Download as pdf or txt
Download as pdf or txt
You are on page 1of 13

See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/270605642

Clinical supervision in a competency-based era

Article in South African Journal of Psychology · February 2014


DOI: 10.1177/0081246313516260

CITATIONS READS

43 6,619

1 author:

Carol A Falender
University of California, Los Angeles
71 PUBLICATIONS 2,224 CITATIONS

SEE PROFILE

All content following this page was uploaded by Carol A Falender on 09 April 2016.

The user has requested enhancement of the downloaded file.


516260
research-article2014
SAP0010.1177/0081246313516260South African Journal of PsychologyFalender

South African Journal of Psychology 2014, Vol. 44(1) 6­–17 © The Author(s) 2014
Reprints and permissions: sagepub.co.uk/journalsPermissions.nav
DOI: 10.1177/0081246313516260 sap.sagepub.com

State of the Science


Clinical supervision in a
competency-based era

Carol A Falender

Abstract
Since clinical supervision has become recognized as a distinct professional practice, competency-
based supervision has gained considerable traction internationally. Competency-based supervision
enhances accountability and is compatible with evidence-based approaches. Competency-based
supervision is defined by supervisor and supervisee collaboratively and explicitly identifying the
knowledge, skills and attitudes comprising each clinical competency, determining specific learning
strategies, and monitoring and evaluating the development of those. Recommendations for
supervision practice are described based on the growing evidence base for practice and responsive
to emerging ethical and legal issues.

Keywords
Clinical supervision, competence, competency-based, supervision

Only recently has clinical supervision been recognized as a distinct professional competency that
requires specific training and competence apart from general clinical competencies (Falender &
Shafranske, 2004; Fouad et al., 2009; Kaslow et al., 2004). Since then, focus on all aspects of clini-
cal supervision has dramatically increased. Mirroring regulatory and education and training devel-
opments in the international arena (e.g., British Psychological Society, 2003, 2006; New Zealand
Psychologists Board, 2010; Psychology Board of Australia, 2013), the emphasis in North America
has focused on competency-based clinical supervision (Falender & Shafranske, 2004; Hunsley &
Barker, 2011). Research, scholarship, and task forces have been initiated. Guidelines and best
practices are emerging. Major among these in the United States and Canada are counseling psy-
chology (Borders et al., 2011), Board of Educational Affairs, American Psychological Association
(BEA, APA, 2013), Association of State and Provincial Psychology Boards (ASPPB, in press), and
the Canadian Psychological Association (CPA) Ethical Guidelines for Supervision in Psychology

Graduate School of Education and Psychology, Pepperdine University, USA; Department of Psychology, University of
California, USA

Corresponding author:
Carol A Falender, 1158, 26th Street, #189, Santa Monica, CA 90403, USA.
Email: cfalender@gmail.com

Downloaded from sap.sagepub.com by guest on January 18, 2016


Falender 7

(CPA, 2009). Agreement exists internationally on the highest duty of the supervisor: protecting the
client and society, and serving as a gatekeeper for the profession ensuring that individuals who
enter the profession are suitable to practice. The supervisor is at the same time responsible for
promoting the competencies of the supervisee to ensure client protection and gatekeeping func-
tions. Although there is significant overlap between regulatory and education and training guide-
lines, regulatory guidelines are directed to ensuring protection of the client/patient and society.
Clinical supervision is defined as

a distinct professional activity in which education and training aimed at developing science-informed
practice are facilitated through a collaborative interpersonal process. It involves observation, evaluation,
feedback, facilitation of supervisee self-assessment, and acquisition of knowledge and skills by instruction,
modeling, and mutual problem-solving. Building on the recognition of the strengths and talents of the
supervisee, supervision encourages self-efficacy. Supervision ensures that (it) is conducted in a competent
manner in which ethical standards, legal prescriptions, and professional practices are used to promote and
protect the welfare of the client, the profession, and society at large. (Falender & Shafranske, 2004, p. 3)

In addition, the superordinate values include integrity-in-relationship, ethical, values-based prac-


tice; appreciation of diversity and multiple cultural identities among client, supervisee/therapist,
and supervisor; and science-informed, evidence-based practice in the spirit of the emerging empiri-
cal basis for psychological practice (Falender & Shafranske, 2004).

Competency-based supervision defined


More specifically, competency-based supervision is defined as

an approach that explicitly identifies the knowledge, skills and values that are assembled to form a clinical
competency and develop learning strategies and evaluation procedures to meet criterion-referenced
competence standards in keeping with evidence-based practices and the requirements of the local clinical
setting. (Falender & Shafranske, 2007, p. 233)

Considering the full range of competence, knowledge, skills, and attitudes/values is founda-
tional to competency-based supervision. Psychology has made great strides in criterion-
referenced competence standards including Benchmarks (Fouad et al., 2009) and the Canadian
core competencies (CPA, 2004, Mutual Recognition Agreement). However, determining
whether the core competencies are being achieved in training is still a question. Attitudinal fac-
tors are generally recognized as the most neglected in training and practice. These include
demonstrating adherence to all of the principles of ethical codes—integrity, beneficence and
nonmaleficence, fidelity and responsibility, justice, and respect for people’s (and persons)
rights and dignity (APA, 2010; CPA, 2000; Professional Board for Psychology, Health
Professions Council of South Africa, 2010). The CPA’s (2009) Ethical Guidelines for Supervision
in Psychology provide an exemplary guide to ethical practice and a frame for consideration of
attitudes of supervisors and supervisees.
Some of the major tensions in definition beyond acceptance of supervision as a distinct profes-
sional model include appreciation of the impact of the power differential, an implicit part of clini-
cal supervision as the supervisor’s primary responsibility is protection of the client, and public, and
is also responsible for gatekeeping or ensuring that unsuitable candidates do not enter the profes-
sion. And then, the supervisor is responsible for enhancing the competencies of the supervisee, a
task that is inextricably interwoven with the other responsibilities. In competency-based supervi-
sion, the supervision process is constructed to be collaborative within the power structure. However,

