COUNSELING AND PSYCHOTHERAPY:
INVESTIGATING PRACTICE FROM SCIENTIFIC,
HISTORICAL, AND CULTURAL PERSPECTIVES
A Routledge book series
Editor, Bruce E. Wampold, University of Wisconsin
This innovative new series is devoted to grasping the vast complexities of the practice of counseling
and psychotherapy. As a set of healing practices delivered in a context shaped by health delivery
systems and the attitudes and values of consumers, practitioners, and researchers, counseling and
psychotherapy must be examined critically. By understanding the historical and cultural context of
counseling and psychotherapy and by examining the extant research, these critical inquiries seek a
deeper, richer understanding of what is a remarkably effective endeavor.
Published
Counseling and Therapy with Clients Who Abuse Alcohol or Other Drugs
Cynthia E. Glidden-Tracy
The Great Psychothearpy Debate
Bruce Wampold
The Psychology of Working: Implications for Career Development, Counseling, and Public Policy
David Blustein
Neuropsychotherapy: How the Neurosciences Inform Effective Psychotherapy
Klaus Grawe
Principles of Multicultural Counseling
Uwe P. Gielen, Juris G. Draguns, Jefferson M. Fish
Beyond Evidence-Based Psychotherapy: Fostering the Eight Sources of Change in Child and Adolescent
Treatment
George Rosenfeld
Cognitive Behavioral Therapy for Deaf and Hearing Persons with Language and Learning Challeneges
Neil Glickman
The Pharmacology and Treatment of Substance Abuse: Evidence and Outcome Based Perspectives
Lee Cohen, Frank Collins, Alice Young, Dennis McChargue, Thad R. Leffingwell, Katrina Cook
IDM Supervision: An Integrated Developmental Model for Supervising Counselors and Therapists,
Third Edition
Cal Stoltenberg and Brian McNeill
Forthcoming
The Handbook of Therapeutic Assessment
Stephen E. Finn
The Great Psychotherapy Debate, Revised Edition
Bruce Wampold
Culture and the Therapeutic Process: A guide for Mental Health Professionals
Mark M. Leach and Jamie Aten
An Integrative Developmental Model
for Supervising Counselors and Therapists
T H IR D EDIT IO N
Cal D. Stoltenberg and Brian W. McNeill
New York London
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Library of Congress Cataloging-in-Publication Data
Stoltenberg, Cal D.
IDM supervision : an integrative developmental model for supervising
counselors and therapists / Cal D. Stoltenberg and Brian W. McNeill. -- 3rd ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-8058-5824-2 (hardback : alk. paper) -- ISBN 978-0-8058-5825-9
(pbk. : alk. paper)
1. Psychotherapists--Supervision of. 2. Counseling. I. McNeill, Brian, 1955-
II. Title.
RC459.S76 2009
616.89--dc22 2009011051
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ISBN 0-203-89338-7 Master e-book ISBN
Dedicated to Ursula Delworth.
Contents
•
Series Preface xiii
1
Theoretical Foundations 1
Cognitive Models 4
Cognitive Processing 6
Schema Development and Refinement 7
Skill Development 10
Expert Versus Novice 12
Interpersonal Influence and Social Intelligence 14
Motivation 16
Models of Human Development 18
2
An Overview of the IDM 21
Overarching Structures and Specific Domains 22
Overriding Structures 23
Specific Domains 25
Structures Across Levels of Therapist Development 27
Level 1 27
Level 2 33
Level 3 37
Level 3i (Integrative) 39
Interaction of Structures and Domains 40
The Level 1 Therapist 41
The Level 2 Therapist 42
The Level 3 Therapist 43
The Level 3i Therapist 44
vii
viii Contents
3
The Level 1 Therapist 45
The Entry-Level Trainee 45
Learning and Cognition 46
Motivations for Entering the Field 46
Advanced Supervisees 47
Level 1 Structures 48
Self- and Other-Awareness 48
Motivation 50
Autonomy 51
Structures Across Domains 52
Intervention Skills Competence 52
Assessment Techniques 55
Interpersonal Assessment 55
Client Conceptualization 58
Individual Differences 59
Theoretical Orientation 60
Treatment Plans and Goals 61
Professional Ethics 62
Supervising the Level 1 Therapist 63
General Considerations 64
Client Assignment 66
Interventions 67
Supervisory Mechanisms 70
Final Considerations 73
Sublevel 1 Trainees 74
Other Considerations 78
Transition Issues 80
4
The Level 2 Therapist 83
Learning and Cognition 86
Level 2 Structures 87
Self- and Other-Awareness 87
Autonomy 90
Motivation 92
Interaction of Domains and Structures 93
Intervention Skills Competence 94
Assessment Techniques 94
Contents ix
Interpersonal Assessment 95
Client Conceptualization 95
Individual Differences 96
Theoretical Orientation 97
Treatment Plans and Goals 98
Professional Ethics 98
Supervising the Level 2 Therapist 99
Therapeutic Adolescence 100
Client Assignment 101
Supervisor Interventions 102
Normalizing the Level 2 Experience 108
Supervisory Mechanisms 108
Transitional Issues 111
5
The Level 3 Therapist 113
Constraints on Supervision 114
Learning and Cognition 115
Level 3 Structures 117
Self- and Other-Awareness 117
Motivation 119
Autonomy 120
Structures Across Domains 121
Intervention Skills Competence 121
Assessment Techniques 122
Interpersonal Assessment 123
Client Conceptualization 124
Individual Differences 125
Theoretical Orientation 126
Treatment Plans and Goals 127
Professional Ethics 127
Supervising the Level 3 Therapist 127
General Considerations 128
Client Assignment 131
Interventions 131
Supervisory Mechanisms 132
Beyond Levels 134
x Contents
6
The Supervisory Relationship 137
Theory and Research in Supervisory Relationships 138
Supervisory Relationships Across Levels 144
Level 1 144
Level 2 145
Level 3 148
Supervisory Relationships With Diverse Therapists 150
7
Nuts and Bolts of Supervision 157
Supervision Standards 157
Who Can Supervise? 158
What Constitutes an Acceptable Activity? 158
Documentation and Formats 160
Supervisor Responsibilities 161
Enhancing General Skill Development 163
Scientist–Practitioner Methods of Supervision 168
Supervisee Qualities 170
Supervision Plan 171
Evaluation 172
Setting the Stage in Initial Sessions 173
Supervisee Assessment and Evaluation 174
Therapeutic Effectiveness of Supervisees 175
Qualitative Assessment Across Domains 177
Methods of Assessment 179
Work Samples 179
Supervisee Perceptions 180
Supervisor Perceptions 181
Providing Therapist Feedback 182
Group Supervision 184
8
Supervision Across Settings 187
Ursula Delworth
The Supervision-in-Context Model 187
Components 189
Function 190
Utility 190
Contents xi
Settings 193
Challenges of Managed Care 196
9
Supervisor Development and Training 199
Levels of Supervisor Development 200
Level 1 201
Level 2 203
Level 3 205
Level 3i 206
Recommendations for Supervisor Training 207
Conceptual and Didactic Training 209
Experiential Training 212
Supervisor Assessment 213
Supervision in Field Settings 214
10
Ethical and Legal Issues 217
Ethical Codes and Guidelines 217
Ethical Knowledge and Behavior 219
Competence 221
Professional Competencies 221
Competence to Supervise 224
Additional Ethical and Legal Concerns 225
Personal Functioning 227
Implications for Specific Levels 228
11
A Qualitative Examination of the IDM 231
Rachel Ashby, Cal Stoltenberg, Paul Kleine
Empirical Evidence of Counselor Development 232
The Intent of the Study 233
Our Method 234
What We Found 236
Support for the Model 237
Intervention Skills Competence 237
Interpersonal Assessment 240
Theoretical Orientation 244
Limited Support for the Model 246
xii Contents
Treatment Plans and Goals 246
Individual Differences 248
Discussion 249
Epilogue 263
Appendix A: Case Conceptualization Format 267
Appendix B: Practicum Competencies Outline: Overview 271
Appendix C: Supervisee Information Form 277
References 281
Index 297
Series Preface
•
This series is devoted to understanding the complexities of the practice of
counseling and psychotherapy. As a set of healing practices, delivered in a
context molded by health delivery systems and the attitudes and values of
consumers, practitioners, and researchers, counseling and psychotherapy
must be examined critically. Volumes in this series discuss counseling and
psychotherapy from empirical, historical, anthropological, and theoretical
perspectives. These critical inquiries avoid making assumptions about the
nature of counseling and psychotherapy and seek a deeper understanding of
the bases of what is a remarkably effective endeavor.
