Training and Supervision of Clinical Supervisors

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Chapter Four
Training and Supervision of Clinical Supervisors
Nicola Gazzola and Jack De Stefano
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Learning Objectives
The objectives of this chapter are to:
 examine the role of supervision in the context of mental health;
 promote the value of developing one’s own metamodel of clinical supervision;
 identify the traditional categories of supervision models as well as some newer cross-theoretical
and learning-based models;
 examine the relational demands of supervision;
 outline some of the special characteristics and demands of working as a clinical supervisor; and
 review some important research being used to guide supervisor-training experiences.

Training and Supervision of Clinical Supervisors
Supervision is the cornerstone of clinical education and formal supervision training has now
become either a mandatory or highly recommended requirement for all practitioners who act as clinical
supervisors. This chapter will familiarize the reader with several important issues relative to clinical
supervision and to the training of clinical supervisors. More specifically we will:
 summarize recent developments in clinical supervision;
 describe important elements of effective supervision;
 discuss the training of supervisors and supervision of supervision; and
 situate the topic within a Canadian context.
Preamble
In order to facilitate the communication of this material we have opted to use the term “trainee”
to denote a student counsellor-in-training who has pre-degree status. Supervisor-in-training (SIT) will be
reserved for those students who are undergoing preparatory education (often at the doctoral level) in the
theory and practice of supervision. And finally, those clinicians and faculty who train SITs will be
referred to as SIT supervisors.
The Changing Landscape of Clinical Supervision
Clinical supervision is often referred to as the signature pedagogy of the mental health
professions (Barnett, Cornish, Goodyear, & Lichenberg, 2007; Bernard & Goodyear, 2014; Shulman,
2005). This implies that the main crucible for learning the competencies; the skills, attitudes, and
knowledge required by counsellors and therapists is a supervisory apprenticeship context where work is
monitored and shaped under the watchful eye of a more senior, experienced clinician (Bernard &
Goodyear, 2014). Certainly much learning also happens in the classroom in the way of formal academic
courses. Yet, it is the close scrutiny of the trainee’s clinical skills and reasoning, and the ongoing attempts
to amplify existing capacities and to correct missteps and unproductive behaviour that forms the clinician.
Indeed, supervision plays an indispensable role in the training and development of counsellors (Holloway,
1997; Milne & Oliver, 2000; Watkins, 2013). Although direct contact with clients is often cited as the
most important source of ongoing learning (Jennings, Goh, Skovholt, Hanson, & Banerjee-Stevens,
2003), a beginner’s sense of competence seems to be directly related to the hours of supervision and to
the number of supervisors assigned over the course of clinical training (Bradley & Olson, 1980; Hill,
Charles, & Reed, 1981). More recently, Watkins (2012a) discussed the role of supervisors in fostering a
professional identity and so we see supervision as being active in all spheres of a trainee’s development.
Despite a quasi-universal acknowledgment of its importance to effective and competent practice,
until recently, the provision of clinical supervision was conducted primarily by experienced clinicians
who had no formal training in supervision (Johnson & Stewart, 2000, 2008; Russell & Petrie, 1994)
prompting Hoffman (1994) to refer to this lacuna as the mental health profession’s “dirty little secret” (p.
25). Fortunately, the scenario has changed in recent years so that we are now seeing increasing numbers
of supervisors who have engaged in specific and formal training in this important professional
development activity.
Clinical supervision has been around since the days of Freud’s training analysis, but it has only
recently become a mandatory training requirement of accredited programs in the mental health

professions, even for trainees who have no interest in becoming clinical supervisors (Falender et al.,
2004). Perhaps this move is intended to redress a historical fact – that most supervisors today probably
stumbled into supervision and were given its mantle without much forethought or training (Johnson &
Stewart, 2000; Peake, Nussbaum, & Tindell, 2002). Supervisors have most often been chosen because of
their accumulated experience, prompting Alonso (2000) to state wryly, “…one becomes a supervisor just
by aging” (p. 60). However, this reality is no longer commensurate with a field that is increasingly
concerned with supervision as a core competency (Falender et al., 2004) and where the notion of
qualifying sufficiency is increasingly challenged (Watkins, 2012b, p. 282).
Doctoral programs in clinical and counselling psychology are increasingly being required to
include some form of supervision training (e.g., some didactic coursework, experiential learning, or both).
The entire mental health field has, without question, embraced the notion that formal supervision training
is vital and necessary (Bernard & Goodyear, 2014; McMahon & Simons, 2004; Milne & James, 2002).
All of the major associations of helping professionals in North America (e.g., the American Psychological
Association, the Canadian Psychological Association, the American Association of Marriage and Family
Therapy, the Association of Counselor Education and Supervision, the Canadian Counselling and
Psychotherapy Association, to name a few) are moving toward formalizing the minimum requirements for
those providing supervised clinical hours to graduates enrolled in accredited programs. At the
international level, there is a growing push to make formal training as a supervisor a compulsory part of
doctoral education as well as a condition for acquiring and maintaining a license to practice (O’Donovan,
Halford, & Walters, 2011; Scott, Ingram, Vitanza, & Smith, 2000).
Current Context
In Canada, training and licensing of psychologists is regulated at the provincial and territorial
level under the Mutual Recognition Agreement (MRA). The MRA requires core competencies in
interpersonal relationships, assessment and evaluation, intervention and consultation, research, and ethics
and standards, regardless of title or jurisdiction for the professional providing the service (Hunsley &
Barker, 2011). In addition to the aforementioned core competencies, some jurisdictions also require two
additional competencies: supervision and administration (Hunsley & Barker, 2011). Despite the
requirements that are specified across all Canadian jurisdictions, training in clinical supervision is
inconsistent across educational programs and there has been no formal evaluation of the different
approaches undertaken (Hadjistavropoulos, Kehler, & Hadjistavropoulos, 2010). Even where programs
have supervisor training as a curricular requirement, it is often not given the attention afforded other
competencies (e.g., psychological testing). Watkins (1991) referred to this training imbalance as a
“persistent paradox without parallel” (p. 146) and concluded that a more direct and “systematic, guiding
ethos” is needed; otherwise supervisor training may be “allowed to languish in its current stage of benign
neglect” (p. 147).
This call to action has not gone unheard and there are signs that supervision is being given the
attention it deserves. Bernard and Goodyear (2014) point out that “it is an ethical imperative that those
who supervise must have the requisite competence to do so” (p. 282). This underscores the reality that in
the current mental health context supervisor training is expected to begin in graduate school, usually at
the doctoral level, and is maintained through ongoing continuing education and professional development.
The British Association of Counsellors (1996) has gone one step further in asserting that all supervisors
must have the “requisite competence” but are also required to have supervision of their supervision, a
practice that had the initial goal of protection of the public but which seems to have professional merit as
well (Wheeler & King, 2000).

