Transtheoretical. (or . Metatheoretical. ) Approach. Carol Falender, Ph.D.. Edward P. Shafranske, Ph.D., ABPP. American Psychological Association Task Force on Supervision Definition. Competency-based supervision is . ID: 562255
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Competency-based Clinical Supervision: A Transtheoretical (or Metatheoretical) Approach
Carol Falender, Ph.D.
Edward P. Shafranske, Ph.D., ABPPSlide2
American Psychological Association Task Force on Supervision Definition
Competency-based supervision is
approach that explicitly identifies the knowledge, skills and attitudes that comprise clinical competencies, informs learning strategies and evaluation procedures, and meets criterion-referenced competence standards consistent with evidence-based practices (regulations), and the local/cultural clinical setting (adapted from Falender & Shafranske, 2007). Competency-based supervision is one approach to supervision; it is
and does not preclude other models of supervision. (APA, 2014)Slide3
Transtheoretical or Metatheoretical
Our use of
differs significantly from
and Norcross (2007), and refers to its application as a framework for any other model of clinical supervision as well as on its own (Falender & Shafranske, in press). As such it offers a
approach across different models of supervision.
& Calvert (2014) described competency-based models as
as they can be integrated with other models (psychotherapeutic and developmental) and provide a molecular model, “starting with the end in mind” (p. 202)Slide4
Competency-based Clinical Supervision
Competency-based clinical supervision entails an intentional, systematic approach to the multiple competencies— knowledge, skills, and attitudes
It includes observation, collaborative
assessment and feedback on the assessment; experiential learning and skill development, instruction
, modeling, and mutual problem solving;
ongoing assessment, feedback
Competency-based Clinical Supervision
Competency-based supervision’s intentional, systematic approach is in contrast to psychotherapy-driven or other supervision approaches are not comprehensive in all the components essential to clinical supervision
Essential is the interplay of self-assessment, supervisor collaborative assessment and feedback with the collaborative development of a training contract articulating discrete competencies to be attained and means to achieve those.Slide6
The Learning Cycle (Falender & Shafranske, 2016)
Shafranske & Falender, in press
The Learning CycleSlide7
Complexity of Supervision
Supervisor competence—to make valid entrustment decisions about supervisee
Competence clinical practice under supervision
(e.g., populations, theories, assessment, interventions, models, multiculturalism, context, research, evidence-base)
Competence in clinical supervision
(e.g., competencies outlined in APA Supervision Guidelines)Slide8
Clinical Supervision, Training, and Professional Development Research Center, at Pepperdine University
Three Studies on Counterproductive Supervision that frame essential need for change in clinical supervision
. Q-sort by current graduate students
i. Q-sort by experts in clinical supervision
Iii. Q-sort by practicing supervisors
Study (Wall, 2009) found high frequency of non-adherence to ethical practices affected alliance
Four studies on impact of supervisory alliance on supervisee disclosureSlide9
Current Graduate Students (rank order)
Inadequate Understanding of Performance Expectations for Supervisee and Supervisor/Role Conflict
Failure to Address Needs of Supervisee
Supervisor Supervision Approach and Supervisee Learning Approach Mismatch
Additional Counterproductive Experiences
Inadequate Attention to Ethics, Ethical Lapses, and Unethical Behavior
Supervisor/Supervisee Theoretical Orientation Mismatch
Inappropriate Supervisor Self-DisclosureSlide10
We are Very Poor at Self-Assessment
25% of mental health professionals viewed their skill to be at the
when compared to their peers, and none viewed themselves as
below average (defying statistical probabilities)
Review of therapist lack of skill in identifying clients who got worse
, McAlister, O’Donnell, & Lambert, 2012
…all the children are above average?