Downloaded from sap.sagepub.com by guest on January 18, 2016


8 South African Journal of Psychology 44(1)

there is disagreement in the field whether there can truly be a collaborative process within what is
viewed as a strictly hierarchical relationship. Prototypes for collaborative process come from femi-
nist supervision models (Porter, 2014; Porter & Vasquez, 1997) as well as from psychodynamic
supervision models (Frawley-O’Dea & Sarnat, 2001) and are laid out in competency-based clinical
supervision (Falender & Shafranske, 2004, 2008).
Other tensions include (1) provision of supervisor training and ensuring that supervisors achieve
a level of competence prior to commencing supervision—from the finding that clinical compe-
tence does not translate to supervision competence; (2) assessment of supervisee competence as a
dynamic and critical assessment piece (Kaslow et al., 2007)—recognition is widespread in the
medical community (Farnan et al., 2012) but not in the United States or Canada; and (3) necessity
of an opportunity to observe live or video of the clinical work of the supervisee (Falender &
Shafranske, 2012b; Milne & Reiser, 2012) to ensure competent practice and to assess progress to
provide accurate feedback.

Supervisor competence
As attention has increased, the scholarship has been directed to the realization that although an
assumption is that supervisors are competent, there are increasing data that that is not a correct
assumption (Ellis et al., in press). In fact, supervisees report a wide range of practices ranging from
excellent to adequate to lousy to harmful (Magnuson, Wilcoxon, & Norem, 2000)—all of which
have dramatic impact on the quality of clinical supervision. The supervisory alliance is the founda-
tion of clinical supervision, and if supervisors do not perform with competence, integrity, and ethi-
cal adherence, supervisees experience diminished trust and make fewer disclosures—a critical
issue as in many instances the entire content of clinical supervision is based solely on what the
supervisee discloses about client sessions!
An excerpt from the BEA Guidelines (draft, 2013, p. 17) provides a framework for understand-
ing supervisor competence: “Supervisors possess competencies reflecting that the practice of
supervision is a distinct professional practice with knowledge, skills, and attitudes that require
specific training to attain” (Bernard & Goodyear, 2014; Falender, Burnes, & Ellis, 2013; Falender,
Ellis, & Burnes, 2013; Reiser & Milne, 2012). The supervisor serves as role model for the super-
visee, fulfills the highest duty of protecting the public, and is a gatekeeper for the profession ensur-
ing that supervisees meet competence standards. The power differential is a central factor in the
supervisory relationship, and the supervisor bears responsibility for managing, collaborating, and
discussing power within the relationship (Porter & Vasquez, 1997).

Training in supervision
Since supervision is a distinct professional practice, it requires specific training, much like psy-
chologists receive for clinical assessment, intervention, diagnosis, and so on. However, there is still
a significant lag in recognition of this internationally such that training in clinical supervision is not
widely offered in graduate training (e.g., Crook-Lyon, Presnell, Silva, Suyama, & Stickney, 2011;
Hadjistavropoulos, Kelher, & Hadjistavropoulos, 2010), and when it is, may be piecemeal rather
than in a competency-based frame with requisite knowledge, skills, and attitudes and assessment
of achieving a level of competence. A proposed sequence of training includes competence as a
supervisee incorporating specific tenets of supervision structure, expectations, theory, research,
skills, process (Falender & Shafranske, 2012b), and didactic training to bridge the transition from
supervisee to supervisor in clinical supervision. The perspective of “supervisor,” a significant cog-
nitive shift from supervisee, requires acquisition of knowledge, skills, and attitudes to ensure

Downloaded from sap.sagepub.com by guest on January 18, 2016


Falender 9

effective supervision practice. Next would be peer supervision or experience supervising a less
advanced cohort with accompanying supervision to reinforce the competencies in the course—
supervision of supervision with video or live supervision, and finally, a point of assessment of
supervision competence (Falender, Ellis, et al., 2013).

Metacompetence and self-assessment


An essential element of supervision is metacompetence, or knowing what we do not know. The
concept is essential for supervision both for supervisors to accurately assess their own competence
and to know what is transpiring in the clinical work of supervisees. A major supervisory task is
assisting supervisees in their growth of metacompetence. As supervisees only know what they
know, they do not know what they do not know, and thus if supervision is based only on supervisee
self-report of what occurred in the clinical session, it is limited by multiple factors including mem-
ory recall and the supervisee’s own competence. Use of some video or live supervision is essential
so the supervisor can directly observe, identify skills and behavior in development, and strategize
regarding the client’s progress and treatment. The concept of self-assessment is increasingly an
important one in supervision as very few clinicians have received formal training, so it should be
no surprise that self-assessment prowess is generally lacking (Brosan, Reynolds, & Moore, 2008;
Dunning, Heath, & Suls, 2004; Walfish, McAlister, O’Donnell, & Lambert, 2012), with clinicians
generally over (or under) predicting their own competence.