In Quebec, Bill 21, adopted by the National Assembly of Quebec (2009) and effective since June
2012, made sweeping changes to the scope and practice of those professions providing counselling and
psychotherapy services to the population. Four core principles were identified: (a) protection of the
public, (b) keeping clients at the centre of care, (c) interdisciplinary collaboration, and (d) having access
to competent professionals. Part of this Bill requires that psychologists (with two years of post-doctoral
clinical experience) who graduated post 2006 and did not receive supervision training in their graduate
coursework, complete a minimum of six hours of continuing education (CE) before being permitted to
supervise other clinicians. Six hours of training hardly seems sufficient to establish supervision
competencies but few if any doctoral students since 2006 have not had supervision training. Furthermore,
Bill 21’s mandatory continuing education requirements can be used for the purpose of improving
supervisor competencies. Indeed, support for supervision as a specialty separate from counselling,
psychotherapy, and other related activities continues to grow making Gonsalvez and Milne’s (2010)
conclusion that the “identified competencies required of supervisors are sufficiently advanced and
complex to require more than an isolated and short (e.g., 1-day) workshop on its own to be effective” (p.
237) particularly timely.
Professional bodies (e.g., the APA) are now beginning to articulate guidelines so that training
programs can ground their supervisory practices in research, ethics, and sound clinical experience
(DeAngelis, 2014). These will eventually be organized as a set of unique competencies. Our intent in this
chapter is not to anticipate or debate what should be at the heart of these competencies. Rather, we prefer
to offer some observations and suggestions that will undoubtedly be reflected in future iterations of the
supervisor’s competencies.
Provide Opportunities to Help Develop Their Own Approach
For competence to manifest itself in a regular and consistent fashion, all supervisors must develop
their own personal method of supervision that represents their internal map or metamodel of effective
supervisory behaviour. Through training and experience, SITs appropriate aspects and fragments of
various formal and informal models of counselling and supervision as they distil the academic course
work, clinical practice, and their own experiences of being supervised into a method for supervision.
Thus, a likely starting place for training supervisors is to introduce SITs to working models of supervisory
practices that can inform them about how to approach the demands of this new role. More than likely, the
more pervasive of these are supervision approaches that are analogs to actual counselling and therapy.
This reflects the historical tradition of the training analyst where the interpersonal process of the
supervisor and SIT was expected to mirror the same dynamics of the analyst and patient. This tradition
has continued: “Supervision is a parallel process to that of psychotherapy such that the dynamics of a
therapist’s training cases are re-enacted and interpreted in the supervisory relationship” (Strupp, Butler, &
Rosser, 1988, p. 691). The idea that aspects of the therapy experience are reflected in supervision is
germane to other models and so we have today a plethora of supervisory practices that closely follow the
theoretical dictates and techniques of a particular approach (e.g., Milne, Pilkington, Gracie, & James,
2003). However, clinical supervision is not psychotherapy - an important distinction that often gets
forgotten or ignored. The more important difference between the two is that supervision is evaluative
(Bernard & Goodyear, 2014) and even when a SIT is already a licensed professional there is the implicit
understanding that the supervisor will offer critical feedback or assess the SIT’s performance to a
standard of practice commensurate with the practitioner’s level of training and experience. Nevertheless,
the practice of psychotherapy itself has greatly impacted supervision and there is an implicit assumption
that supervisors “…must listen with the clinician’s ear but speak with a teacher’s mouth” (Alonso, 2000,
p. 5). Milne (2006) has done a thorough analysis of the parallels between supervision and psychotherapy
and outlined some of the common ground that they share. Yet, while it is often difficult for clinicians to

put aside their usual way of observing and hearing, even supervisors who tend to focus more readily on
the trainee’s own dynamics or on parallel processes acknowledge that a focus on the trainee’s personal
issues must always be tied to the work with the client (Glickauf-Hughes & Campbell, 1991).
In contrast to a model where the supervisor operates like a therapeutic agent, social role models
of supervision (Bernard 1979, 1997; Holloway, 1997) situate the supervisor’s set of actions/interventions
within a flexible set of changing roles that are expected to match the needs or learning stage of the SIT.
Stated differently, these social role models locate the supervisor’s interventions within a set of activities
or intentions that intersect with the student’s training needs. For example, in Bernard’s (1979, 1997)
discrimination model the supervisor’s activities are situated within the roles of teacher, consultant, and
counsellor, with each role having a specific function: that of mastering interventions, case
conceptualization skills, or of fostering self-awareness, respectively. Social role models have lost much of
their initial appeal, in part because they have a limited research base of support, or perhaps because the
notion of role-based supervisory tasks is subsumed more efficiently under developmental models of
supervision.
Developmental models of supervision (e.g., Stoltenberg, 1981) have innate intuitive appeal and
much contextual validity. Developmental models imply that counsellors-in-training move through
predictable and recognizable stages of learning, and identifying the particular stage at which the trainee is
performing informs supervisor’s focus and interventions. In this way, the supervisor is able to adjust to
the trainee’s level of development and choose interventions or tasks suited for that trainee’s particular
developmental needs. The implication here is that throughout the life of supervision the supervisor
inhabits multiple flexible roles and that the structure and content of supervision is dependent on the
trainee’s changing developmental needs and not on the supervisor’s predilections or preferences.
Stoltenberg’s (2004) integrated developmental model (IDM) is perhaps the better known of the models
and represents a way of thinking about supervision that focuses on trainee’s awareness, motivation, and
autonomy as these manifest themselves across three distinct developmental levels (i.e., beginner,
intermediate, and advanced levels). The model describes the needs for each level and for each of the foci.
Generic supervision interventions (e.g., supporting, challenging, prescribing) are used to facilitate the
trainee’s evolution across levels. There are some inherent assumptions that may limit the actual
prescriptive value of these developmental models. For one thing, trainees are expected to be at similar
starting points and their learning trajectories are thought to be uniform and consistent throughout the
training program. Many who have trained practitioners will quickly recognize the obvious heterogeneity
of their students’ abilities as well as the diverse potential that cohorts of trainees possess. In spite of these
limitations of a developmental viewpoint, it is a useful framework in that it positions the trainee’s
difficulties and needs as dynamic and evolving. This obliges the supervisor to tailor the supervision to fit
with each trainee’s unique needs as a way to militate against formulaic supervisory interventions (Ellis &
Douce, 1994; Watkins, 2012a).
More recently, Ladany, Friedlander, and Nelson (2005) have introduced a cross-theoretical
approach to supervision that touches on many of the elements and issues of previous models but in a more
explicit way. They use the term events-based model of supervision to capture the series of actions that
circumscribe a particular process of supervision. Informed by previous work on task analysis (Greenberg
1992; Greenberg & Foerster, 1996), the process entails four distinct phases starting with the identification
by the trainee of a critical event or difficulty followed by a set of interactions focused on specific yet
typical issues of practice (e.g., alliance building, managing countertransference, etc.). The goal is for the
trainee to develop a heightened sense of awareness of the particular dynamic so that appropriate planning
and clinical action become clear. When this process goes well there is a sense of closure and other

