Current Trend in Clinical Supervision
Clinical Supervision - Current Status
Presentation for HKADCP Aug 2018
Presenters: Carol Falender, Ph.D. and Rodney Goodyear, Ph.D.
中文 ｜ Eng
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.
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.
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:
“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)
Essential components are Supervision Competence, Multicultural Diversity, Supervisory Relationship, Professionalism, Assessment, Evaluation, Feedback; Professional Competence Problems of the Supervisee; Ethical, Legal, and Regulatory Considerations.
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.
Supervisors also use Routine Outcome Monitoring of client self-reported symptoms and presentation and client-therapist alliance measures to track client care and outcomes.
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.
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.
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?
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.
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?
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.
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.
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.
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.
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.
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.
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.
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.
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.
Carol Falender, Ph.D. and
Rodney Goodyear, Ph.D.
1. 督導模式: 臨床心理學家督導模式的世界趨勢是什麼？ 發達國家, 如美國，加拿大，英國，澳洲，新西蘭等普遍採用什麼督導模式？
2. 督導模式的特點：能力為本臨床督導模式應保持的必要特性是什麼？需要避免哪些潛在風險或不當行為？對於評估不同督督模式是否符合基本標準, 有什麼特性是可接受但非必要的？
“是一個跨理論的督導模式，把臨床的能力清晰的劃分為知識、技能和態度三個方面， 以此框架制定學習策略及評估方法。 目的是使學員能達到規範標準所要求的能力水平， 這些規範標準是基於有實證 支持的實務方法和法規，同時考慮和配合個別文化風俗的情景來訂定的。”能力為本臨床督導是一種督導取向;它是一個跨理論的督導模式，可按情況和需要與其他督導模式融合使用 (美國心理學會健康服務心理學家臨床督導指南, 2014, p.5) 。
必要的元素是督導的能力，多元文化的多樣性，督導關係，專業規範，評估，考量，反饋; 受督導者的專業能力問題; 專業倫理，法律和監管因素。
由於能力為本的臨床督導是一個跨理論的模式, 因此適用於基於心理治療的模式，過程模式，發展模式，以及基本上所有的臨床督導模式。 而對於採用各種督導模式的考量, 在於評量每個督導模式的目標取向和系統結構的因素。
3. 學徒督導模式（注1）：為什麼學徒督導模式是過時的督導模式? 學徒督導模式在哪一個地區仍然使用？ 什麼導致能力為本的臨床督導模式取代學徒督導模式？ 是否基于研究結果？ 還是根據案例而導致能力為本的臨床督導成為普遍採用的模式？
5. 以下臨床督導模式的利弊是什麼; 如對以下模式實施能力為本的臨床督導模式,有什麼影響?
b) 委任督導。 美國的定義是指主任督導師將某些職責委託給委任督導師，但主任督導師負責監督他們(委任的督導師)及承擔主要責任。這是美國許多州份的標準。
注1: 學徒督導模式: 這種模式的做法是在醫院/機構工作的臨床心理學家督導師，在任何時候都需陪伴臨床心理學實習生的配對做法，包括提供標準的心理評估和心理治療。
注3: CSPP-HK目前採用主任督導師及委任督導師的方式進行督導。 主任督導師是隸屬CSPP專業學院的博士臨床心理學家。委任督導師是在實習機任職的合資格心理健康專業人員，為實習生提供現場督導。 在美國，這種方法被認定為是可接受的督導方式。 以下是“加州心理學委員會法律法規（2015）”文件第98頁的摘錄，其中制定了以下條款：
(c) 委任督導條款:（1）除了規範助理心理師的條款1391.5外，主任督導師可將督導工作委託給其他合資格心理學家，或合資格的心理健康專業人士，包括持牌婚姻及家庭治療師，持牌教育心理學家，持牌社工及委員會認證的精神科醫生等; （2）主任督導師仍負責每周至少提供一小時的直接，個人面對面督導; （3）主任督導師仍然有責任確保遵守本節規定。
Clinical Supervision defined
Clinical supervision has been defined by Powell, D. &Brodsky A. (2004) as “a disciplined, tutorial process wherein principlesare transformed into practical skills,with four overlapping foci: administrative,evaluative, clinical and supportive.” In brief, for the purpose of this Scheme, it is an accountable and systematic process in which a senior clinical psychologists or/ and respectful professional peer psychologist as a supervisor provides to our clinical psychologist as a supervisee and a participating member of the Association a support and intervention with the aim of enhancing his or her professional functioning and core competence in terms of case management, clinical effectiveness, skills and professional development.