Distinguishing clinical supervision


It is essential to distinguish clinical supervision from consultation and psychotherapy. Supervision
is distinguished from consultation by the power, responsibility, and liability the supervisor holds
for the cases the supervisee carries contrasted to a consultation relationship, often between peers in
which the consultant has no necessity for obtaining complete information about the case and the
consultee has no obligation to enact the consultation suggestions. In contrast, the supervisee must
carry out the directives of the supervisor as the supervisee is functioning under his or her license.
Supervision is distinguished from psychotherapy—a critical difference as harm is inflicted on
supervisees when supervisors cross this boundary. In supervision, the focus remains upon the
client—discussion of the supervisee’s emotional reactivity or countertransference to the client
(or supervisor) is conducted in the context of client care without crossing the line to transform the
supervisee into a client. Countertransference or reactivity management is an important part of
supervision but is conducted with care to ensure that focus remains upon its relationship to client
services (Falender & Shafranske, 2004, 2008, 2012a).

Effective clinical supervision


Although there is growing consensus that supervision competencies are generally uniform across
disciplines (Kavanagh et al., 2008), determination of components of effective supervision is still in
progress. However, there is agreement that the following are aspects of effective clinical supervi-
sion: formation of a strong supervisory alliance; development of a supervision contract; supporting
the supervisee in self-assessment of competencies and construction of goals and tasks for supervi-
sion; ongoing monitoring of supervisee progress, development, and both constructive and positive
feedback linked to goals and competencies; formative and summative evaluation with transpar-
ency so the supervisee knows the supervisors’ appraisal and there are no surprises; identification
and repair of strains and ruptures to the alliance; infusion of multicultural and diversity through

Downloaded from sap.sagepub.com by guest on January 18, 2016


10 South African Journal of Psychology 44(1)

consideration of the worldview of client, supervisee/therapist, and supervisor; managing reactivity


or countertransference; managing supervisees who do not meet performance criteria; and assessing
client and supervision outcomes, legal and ethical aspects of supervision, and self-care.
In addition, attention is devoted to defining supervisor competence, considering ways to enhance
appreciation, and an attitude of readiness to learn supervision competencies and defining a training
trajectory. What are some of the criteria for supervisor competence? In the BEA draft supervision
guidelines (BEA, APA, 2013), supervisors must be competent to treat and/or assess any client
whom a supervisee is seeing under their supervision. Supervisors must achieve and maintain com-
petence in supervision through formal training—competence includes evidence-based practice in
supervision modalities, theories, and general knowledge, skills, and attitudes in competency-based
supervision practice, competence in technology in supervision, coordination with other supervisors
and clarity in management of roles and responsibilities, and diversity competence across diverse
settings. This description of competence of the supervisor was derived from the document that
emerged from the Competencies Conference (Kaslow et al., 2004) and the specific paper address-
ing supervision competencies (Falender et al., 2004). An assumption is that supervisors possess
attitudes supportive of supervision and supervisees—engaging in respectful behavior, encouraging
and empowering supervisees, valuing the process, and generally committed to the process of
supervisees in their progression from supervisee to independent practitioner and colleague.
Supervisors model professionalism and ensure that the supervisee meets the requisite standards,
behaving in a way that befits their role as an emerging professional. Professionalism refers to
behavior and comportment that reflect values and attitudes of the professional psychologist (Fouad
et al., 2009) and is reflective of putting the needs and attitudes of the client at the forefront (Grus
& Kaslow, 2014).

Defining supervisee competencies


Defining strategies to assess competence is a core component of the shift to competency-based
clinical supervision. While such tools are in development, and many preliminary strategies have
been proposed (Hatcher et al., 2013; Kaslow et al., 2009), there is no agreement on a competence
frame—or mechanism that is empirically supported for assessment of competencies. A first step
would be agreement upon what competencies of supervisees are essential for entry to practice.
Competencies are proposed or in development in multiple countries (e.g., United States,
Benchmarks [Fouad et al., 2009; Hatcher et al., 2013]; Canada, Mutual Recognition Agreement
Competencies [CPA, 2004]; ASPPB Practice Analysis [ASPPB, 2010; Rodolfa et al., 2013];
Australian Psychology Accreditation Council, 2012 [draft]; and UK Competencies [Roth & Pilling,
2009]). Recently, an effort was initiated by the ASPPB, the Norwegian Psychological Association,
and the APA to develop international competencies for entry to practice or point of licensure for
psychologists (ASPPB, 2013).

Components of supervision process


The supervisory alliance or relationship is generally accepted as the foundation of clinical supervi-
sion. Research has established correlations between the alliance and supervisee satisfaction, mul-
ticulturally competent supervision, and supervisee disclosures (Inman & Ladany, 2008). Since
much of supervision is based purely on the supervisee’s disclosures regarding the clinical session,
as most supervisors do not observe their supervisees live or review video, supervisee disclosure is
a critical aspect of supervision. Generally, an alliance is established by supervisor and supervisee
mutually engaging in a discussion of the supervisee’s self-assessed competencies and areas in