positive outcomes (e.g., learning) occur. Readers with supervisory experience may resonate with this
approach and recognize that they have been using an events-based approach to guide their supervisory
actions all along, especially when assisted by video-recorded material. The authors acknowledge that
much of the success of an events-based perspective rests on the trainee’s willingness and capacity to self-
disclose - a challenge that has been identified by several research studies (Ladany, Hill, Corbett, & Nutt,
1996; Ladany & Lehrman-Waterman, 1999; Ladany & Walker, 2003). With an events-based model there
is less of a focus on specific roles, and supervision relies more on the moment-to-moment interaction
around the analysis of a particular clinical event, issue, or challenge. This provides the supervisor and the
SIT a basis for their discussions, which becomes the source of the supervisor’s suggestions and
interventions.
In spite of that fact that these and other supervision models (e.g., see Westefeld, 2009) and
approaches have not been adequately tested, they remain the cornerstone of training in supervision and
provide guidance for supervisors at any level of experience. For novice supervisors (i.e., SITs) they can
ground the tasks and procedures that facilitate the work of supervision. Anxiety and feelings of doubt are
common among trainees and novice counsellors and so more prescriptive approaches (e.g., IDM) that
anticipate their developmental trajectory allow SITs to situate and adjust interventions accordingly. SITs
need to resist the allure of relying on just one model so that they can open themselves up to the
possibilities inherent in borrowing and adapting from multiple sources and experiences as they work
towards the training goals that they have set for themselves and their trainees. In this way the SIT’s
emerging metamodel can begin to integrate evidence and practice-based aspects of competent
supervision. Scaturo (2012) has called supervisors to work towards multilevel case formulations where
they can integrate aspects of bone fide psychotherapy models into their supervisory practice.
Recently, Watkins and Scaturo (2013) articulated a model for supervision training that is situated
within the language of learning and educational psychology. They present a tripartite learning-based
model that incorporates and integrates much of the preceding discussion. They maintain that a
comprehensive teaching of the process of supervision should contain: (a) a psychotherapy focus (oriented
around a specific approach), (b) developmental focus (oriented around stages of growth), and (c) social
role/process models (oriented towards the needs of trainees and experience optimization). Within this
framework they include three core tasks of the supervisor: (a) alliance building and maintenance, (b) case
conceptualization, and (c) fostering behavioural, mental, and corrective emotional experiences as the
primary components of a “successful educational exposure experience” (p. 87). These discrete tasks are
grounded in specific processes that involve cognitive, affective, and behavioural learning. In essence,
Watkins and Scaturo (2013) highlight what many believe to be essential to the formation of effective
supervisors, underscoring that it is a multi-modal learning process where the SIT integrates theoretical
and research information with performance-based (i.e., behavioural) skills, within an interpersonal,
relational (i.e., affective) environment.
Emphasize Relational Aspects of Supervision and Supervisor Training
Regardless of the particular approach or model SITs use with their trainees and whether the focus
is on discrete behaviours (e.g., micro skills) or on higher order learning (e.g., self-reflexivity), these goals
cannot occur outside the context of an appropriate supervisory relationship. In describing the importance
of an authentic relationship in a psychotherapy context, Yalom (2002) stated, “The establishment of an
authentic relationship with patients, by its very nature, demands that we forego the power of the
triumvirate of magic, mystery, and authority” (p. 107). Within a supervision context, the relationship
between supervisor and SIT is of paramount importance. Indeed, a high quality relationship has been
consistently associated with effective supervision and there is quite a robust literature that shows that the

