitioners
in this study said that because they received RS/C, they were better able to empathize and feel
compassion toward the children/families with whom they worked.
 EARLY EDUCATION & DEVELOPMENT 1163

Reflective practitioners also described experiences of RS/C that promoted their emotional resi­
lience, which includes emotional awareness, empathy and self-efficacy. These skills are critical, as they
enable early childhood professionals to process and carry the emotional load that accompanies their
work and maintain a sense of balance and competence. Emotional awareness, self-efficacy, empathy
and compassion have been linked to psychological health, job satisfaction, and resilience to job stress
(Carmeli & Josman, 2006; Grant & Kinman, 2012; Salovey et al., 2002). Furthermore, self-efficacy is
important for job outcomes, as early childhood teachers with a higher sense of self-efficacy provide
higher levels of emotional support in the classroom (Jennings, 2015) and are more likely to demon­
strate higher professional commitment to their teaching (Grant et al., 2019).
The survey responses from the reflective supervisors in this study suggest that RS/C helped them
cultivate greater reflective capacity. Reflection is a tool that enhances the ability to recognize mental states
(e.g., the perspectives, emotions, and motivations of one’s self and of others), and to organize and make
sense of complex situations (Tomlin et al., 2009). It is not necessarily an instinctual thought process, but
can be cultivated and supported through RS/C (Harrison, 2016; Virmani & Ontai, 2010; Watson et al.,
2014), which provides a formal structure for regularly taking time to step back from activating inter­
personal experiences and consider the links between emotions and behaviors. Reflective skills enable
positive coping strategies, such as cognitive restructuring, a type of coping especially useful for con­
fronting stressors not under one’s control, which is a situation often faced by early childhood profes­
sionals working with families who must make their own decisions (Collins, 2008). Reflection has been
called a “self-protective mechanism” (Grant & Kinman, 2012), as those who are better able to reflect on
their own and others’ thoughts, feelings, and beliefs are happier and more resilient to job stress and
emotional challenges (Graham & Shier, 2010; Grant & Kinman, 2012; Heffron et al., 2016; Leroux &
Théorêt, 2014). Reflective skills may also be interwoven with other aspects of well-being, as higher levels
of perspective-taking has been associated with higher levels of mindfulness and self-efficacy in preschool
teachers (Jennings, 2015).
Reflective supervisors also emphasized that they built strong and supportive relationships with
colleagues. They noted these relationships were important for both personal and professional growth
as they enhanced their ability to understand other colleagues and children/families as well as
themselves and their own behaviors and feelings toward themselves and others. A defining feature
of infant mental health-based reflective supervision is that it does not simply encourage reflection, but
provides a reflective relationship experience in which all learning takes place (Frosch et al., 2018).
Reflective supervision is hypothesized to effect change by the parallel process of providing
a relationship in which the professional feels understood and regulated, which in turn enables the
professional to support caregivers in understanding and regulating the child (Many et al., 2016). High-
quality supervision is key for impacting factors such as emotional exhaustion, job stress and low job
satisfaction (Harden et al., 2010). For example, professionals perceive workplace support from super­
visors and colleagues as crucial for job satisfaction (Heffron & Murch, 2010), and social support is
sought for both practical advice and emotional coping (Collins, 2008). Conversely, lack of emotional
support has been specifically tied to turnover (Mor Barak et al., 2009).
It is well-established that work-related stress experienced by practitioners and teachers affects their
well-being (Harrison, 2016; Roberts et al., 2019) and their ability to promote healthy social-emotional
development (Jennings, 2015; Watson et al., 2016). Reflective supervisors in this study offered multiple
examples of how RS/C helped them learn to cope with stress, which included not only alleviating
stressful thoughts and feelings, but also learning how multiple aspects of RS/C (e.g., the reflective
process, supportive relationships) resulted in professionals’ growing ability to regulate their emotional
responses. They also reported that feeling supported in their work allowed them to retain a more
positive perception of their job, feel less burdened, and less likely to burnout.
Decreases in job stress or burnout have been the most consistently documented effect of RS/C, with
participants reporting they value reflective supervision because it is an opportunity to release stress
(Frosch et al., 2018; Harrison, 2016; Virmani & Ontai, 2010; Watson et al., 2016; Watson & Gatti,
2012). RS/C has previously been found to reduce providers’ stress and their reactions to it (Frosch
1164 A. SUSMAN-STILLMAN ET AL.

et al., 2019; Heffron et al., 2016; Heller & Gilkerson, 2009), and reducing stress is directly linked to
lower rates of burnout (Flook et al., 2013).