Downloaded from sap.sagepub.com by guest on January 18, 2016


Falender 11

development, goals for supervision, and tasks to achieve the goals. The greater the clarification of
the alliance and the supervisory and setting expectations for the supervisee, the greater the super-
visee satisfaction. Supervisory alliance formation arises from work by Bordin (1983), who extrap-
olated from the therapeutic alliance. However, the extrapolation did not factor the power differential
between supervisor and supervisee into the equation. A therapeutic relationship is very different
from a supervisory one. To enhance supervisee alliance, we urge discussion of difference among
supervisor, supervisee, and clients in multiple identities (Falender, Shafranske, & Falicov, 2014)
and discuss power drawing from feminist (Porter & Vasquez, 1997) and psychodynamic supervi-
sion (Frawley-O’Dea & Sarnat, 2001) theory. We encourage the enhancement of a collaborative
process by clarity of expectations and the promise of ongoing transparency communicated through
anchored feedback based on competencies for the requisite level of practice.
Conflict, disagreement, and misunderstanding occur in clinical supervision and challenge the
supervisory alliance and ultimately the client relationship as well, considering the parallel process
or isomorphism (that dynamics or behaviors that occur in supervision which may be paralleled in
the client process or vice versa). It is a supervisor’s responsibility to notice or identify conflict and
disagreement, and to repair the supervisory strain that occurred. If such strains are not identified
and addressed, they can become a rupture. After the supervisor identifies (attempts to do so col-
laboratively) the strain—or rupture—a process occurs in which the supervisor acknowledges
responsibility and discusses (again hopefully collaboratively) the interaction, which ensued
between supervisor and supervisee and the contributions of both. The emotional response of both
supervisor and supervisee is addressed, and strategies for moving forward and restoring the alli-
ance between supervisor and supervisee—and always maintaining the priority of client protection
and welfare (Aspland, Lleweylen, Hardy, Barkham, & Stiles, 2008, applied in Falender &
Shafranske, 2012a).
Multicultural or diversity competence infuses every aspect of clinical supervision (Falender
et al., 2014). By multicultural competence, we are referring to integrating consideration and direc-
tion regarding the worldviews of supervisor, supervisee, and client(s). Worldviews relate to the
multiple diversity characteristics of each, including age, gender, gender identity, race, ethnicity,
culture, national origin, religion, sexual orientation, disability, language, body size, and socioeco-
nomic status—and the equation formed by supervisor, supervisee, and client(s) in terms of cultural
overlap and cultural differences. Such an approach provides an important frame for consideration
of the critical quality of the supervisor’s power and the importance of the different worldviews of
each. Research conducted in the United States identified that while most psychologists consider
themselves cultural competent, their responses on specific cultural practices do not support that
belief (Hansen et al., 2006). Furthermore, although supervisors believe they introduce discussion
and consideration of diversity factors in supervision, supervisees report that if the subject comes
up at all it is because they bring it up—and their initiation is not always well received or accepted
(Jernigan, Green, Helms, Perez-Gualdron, & Henze, 2010). Generational differences in training
and value attached to multiculturalism are reasons cited for supervisory practices that differ from
expectations of supervisees. Bias, awareness, and integration of historical trauma, oppression, and
privilege are essential components of supervision. The power of the supervisor is amplified by
privilege brought by position, education, status, and socioeconomic status, which increase the
potential for strain or rupture if not addressed.
A significant weakness in clinical supervision, closely tied to lack of supervisor training, is that
supervisees do not perceive supervisors as giving them effective feedback, and supervisors report
grave difficulty giving corrective feedback and regret in retrospect that such feedback was not
given (Hoffman, Hill, Holmes, & Freitas, 2005). The competencies movement heralds the ideal
vehicle for monitoring competence through use of consensually agreed upon competencies.

Downloaded from sap.sagepub.com by guest on January 18, 2016


12 South African Journal of Psychology 44(1)

Feedback should occur in every supervision meeting, highlighting areas of strength and those in
development. And translating transparency into action, the supervisor should let the supervisee
know when he or she (the supervisor) has concerns about the supervisee’s progress in the attain-
ment of competencies. Reasons supervisors do not give feedback include a belief that corrective
feedback would harm the supervisory relationship, while in fact supervisees welcome and value
feedback (properly delivered), fear of administrative or other reprisals or increased scrutiny, and
generally fear of conflict or uncertainty of the validity of the supervisor’s appraisal given the dearth
of evidence-supported assessment tools. Feedback should be respectful, behavioral, balanced with
positive, and given as close in time as possible to the time observed or when the behavior occurred.
Not providing ongoing corrective feedback eliminates the supervisee’s opportunity to learn,
develop, and improve and is an ethical infraction. Feedback is simply one part of the supervisory
responsibility for ongoing formative and then summative (final) evaluation. Evaluation, assess-
ment, and feedback are all interwoven competencies of the supervisor.
Supervisors are responsible for monitoring and providing evaluation to supervisees, ensuring
that clarity is achieved to inform the supervisee if he or she is not meeting performance criteria and
is being moved to a different status with remediation of identified competence areas. Such infor-
mation should not be a surprise, as the supervisee should have been receiving assessment, feed-
back, evaluation, and ongoing monitoring. This is another reason it is so important to give corrective
and evaluative feedback to supervisees when competence issues first arise. Supervisors may hesi-
tate, believing it is a “developmental” issue, or that the supervisee is not “ready” to receive such
feedback. Those are not good reasons to withhold evaluative information to the supervisee. In
addition to the process of ensuring supervisee awareness, before proceeding to remediation, the
supervisor should ensure that the competence problems are perceived by multiple supervisors, and
that preliminary developmental interventions mutually instituted by supervisor and supervisee and
carefully tracked were not effective. In studies of supervisee impressions of supervisors, supervi-
sees perceive lack of monitoring of their performance to be one of the most frequent ethical infrac-
tions supervisors commit (Ladany, Lehrman-Waterman, Molinaro, & Wolgast, 1999; Wall, 2009).
Once the performance issues are identified, a remediation plan is developed with specific targeted
behavioral goals. If possible, the training program where the supervisee is enrolled should be
involved from the onset to provide support and input. Timelines are established with particular
behavioral (measurable) target behaviors or goals and a time line developed with frequent check-
ins. Cultural factors need to be carefully considered in the consideration of performance to ensure
fairness and respectful process (Shen-Miller, Forrest, & Burt, 2012). Generally, the supervisee
should be aware of the supervisor’s concerns regarding supervisee performance, and great clarity
is essential to define the areas of competence concern. The supervisor communicates with the
supervisee first, and consults with the academic institution (if the supervisee is still a student), to
coordinate and plan intervention strategies collaboratively. Keys to the process include transpar-
ency, monitoring, consistency, and ongoing feedback, ensuring that the supervisee is aware of the
competence issues, progress, and lack of such toward stated behavioral goals. Competencies
frameworks are key components of performance plans, ensuring clarity and behavioral statements
of competence expectations for each level of training.
Multiple legal and ethical standards inform clinical supervision, and competence in these is
an essential component. Informed consent is the concept that binds the various elements of
supervision. The supervision contract, an informed consent document, lays out the expecta-
tions, roles, and parameters of the supervisory relationship. Formal elements include clarifica-
tion of the highest duties of the supervisor, the legal and ethical responsibilities of protection of
the public and gatekeeping for the profession, setting specific expectations, performance crite-
ria and consequences if those are not met, expectations that supervisee personal reactions to