interpersonal qualities of empathy, acceptance, and approachability, to name a few, are consistently
valued in clinical supervisors (Johnson & Stewart, 2008; Shanfield, Matthews & Hetherley, 1993;
Watkins & Scaturo, 2013). It is no wonder that Watkins and Scaturo (2013) make alliance building a
central task of their learning model. It is also here that the parallels between psychotherapy and clinical
supervision are the most congruent and many of the lessons learned from the psychotherapy research are
applicable in supervision (Bordin, 1983; Patton & Kivlighan, 1997). To make a simple analogy: the
therapeutic relationship or alliance is to client change what the supervisory relationship is to trainee
learning.
While it is not clear exactly how the supervisory alliance operates within the scope of the
trainee’s or the SIT’s development, there is a strong and robust association between the quality of the
supervisory alliance and overall training outcomes. Poor supervisory alliances have been associated with
negative events and outcomes (Worthen & McNeill, 1996) including trainee shame (Hahn, 2001) and
nondisclosure of important information (Ladany et al., 1996). In contrast, a positive perception of the
supervisory relationship has been associated with “good” supervision and can contribute to trainee
internalization of the supervisor (Geller, Farber, & Schaffer, 2010) and tends to predict competence
across multiple tasks. For example, a good supervisory alliance facilitates the resolution of tensions and
conflicts around multicultural and diversity issues (Burkard, Knox, Hess, & Schultz, 2009) and is related
to satisfaction with the evaluative process of supervision (Ladany & Lehrman-Waterman, 1999). Further,
strong supervisory alliances have been shown to be associated with trainee self-efficacy (Larson &
Daniels, 1998). It would be fair to conclude that establishing, maintaining, and repairing a supervisory
relationship can be considered the sine qua non of effective supervision practice.
Gazzola and Theriault’s (2007) findings regarding trainees’ experiences of broadening and
narrowing in supervision underscore the importance of a strong supervisory relationship. Broadening
refers to the effects of experiencing positive emotions (e.g., interest, love, joy) leading to thinking and
acting in creative new ways (Fredrickson, 2001). Narrowing, on the other hand, limits a person’s choices
and fewer creative ideas result. When Gazzola and Theriault’s (2007) asked trainees what their
supervisors did to facilitate broadening they reported two general functions - supervisors created a
nurturing, validating learning environment focused on the trainee’s needs and they displayed positive
personal and interpersonal qualities that demonstrated their enthusiasm, interest in the task at hand, and
openness to differences. On the other hand, trainees experienced narrowing when their supervisors
behaved as polar opposites, were disrespectful of trainees, imposed their own views of clinical practice,
and presented themselves as the all-powerful and all-knowing supervisor (Gazzola & Theriault, 2007). So
we see that broadening and narrowing are impacted by the personal qualities of the supervisor as well as
the supervisor’s way of relating interpersonally. This is resonant with Watkins’ (2013) notion that SITs
engage and buy into the value of supervision when supervisors effectively demonstrate a “passion for
supervising, your deep respect for and joy in performing the activity and your abiding belief in its power
and potential” (p. 146).
Fully engaging with the process of learning is often hampered by the very personal, sometimes
intimate demands of clinical supervision. We know that the nature of clinical work and especially the
scrutiny that supervisors bring to it opens the trainee up to a number of challenges and difficulties. The
experience of shame, as an example, is often catalyzed in supervisory meetings and trainees are careful to
avoid issues that elicit negative affect in them (Hahn, 2001). Even when supervision does not typically
evoke negative emotions, we know from the literature and from anecdotal reports from peers, that non-
disclosure of important information on the part of trainees is very common (Ladany et al., 1996; Ladany
& Walker, 2003; Reichelt et al., 2009). We suspect that the same is also true of supervisees and the

parallels between the trainee receiving supervision and the supervisor in training are obvious. Non-
disclosure is more likely when the alliance with the supervisor is weak. Both SITs and trainees withhold
important disclosures primarily out of a fear of making a poor impression or receiving negative feedback.
Clear and specific feedback that is balanced, focusing on both strengths and needs for
improvement, has been shown to affect positive experiences with supervisors (Lehrman-Waterman &
Ladany, 2001). While the value of clear feedback seems obvious, what is perhaps more challenging is
finding the best process fit for each individual. Whether dealing with trainees or SITs, attending to their
unique preferences for how to best engage in the evaluation process can only occur within a collaborative
framework where SITs are clear and forthcoming about their needs and goals. We are starting to see
progress monitoring in counselling and psychotherapy as a routine practice intended to enhance client
outcomes and render more efficient treatment (Lambert & Hawkins, 2001). The core element of progress
monitoring is the elicitation of ongoing feedback from clients so that counsellors can adjust their methods
to the clients’ responses. This is an idea that will make its way into the practice of supervision where the
SIT’s response to supervision of supervision (SOS) can be formally tracked to maximize supervisory (and
client) outcomes (Worthen & Lambert, 2007).
Attend to the (Research on) SIT Experience to Guide Training
The benefit of having formal supervision training (both didactic and experiential) is clear
(McMahon & Simons, 2004; Milne & James, 2002). For example, we see that the total number of
supervision activities (e.g., discussion topics, opportunity to supervise a trainee, supervision of
supervision) were found to predict overall supervisory development but it appeared that increasing the
hours of training predicted better overall development (Lyon, Heppler, Levitt, & Fisher, 2008). Similarly,
Baker, Exum, and Tyler (2002) found that doctoral level SITs who received didactic and experiential
learning opportunities had significantly improved scores on a self-reported supervisor development
measure from start to end of training while those who had not received the experiential training did not
show improvement. Although didactic learning is important it appears that opportunities to try on and
practice the role of the supervisor are a key part of the learning process. This experiential component is
typically embedded in a supervision-of-supervision context where supervisors can adjust their guidance
and feedback to the unfolding experience of the SIT. In this regard there are numerous lessons that can be
learned from the qualitative research on the SIT’s lived experiences of supervision training.
In a qualitative study exploring SITs’ experiences of their supervision training and SOS, De
Stefano, Gazzola, Theriault, and Audet (2014) found that SITs valued SOS and considered it a crucial
part of their professional development. This study, which focused on group format SOS, showed that the
group supervision process provided an opportunity for SITs to practice self-care and it was a place that
allowed for consolidation of their previous, didactic learning, and the opportunity for broadening their
perspectives. These results were consistent with Bernard and Goodyear’s (2014) description of the
benefits of group supervision for learning the competencies of supervision.
In spite of benefits, De Stefano et al. (2014) also found liabilities stemming from the use of the
group format for SOS. In particular, some participants reported that honesty/disclosure was at times
hindered in the group because of interpersonal tensions and conflicts that were unresolved. These findings
underscored the need to have the additional layer of experience in group work for those supervisors who
use groups for SOS. Given the extent to which group supervision is routinely used for supervision, the
supervisor’s skill in managing group processes becomes an important consideration and a necessary
component of supervision education. However, the general conclusion was that the SOS group experience
was central to doctoral students’ overall professional development and that the group itself was the