Implications for Practice and Policy

Implementing RS/C takes significant resources to train or hire a reflective supervisor and then allow staff to
consistently take time to participate. Therefore, it is crucial that clear evidence is established about the
benefits of RS/C in order to inform those who make decisions around such investments. The current study
provides new evidence that RS/C providers strongly perceive RS/C to benefit multiple facets of workforce
well-being, suggesting that RS/C may be a useful investment to support the social and emotional well-being
of early childhood professionals. Furthermore, the growing interest in RS/C and evidence to support its use
may help shift the traditional mind-set about productive professional development in early care and
education. Traditionally, professional development has focused solely on skill-building topics such as
curriculum content, environment set-up, service delivery models, and teaching strategies and occurs for
a pre-determined number of hours. In contrast, RS/C offers ongoing support through collaborative
relationships that build reflective capacity, perspective-taking, emotional resilience and coping skills. This
study contributes to a beginning understanding of the impact of this consistent, relationship-based
professional development on the well-being and work of early childhood professionals.
Specifically, the results here add to the growing literature on RS/C indicating that it may be a useful
tool to positively impact early childhood professionals’ job-related stress and coping, reflective
capacity, and relationships with colleagues (e.g., Frosch et al., 2018, 2019; Harrison, 2016; Shea
et al., 2016; Virmani & Ontai, 2010). The emotional self-knowledge, relational skills, and experiences
described by the reflective supervisors offer support to the developing theoretical models of the
Institute of Medicine (IOM & NRC, 2015) and Gallagher et al. (2019), which both link professional
knowledge and competencies to professionals’ well-being. Engaging in RS/C has the potential to
impact multiple skills and aspects of well-being.
Continued attention to RS/C as a promising practice to promote workforce well-being is warranted. As
we reviewed all the responses, we were struck by the preponderance of spontaneous and positive statements
made regarding professional well-being, despite the fact that the survey questions were quite general and did
not specifically prompt respondents to answer in relation to their well-being or the well-being of their
supervisees. Through the inductive process of identifying themes, it was clear that the professionals
frequently brought up well-being themes as something they found most salient about their experiences
with RS/C.
Furthermore, this study captured the voices of reflective supervisors, who have unique perspectives on
the process of RS/C as virtually all had both provided and received reflective supervision. The vast majority
of research on RS/C up to this point has only focused on the supervisees, but the supervisors may
understand the process more deeply because of their responsibility guiding the reflective process.
Additionally, many studies have focused on one professional field in one location or setting, but our
sample featured a national cross-section of early childhood professionals from diverse early childhood
fields. This suggests that our findings may be more generalizable to the array of potential RS/C participants,
which is important because RS/C is not limited to specific professions or service delivery models.

Limitations
The study had a number of limitations. The current study was not designed to assess causal relation­
ships between RS/C and workforce well-being. Furthermore, the sample was not random nor
representative – in asking for names from state associations and other RS/C providers, it may have
been skewed toward those who have been in practice longer, had established relationships with their
state association or are in leadership roles, or provide to a larger number of supervisees. Therefore,
these reflective supervisors may have been more positively inclined toward RS/C since they have
chosen to devote a significant portion of their career to its practice. Their positive perceptions of RS/C
 EARLY EDUCATION & DEVELOPMENT 1165

may have resulted in an overstatement of the relation between RS/C and workforce well-being. Future
research is necessary to assess the true connection between RS/C and workforce well-being and ensure
representative samples of reflective supervisors.
In addition, we did not have data regarding which early childhood professionals were served by the
reflective supervisors. It is possible that the reflective supervisors’ views about well-being issues may differ
depending not only upon their own field of work, but also upon the groups of early childhood professionals
for whom they provide RS/C. We also did not collect data from providers on frequency of receiving RS/C or
on how many carried direct caseloads. It will be important in future research to explore how these factors
may affect perceptions of RS/C and its relation to workforce well-being.
Additionally, professionals who receive but do not provide RS/C were not included in this sample.
Thus, further research will be needed to directly assess relations between RS/C and workforce well-
being and to see if these themes are generalizable to a broader population of those who receive RS/C.
We noted with interest the very low frequency of responses that described negative or null effects. Of
the 84 responses to the 4 survey questions coded and analyzed for this paper, we only read 2 negative
responses. It is possible that there was selection bias in the reflective supervisors such that those who
felt most positively about RS/C chose to respond, or those who responded felt the social desirability to
respond positively even though the questions were worded as neutrally as possible. Asking additional
questions about whether participating in RS/C was challenging for them emotionally or created
barriers in their practice may have also yielded negative perceptions or experiences with RS/C and
should be included in future research. That notwithstanding, it was clear from the passionate
responses that those who participate in RS/C almost universally found great value in the practice.

Future Directions
While this study was an important first step in this line of research, all findings in the study are self-
report and have the potential to be affected by expectation and desirability biases. The purpose of this
study was to elucidate possible effects and mechanisms of RS/C to provide a foundation for future
research. In the current study, we highlighted workforce well-being as a crucial outcome that RS/C has
the potential to impact. While it is also important to determine effects that RS/C has on professionals’
job skills and effectiveness, and therefore on child or family outcomes, we want to emphasize that
professionals’ well-being is a worthwhile outcome in and of itself.
This study provides self-report data to establish hypotheses about the relations between the
experience of RS/C and early childhood professionals’ social and emotional well-being. The findings
encourage future research that directly assesses the linkages between RS/C and early childhood
workforce well-being and clarifies how the skills of RS/C promote specific aspects of professionals’
social and emotional well-being. For example, the relations between emotional awareness and levels of
stress, or between reflective capacity and emotion regulation, could be explored, as well as the
mechanisms by which RS/C promotes well-being. Future research should investigate parameters
such as frequency of sessions, length of relationships between supervisors and supervisees, group vs.
individual supervision, in person vs. online sessions, all of which may have important implications for
the effectiveness of RS/C as a strategy to promote aspects of well-being. Although it can be challenging
in community-based work to conduct rigorously designed studies using control groups (Low et al.,
2018), future research that incorporates designs that lend themselves toward clarifying causality is
necessary. There is still much to be learned about how to capture the power of RS/C to support the
well-being of early childhood professionals.

Acknowledgments
We appreciate the participation of reflective supervisors across the country who responded to the survey and shared
their experiences.
1166 A. SUSMAN-STILLMAN ET AL.

Disclosure Statement
No potential conflict of interest was reported by the author(s).

Funding
Funding for this study was generously provided by the Lynne and Andrew Redleaf Foundation.

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