Expert performers actively sought more feedback than moderate performers (
We do not systematically teach supervisees self-assessment or provide feedback to increase accuracy
We believe a core component of competency-based supervision is competence of the supervisor to assess supervisee “
” and to systematically address the multiple aspects of clinical supervision as they relate to clinical practiceSlide12
Complexity of Supervisor Competence
Concept of “
” of supervisee
Truthfulness and honesty
Recognizing limitations and asking for help
Empathy, openness towards patients
Habits of self-evaluation, reflection, development
Knowing how to deal with mistakes by self and others
Ten Cate et al., 2016Slide13
Dr. Hass, a 57 year old Caucasian male, prefaced supervision that has been supervising for over 20 years, and launched right in with Alberta, a 27 year old self described “African-American digital native.” In response to Alberta’s persistent efforts to structure supervision, Dr. Hass told her he simply works from theory and all else falls into place. He finds goals cumbersome, and urged her simply to begin discussing her client cases. Quickly he began reflecting about several aspects of client dynamics and they have only covered the one case in the first three weeks, her efforts notwithstanding. He refers to her as “Amanda.”Slide14
Strengths and What is Missing?Slide15
Essentially, study of clinical supervision is compromised without consensus on its definition, lack of formal training—and highly variable training if any—and debate whether supervision
distinct professional practice
Movement towards agreement on definition?Slide16
First Step: Components
Self-assessment and collaborative assessment of supervisee competence and ongoing feedback
Addressing strains and ruptures to relationship
Diversity and multiculturalism
Reactivity or countertransference, self-care
Legal and ethical standards/aspects
Addressing performance/competence problemsSlide17
Adoption of Competency-based Supervision model by multiple countries including Australia and New Zealand
Intersection of competency-based and psychotherapy model for Motivational Interviewing
Bassett, Martin, & Clarke, 2015
Skill sets associated with client outcomes
et al., 2015
Use of symptom checklists, therapeutic alliance associated with enhanced client outcomesSlide18
Do supervisors matter?
-Wagner, Whipple, &
Are we throwing away the baby with the proverbial bath water focusing so intensively on client outcomes and failing to attend to the therapist’s contributions?
Miller, Hubble, Chow, & Seidel, 2015
Or the supervisory contributions? (F & S)
Need to consider the therapist’s contribution—supervisee, supervisor AND systematic, intentional processSlide19
Train supervisees in role invocation—to be successful supervisees as an entrée into the supervision process (
et al., Falender & Shafranske, 2012)
Train supervisors, use of supervisor competence assessment to ensure intentional, ethical supervision practice
Assess supervisor competence and develop a protocol for supervisors to self-assess and model development of their own goals for the training sequenceSlide20
Track supervisee supervision outcomes and client outcomes as a matter of course—and use these as feedback to inform supervision/treatment
Through practice and guidelines adoption, increase value attached to clinical supervision in our profession, settings, and more generallySlide21Slide22
American Psychological Association. Board of Educational Affairs. (2014) Guidelines for clinical supervision for health service psychologists. Retrieved from:
, S. K., Weisz, J. R., Chorpita, B. F.,
, K., Ward, A.,
, A. M., & Bernstein, A. (2013). More practice, less preach? The role of supervision practices and therapist characteristics in EBP implementation.
Administrative Policy in Mental Health
, C. A., & Shafranske, E. P. (2007). Competence in competency-based supervision practice: Construct and application.
Professional Psychology: Research and Practice, 38
Falender, C. A. & Shafranske, E. P. (in press).
Supervision essentials for the practice of competency-based supervision.
American Psychological Association
, C. J., & Calvert, F. L. (2014). Competency-based models of supervision: Principles and applications, promises and challenges.
Australian Psychologist, 49
, J. O., & Norcross, J. C (2009). Systems of psychotherapy: A
ed.). Belmont, Ca.: Brooks Cole
Shafranske, E. P., & Falender, C. A., (in press). Clinical Supervision. In J. C. Norcross, G. R.,
& D. K.
APA Handbook of Clinical Psychology Volume V: Education and Profession
. Washington, DC: American Psychological Association.
, L. A. R., Clair, M.,
-Bassett, S., Martin, R. A., & Clarke, J. G. (2015). Studying process and proximal outcomes of supervision for motivational interviewing.
Training and Education in Professional Psychology, 9
Ten Cate, O., Hart, D.,
, J., Englander, R., Glasgow, N,….Wycliffe-Jones, K. (2016). Entrustment decision making in clinical training.
Academic Medicine, 91
, S., McAlister, B., O’Donnell, P., & Lambert, M. J. (2012). An investigation of self-assessment bias in mental health providers.
Psychological Reports, 110
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