primary source of a significant amount of learning, echoing what others had previously reported (Carter,
Enyedy, Goodyear, Arcinue, & Puri, 2009; Ray & Altekruse, 2000; Sundin, Ogren, & Boethius, 2008).
While the accumulation of training experiences produces more competent supervisors, the actual
process of becoming more confident and competent with this activity is predictably a mixed experience
for most SITs. In the area of counsellor training there is a well-established literature that describes the
experiences, both positive and negative, of trainees as they move through their learning (De Stefano,
Overington & Bradley, 2014; Pica, 1998; Skovholt & Ronnestad, 2003). This literature is only emerging
with regard to SITs. For example, Majcher and Daniluk (2009), in studying the experiences of six
doctoral students, found that their participants underwent a number of changes in perspective taking and
understanding as a result of their eight-month-long supervision training. In contrast, in two studies that
investigated the experiences of doctoral-level counselling psychology students supervising masters’
students (Gazzola, De Stefano, Theriault, & Audet, 2013, 2014) found that both positive and negative
experiences were reported. A universal occurrence among this group of participants was the increased
sense of confidence that they experienced as a function of their direct work with trainees (Gazzola et al.,
2014). Like Majcher and Daniluk (2009), the SITs in the studies by Gazzola et al. (2014) reported more
confidence in their own supervisory abilities. This confidence was associated with increased sensitivity
for the needs of their trainees and the SITs’ changing perspectives allowed them to become increasingly
flexible over time. One of the key findings was that providing supervision for the first time required SITs
to reflect upon their evolving work as clinicians and, thus, supervision actually strengthened their
clinician identities (Gazzola, De Stefano, Audet, & Theriault, 2011). These findings would be consistent
with Watkins’ (2012a) theme of “remoralization” as a necessary outcome of training.
Confidence does increase with training and experience and this has a salutary effect on overall
learning (Gazzola et al., 2014) but it does not mitigate all challenges faced by new supervisors. One of the
more prominent challenges experienced is the difficulty with providing negative feedback and, more
generally, in assuming an evaluative role (Gazzola et al., 2013). Perhaps this is attributable to SITs’ status
as doctoral students in that they are unaccustomed to being in a position of power. Or, it may simply be
the result of the demands of negotiating the multiple role identities that graduate students inhabit when
wearing various “hats” during their education (e.g., those of student, class peer, psychotherapist, SIT,
etc.). Yet, even in spite of the guidance and support that SOS and the training context provide, SITs
reported feeling ill-equipped to make judgments about their trainees’ skill development and level of
competence (Gazzola et al., 2013). This might reflect the difficulty that the field as a whole experiences
when it comes to making good on its promise to be a gatekeeper for the profession. After all, counsellors
and therapists are seen as warm and supportive, and the expectation that in the role of supervisors they
may have to make unpleasant decisions or provide negative evaluations does not often fit with this
persona. We see this supported by Hoffman, Hill, Holmes, and Freitas (2005) who described how
feedback that was easy to give was offered directly and focused on a clear aspect of clinical practice,
whereas difficult feedback (e.g., about a personal issue or a negative personality trait) was given
indirectly or not given at all. In the study by Hoffman and colleagues, the participants were doctoral level
psychologists with at least three years of supervision experience. That SITs with much less experience
would have difficulty with evaluation and the gatekeeping role should, therefore, not surprise us.
Coda
The current emphasis on clinical supervision training reflects changes in the organization and
delivery of mental health programs. Because of the continued increase in stress-related and other
psychological conditions, the mental health system has had to change and adapt and now we are seeing
expansions in the roles of many mental health professionals. Quebec’s recent Bill 21 has dramatically

changed the scope of practice of many professions and has made the practice of psychotherapy a
protected activity that can only be exercised by those who have received sufficient training and
supervised clinical experience. The use of masters’ level practitioners in the delivery of mental health
services is a worldwide trend that has been shown to be both cost-sensitive and effective. However, as
more individuals engage in the practice of counselling and psychotherapy as their main professional
activity, there will be an increased need for well-trained and effective clinical supervisors. In fact, while
not yet a Canadian reality, many jurisdictions (e.g., U.K) have had ongoing, regular supervision a
requirement of practice for some time (BAC, 1996).
In North America the various regulatory and professional bodies have already begun to articulate
what they believe will constitute the core competencies of the supervisor. These will be informed by the
research evidence but will also take into account the clinical realities of the real world so that the
competencies have an ecological fit. The expectation is that with the accumulation of discrete
competencies, overall supervisory “competence” will become a realizable outcome. However, while the
competency-based educational paradigm continues to grow in popularity, its real impact on professional
development and identity remains to be evaluated. Recently, Smythe, MacCulloch and Charmley (2009)
advocated for an approach to supervision (and supervision training) that acknowledges the role of
evidence but that privileges the lived experiences of those who train and are trained. Supervisors-in-
training need to master “how to” knowledge that comes from theory and research but it is practical
wisdom that is at the heart of effective supervision. Practical wisdom is achieved through the
“…celebration of the intuitive, responsive, playful approach to supervision that simply listens and
responds, that is different in each encounter, and that follows no prescribed dictates (Smythe et al., 2009,
p. 23).
We conclude with an anecdote from the master therapist Irvin Yalom, who eloquently describes
the elusive ingredients of becoming a therapist. Yalom (1998) uses a personal example to illustrate the
qualitative differences that are needed in developing a unique and authentic therapy style. Yalom
describes taking a cooking class that was given by an Armenian matriarch and her assistant. As much as
the students tried to emulate her style and as much as they closely followed her ingredients, none of them
could quite capture the flavour of her dishes. Yalom then observed that when her assistant would carry
her dishes from the kitchen to the oven he would casually throw in various spices. Yalom concluded that
these “surreptitious ‘throw-ins’ made all the difference” (p. 168). Yalom’s conclusions resonate with our
perspectives on supervision even though Yalom (1998) is referring to psychotherapy. Yalom continued:
That cooking class often comes to mind when I think about psychotherapy, especially when I
think about the critical ingredients of successful therapy. Formal texts, journal articles, and lectures
portray therapy as precise and systematic, with carefully delineated stages, strategic technical
interventions, the methodical development and resolution of transference, analysis of object relations, and
a careful, rational program of insight-offering interpretations. Yet I believe deeply that, when no one is
looking, the therapist throws in the “real thing.”
But what are these “throw-ins,” these elusive, off-the-record extras? They exist outside of formal
theory, they are not written about, they are not explicitly taught. Therapists are often unaware of them; yet
every therapist knows that he or she cannot explain why many patients improve. The critical ingredients
are hard to describe, even harder to define. Indeed, is it possible to define and teach such qualities as
compassion, “presence,” caring, extending oneself, touching the patient at a profound level, or – that most
elusive one of all – wisdom? (p. 168).

Supervision is in many ways very similar. Learning developmental models, acquiring
competencies, and emulating a valued role model are most certainly important ingredients in the process
of becoming a skilled supervisor. However, supervisors must also trust in the process and develop their
own styles of supervising. Only by developing their own unique metamodel of supervision can
supervisors truly practice in a manner that is not only ethical and competent, but also genuine and
authentic.