Downloaded from sap.sagepub.com by guest on January 18, 2016


Falender 13

clients and personal exploration are normative parts of supervision, and the distinct limits of
confidentiality including that supervisors are responsible to disclose supervisee information to
graduate schools, training committees, site supervision teams, and licensing boards. Expectations
for supervisee self-assessment is spelled out. Self-assessment should be linked to a competen-
cies document such as Benchmarks (Fouad et al., 2009). Two-way feedback occurs from super-
visor to supervisee in every supervision session, and from supervisee to supervisor concerning
the perceived efficacy of the supervision processes. The expectations regarding preparation for
supervision sessions including completion of case record keeping, video review, formulations,
and questions to be discussed are clarified. Emergencies will be defined for the setting and
proper procedures for dealing with these outlined, including mechanisms for supervisor con-
tact. Specific topics that require immediate supervision (e.g., child abuse reporting, homicidal-
ity, suicidality) are laid out, including reference to the legal standards of the state regarding
duty to warn and protect. The contract also describes the expectation that supervisors will
introduce ethical decision-making models to approach the multiple ethical dilemmas that arise
in supervision and clinical process (Koocher & Keith-Spiegel, 2008). Normative multiple rela-
tionships between supervisors and supervisees and supervisees/therapists and clients may be
described with ethical decision-making frames for determining whether to engage in the multi-
ple relationship (Gottlieb, Robinson, & Younggren, 2007). Clarity about boundaries and expec-
tations for the setting are laid out. Due to the concern that much of the supervisee’s training in
ethics has been in risk avoidance, the contract lays out the expectation that ethical practice and
identification of ethical issues/dilemmas are significant competencies in supervision (Falender
& Shafranske, 2014). The issue of confidentiality is misunderstood with supervisees often
believing that personal disclosures they make to the supervisor will be held confidential. In
fact, there are limits of confidentiality guided by legal, ethical, including normative reporting
to universities, training teams, administrative supervisors, and licensing boards. Clarity in the
contract prevents misunderstandings.

Ethical and legal challenges to supervision through Internet use


With the enormous growth of Internet social networking and search engines, the terrain of clinical
supervision and the need for ethical and legal guidelines specific to these issues is essential. For
example, Facebook logged its 1.11 billionth active user in 2013, Twitter its 500 millionth. The vast
number of supervisees has a personal webpage and is actively participating in at least one social
network (DiLillo & Gale, 2011; Myers, Endres, Ruddy, & Zelikovsky, 2012). Because of the online
identity crisis, supervisors need to enhance recognition that social media exist in potentially public
spaces, not exclusively professional or personal ones. In fact, posting information on the Internet
is likened to putting it on a billboard. The distinction between private (personal) and public infor-
mation is substantially diminished. So the decision of whether to post information on social media
depends on whether it is an appropriate posting by a psychologist in a public space, accessed by
future clients, employers, and so on (DeCamp, Koenig, & Chisolm, 2013) through the lens of
professionalism.
Another major issue is use of search engines by supervisees and supervisors to obtain informa-
tion about clients or supervisees. Although most supervisees reported it was unethical and inap-
propriate to use search engines or social networks to find client information, the vast majority of
supervisees still reported they did access such information (DiLillo & Gale, 2011). Supervisees
reported they accessed the information planfully and usually with client consent. Supervisors bear
responsibility for ensuring planful, ethical process in these considerations. Increasingly, medical
schools and graduate schools—as well as employers—are utilizing search engines and accessing

Downloaded from sap.sagepub.com by guest on January 18, 2016


14 South African Journal of Psychology 44(1)

social networks or even requesting passwords to access private sites in application materials (Jain,
2009; Wester, Danforth, & Olle, 2013), further decreasing the border between personal and profes-
sional realms.
Some proposed areas to discuss or incorporate into the supervision contract (derived from
DeJong et al., 2012) include acknowledging and ensuring respectful (and often different) attitudes
across generations (e.g., among supervisor, supervisee, and client[s]) toward digital media; not
assuming supervisees recognize and proactively demonstrate professionalism, make them explicit;
using active learning including role play and vignettes derived from experience close to the super-
visees’ own to ensure ethical compliance in Internet practice (e.g., netiquette, boundaries, safety
issues); and discussing and providing readings and guidelines on professionalism, ethics, and
ensuring a professional online footprint. As with all supervision practice, Internet practices should
be guided by the ethical principles and code of conduct.