We know that psychotherapy is a remarkably effective practice—more
effective than many medical treatments and as effective as psychopharma-
cotherapy for many mental disorders. We also know that the therapist is the
key to the effectiveness of psychotherapy. We know relatively less about the
process of becoming an effective therapist. Nevertheless, Stoltenberg and
McNeill, in this edition of Integrative Developmental Model of Supervision,
have created a model that is based on clinical research as well as the larger
domain of what is known about expertness. What results is a coherent,
grounded, and, most importantly, useful model of supervision. This vol-
ume provides the basis of supervision that will be informative for use in
training programs, for supervisors, in psychotherapy, and for counselors
in training. The integrative developmental model (IDM) recognizes that
clinical expertise is created in the complex system of client, therapist,
and supervisor and involves a long developmental journey from neophyte
therapist to effective master therapist. This is not simply a journey for
the trainee from novice to skilled, but a personal journey as well. The IDM
is a comprehensive guidebook to the professional and personal journey for
those involved in the field, regardless of their theoretical orientation and
professional affiliation.
xiii
1
Theoretical Foundations
•
The model of clinical supervision we will examine in this book has been in
development for more than 25 years. Research conducted on the supervision
process and our years of experience actively supervising trainees provide the
basis for the evolving model we call the Integrative Developmental Model
of supervision. For a model or theory to remain relevant and useful, it must
reflect recent research and guidance from theories in other areas as well as
work within this field. Thus, we have attempted to use what we have learned
through research in clinical supervision as well as other disciplines, and the
understanding of the process we have gained through our experiences as
practicing psychologists and educators.
Before we get to the nuts and bolts of how one engages in the process of
clinical supervision, we think it is important to examine what other areas
of knowledge have to offer our understanding of the processes of learning
and development. We realize some individuals reading this book will want
to move quickly to the how-to chapters. We hope, however, that you will
find the perspectives presented from other areas of psychology to be useful
in understanding how trainees learn and develop into skilled professionals.
Indeed, in many ways, the process for learning and the acquisition of desired
skills in counseling and psychotherapy are not unique to the mental health
field, but rather reflect general principles of learning and development that
supervisors would be wise to consider.
Our goal is to offer the most comprehensive model of supervision pos-
sible. In order to accomplish this task, we believe it is necessary to build
upon theory and research from other related fields, examine some historical
approaches to training, and build an understanding of how one progresses
from novice to expert in professional practice. This foundation will then
1
2 IDM Supervision: An Integrative Developmental Model
allow us to attend to the changes in characteristics and needs of trainees
over time and across domains of professional practice, enabling us to provide
learning environments that will enhance development.
Understanding change over time in the ability to function as a profes-
sional is fundamental in the practice of clinical supervision. Early models of
clinical supervision, as documented by Bernard and Goodyear (2004) and
discussed by Stoltenberg (2008a), relied heavily on psychotherapeutic pro-
cesses to describe how to become a psychotherapist. This approach can be
useful in providing some guidance to the process of clinical supervision and
training, but its applicability tends to be limited to helping the supervisee
work through personal issues that stand in the way of effective functioning.
Even then, not all models of therapy allow for effective brief interventions for
personal blocks and issues that do not subsequently have a negative impact on
the supervisory relationship. It is well known that dealing in detail with these
blocks or disorders is best left to the supervisee’s therapist, not the supervi-
sor. As has been noted elsewhere (Stoltenberg & Pace, 2008), to the extent
that the goals, processes, and roles of the therapeutic approach approximate
those of supervision, the models can be useful translations. For example, as
Bernard and Goodyear (2004) have observed, person-centered approaches to
supervision that emphasize facilitative conditions (e.g., warmth, genuineness,
empathy) fit well with the goal of creating positive relationship conditions
in supervision. This is particularly true to the extent that the working alli-
ance in supervision (Bordin, 1979, 1983) functions similarly to the work-
ing alliance in therapy (Horvath & Symmonds, 1991). Pearson (2006) sees
parallels between the focus on growth and change in the client through
psychotherapy and the growth and change in the supervisee in supervision.
However, Bernard (1992) and Bernard and Goodyear (2004) emphasize the
greater education function of supervision compared with psychotherapy. We
have previously warned against supervisors falling into the habit of psycho-
therapy-based behaviors in supervision, which can result in ethical problems
(Stoltenberg, McNeill, & Delworth, 1998).
The roles of counselor/psychotherapist and supervisor differ, as do the
goals and, as we shall see, the techniques and interventions. As such, we
strongly believe that counseling and supervision, while sharing some com-
monalities, are separate domains requiring training in each, and simplistic
extrapolations of psychotherapeutic orientations to the supervision domain
lack credibility as well as empirical validation.
Process-based models (Bernard & Goodyear, 2004) or social role mod-
els (Holloway, 1992) view supervision as components (roles, tasks, etc.)
Theoretical Foundations 3
that define and describe the process of supervision. Common across these
approaches are the roles of teacher, counselor, and consultant (Bernard, 1979;
Hess, 1980); sometimes evaluation and client monitoring are added to these
roles (Williams, 1995; Holloway, 1995; Carroll, 1996). The roles are viewed
as general mechanisms for engaging supervisees in specific tasks and processes
for specific contexts. Little empirical support exists for these models in gen-
eral, although most of the work has been done on Bernard’s Discrimination
Model, which suggests that the roles of teacher and counselor are broadly
viewed as useful constructs (Bernard & Goodyear, 2004).
Another common approach to training and supervision conceptualizes
the learning process as simple skills or competence acquisition and assumes
that the process is largely one of acquiring new information and skills, which
are added to existing knowledge and proficiencies. Thus, the individual col-
lects pieces of information, techniques, and concepts and is able to become
a better therapist by having a larger armamentarium of tools from which to
draw in working with clients. Early research on skills training approaches
indicated that skills could be learned (Cormier, Hackney, & Segrist, 1974),
but that they may not generalize well across contexts (Spooner & Stone,
1977) and also may decay over time (Mahon & Altmann, 1977; McCarthy,
Danish, & D’Augelli, 1977). Hill (2004) has found that counseling skills
are used in sessions by therapists and do seem to have a limited effect within
given sessions. Although this model may be adequate for entry-level counsel-
ors or experienced therapists acquiring training in new areas, it is insufficient
to describe higher-order knowledge acquisition and therapist development.
This additive model would suggest that therapists will continue to improve in
a linear manner directly related to increasing knowledge and experience. Our
professional experience, as well as the empirical literature, suggests that this
simply does not occur (Stoltenberg, McNeill, & Crethar, 1994). A conceptual
extension of these approaches is the competency movement in professional
psychology (for example, the supervision model of Falender and Shafranske,
2004). Kaslow (2004) has focused on the acquisition of knowledge, skills,
and attitudes, while Rodolfa and colleagues (Rodolfa et al., 2005) focus on
foundational competencies (e.g., ethics, diversity issues, science of psychol-
ogy) that affect the development of functional competencies (e.g., interven-
tion, assessment, consultation, research). This work has also been extended
to supervision competencies (Falender et al., 2004). Although these efforts
offer promise in delineating behaviors and expectations for various levels
of training, they do not address how these skills, knowledge, and attitudes
are developed.
4 IDM Supervision: An Integrative Developmental Model
Professional (and, for that matter, personal) growth tends to follow a
less linear path. Although there will be periods of rather smooth growth
in knowledge, skills, and proficiencies, change over time tends to occur in
spurts interspersed with periods of delay (and sometimes regression). Thus,
the metaphor of development has been useful in understanding how trainees
change as individuals and therapists. Of additional importance is an under-
standing of how cognitive processing and motivation affect learning. We will
briefly explore the role of cognition, motivation, and attitudes in learning
and behavior. We then consider how developmental processes provide an
overarching framework that sets the stage for a developmental model of clini-
cal supervision.