Learning Activities
1. Interview a clinical supervisor. How did this supervisor develop supervision skills? Did she/he
receive any formal supervision training? What does she/he perceive to be the necessary
qualifications for supervisors? How does she/he conceptualize the development of supervision
competencies (e.g., experience as a clinician, workshops on supervision, supervision
coursework, formal supervised practice as a supervisor in training, etc.)?
2. Simulate a group format supervision-of-supervision (SOS) session. In the simulation, all
participants are supervisors-in-training who attend a weekly SOS group to discuss their work
as supervisors. Take turns discussing some of the challenges and opportunities of supervising
for the first time. One person should assume the role of supervisor and guide the discussion.
Discuss for about 15 minutes and then debrief. What was this experience like? What were
some of the challenges of disclosing in a group? What were some advantages?
3. Imagine that the Canadian Counselling and Psychotherapy Association (CCPA) consults with
you, seeking your input in the development of recommended training protocols for clinical
supervisors. You are asked to respond to the question “What is the ideal supervisor training?”
Based on your understanding of SIT needs, supervisor development models, research literature
on supervision, and your own personal experiences in various supervision roles, what do you
perceive to be the key components of an ideal supervisor training program? Include discussion
about supervision curriculum, experiential learning opportunities, continuing education, etc.
4. Given the Canadian context regarding statutory regulation of counselling and psychotherapy as
well as counsellor certification, why is supervisor training both a legal and ethical imperative?
Identify all of the sections and articles of CCPA’s Code of Ethics and Standards of Practice
that guide supervision training and practice.
5. A client is seen by a counsellor-in-training or trainee, the trainee is supervised by a supervisor-
in-training (SIT), and the SIT receives supervision for her/his supervision by a senior
supervisor. Mander (1997) uses an analogy of a ladder in which each rung is farther from the
bottom where the client is located. There are four people (i.e., client, counsellor-in-
training/trainee, supervisor-in-training[SIT], SIT supervisor) and three relationships. Mander
refers to the complexity of problems going up the ladder as “mindboggling” (p. 295).
(a) Since protection of the public is paramount, how do we demonstrate that the SIT’s
supervisor has any impact on the client, being so many rungs removed?
(b) What liability does the supervising supervisor bear?
(c) Describe a multilayered parallel process that can emerge in this scenario.
(d) How is informed consent handled at each of these levels?

References
Alonso, A. (2000). On being skilled and deskilled as a psychotherapy supervisor. The Journal of
Psychotherapy Practice and Research, 9, 55-61.
Baker, S. B., Exum, H. A., & Tyler, R. E. (2002). The developmental process of clinical supervisors in training: An
investigation of the supervisor complexity model. Counselor Education & Supervision, 42, 15-30.
doi:10.1002/j.1556-6978.2002.tb01300.x
Barnett, J. E., Cornish, J. A. E., Goodyear, R. K., & Lichtenberg, J. W. (2007). Commentaries on the ethical and
effective practice of clinical supervision. Professional Psychology: Research & Practice, 38, 268-275.
Bernard, J. M. (1979). Supervisor training: A discrimination model. Counselor Education and Supervision, 19(1),
60-68. doi:10.1002/j.1556-6978.1979.tb00906.x
Bernard, J. M. (1997). The discrimination model. In C. E. Watkins, Jr. (Ed.), Handbook of psychotherapy
supervision (pp. 249-276). Hoboken, NJ: John Wiley & Sons.
Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Upper Saddle River, NJ:
Pearson.
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
Bradley, J. R., & Olson, J. K. (1980). Training factors influencing the felt therapeutic competence of psychology
trainees. Professional Psychology, 11, 930-934. doi:10.1037/0735-7028.11.6.930
British Association for Counselling (BAC). (1996). Code of ethics and practice for supervisors of counsellors.
Rugby, UK: Author.
Burkard, A. W., Knox, S., Hess, S. A., & Schultz, J. (2009). Lesbian, gay, and bisexual supervisees' experiences of
LGB-affirmative and nonaffirmative supervision. Journal of Counseling Psychology, 56, 176-188.
doi:10.1037/0022-0167.56.1.176
Carter, J. W., Enyedy, K. C., Goodyear, R. K., Arcinue, F., & Puri, N. N. (2009). Concept mapping of the events
supervisees find helpful in group supervision. Training and Education in Professional Psychology, 3, 1-9.
doi:10.1037/a0013656
DeAngelis, T. (2014). Fostering successful clinical supervision. APA Monitor, 45(8), 42-45.
De Stefano, J., Gazzola, N., Theriault, A., & Audet, C. (2014). Supervisors-in-training: The experience of group-
format supervision-of-supervision. Canadian Journal of Counselling and Psychotherapy, 48, 409-424.
De Stefano, J, Overington, L. & Bradley, S. (2014). Developing repertoire: A qualitative study of trainees’ self-
reflection on clinical practice. Canadian Journal of Counselling and Psychotherapy, 48, 425-440.
Ellis, M. V., & Douce, L. A. (1994). Group supervision of novice clinical supervisors: Eight
recurring issues. Journal of Counseling & Development, 72, 520-525.
doi:10.1002/j.1556-6676.1994.tb00985.x
Falender, C. A., Cornish, J. A., Goodyear, R., Hatcher, R., Kaslow, N. J., Levanthal, G., . . . Grus, C. (2004).
Defining competencies in psychotherapy supervision: A consensus statement. Journal of Clinical Psychology,
60, 771–785. doi:10.1002/jclp.20013
Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden-and-build theory of
positive emotions. American Psychologist, 56, 218-226.