Conclusion
As we move into a competency-based era of clinical supervision, accountability, transparency, and
evidence-based practice are increasing. As supervision guidelines and standards are adopted inter-
nationally, goals include enhancing the appreciation of clinical supervision as a distinct profes-
sional activity that requires specific training and competence. Supervision is the key to transmitting
the profession to future generations of psychologists.

Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit
sectors.

References
American Psychological Association. (2010). Ethical principles of psychologists and code of conduct (2002,
Amended June 1, 2010). Retrieved from http://www.apa.org/ethics/code/index.aspx
Aspland, H., Lleweylen, S., Hardy, G., Barkham, M., & Stiles, W. (2008). Alliance ruptures and rupture
resolution in cognitive-behavioral therapy: A preliminary task analysis. Psychotherapy Research, 18,
699–710. doi:10.1080/10503300802291463
Association of State and Provincial Psychology Boards. (2010). Study of the practice of licensed psychologists
in the United States and Canada. Retrieved from http://c.ymcdn.com/sites/ www.asppb.net/resource/
resmgr/EPPP_/ASPPB_PA_July_2010.pdf
Association of State and Provincial Psychology Boards. (2013, July 7–9). Definitions of competence. Day
2, 5th International Congress on Licensure, Certification and Credentialing in Psychology, Stockholm,
Sweden.
Association of State and Provincial Psychology Boards. (in press). ASPPB supervision guidelines.
Australian Psychology Accreditation Council. (2012). Accreditation standards for programs of study in psy-
chology. (Consultation draft). Melbourne, Australia. Retrievedfrom: http://www.psychologycouncil.org.
au/Assets/Files/APAC_Standards_Consultation_Draft_Sept_2012.pdf
Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Boston: Pearson.
Board of Educational Affairs, American Psychological Association. (2013). Proposed guidelines for compe-
tency-based clinical supervision in health service psychology education and training programs (Task
Force on Supervision Guidelines draft). Washington, DC: Author.
Borders, L. D., DeKruyf, L., Fernando, D. M., Glosoff, H. L., Hays, D. G., Page, B., & Welfare, L. E.
(2011). Best practices in clinical supervision. Alexandria, VA: Association for Counselor Education
and Supervision. Retrieved from http://www.acesonline.net/wp-content/uploads/2011/10/ACES-Best-
Practices-in-clinical-supervision-document-FINAL.pdf

Downloaded from sap.sagepub.com by guest on January 18, 2016


Falender 15

Bordin, E. S. (1983). Supervision in counseling: II. Contemporary models of supervision: A working alliance
based model of supervision. The Counseling Psychologist, 11, 35–42. doi:10.1177/0011000083111007
British Psychological Society. (2003). Policy guidelines on supervision in the practice of clinical psychology.
Leicester, UK: Author.
British Psychological Society. (2006). Continued supervision. Leicester, UK: Author.
Brosan, L., Reynolds, S., & Moore, R. G. (2008). Self-evaluation of cognitive behavioral therapy perfor-
mance: Do therapists know how competent they are? Behavioural and Cognitive Psychotherapy, 36,
581–587. doi:10.1017/S1352465808004438
Canadian Psychological Association. (2000). Canadian code of ethics for psychologists. Retrieved from http://
www.cpa.ca/cpasite/userfiles/Documents/Canadian%20Code%20of%20Ethics%20for%20Psycho.pdf
Canadian Psychological Association. (2004). Mutual recognition agreement (MRA). Retrieved from http://
www.cpa.ca/documents/MRA.pdf
Canadian Psychological Association. (2009). Ethical guidelines for supervision in psychology: Teaching,
research, practice, and administration. Retrieved from http://www.cpa.ca/aboutcpa/committees/ethics/
ethicalguidelinesforsupervisioninpsychology/
Crook-Lyon, R. E., Presnell, J., Silva, L., Suyama, M., & Stickney, J. (2011). Emergent supervisors:
Comparing counseling center and non-counseling center interns’ supervisory training experiences.
Journal of College Counseling, 14, 34–49. doi:10.1002/j.2161-1882.2011.tb00062.x
DeCamp, M., Koenig, T. W., & Chisolm, M. S. (2013). Social media and physicians’ online identity crisis.
JAMA, 310, 581–582. doi:10.1001/jama.2013.8238
DeJong, S. M., Benjamin, S., Meyer, A. J., Nadvah, J., Boland, R. J., Lomax, J., & Rostain, A. L. (2012).
Professionalism and the Internet in psychiatry: What to teach and how to teach it. Academic Psychiatry,
36, 356–362. doi:10.1176/appi.ap.11050097
DiLillo, D., & Gale, E. B. (2011). To Google or not to Google: Graduate students’ use of the Internet to access
personal information about clients. Training and Education in Professional Psychology, 5, 160–166.
doi:10.1037/a0024441
Dunning, D., Heath, C., & Suls, J. M. (2004). Flawed self-assessment: Implications for health, education,
and the workplace. Psychological Science in the Public Interest, 5(3), 69–106. doi:10.1111/j.1529-
1006.2004.00018.x
Ellis, M. V., Berger, L., Hanus, A., Ring, E. E., Siembor, M. J., & Swords, B. A. (in press). Inadequate
and harmful clinical supervision: Revising the framework and assessing occurrence. The Counseling
Psychologist.
Falender, C. A., Burnes, T., & Ellis, M. (2013). Introduction to major contribution: Multicultural clini-
cal supervision and benchmarks: Empirical support informing practice and supervisor training. The
Counseling Psychologist, 41, 8–27. doi:10.1177/0011000012438417
Falender, C. A., Cornish, J. A. E., Goodyear, R., Hatcher, R., Kaslow, N. J., Leventhal, G., . . .Sigmon, S. T.
(2004). Defining competencies in psychology supervision: A consensus statement. Journal of Clinical
Psychology, 60, 771–785. doi:10.1002/jclp.20013
Falender, C. A., Ellis, M. V., & Burnes, T. (2013). Response to reactions to major contribution:
Multicultural clinical supervision and Benchmarks. The Counseling Psychologist, 41, 140–151.
doi:10.1177/0011000012464061
Falender, C. A., & Shafranske, E. P. (2004). Clinical supervision: A competency-based approach. Washington,
DC: American Psychological Association (APA).
Falender, C. A., & Shafranske, E. P. (2007). Competence in competency-based supervision practice: Construct
and application. Professional Psychology: Research and Practice, 38, 232–240. doi:10.1037/0735-
7028.38.3.232
Falender, C. A., & Shafranske, E. P. (Eds.). (2008). Casebook for clinical supervision: A competency-based
approach. Washington, DC: American Psychological Association (APA).
Falender, C. A., & Shafranske, E. P. (2012a). Getting the most out of clinical training and supervision: A
guide for practicum students and interns. Washington, DC: American Psychological Association (APA).
Falender, C. A., & Shafranske, E. P. (2012b). The importance of competency-based clinical supervision and
training in the twenty-first century: Why bother? Journal of Contemporary Psychotherapy, 42, 129–137.
doi:10.1007/s10879-011-9198-9