Cognitive Models
Considerable new understanding of the processes of learning and cognition
has occurred over the past couple of decades through the ongoing process of
building theories, examining them through research, and altering the theo-
ries accordingly. It is not our purpose here to exhaustively review this infor-
mation, but we would be remiss in not considering what this research has to
say about supervising and training psychotherapists. Anderson (2005) has
effectively summarized what is known about the development of expertise,
which is directly related to what supervisors hope to accomplish in supervision
and training activities. The theory describes the transformation of knowledge
from discrete pieces of knowledge to condition–action pairs that become
increasingly complex over time, leading to expertise. Similar to models of
development that are discussed later, in this theory three stages explain how
people learn skills. The first is a cognitive stage during which a declarative
verbal or image representation of a procedure is learned, allowing for a rudi-
mentary understanding of what is to be accomplished. Here, a collection of
facts relevant to the skill being developed are committed to memory. Initial
use of the memorized knowledge is quite slow, as it is still in the declarative
form and thus must be retrieved and interpreted when performing the skill.
In the second, associative, stage, the errors in how the individual initially
understands a procedure are gradually identified and altered to enable a more
effective application of the skill. Also, the connections among the elements
necessary to effectively perform the skill are strengthened. This refinement
occurs over time, reflecting the adaptive aspect of the process. This adaptive
process can be facilitated by the individual carefully examining his or her
Theoretical Foundations 5
success in skill performance and/or receiving feedback from others, correct-
ing the errors in understanding, and streamlining the procedures. Also, the
strengthened connections among the required elements allow for successful
performance of the skill. Thus, procedural knowledge develops, which gov-
erns the performance of the skill. Here, rather than recalling the declarative
information in bits and pieces, the skill can be implemented in a single step,
which is the goal of this stage. The individual doesn’t mentally rehearse the
components of a skill, but rather quickly recognizes what should be done
in the specific situation (condition–action pairs, pattern-driven recognition).
Of course, the quality of the step is very important. Bad or insufficient pro-
cedures can and do develop, so it is necessary for the individual to care-
fully evaluate the effectiveness of the procedures in skill development. It is
also very important that the feedback provided regarding the procedure be
accurate, carefully constructed, and well communicated, as well as attended
to by the individual. Thus, instruction and supervision (and encouraging
reflection) must be conducted with vigilance in this stage. Finally, it is also
important for the individual to have varied experiences during skill develop-
ment after basic skills are acquired; without this, he or she runs the risk that
schemata reflecting restrictive stereotypes will hinder continued movement
toward expertise. During the final, autonomous stage, the student practices
and becomes more proficient (and quicker) in performing the skill until it
becomes more automatic under the correct conditions and requires less pro-
cessing. Past a critical point, additional practice yields limited additional
proficiency. However, spacing practice over time, separating out indepen-
dent parts of a skill and learning them independently, providing immediate
feedback, and grouping similar skills to enhance positive transfer are impor-
tant considerations to incorporate into supervision and training. In addition,
skills that have reached a high level of proficiency also generally show high
levels of retention.
Research in related fields can provide some insight into how a psy
chotherapist learns the trade and becomes a master in his or her practice.
Anderson (1996) provides some useful descriptions of learning in other con-
tent areas. For example, master chess players are not more intelligent than
novice ones. Rather, their considerable practice in encountering and deal-
ing with numerous situations allows them to develop a better memory for
chess positions and strategies to deal with them. Thus, they may demonstrate
tactical learning by mastering specific procedures that solve specific chess
problems. At a more advanced level for more advanced problems, the chess
master learns to organize solutions to more complex problems that are not
6 IDM Supervision: An Integrative Developmental Model
exact examples of problems he or she has faced in the past (strategic learn-
ing). Research on learning geometry also yields some interesting conclusions.
Geometry experts are able to learn inference rules and convert them into
mental procedures. These “productions” are fine-tuned to specific situations,
allowing the individual to develop forward-inference procedures that can be
used even when specific goals are not present. Similarly, physicists learn to
reason forward from known information in a given physics problem rather
than reason backward from the problem statement. Experts represent physics
problems in abstract concepts that predict a method of solution.
These same processes can be applied in learning psychotherapy and related
professional activities. For example, therapists use clinical interview data and
other background information about their clients to develop initial hypoth-
eses concerning personality factors, historical and environmental influences,
and how these interact to have an impact on the problems the client brought
into therapy. These pieces of information will suggest possible diagnoses,
which subsequently lead to treatment parameters to deal with the client’s
situation. Sets, or patterns, of characteristics, including personality style, the
therapist’s reactions to the client, and environmental circumstances, will be
recognized by expert therapists and lead to forward thinking about paths to
solutions to problems not even mentioned by the client at intake (for exam-
ple, the need for personality change, as opposed to specific solutions to cir-
cumscribed interpersonal difficulties).
Cognitive Processing
An important concept in understanding the role of cognitive processing in
learning psychotherapy is the notion of schemata, which is a way of describ-
ing the conceptual organization of both declarative and procedural know
ledge. This discussion relies heavily on the work by Gagne, Yekovich, and
Yekovich (1993) in examining schemata and their formulation and refine-
ment. According to this research, information (propositions) regarding the
function, categories, parts, and so on of something, as well as images of the
entity, are organized together in memory into what are referred to as schemata.
Activation of any one element of a schema leads to easy access of other con-
nected elements. Schemata allow us to recognize new examples of something
quickly and draw inferences in new situations. Therapists can use knowledge
stored in schemata to solve problems encountered in psychotherapy.
Schemata are initially formulated when a learner notes similarities across
more than one example and forms a mental representation that encodes these
Theoretical Foundations 7
similarities. Interestingly, during the early stages of schema formation, dif-
ferences are not focused on or processed. These common elements across
examples are abstracted by the learner into a representation that describes the
entity across a set of instances. This classification of similarities across exam-
ples leads to schema formation, which subsequently will be used to accept or
reject new examples into a classification. We might expect that new examples
are compared with the recollection of a previously encountered example and
then included or discarded. What appears to happen, however, is that an aver-
age set of characteristics is developed into a schema against which any new
examples are compared. This schema may not completely match any specific
example previously encountered, but will serve as the protot ype for compari-
son purposes.
In this process, common elements across at least two examples of an entity
are identified. The attributes of example 1 are described, and an image of it
is created. The attributes of example 2 are described, and an image of it is
created. Then the attributes and images of examples 1 and 2 are compared.
This comparison of shared attributes and images results in the creation of a
schema. It is important to note that if the learner does not consciously look
for similarities, a schema may not be formed, and the information collected
from experience may not be encoded in a way that benefits understanding
and problem solving down the road.
So how does this process work in learning psychotherapy? It might be
expected that in early course work and clinical experience, psychotherapists
in training strive to understand similarities across clients, therapy interven-
tions and processes, and so on. Following the process we have identified,
early schemata related to psychotherapy are developed, against which new
information and experiences are compared. For example, supervisors will
notice supervisees classifying their clients (often erroneously) into diagnostic
or conceptual categories based on a limited number of client characteris-
tics. This initial diagnosis may focus primarily on similarities among clients
and ignore important differences. As noted, unless the learner consciously
searches for similarities and differences, a useful schema may not develop,
and his or her understanding of clients and the psychotherapeutic process
will be limited accordingly.
Schema Development and Refinement
Creation of schemata is important, but it is also important to be able to
refine an existing schema in the light of new information and experiences.
8 IDM Supervision: An Integrative Developmental Model
Initial schemata tend to be overly general and are not as useful as later ones in
distinguishing among numerous characteristics and suggesting solutions to
problems. This tendency to overgeneralize in schema development is a char-
acteristic of novices within a given domain. As the novice learns more about
a particular domain, he or she can make increasingly refined discriminations
(which is relevant to stage 3 of Anderson’s model).