Gazzola, N., & Thériault, A. (2007). Super- (and not-so-super-) vision of counsellors-in-training: Supervisee
perspectives on broadening and narrowing processes. British Journal of Guidance and Counselling, 35, 189-204.
doi:10.1080/03069880701256601
Gazzola, N., De Stefano, J., Audet, C., & Thériault, A. (2011). Professional identity among counselling psychology
doctoral students: A qualitative investigation. Counselling Psychology Quarterly, 24, 257-275.
doi:10.1080/09515070.2011.630572
Gazzola, N., De Stefano, J., Thériault, A., & Audet, C. (2013). Learning to be supervisors: A qualitative
investigation of difficulties experienced by supervisors-in-training. The Clinical Supervisor: An Interdisciplinary
Journal of Theory, Research, and Practice, 23, 15-39. doi:10.1080/07325223.2013.778678
Gazzola, N., De Stefano, J., Thériault, A., & Audet, C. (2014). Positive experiences of doctoral-level supervisors-in-
training conducting group-format supervision: A qualitative investigation. British Journal of Guidance and
Counselling, 42, 26-42. doi:10.1080/03069885.2013.799263
Geller, J. D., Farber, B. A., & Schaffer, C. E. (2010). Representations of the supervisory dialogue and the
development of psychotherapists. Psychotherapy: Theory, Research, Practice, Training, 47, 211-220.
doi:10.1037/a0019785
Glickauf-Hughes, C., & Campbell, L. F. (1991). Experiential supervision: Applied techniques for a case presentation
approach. Psychotherapy: Theory, Research, Practice, Training, 28, 625-634.
Gonsalvez, C. J., & Milne, D. (2010). Clinical supervisor training in Australia: A review of current problems and
possible solutions. Australian Psychologist, 45, 233–242. doi:10.1080/00050067.2010.512612
Greenberg, L. S. (1992). Task analysis: Identifying components of intrapersonal conflict resolution. In S. G.
Toukmanian & D. L. Rennie (Eds.), Psychotherapy processes research: Paradigmatic and narrative approaches
(pp. 22-50). Thousand Oaks, CA: Sage.
Greenberg, L. S., & Foerster, F. S. (1996). Task analysis exemplified: The process of resolving unfinished business.
Journal of Consulting and Clinical Psychology, 64, 439-446. doi:10.1037/0022-006X.64.3.439
Hadjistavropoulos, H., Kehler, M., & Hadjistavropoulos, T. (2010). Training graduate students to be clinical
supervisors: A survey of Canadian professional psychology programmes. Canadian Psychology/Psychologie
Canadienne, 51, 206-212. doi:10.1037/a0020197
Hahn, W. K. (2001). The experience of shame in psychotherapy supervision. Psychotherapy: Theory, Research,
Practice, Training, 38, 272-282. doi:10.1037/0033-3204.38.3.272
Hill, C. E., Charles, D., & Reed, K. G. (1981). A longitudinal analysis of changes in counseling skills during
doctoral training in counseling psychology. Journal of Counseling Psychology, 28, 428-436. doi:10.1037/0022-
0167.28.5.428
Holloway, E. L. (1997). Structures for the analysis and teaching of supervision. In C. E. Watkins, Jr. (Ed.),
Handbook of psychotherapy supervision (pp. 249-276). Hoboken, NJ: Wiley.
Hoffman, L. W. (1994). The training of psychotherapy supervisors: A barren scape. Psychotherapy in Private
Practice, 13(1), 23-42.
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(1), 3-13.
doi:10.1037/0022-0167.52.1.3
Hunsley, J., & Barker, K. K. (2011). Training for competency in professional psychology: A Canadian perspective.
Australian Psychologist, 46, 142-145. doi:10.1111/j.1742-9544.2011.00027.x

Jennings, L., Goh, M., Skovholt, T. M., Hanson, M., & Banerjee-Stevens, D. (2003). Multiple factors in the
development of the expert counselor and therapist. Journal of Career Development, 30(1), 59-72.
Johnson, E. A., & Stewart, D. W. (2000). Clinical supervision in Canadian academic and service settings: The
importance of education, training, and workplace support for supervisor development. Canadian
Psychology/Psychologie Canadienne, 41(2), 124-130. doi:10.1037/h0086862
Johnson, E. A., & Stewart, D.W. (2008). Perceived competence in supervisory roles: A social cognitive analysis.
Training and Education in Professional Psychology, 2(4), 229-236. doi:10.1037/1931-3918.2.4.229
Ladany, N., Friedlander, M. L., & Nelson, M. L. (2005). Critical events in psychotherapy supervision: An
interpersonal approach. Washington, DC: American Psychological Association.
Ladany, N., Hill, C. E., Corbett, M. M., & Nutt, E. A. (1996). Nature, extent, and importance of what psychotherapy
trainees do not disclose to their supervisors. Journal of Counseling Psychology, 43(1), 10-24. doi:10.1037/0022-
0167.43.1.10
Ladany, N., & Lehrman-Waterman, D. E. (1999). The content and frequency of supervisor self‐disclosures and their
relationship to supervisor style and the supervisory working alliance. Counselor Education and Supervision, 38,
143-160. doi:10.1002/j.1556-6978.1999.tb00567.x
Ladany, N., & Walker, J. A. (2003). Supervisor self‐disclosure: Balancing the uncontrollable narcissist with the
indomitable altruist. Journal of Clinical Psychology, 59, 611-621. doi:10.1002/jclp.10164
Lambert, M. J., & Hawkins, E. J. (2001). Using information about patient progress in supervision: Are outcomes
enhanced? Australian Psychologist, 36, 131-138.
doi:10.1080/00050060108259645
Larson, L. M., & Daniels, J. A. (1998). Review of the counseling self-efficacy literature. The Counseling
Psychologist, 26, 179-218. doi:10.1177/0011000098262001
Lehrman-Waterman, D., & Ladany, N. (2001). Development and validation of the Evaluation Process Within
Supervision Inventory. Journal of Counseling Psychology, 48, 168-177. doi:10.1037/0022-0167.48.2.168
Lyon, R. C., Heppler, A., Leavitt, L., & Fisher, L. (2008). Supervisory training experiences and overall supervisory
development in predoctoral interns. The Clinical Supervisor, 27, 268-284. doi:10.1080/07325220802490877
Majcher, J. A., & Daniluk, J. C. (2009). The process of becoming a supervisor for students in a doctoral supervision
training course. Training and Education in Professional Psychology, 3(2), 63-71. doi:10.1037/a0014470
Mander, G. (1997). Supervision of supervision: Specialism or new profession? Psychodynamic Counselling, 3, 291-
301. doi:10.1080/13533339708402494
McMahon, M., & Simons, R. (2004). Supervision training for professional counselors: An exploratory study.
Counselor Education and Supervision, 43, 301-309. doi:10.1002/j.1556-6978.2004.tb01854.x
Milne, D. (2006). Developing clinical supervision research through reasoned analogies with therapy. Clinical
Psychology & Psychotherapy, 13, 215-222.
Milne, D. L., & James, I. A. (2002). The observed impact of training on competence in clinical supervision. British
Journal of Clinical Psychology, 41(1), 55-72.
doi:10.1348/014466502163796
Milne, D., & Oliver, V. (2000). Flexible formats of clinical supervision: Description, evaluation, and
implementation. Journal of Mental Health, 9, 291-304.
Milne, D. L., Pilkington, J., Gracie, J., & James, I. (2003). Transferring skills from supervision to therapy: A
qualitative and quantitative N= 1 analysis. Behavioural and Cognitive Psychotherapy, 31, 193-202.

