Responses to Inquiries 
Carol Falender, Ph.D. and
Rodney Goodyear, Ph.D.

1. The model: What are the world trends in clinical supervision model(s) of clinical psychologists? What are the supervision models commonly adopted in developed countries like US, Canada, UK Australia and New Zealand, etc. 

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The trends are towards organized supervision models, and especially competency-based clinical supervision which has been adopted in part or totality in all the countries listed.

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2. The characteristics: What are the basic and essential characteristics a competency-based model that should always be maintained? What are the potential risks or malpractices that need to be avoided? What are acceptable but not essential characteristics, especially for the purposes of evaluating different supervision models that meet basic standard?

Competency-based clinical supervision is defined as: 

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“a metatheoretical 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 metatheoretical and does not preclude other models of supervision.” (APA Guidelines for Clinical Supervision of Health Service Psychologists, 2014, p. 5)

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Essential components are Supervision Competence, Multicultural Diversity, Supervisory Relationship, Professionalism, Assessment, Evaluation, Feedback; Professional Competence Problems of the Supervisee; Ethical, Legal, and Regulatory Considerations. 

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An essential aspect is the assessment, monitoring, and tracking of supervisees’ actual independent clinical practice with clients/patients.  Supervisees use self-assessment and supervisors provide ongoing feedback, assessment, and evaluation and collaboratively shape goals for the supervisee’s development. 

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Supervisors also use Routine Outcome Monitoring of client self-reported symptoms and presentation and client-therapist alliance measures to track client care and outcomes. 

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Risk of malpractice should not be great as the supervisor is overseeing the clinical work.  Ideally, the supervisor has access to audio or video recording of sessions at several points during the training sequence and reviews these with the supervisee. 

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Competency-based clinical supervision is metatheoretical and thus is applicable to psychotherapy-based models, process models, developmental models, and essentially all models of clinical supervision.  A way to evaluate various supervision models is to assess the intentional and systematic quality of each.

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3. Apprenticeship supervision model (Note 1): Why apprenticeship supervision is an outdated model and where is it still being practiced in the international community? What leads to the replacement of apprenticeship supervision by the competency model? Is it a result driven by research? Or is case law that leads to the competency model become a commonly adopted one? 

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The supervision community as well as psychiatry, psychology, medicine in general, nursing, and mental health generally have transformed to an outcome model.  Emphasis is on the supervisee’s direct independent clinical practice. Emphasis also is on the autonomy of the supervisee as he/she progresses to independent practice.   This model is driven by empirical research, and is described as the “zeitgeist” of clinical training currently.  Colleagues in the U.S., Australia, Canada and U.K. are pursuing research protocols.    

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4. On-site supervision (Note 2): What are the defining/essential characteristics of on-site supervision? Does the approach using primary and delegated supervisors (Note 3) meet the criteria of on-site supervision? 

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Generally, it is important to have either an on-site supervisor or access to a supervisor through some electronic means (telephone, email, text) in case of emergency.  

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5. What are the pros and cons of the following forms of clinical supervision practices; and the impacts on the implementation of the competency-based model for each practice. 

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a) Apprenticeship supervision; 
b) Delegated supervision using a primary supervisor and a delegated supervisor; 
c) Supervision via site-employed clinical psychologist as supervisor for the intern; 

a) Apprenticeship supervision is not a viable option in the competency-based era.  It is essential that the supervisee develop independent functioning as a clinician in order to be prepared for independent practice. 

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b) Delegated supervision—the meaning in the U.S. is that the primary supervisor delegates some responsibilities to the delegated supervisor but oversees them and maintains primary responsibility.  That is a standard in many states in the U.S.

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c) Supervision via site-employed clinical psychologist.  This is a good model as the supervisor is familiar with the setting, issues that arise, and may be called upon as needed.

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6. As the clients’ interest and feedback are important for the whole supervision process in the development of the supervisee, what are the implications for the future development of clinical supervision? 

We strongly believe that Routine Outcome Monitoring is an essential aspect of clinical supervision as is tracking of the Therapist-Client alliance or relationship.  Using these measures in clinical supervision is an extremely important practice.  

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Notes

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Note 1: Apprenticeship Supervision Model: the practice of pairing a clinical psychologist who is employed in the hospital/agency with a trainee who shadows the clinical psychologist at all times, including the provision of standardized psychological assessments and psychotherapy. 

In Hong Kong, some training programs advocate for such model with the justification that since trainees will inevitably make mistakes, patients being treated by a trainee must be protected from harm, and so it is necessary for this intensive presence and watchfulness. They called this model on-site supervision, but literatures seem to refer this model as the apprenticeship model. So we used the common name here to call this model.

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Note 2: In Hong Kong, the concept of on-site supervision is not clear as some programs claim the apprenticeship model as on-site supervision.

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Note 3: CSPP-HK currently adopts the approach of primary and delegated supervisors for supervision. The primary supervisor is a doctoral clinical psychologist from the faculty of CSPP. The delegated supervisor is a qualified mental health professional employed by the internship agency providing supervision on-site to the trainee. This approach is indicated as an acceptable way for supervision in the US. The following is an excerpt from page 98 of the “California Board of Psychology Laws and Regulations (2015)” document, specifying the requirement:

(c) Delegated Supervision Requirements: (1) Except as provided in 1391.5, which regulates the supervision of psychological assistants, primary supervisors may delegate supervision to other qualified   psychologists or to other qualified mental health professionals including licensed marriage and family therapists, licensed educational psychologists, licensed clinical social workers and board certified psychiatrists. (2) The primary supervisor remains responsible for providing the minimum one hour per week of direct, individual face to face supervision. (3) The primary supervisor remains responsible for ensuring compliance with this section.