For this to occur, the learner needs to engage in a conscious decision to
understand the limitations of his or her existing schemata. The supervisor’s
role in highlighting crucial differences between the characteristics of the cur-
rent client and the schema the supervisee is using for classification (based on
prior clients or other information) can help the supervisee refine the schema
to be more accurate and helpful. Of course, having a range of experiences
helps the learner refine schemata and avoid rigid stereotypes. Experienced
therapists continue the process of schema refinement. For example, when a
psychotherapist decides on a course of action with a client that results in no
improvement or, worse, decompensation, a conscious decision to find out
why treatment did not work as expected is required. Of note here is also
the importance of being able to recognize when something did not work
as planned (an argument for evidence-based practice, which will be dis-
cussed later in this book). The current situation is compared to informa-
tion retrieved from memory concerning a prior situation where the schema
was useful. A conscious search for differences in attributes between two (or
more) situations results in a modification of the schema to include these
differences. Discovering that the schema did not work and deciding to set
about discovering why appears not to be an automatic process. Thus, exten-
sive experience is not sufficient for the refinement of psychotherapy-relevant
schemata. Psychotherapists who intentionally monitor and evaluate the util-
ity of their schemata and refine them over time develop expertise.
In general, this process describes the importance and development of,
among other things relevant to psychotherapy, differential diagnosis. The
process therapists go through in learning to distinguish among a collection
of information provided by and about a client in developing a useful diagno-
sis and case conceptualization occurs over an extended period of time. They
continually refine schemata based on similarities across clients and situations
into useful diagnostic classifications suggesting treatment alternatives. The
greater the amount of carefully evaluated experience the therapist acquires,
the greater the likelihood of developing schemata that will allow for effective
problem solving.
Theoretical Foundations 9
Forming schemata from abstract definitions appears to be difficult. In
other words, simply telling someone what an important schema is or describ-
ing it will not result in the formation of a useful schema. What appears
to be necessary is providing examples or direct experience with the entity.
Learning occurs better with better examples. Without them, the process of
constructing or changing schemata will not occur.
Recently, efforts to broaden the scope of schema theory by incorporating
sociocultural perspectives have received attention. McVee, Dunsmore, and
Gavelek (2005) summarize much of this work, noting three key points from
this perspective:
(1) Schema and other cognitive processes or structures are embodied—
that is, who we are as biological beings determines our sensorial inter-
actions with the world and thus the nature of the representations we
construct; (2) knowledge is situated in the transaction between world
and individual; and (3) these transactions are mediated by culturally
and socially enacted practices carried out through material and ideal
artifacts. (pp. 555–556)
Thus, rather than assuming that a schism exists between the individual
and what he or she knows, the assumption is that schematic understandings
come from sociocultural transactions with those in the individual’s environ-
ment. An individual’s patterns of understanding the world, interacting with
others, and remembering influence that person’s thoughts and behaviors and
are influenced by his or her active experiences in the world. This includes
how culture affects development through convention or culturally influenced
knowledge or ideas, the individual’s appropriation of this knowledge or con-
ventions obtained via social interactions, the transformation of these ideas
by personal thought and reflection, and sharing this with others (publica-
tion). Thus, schema development and accessing relevant schemata are context
driven rather than reflecting static representations of mind. This suggests
that what constitutes useful schemata in a given situation will be a function
of the sociocultural contexts within which the supervisor, trainee, and clients
have had and continue to have experiences.
Another useful way of examining refining schemata or knowledge evolution
is proposed by Schön (1987) as the process of reflective practice. He describes
knowing-in-action (KIA) as the process by which our actions indicate what
we really know. This information about a particular action reflects solidified
knowledge that we often overlook when we describe our own behavior. In
10 IDM Supervision: An Integrative Developmental Model
essence, it has become automatic and doesn’t require conscious monitoring.
When our actions fail to lead to anticipated outcomes, this “surprise” elicits
a process he calls reflection-in-action (RIA), where we consciously reflect on
our actions, in real time, using reasoned and purposeful experimentation to
improve our performance in the here and now. KIA may reflect skills devel-
oped in other areas that do not readily transfer into new domains. During
RIA we attend more carefully to the current context, notice aspects that
may differ from what we typically encounter, and modify our thinking to
enhance the likelihood of success at the new task. This process describes what
can occur in a psychotherapy session when the therapist’s typical response or
intervention with a client doesn’t produce the expected reaction or outcome.
Of course, the therapist needs to be attentive to client reactions in the here
and now to be aware of unexpected responses (verbal or nonverbal).
When we reflect back on our actions at a later time, evaluating the pro-
cess we used and the lessons learned, we are engaging in reflection-on-action
(ROA). By doing this, we come to understand more completely how our
KIA might have led to an unexpected outcome and how effectively, or not,
our RIA might have addressed the new challenge. This, of course, describes
the process by which a therapist reflects on clients and the therapy process
between sessions (as time permits) as well as what typically occurs in super-
vision. It is important to realize, however, that a therapist cannot reflect on
something that he or she doesn’t notice. Reflection (RIA or ROA) works only
when we recognize the need for it, whether through close attention to work
in sessions, careful monitoring of videos of sessions, or recognizing events
through interaction in supervision.
Skill Development
Anderson’s model is useful in helping us understand how we determine what
knowledge is relevant in a given situation and how we retrieve from memory
the exact information for which we are searching. As psychotherapists gain
in knowledge and experience, the types of information and the strength
of associations between them will change. Information (concepts) closely
related to initially activated concepts will be more quickly available (schema
activation) and moved into working memory for use in problem solving.
Increasing experience and training can enhance the availability of concepts
and strengthen their links. Of course, the possibility exists that inaccurate
concepts can be developed and linked together if adequate evaluation of facts
and information is not part of the ongoing process of learning psychotherapy
Theoretical Foundations 11
and an adequate breadth of experience doesn’t occur. Indeed, in early learn-
ing occurring in any domain of the psychotherapy process, initially acti-
vated concepts and associated links may be a function of limited knowledge
and experience and be inappropriate in solving problems in psychotherapy.
The role of the supervisor is to assist the psychotherapist-in-training to learn
additional concepts and reinforce linkages to related ones for particular
psychotherapeutic situations. Of additional importance in supervision is to
encourage RIA and ROA (Schön, 1987) by supervisees as a process of ongo-
ing evaluation and refinement of skills. Appropriate supervision environ-
ments and experience can lead to the development of expertise, improving
the ability to organize information and concepts into patterns that can be
quickly recognized and the ability to activate solutions to these problems.
Another important consideration for the role of supervision in learning
counseling and psychotherapy is deliberate practice. Anderson notes that
considerable time (a decade or more) is required for geniuses or experts to
produce their best work. He notes that research shows there is typically little
early evidence, in terms of natural abilities, that a given person will develop
into an expert rather than a nonexpert. One can spend a lifetime practicing
a skill and still not become very good at it. Essential conditions for optimal
skill development include motivation to learn, provision of accurate feed-
back regarding performances, monitoring how one’s own performance cor-
responds to examples of effective skill implementation (noting similarities
and deviations), and focusing on elimination of discrepancies. Thus, simple
practice and experience in counseling and psychotherapy are unlikely, in
many cases, to naturally lead to greater proficiency. Here is where effec-
tive supervision comes into play. Simply put, one can engage in professional
work for decades and not reach the level of expertise desired. Accurate and
relevant feedback from supervisors, clients, and other sources of evaluation
is necessary to avoid engaging in ineffective practices over extensive periods
of time.
A related issue that is important to consider is that, as noted by Anderson,
domains of expertise can be quite narrowly defined. Skills developed in one
area do not necessarily transfer well to other areas. For example, chess geniuses
do not appear to be geniuses in other areas requiring complex thinking. In
other words, the context appears to be very important. Even between similar
domains transfer of skills can be limited, and when the domains are quite dif-
ferent no transfer of skills may occur. This foreshadows discussions that will
occur later in this book. Proficiency in counseling, psychotherapy, and other
professional activities is also domain specific. For example, a psychologist
12 IDM Supervision: An Integrative Developmental Model
who has developed extensive skills in psychological assessment may be inef-
fective in conducting psychotherapy. A therapist who is skilled in individual
psychotherapy may be dangerous in doing marital therapy. Supervisors must
be careful about assuming generalization of skills across domains.