National Assembly of Quebec. (2009). Bill 21 (2009, chapter 28) An act to amend the Professional Code and other
legislative provisions in the field of mental health and human relations. Retrieved from
http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=5&file=2009C28A.PDF
O’Donovan, A., Halford, K., & Walters, B. (2011). Toward best practice supervision of clinical psychology trainees.
Australian Psychologist, 46, 101–112.
doi:10.1111/j.1742-9544.2011.00033.x
Patton, M. J., & Kivlighan, D. M., Jr. (1997). Relevance of the supervisory alliance to the counseling alliance and to
treatment adherence in counselor training. Journal of Counseling Psychology, 44(1), 108-115. doi:10.1037/0022-
0167.44.1.108
Peake, T., Nussbaum, B., & Tindell, S. (2002). Clinical and counseling supervision references: Trends and needs.
Psychotherapy: Theory, Research, Practice, Training, 39(1), 114-125. doi:10.1037/0033-3204.39.1.114
Pica, M. (1998). The ambiguous nature of clinical training and its impact on the development of student clinicians.
Psychotherapy: Theory, Research, Practice, Training, 35, 361-365. doi:10.1037/h0087840
Ray, D., & Altekruse, M. (2000). Effectiveness of group supervision versus combined group and individual
supervision. Counselor Education and Supervision, 40(1), 19-30.
doi:10.1002/j.1556-6978.2000.tb01796.x
Reichelt, S., Gullestad, S. E., Hansen, B. R., Rønnestad, M. H., Torgersen, A. M., Jacobsen, C. H., . . . & Skjerve, J.
(2009). Nondisclosure in psychotherapy group supervision: The supervisee perspective. Nordic Psychology,
61(4), 5-27. doi:10.1027/1901-2276.61.3.5
Russell, R. K., & Petrie, T. (1994). Issues in training effective supervisors. Applied and Preventive Psychology, 3(1),
27-42. doi:10.1016/S0962-1849(05)80106-4
Scaturo, D. J. (2012). Supervising integrative psychotherapy in the 21st century: Pressing needs, impressing
possibilities. Journal of Contemporary Psychotherapy, 42(3), 183-192.
doi:10.1007/s10879-011-9204-2
Scott, K. J., Ingram, K. M., Vitanza, S. A., & Smith, N. G. (2000). Training in supervision: A survey of current
practices. The Counseling Psychologist, 28, 403-422.
doi:10.1177/0011000000283007
Shanfield, S. B., Matthews, K. L., & Hetherly, V. (1993). What do excellent psychotherapy supervisors do?
American Journal of Psychiatry, 150, 1081- 1084.
Shulman, L. S. (2005). Signature pedagogies in the professions. Daedalus, 134(3), 52-59.
Skovholt, T. M., & Ronnestad, M. H. (2003). Struggles of the novice counselor and therapist. Journal of Career
Development, 30(1), 45-58. doi:10.1177/089484530303000103
Smythe, E. L. A., MacCulloch, T., & Charmley, R. (2009). Professional supervision: trusting the wisdom that
‘comes.’ British Journal of Guidance & Counselling, 37(1), 17-25.
Stoltenberg, C. (1981). Approaching supervision from a developmental perspective: The counselor complexity
model. Journal of Counseling Psychology, 28(1), 59-65.
doi:10.1037/0022-0167.28.1.59
Stoltenberg, C. D. (2004). Developmental approaches to supervision. In C. A. Falender & E. P. Shafranske (Eds.),
Casebook for clinical supervision: A competency-based approach. Washington, D.C.: American Psychological
Association.

Strupp, H. H., Butler, S. F., & Rosser, C. L. (1988). Training in psychodynamic therapy. Journal of Consulting and
Clinical Psychology, 56, 689-695.
doi:10.1037/0022-006X.56.5.689
Sundin, E. C., Ögren, M. L., & Boëthius, S. B. (2008). Supervisor trainees' and their supervisors' perceptions of
attainment of knowledge and skills: An empirical evaluation of a psychotherapy supervisor training programme.
British Journal of Clinical Psychology, 47(4), 381-396. doi:10.1348/014466508X304414
Watkins, C. E., Jr. (1991). Psychodiagnostic assessment supervision: What do we really know about it? Professional
Psychology: Research and Practice, 22(1), 3-4. doi:10.1037/h0092797
Watkins, C.E., Jr. (2012a). On demoralization, therapist identity development, and persuasion and healing in
psychotherapy supervision. Journal of Psychotherapy Integration, 22, 187-205. doi:10.1037/a0028870
Watkins, C. E., Jr. (2012b). Psychotherapy supervision in the new millennium: Competency-based, evidence-based,
particularized, and energized. Journal of Contemporary Psychotherapy, 42, 193-203. doi:10.1007/s10879-011-
9202-4
Watkins, C. E., Jr. (2013). Being and becoming a psychotherapy supervisor: The crucial triad of learning difficulties.
American Journal of Psychotherapy, 67, 134-150.
Watkins, C. E., Jr., & Scaturo, D. J. (2013). Toward an integrative, learning-based model of psychotherapy
supervision: Supervisory alliance, educational interventions, and supervisee learning/relearning. Journal of
Psychotherapy Integration, 23(1), 75-95. doi:10.1037/a0031330
Westefeld, J. (2009). Supervision of psychotherapy: Models, issues, and recommendations. The Counseling
Psychologist, 37, 296-316. doi:10.1177/0011000008316657
Wheeler, S., & King, D. (2000). Do counselling supervisors want or need to have their supervision supervised? An
exploratory study. British Journal of Guidance and Counselling, 28, 279-290.
Worthen, V. E., & Lambert, M. J. (2007). Outcome oriented supervision: Advantages of adding systematic client
tracking to supportive consultations. Counselling and Psychotherapy Research, 7(1), 48-53.
doi:10.1080/14733140601140873
Worthen, V., & McNeill, B. W. (1996). A phenomenological investigation of "good" supervision events. Journal of
Counseling Psychology, 43(1), 25-34. doi:10.1037/0022-0167.43.1.25
Yalom, I. D. (1998). The Yalom reader: Selections from the work of a master therapist and story-teller. New York:
Basic.
Yalom, I. D. (2002). The gift of therapy: An open letter to a new generation of therapists and their patients.
HarperCollins e-books.