Downloaded from sap.sagepub.com by guest on January 18, 2016


16 South African Journal of Psychology 44(1)

Falender, C. A., & Shafranske, E. P. (2014). Supervision. In W. B. Johnson & N. J. Kaslow (Eds.), Oxford
handbook of education and training in professional psychology. New York, NY: Oxford University Press.
Falender, C. A., Shafranske, E. P., & Falicov, C. (Eds.). (2014). Multiculturalism and diversity in clinical super-
vision: A competency-based approach. Washington, DC: American Psychological Association (APA).
Farnan, J. N., Petty, L. A., Georgitis, E., Martin, S., Chiu, E., Prochaska, M., & Arora, V. M. (2012). A
systematic review: The effect of clinical supervision on patient and residency education outcomes.
Academic Medicine, 87, 428–442. doi:10.1097/ACM.0b013e31824822cc
Fouad, N. A., Grus, C. L., Hatcher, R. L., Kaslow, N. J., Hutchings, P. S., Madson, M. B., . . .Crossman,
R. E. (2009). Competency benchmarks: A model for understanding and measuring competence in pro-
fessional psychology across training levels. Training and Education in Professional Psychology, 3,
S5–S26. doi:10.1037/a0015832
Frawley-O’Dea, M. G., & Sarnat, J. E. (2001). The supervisory relationship: A contemporary psychodynamic
approach. New York, NY: Guilford Press.
Gottlieb, M. C., Robinson, K., & Younggren, J. N. (2007). Multiple relations in supervision: Guidance
for administrators, supervisors, and students. Professional Psychology: Research and Practice, 38,
241–247. doi:10.1037/0735-7028.38.3.241
Grus, C. L., & Kaslow, N. J. (2014). Professionalism: Professional values and attitudes in psychology. In
W. B. Johnson & N. J. Kaslow (Eds.), Oxford handbook of education and training in professional psy-
chology. New York, NY: Oxford University Press.
Hadjistavropoulos, H., Kelher, M., & Hadjistavropoulos, T. (2010). Training graduate students to be clinical
supervisors: A survey of Canadian professional psychology programmes. Canadian Psychology, 51,
206–212. doi:10.1037/a0020197
Hansen, N. D., Randazzo, K. V., Schwartz, A., Marshall, M., Kalis, D., Frazier, R., . . .Norvig, G. (2006).
Do we practice what we preach? An exploratory survey of multicultural psychotherapy competencies.
Professional Psychology: Research and Practice, 37, 66–74. doi:10.1037/0735-7028.37.1.66
Hatcher, R. L., Fouad, N. A., Grus, C. L., Campbell, L. F., McCutcheon, S. R., & Leahy, K. L. (2013).
Competency benchmarks: Practical steps toward a culture of competence. Training and Education in
Professional Psychology, 7, 84–91. doi:10.1037/a0029401
Hoffman, M. A., Hill, C. E., Holmes, S. E., & Freitas, G. F. (2005). Supervisor perspective on the process and
outcome of giving easy, difficult, or no feedback to supervisees. Journal of Counseling Psychology, 52,
3–13. doi:10.1037/0022-0167.52.1.3
Hunsley, J., & Barker, K. K. (2011). Training for competency in professional psychology: A Canadian per-
spective. Australian Psychologist, 46, 142–145. doi:10.1111/j.1742-9544.2011.00027.x
Inman, A. G., & Ladany, N. (2008). Research: The state of the field. In A. K. Hess, K. D. Hess, & T. H. Hess
(Eds.), Psychotherapy supervision: Theory, research, and practice (2nd ed., pp. 500–520). Hoboken,
NJ: John Wiley & Sons.
Jain, S. H. (2009). Practicing medicine in the age of Facebook. New England Journal of Medicine, 361,
649–651. doi:10.1056/NEJMp0901277
Jernigan, M. M., Green, C. E., Helms, J. E., Perez-Gualdron, L., & Henze, K. (2010). An examination of
people of color supervision dyads: Racial identity matters as much as race. Training and Education in
Professional Psychology, 4, 62–73. doi:10.1037/a0018110
Kaslow, N. J., Borden, K. A., Collins, F. L., Forrest, L., Illfelder-Kaye, J., Nelson, P. D., . . .Willmuth, M.
E. (2004). Competencies conference: Future directions in education and credentialing in professional
psychology. Journal of Clinical Psychology, 60, 699–712. doi:10.1002/jclp.20016
Kaslow, N. J., Grus, C. L., Campbell, L. F., Fouad, N. A., Hatcher, R. L., & Rodolfa, E. R. (2009). Competency
assessment toolkit for professional psychology. Training and Education in Professional Psychology, 3,
S27–S45. doi:10.1037/a0015833
Kaslow, N. J., Rubin, N. J., Bebeau, M. J., Leigh, I. W., Lichtenberg, J. W., Nelson, P. D., . . .Smith, I.
L. (2007). Guiding principles and recommendations for the assessment of competence. Professional
Psychology: Research and Practice, 38, 441–451. doi:10.1037/0735-7028.38.5.441
Kavanagh, D. J., Spence, S., Sturk, H., Strong, J., Wilson, J., Worrall, L., . . .Skerrett, R. (2008). Outcomes
of training in supervision: Randomised controlled trial. Australian Psychologist, 43, 96–104.
doi:10.1080/0005006080205056534