Expert Versus Novice
Differences between expert and novice computer programmers suggest
some patterns that may apply to the practice of psychotherapy. For exam-
ple, as programmers become more expert in their field, they learn to repre-
sent programming problems in terms of abstract constructs, they learn to
approach programming tasks from a breadth-first orientation (which allows
for more efficient programming than depth-first), and they acquire better
memories for programs and patterns. In short, there appears to be a change
over time in moving from novice to expert that involves a shift in problem-
solving approach from serial processing and deduction to memory retrieval
and pattern matching. This movement allows programmers to approach and
resolve problems more quickly and efficiently. Experts have advantages over
novices. First, because they have memorized solutions to past problems
they have encountered (schema development and refinement), they are less
likely to make errors in solving new problems that are similar (KIA). This
also allows them to attend more carefully to more complex or sophisticated
aspects of the problem than can novices (RIA, ROA). Experts also have more
ability to store information relevant to the particular domain of their exper-
tise. They can remember more and larger patterns than can novices (schema
refinement).
A similar process likely occurs for psychotherapists, resulting in different
patterns of activity in novices and in experts. For example, the novice thera-
pist observing an expert may be unclear as to why the expert pursues certain
avenues during diagnosis and treatment and quickly abandons others. An
experienced therapist can match patterns of characteristics in the current
client with patterns previously encountered in work with other clients, there-
fore approaching assessment across a breadth of client experience and abilities
rather than homing in on a particular aspect of a presenting problem. Thus,
while the novice may collect considerable information related to an initial
concern presented by the client, the expert therapist will efficiently assess
a number of factors that may at first blush seem unrelated to the present-
ing problem. This information allows the expert to more quickly develop
Theoretical Foundations 13
a treatment plan to address core issues, while the novice may end up work-
ing on various treatment plans to deal with a collection of circumscribed
problems as they arise in therapy. This process is similar to what others have
described in developing proficiency in medical diagnosis.
Cognitive research and theory suggest that simply acquiring more facts
and skills is not sufficient to explain how someone moves from being a novice
to becoming an expert psychotherapist. Anderson views memory as a net-
work of nodes and links organized into propositions, which are defined as the
smallest unit of meaning that enables us to determine whether a statement
is true or false (or, in the case of psychotherapy, relevant or irrelevant). The
process of attempting to retrieve information from this network is described
as spreading activation. Thus, a topic or issue being considered elicits the
activation of related concepts in memory, which in turn activate other closely
related (neighboring) concepts linked to the first. Recognition occurs when
the appropriate proposition is activated and the level of activation reaches
a threshold. The strongest links from the concepts that are activated will
receive more activation. The strength and number of activated concepts
will determine how any given concept is determined to be important to the
problem solution.
Again, this process highlights differences in how expert and novice thera-
pists use information provided by clients. Personality and counseling theory
(whether formal or personalized) allow the therapist to attend to certain aspects
of client information while ignoring vast amounts of less relevant data. Expert
therapists make these decisions relatively quickly and often with limited cog-
nitive processing (in fact, they may not be very aware of how they are making
these decisions). Novices are more likely to take a trial-and-error approach and
either attend to factors that subsequently prove to be of limited value in diag
nosis and treatment or miss important factors necessary for understanding
the client. As expert therapists attend to client factors, related concepts will be
activated (for example, broad patterns of symptoms) and brought into working
memory for processing. When certain propositions (meaningful concepts) are
activated beyond a threshold, understanding of the problem or issues occurs.
Strong links from extensive knowledge and experience encoded in the mem
ories of expert therapists increase the likelihood that useful propositions will
be activated, which leads to effective problem solving.
Diagnosis and treatment planning is certainly an area where this process is
evident. A novice therapist collects information concerning a client (usually
following a procedure taught to the therapist or outlined in agency guidelines)
and refers to the Diagnostic and Statistical Manual of Mental Disorders (DSM),
14 IDM Supervision: An Integrative Developmental Model
searching for lists of characteristics that match what the therapist knows about
the client. This process is often one of trial and error, where initial diagnoses
are entertained and important information concerning criteria is collected
until the novice settles on a particular diagnosis. Next, the therapist moves on
to the treatment plan, consulting the supervisor and other sources to come up
with a way to deal effectively with the client’s particular disorder.
The expert, however, engages in a process of purposeful data collection
(objective and subjective) with the client and searches his or her memory
for matching patterns, which will enable swifter and more accurate diagno-
sis. Development of a treatment plan is also the result of pattern matching,
involving concepts learned from prior experience and training.
Interpersonal Influence and Social Intelligence
In other contexts, we have discussed the utility of examining the role of social
influence on clinical supervision (Stoltenberg, McNeill, & Crethar, 1995).
The Interpersonal Influence Model (IIM; Strong, 1968) has been an impor-
tant subject of research in professional psychology for decades, although
the attention it receives from researchers appears to be decreasing of late.
However, this model remains valuable for conceptualizing different sources
of influence in the supervision context. Dixon and Claiborn (1987) initially
applied this model to the supervision process when they proposed how super-
visor power and supervisee needs interact in the supervision context. The
supervisor’s persuasive influence over the supervisee is described as a func-
tion of the constructs of expert, referent, legitimate, and informational power
bases. As the supervisee’s needs change over time, he or she becomes more or
less susceptible to the influence of the supervisor as a function of the super-
visor’s perceived expertise. In addition, the similarities the supervisee per-
ceives he or she has with the supervisor form the basis of referent power. As
the designated authority figure, the supervisor also enjoys a legitimate power
base. Thus, by definition, the supervisor has authority over the supervisee,
which usually includes the requirement of evaluation. Finally, the supervisor
is perceived as knowing considerably more about therapy and the supervision
process than the supervisee does. Therefore, the information and skills that
the supervisor can provide to the supervisee form another basis for the power
of persuasion in the supervision context.
Theoretical Foundations 15
We discuss in more detail in subsequent chapters how the needs and char-
acteristics of supervisees at each of three levels of professional development
described in the Integrative Developmental Model (IDM) interact with the
supervisor power bases in the supervision relationship. We also make recom-
mendations regarding the most effective use of these power bases for each
level of supervisee.
Much of what this chapter discusses, and what will follow, focuses on the
way trainees learn and how the environment or context affects this learning
and the integration of knowledge. Of additional interest is the learning envi-
ronment created in the interaction between trainee and client. Over the past
few years there has been a growing body of research in social neuroscience
(Cacioppo & Berntson, 1992; Cacioppo, 2002) and social cognitive neuro-
science (Ochsner & Lieberman, 2001) that has implications for understand-
ing and enhancing our utilization of social interactions, including those
occurring in psychotherapy. Goleman (2006) has summarized much of this
research, which provides a conceptual bridge between emotion and cogni-
tion. Later chapters will examine some of this research as it addresses various
components of the IDM, but of particular interest for the discussion here is
the distinction between “high-road” information processing, which tends to
be methodical, deliberate, and conscious (active schema development and
refinement, RIA, ROA), and “low-road” processing, which functions at more
of an emotional level with no direct connection to speech centers in the brain
(perhaps also reflecting nonconscious KIA). Essentially, low-road processing
is preconscious; we “feel” others’ expressed emotions (nonverbal behavior)
rather than “see” them. This view provides depth to an understanding of
empathy and of how to encourage it in trainees. It also suggests additional
avenues of communication between trainees and their clients, which later
discussions will expand upon. High-road processing draws into play our
conscious decision-making and reflection abilities, allowing us to exert more
direct control over our behavior. It also allows us to label our feelings, and
those of others through the empathy process, and examine more consciously
the genesis and impact of this emotional experience.
The IDM relies heavily on accurate assessment of a supervisee across a
number of domains of professional practice. A trainee’s behavior in supervi-
sion and in therapy sessions provides the supervisor with evidence about the
supervisee’s developmental level for various domains of practice addressed in
the training context. Once the developmental level is identified for a given
16 IDM Supervision: An Integrative Developmental Model
domain, specific supervisory interventions can enhance supervisee learning
and growth.
Motivation
Another important consideration in examining how we learn and what behav-
iors we choose to engage in is motivation. This can have important implica-
tions for the likelihood that one will elaborate on information provided in
supervision and therapy contexts, which in turn will affect utilization of rel-
evant schemata and their continued refinement. A model of persuasion and
information processing, the Elaboration Likelihood Model (ELM; Petty &
Cacioppo, 1986; Petty & Wegener, 1999), has been used to clarify how situ-
ations in supervision and therapy can affect the supervisee’s motivation and
determine how he or she will use available information and encoded sche-
mata in problem solving (Stoltenberg et al., 1995). This chapter will discuss
only the importance of two types of information processing (central route
and peripheral route) and leave the details for exploration in later chapters.
According to the ELM, a continuum of approaches to information pro-
cessing best describes how we use our cognitive resources in making deci-
sions and developing attitudes. At one end of this continuum is an approach
referred to as peripheral route processing. This type of processing is character-
istic of what we tend to do when a topic has limited importance or personal
relevance or we have limited knowledge or experience related to the topic.
Rather than invest a lot of cognitive energy in deciding what our opinion
is or determining what to do in a situation, we will rely on contextual cues
to assist us. In the supervision context, the credibility of the supervisor can
serve as a cue for the supervisee; if the supervisor is seen as an expert with
considerable experience in a particular area, the supervisee may feel that little
effort needs to be expended to consider the merits of the supervisor’s recom-
mendations. Although this may simplify things for the supervisor (and boost
his or her ego), an uncritical acceptance of supervisor recommendations or
interpretations may result in the supervisee becoming more of an extension
of the supervisor than an autonomously functioning therapist. There are a
number of problems with this position that we highlight later in this book.
The other pole on the continuum is central route processing. Here the super-
visee is sufficiently motivated and knowledgeable to elaborate on information
provided in supervision (as well as in therapy), rather than uncritically accept
it. This allows the trainee to fully utilize relevant schemata developed over
Theoretical Foundations 17
time to evaluate the pros and cons of various options, including those sup-
plied by the supervisor. This effortful process should also assist the supervisee
in schema creation and refinement, which should then have a greater impact
on that person’s future behavior in supervision and therapy. Thus, both moti-
vation and ability need to be considered in examining the learning environ-
ment related to supervision and training in psychotherapy.
Consistent with constructs of the ELM, another useful way to conceptu-
alize the role of motivation is provided by Self-Determination Theory (SDT;
Ryan & Deci, 2000), which posits three innate psychological needs: compe-
tence, relatedness, and autonomy. Although these needs can be expressed and
met through various culturally and contextually influenced ways, they form
the basis for optimal functioning both socially and in personal well-being.
Of particular relevance to the discussion here is that motivation is concep-
tualized as a continuum, from amotivation through extrinsic motivation to
intrinsic motivation. Associated with these are various regulatory styles that
affect our perceived locus of causality and our willingness to engage in par-
ticular behaviors (motivation). Amotivation is characterized by nonregula-
tion, or the lack of intention to act. This can reflect the perception of little
or no value to the activity, a lack of perceived competence in performing it,
or no expectation of a desired outcome from the action. Extrinsic motiva-
tion includes a full range of regulation of behavior varying in degree of per-
ceived autonomy, including external, introjected, identified, and integrated.
These regulatory styles reflect perceptions of locus of control from external
through internal. Finally, intrinsic motivation suggests intrinsic regulation
with an internal locus of control, or the sense that we control much of our
own behavior and choose how to act in a given situation.
Of course, the various regulatory styles have implications for behavior
across various contexts. Research suggests that the more we view the locus of
causality for our actions as internal (greater intrinsic motivation), the more
autonomy in action we experience, which results in more engagement in
tasks, better performance, better learning, and more persistence. Conversely,
the more we feel externally regulated, the less interest we show in activities, the
less we value them, the less effort we expend in the activities, and the less
responsibility we assume for the outcomes.
In the context of training to become a therapist, this work suggests that
cognitive activity related to schema creation, refinement, and subsequent ther-
apist behavior tends not to be automatic. The learning environment must be
modified to encourage optimal motivation, understanding, integration, and
retention to have maximal impact on trainee behavior. A number of models
18 IDM Supervision: An Integrative Developmental Model
of human development offer guidelines for understanding how people grow
and the types of environments that encourage this growth. However, the dis-
cussion will now focus on more general developmental constructs and their
utility in understanding how therapists grow professionally.
Models of Human Development
Lerner (1986) notes that a general interpretation of the concept of develop
ment requires systematic and successive changes to occur over some period of
time in an organization (usually how an individual organism is organized).
The concept of development, originally applied in a biological context, has
been applied in a more general way to include the organization of an organism
that changes over time as an adaptation to the environment (Harris, 1957). A
refinement of this idea suggests that only a model in which movement is from
a general global organization to one that is highly differentiated and integrated
into a hierarchy, the orthogenetic principle, adequately describes development
(Werner & Kaplan, 1956). This latter conceptualization fits more closely with
what happens in the professional development of therapists.
In earlier books, we addressed two general categories of models of develop
ment: the mechanistic and the organismic models. The mechanistic model
uses the machine as its basic metaphor. This view of human development is
one of antecedent-consequent relationships and posits a reactive conceptual-
ization of human behavior characteristic of stimulus-response behaviorism
(Baltes, Reese, & Nesselroade, 1977). This approach reflects a natural-
science view of the world, which is reductionistic and sees change as contin
uous, additive, and quantifiable (Lerner, 1986). In the therapy context, this
approach views development as a rather smooth, continuous adding of skills
and knowledge over time that eventually leads to expertise.
The organismic model takes the organism, with its qualitative changes over
time, as its basic metaphor for development. These theories rely on the model
of epistemological constructivism, in which the organism plays an important
role in constructing knowledge and reality (Baltes et al., 1977). This epige-
netic viewpoint maintains that qualitative change cannot be reduced to a
quantitative organization of elemental components. Rather, something new,
with a higher level of complexity, characterizes different stages of develop-
ment. This view of the world reflects an antireductionistic, discontinuous,
and qualitative perspective in which interaction between the organism and
Theoretical Foundations 19
the environment results in goal-directed behavior and growth (Lerner, 1986).
In short, the whole is considerably greater than the sum of the parts.
In considering human learning and development, the mechanistic
approach relies heavily on additive elements, many of them a function of
the environment, or accumulating information in a stimulus-response frame-
work. The organismic model, on the other hand, posits a biological goal-
oriented framework for the process of learning, whereby changes in the
organization of the organism are largely dictated by qualitatively different
stages of development. In practice, most organismic theorists, for example,
Jean Piaget and Freud, assume that general laws govern development across
all stages of psychological functioning, and specific laws affect development
within stages (Lerner, 1986). In the context of therapist development, as we
have suggested in our earlier work, one would expect a general continuous
development whereby therapists accumulate additional knowledge and skills
and achieve qualitatively distinct development that defines changes for var
ious stages (Stoltenberg & Delworth, 1987). Thus, we find a general increase
in therapist knowledge and skills over time, but qualitative differences in the
level of complexity of these and how they are used. In short, according to the
IDM, the Level 1 therapist not only knows less than therapists at Levels 2
and 3, but also is characterized by a different way of viewing therapy (and
related activities) than therapists at higher levels. Consistent with Lerner’s
developmental-contextual perspective, the learning environment provided
in supervision and therapy will interact with the level of development of
the therapist, resulting in change (Lerner, 1986). As Chapters 2 through 5
describe, the context or environment provided by supervisors for supervisees
plays a crucial role in the rate and ultimate level of therapist development.
An understanding of cognitive and human development theories is impor-
tant in considering how individuals become psychotherapists. Learning and
doing psychotherapy is not an isolated specialty. Therapists can gain insight
and avoid reinventing the wheel if they use knowledge already available to
them. In addition, supervisors may avoid making mistakes concerning the
learning process if they attend carefully to what experts in the field of learning
have to contribute. Exhaustive early reviews of the supervision literature by
Worthington (1987) and Stoltenberg, McNeill, and Crethar (1994) have come
to similar conclusions regarding the validity of developmental models of super-
vision. Stoltenberg and colleagues summarized the research on supervision as
indicating that “there is support for general developmental models, perceptions
of supervisors and supervisees are consistent with developmental theories, the
20 IDM Supervision: An Integrative Developmental Model
behavior of supervisors changes as counselors gain experience, and the supervi-
sion relationship changes as counselors gain experience” (p. 419). Other recent
reviews of supervision research by Ellis and Ladany (1997) and Ellis, Ladany,
Krengel, and Schult (1996) conclude that methodological problems signifi-
cantly limit the confidence we can have in the results of many studies. They
go on to note that the IDM has not yet been adequately tested. However, a
cursory review of the supervision literature demonstrates little, if any, empiri-
cal support for the plethora of existing supervision models (see Bernard and
Goodyear, 2004). Consequently, Stoltenberg (2005) argues that the IDM has
been more thoroughly researched than most, if not all, other models of super-
vision. The remaining chapters examine the issues raised here in more detail
and apply them specifically to the education and training of psychotherapists.