Downloaded from sap.sagepub.com by guest on January 18, 2016


Falender 17

Koocher, G. P., & Keith-Spiegel, P. (2008). Ethics in psychology and the mental health professions: Standards
and cases (3rd ed.). New York, NY: Oxford University Press.
Ladany, N., Lehrman-Waterman, D., Molinaro, M., & Wolgast, B. (1999). Psychotherapy supervisor ethical
practices: Adherence to guidelines, the supervisory working alliance, and supervisee satisfaction. The
Counseling Psychologist, 27, 443–475. doi:10.1177/0011000099273008
Magnuson, S., Wilcoxon, S. A., & Norem, K. (2000). A profile of lousy supervision: Experienced counse-
lors’ perspectives. Counselor Education and Supervision, 39, 189–202. doi:10.1002/j.1556-6978.2000.
tb01231.x
Milne, D., & Reiser, R. P. (2012). A rationale for evidence-based clinical supervision. Journal of Contemporary
Psychotherapy, 42, 139–149. doi:10.1007/s10879-011-9199-8
Myers, S. B., Endres, M. A., Ruddy, M. E., & Zelikovsky, N. (2012). Psychology graduate training in the era
of online social networking. Training and Education in Professional Psychology, 6, 28–36. doi:10.1037/
a0026388
New Zealand Psychologists Board. (2010). Guidelines on supervision. Wellington, New Zealand: Author.
Retrieved from http://www.psychologistsboard.org.nz
Porter, N. (2014). Women, culture, and social justice: Supervision across the intersections. In C. A. Falender,
E. P. Shafranske, & C. J. Falicov (Eds.), Multiculturalism and diversity in clinical supervision: A com-
petency-based approach. Washington, DC: American Psychological Association (APA).
Porter, N., & Vasquez, M. (1997). Covision: Feminist supervision, process, and collaboration. In J. Worell
& N. Johnson (Eds.), Shaping the future of feminist psychology: Education, research, and prac-
tice (Psychology of women book series, pp. 155–171). Washington, DC: American Psychological
Association (APA).
Professional Board for Psychology, Health Professions Council of South Africa. (2010). Handbook for intern
psychologists and accredited institutions. Pretoria, South Africa. Retrieved from http://www.hpcsa.
co.za/downloads/psychology/intern_psychology_hand_book.pdf
Psychology Board of Australia. (2013). Guidelines for supervisors and supervisor training providers.
Retrieved from http://www.psychologyboard.gov.au/Standards-and-Guidelines/Codes-Guidelines-
Policies.aspx
Reiser, R. P., & Milne, D. (2012). Supervising cognitive-behavioral psychotherapy: Pressing needs, impress-
ing possibilities. Journal of Contemporary Psychotherapy, 42, 161-171. doi:10.1007/s10879-011-9200-6
Rodolfa, E., Greenberg, S., Hunsley, J., Smith-Zoeller, M., Cox, D., Sammons, M., . . .Spivak, H. (2013). A
competency model for the practice of psychology. Training and Education in Professional Psychology,
7, 71–83. doi:10.1037/a0032415
Roth, A. D., & Pilling, S. (2009). A competence framework for the supervision of psychological therapies.
Retrieved from http://www.ucl.ac.uk/clinical-psychology/CORE/competence_frameworks.htm
Shen-Miller, D. S., Forrest, L., & Burt, M. (2012). Contextual influences on faculty diversity conceptualiza-
tions when working with trainee competence problems. The Counseling Psychologist, 40, 1181–1219.
doi:10.1177/0011000011431832
Walfish, S., McAlister, B., O’Donnell, P., & Lambert, M. J. (2012). An investigation of self-assess-
ment bias in mental health providers. Psychological Reports, 110, 639–644. doi:10.2466/02.07.17.
PR0.110.2.639-644
Wall, A. (2009). Psychology interns’ perceptions of supervisor ethical behavior (Doctoral dissertation).
Available from ProQuest Dissertations and Theses database. (AAT 3359934)
Wester, S. R., Danforth, L., & Olle, C. (2013). Social networking sites and the evaluation of applicants and stu-
dents in applied training programs in psychology. Training and Education in Professional Psychology,
7, 145–154. doi:10.1037/a0032376

Downloaded from sap.sagepub.com by guest on January 18, 2016

View publication stats

You might also like