We are hopeful that the discussion and examples will serve to assist all thera-
pists in the creation and modification of schemata that will positively improve
their work in clinical supervision and other professional activities.
2
An Overview of the IDM
•
Although developmental models of supervision have probably been the most
influential over the past 20 years and have generated considerable research,
critics have argued that the theory has not readily translated into concrete
applications (Watkins, 1996). We would argue that concrete applications
should not be equated with rigid, formulaic prescriptions for supervision
techniques. Sometimes simple cookbook solutions and directions are not pos-
sible, or at least may be misleading. Simple, mechanistic models are easier to
understand, while more complex ones require more time and effort to grasp
and integrate; the more elegant the model, however, the greater the number
of supervisory issues are addressed, and the broader and deeper the impact.
On the other hand, focusing primarily on the trainee’s personal issues (in
essence doing counseling or psychotherapy with the trainee) is generally a
poor substitute for effective supervision (and is unethical). All people have
a tendency to do what they know how to do, and in some cases that means
supervisors will rely too heavily on counseling or psychotherapy skills in
conducting supervision when they lack an understanding of the differences
between the two processes.
We have noticed that some researchers and practitioners tend to use earlier,
and simpler, presentations of our developmental model for their research and
practice (Stoltenberg, 1981; Loganbill, Hardy, & Delworth, 1982) or summa-
ries of our approach gleaned from other sources. Although these earlier, more
simplistic models may be more easily comprehended, they lack the breadth
to more fully guide the supervision process. Related areas of inquiry have
faced similar problems. Clinical intuition has suggested that flexibly apply-
ing therapeutic interventions is superior to rigidly adhering to treatment
approaches set out in manuals, and evidence now indicates that this notion
21
22 IDM Supervision: An Integrative Developmental Model
has merit (Jacobson & Christensen, 1996). Therefore, to adequately meet
the needs of a specific supervisee, the supervisor must be well versed in the
model of supervision and able to adapt to changing needs within and across
sessions. In addition, recent work in evidence-based practice highlights the
importance of the therapist being aware of his or her intentions, mediating/
moderating variables, and expected outcomes in therapy (Norcross, Beutler,
& Levant, 2006). This is also useful for the practice of clinical supervision
and training (Stoltenberg & Pace, 2008).
Our task here is to briefly introduce the IDM, with only limited attention
paid to elaborations and specific applications; those will come later. Just as a
good novel requires time for character and plot development, a good model
requires an adequate framework on which to hang the specifics of therapist
trainees, their development, and the supervision process across contexts.
Overarching Structures and Specific Domains
Earlier models of psychotherapist development have suggested that growth
occurs in broad stages, with supervisees labeled as Level 1, Level 2, and so
on. Although in the present iteration of the IDM we retain the construct
of Levels 1–3 (with a final integrative level), these designations are domain
specific and not seen as general assessments of the therapist’s degree of pro-
fessional development. Clinical practice and now research suggest that the
broad view of general developmental levels is too simplistic and does not
reflect reality. Professional practice consists of a diverse collection of responsi-
bilities and activities requiring a wide range of skills, knowledge, and experi
ence. It is simply not useful to categorize a trainee this broadly, although a
general level designation may prove efficient in considering the degree of
expertise and capacity for assuming responsibilities within a particular con-
text. As we noted in the last chapter, research in cognitive processes and
the development of expertise shows that generalization of learning from one
domain to another, even if the domains are quite similar, may be limited and
is certainly not automatic. If the domains differ appreciably, no generaliza-
tion may occur.
In practice, most therapists tend to function at different levels of profes-
sional development across areas of mental health service delivery. For exam-
ple, a supervisee may function with a relatively high degree of confidence and
autonomy when conducting individual psychotherapy with a depressed female
client, but, due to little experience and training, may lack this confidence and
An Overview of the IDM 23
autonomy when working with issues of childhood sexual abuse. This effect
was demonstrated in a study we conducted with other colleagues (Leach,
Stoltenberg, McNeill, & Eichenfield, 1997). Similarly, Tracey, Ellickson, and
Sherry (1989) found that supervisees desired different types of supervision,
varying in degree of structure provided by the supervisor, depending on their
experience with the problems presented by particular clients.
This perspective on trainee development complicates life for supervi-
sors, who not only need to know how to provide optimal supervision for
different levels of supervisees, but also need to be able to assess their level
of development across the professional activities in which they are engaged
while they are under supervision. Furthermore, supervisors need to move
from supervision appropriate for a particular level of development in one
domain to supervision appropriate for a different level of development in
another domain, often within the same supervision session. One of us has
recently described this process in work with a particular supervisee who was
functioning at different levels with his individual versus his couples’ therapy
clients (Stoltenberg, 2008b).
Before we discuss how to provide this differential supervision, we explore
how to identify the level of trainee development in general. We then move on
to discussing how this plays itself out in specific domains.
Overriding Structures
We have found it useful to monitor trainee development by closely attend-
ing to three overriding structures that provide markers in assessing profes-
sional growth. Within any given area of clinical practice, these structures
reflect the level of development at which the trainee is currently functioning.
How theories of learning, cognitive processing, motivation, and development
inform an understanding of these structures will be briefly discussed here
and more fully developed later as we consider three levels of development and
how these structures differ for each level.
Self- and Other-Awareness: Cognitive and Affective This structure has both
cognitive and affective components and indicates where the individual is in
terms of self-preoccupation, awareness of the client’s world, and enlightened
self-awareness. The cognitive component describes the content of the thought
processes characteristic across levels, and the affective component accounts for
changes in emotions such as anxiety. This structure is affected by the devel-
opment and refinement of schemata (declarative knowledge and procedural
24 IDM Supervision: An Integrative Developmental Model
knowledge) by trainees in domains relevant to clinical practice. The trainee’s
ability to engage in effective empathic understanding is an important aspect
of the affective component of this structure. The content of what is in work-
ing memory during therapy as well as the nature of the KIA for a particular
trainee and the degree to which RIA can positively affect the therapy process
are characteristics of different levels for this structure. Differences will also be
apparent in the nature of the reflection-on-action that occurs in and outside
of supervision. Briefly, this structure reflects the development of the thera-
pist’s knowledge base, cognitive and affective, as well as the therapist’s ability
to utilize this knowledge in the professional context.
Motivation This structure reflects the supervisee’s interest, investment, and
effort expended in clinical training and practice. Changes over time tend
to go from early high levels through a vacillation from day to day and cli-
ent to client, culminating in a stable degree of motivation. Important here
are implications for the supervisor’s influence, stemming from various power
bases, and the ramifications for processing by the supervisee. The roles of
amotivation, extrinsic motivation, and intrinsic motivation as well as various
regulatory mechanisms directly impact the trainee’s willingness to engage
in the learning process. These processes also play an important role in the
trainee’s willingness to recognize his or her responsibility for learning and
subsequent effectiveness in practice. In short, this structure is affected by the
trainee’s awareness of cognitive and affective components of the learning and
practice environments, which can elicit a range of reactions from confusion
to clarity, self-absorption to empathy, and anxiety to a sense of confidence
and efficacy. Clearly, these reactions impact the trainee’s sense of control and
motivation, which, in turn, affect his or her willingness to engage in the often
complex and challenging actions of learning and practice.
Autonomy Changes in the degree of independence demonstrated by train-
ees over time accompany the other structural changes. Beginners tend to
be rather dependent on supervisors or other authority figures and eventu-
ally grow into a dependency–autonomy conflict, or professional adolescence.
Clinical experience and supervision allow therapists to become conditionally
autonomously functioning professionals. This awareness of strengths and
weaknesses allows the individual to accurately assess his or her need for addi-
tional supervision or consultation regarding professional issues. Changes
in motivation from extrinsic to more intrinsic as well as confidence in his
or her knowledge and competence have direct implications for the sense of
An Overview of the IDM 25
autonomy the trainee experiences in different domains. Interestingly, a desire
for independence and a sense of efficacy either can have a motivating effect
on learning (if the trainee perceives that he or she can develop adequate skills
and positively affect professional growth) or can elicit a reticence to explore
new understandings and approaches or even new domains of practice (for
fear of incompetence or unwillingness to invest in the learning process). This
response can also limit the trainee’s investment in self-evaluation or evalu-
ation by others, as well as critical reflection (ROA), so as not to confront
evidence that is contrary to comfortable perceptions of competence.
Specific Domains
Before we go into detail in examining the role of the overriding structures,
it may be helpful to look at some of the specific domains of clinical prac-
tice for which these structures provide guidance in assessing developmental
level. The degree of specificity with which we can approach the discussion
of domains varies a great deal. As a starting point, we consider eight general
domains of clinical activity. These domains are overly large and inclusive but
are meant to highlight the need to attend to particular areas of practice in
considering a trainee’s development, rather than to broadly assume a level of
professional development that lacks meaning and relevance.
Intervention Skills Competence This domain addresses the therapist’s confi-
dence and ability to carry out therapeutic interventions. The developmental
level in this domain will depend on the therapist’s familiarity with a given
modality (for example, individual, group, couples, or family therapy) and the
theoretical orientation used.
Assessment Techniques This domain addresses the therapist’s confidence
in and ability to conduct psychological assessments. Of course, numerous
assessment devices and protocols exist, and the developmental level of the
therapist will vary depending on experience and training across approaches
(for example, personality, vocational, or neuropsychological). Our discussion
of this domain shares some commonalities with other work in the area of
assessment (Finkelstein & Tuckman, 1997).
Interpersonal Assessment Some professionals may consider this domain a
subset of assessment techniques; for example, considering the test-taking
behavior of a client across the assessment period and integration of clinical
26 IDM Supervision: An Integrative Developmental Model
interview data with formal assessment data. Others may argue that this forms
the basis of intervention skills competence, as the therapist needs to carefully
engage in interpersonal assessment to select appropriate interventions. We
see merit in both of these positions, but we view the process (or domain) as
sufficiently independent to warrant specific attention. Our position is that
this domain reflects the use of self in conceptualizing a client’s interpersonal
dynamics, which is crucial across a number of areas of practice. Again, the
nature of this domain differs depending on the theoretical orientation of the
therapist as well as the practice activity in which the therapist is engaged.
Client Conceptualization This domain includes, but is not limited to, diag-
nosis. The inadequacy of current diagnostic criteria for guiding treatment
is well documented (Beutler & Clarkin, 1990). This domain goes beyond
an axis or V-code diagnosis and includes the therapist’s understanding of
how the client’s characteristics, history, and life circumstances blend to affect
adjustment. The nature of this conceptualization varies depending on the
therapist’s worldview and theoretical orientation(s).
Individual Differences This domain includes an understanding of gender,
ethnicity, socioeconomic status (SES), and cultural influences on individu-
als, among other factors, as well as the idiosyncrasies that form the individ-
ual’s personality. Various elements of this domain will surface or submerge
across time depending on the themes addressed in therapy, assessment, or
other enterprises.
Theoretical Orientation This domain includes formal theories of psychology
and psychotherapy, as well as integrative approaches and personal perspec-
tives. The adequacy and complexity, as well as accessibility, of a therapist’s
understanding of processes may vary dramatically across the orientations he
or she uses in clinical practice.
Treatment Plans and Goals This domain addresses how the therapist plans
or organizes his or her efforts in working with clients in the psychotherapeutic
context. The sequencing of issues and interventions leading to achievement of
therapeutic goals and objectives will vary depending on the therapeutic ori-
entation, the therapist’s skill level, and situational resources and constraints.
How consciously or intentionally the therapist focuses on mediating or mod-
erating factors in laying out a framework for achieving particular objectives
and outcomes will vary.
An Overview of the IDM 27
Professional Ethics Different mental health professions are guided by their
own professional ethics, which in turn are affected by their professional prac-
tice. This domain addresses how professional ethics and standards of practice
intertwine with personal ethics in the development of the therapist.
Structures Across Levels
of Therapist Development
Now that we have summarized our overriding structures and presented some
domains for consideration, we examine how these structures vary across lev-
els of therapist development. Later, we expand this discussion by consider-
ing how these structures define the levels across domains. Our model views
development, within specific domains, as progressing through Levels 1,
2, and 3, with a final push toward integration across domains (Level 3i).
Consequently, any given trainee (except perhaps one at the entry level with
no relevant prior experience) will often be functioning at different levels
across various domains at any point in time.
Level 1
Supervisees who are functioning at the early Level 1 stage for a particular
domain display some common characteristics. If they are new to the field and
in the initial phases of education and training in psychotherapy, they often
have limited directly relevant experience, although they may have consider-
able indirectly related experience such as general interpersonal skills. Their
background knowledge will usually be limited to an introduction to theories
and techniques at the graduate level and, perhaps, broad exposure to various
areas of psychology or mental health through undergraduate education. The
supervisor can choose various approaches to take, but typically a focus on
relationship skills and simple intervention strategies is common, while others
will initially focus heavily on assessment.
Supervisees who may have had considerable experience in other domains of
clinical activity (for example, other therapy orientations, other modalities, or
related mental health experience) nevertheless will be functioning at Level 1
if these experiences are significantly different from the primary training focus
in supervision. For example, it is common to encounter supervisees with sig-
nificant training and experience in individual counseling or psychotherapy,
28 IDM Supervision: An Integrative Developmental Model
within one or two orientations, or with particular populations, but little or
no knowledge or experience in another orientation, in another therapeutic
modality (for example, couples, family, or group therapy), or with clients
coming from significantly different cultural backgrounds. Similarly, super-
visees may have engaged in significant training in assessment but little in
psychotherapy, or vice versa.
Level 1 trainees will have limited background in the particular domain of
focus in at least a portion of what is addressed in supervision. New trainees
will be Level 1 across most or all domains; advanced supervisees, sometimes
even relatively seasoned professionals, will have limited background in certain
domains of the clinical experience under supervision. In Chapter 3 we discuss
in more detail how to deal with this variety of Level 1 therapist, but for now we
generally examine the characteristics of the overriding structures for this level.
Self- and Other-Awareness Learning new skills, theories, strategies, and so
on tends to result in considerable confusion and anxiety in Level 1 super-
visees. At this level, their evaluation of self-performance is often guided by
a perception of their proficiency in faithfully performing a given technique
or following a particular strategy with a client. New declarative knowledge is
necessary but not sufficient. Procedural knowledge, or how best to utilize
and implement information, is necessary for effective practice. Thus, devel-
opment and refinement of schemata are required. This cognitive self-focus,
or attempting to tap this information for use in working memory, leaves little
attentional capacity for considering the client’s perspective, for empathy, or
even for processing the therapist’s own affective or cognitive reactions to the
client. Considerable RIA (active here-and-now monitoring of behavior) on
the adequacy of the KIA utilized by the trainee (behaviorally, how and why
the trainee does what he or she does) and ROA (at a later time) are necessary
for the trainee to develop effective and efficient procedures for therapeutic
skill implementation. Research has indicated that this self-focus tends to
elicit significant anxiety in the supervisee, which can complicate effective
performance (Hale & Stoltenberg, 1988). Concern about incompetence, a
sense of lack of efficacy or control of the ability to be effective, or simply con-
fusion regarding what to do can elicit an anxious response in trainees. This
can stimulate or motivate a desire to learn, or it can lead a trainee to fall back
on familiar ways of interacting with people developed outside the therapy
context (or from other earlier marginally relevant experiences). In consider-
ing the awareness structure, supervisors need to monitor both cognitive and
affective components.
An Overview of the IDM 29
Cognitive Confusion, lack of certainty, or loss of a sense of what to do is
characteristic of lack of knowledge of or interference with therapist cognitions
at this level. Due to the need to reflect constantly on the rules or procedures,
skills, theories, and other didactic material being learned, it is difficult for
trainees to carefully listen to and process information provided by the client
in session. It is also difficult for them to recall relevant information (activa-
tion and retrieval) and utilize it in working memory immediately in the ses-
sion when they are struggling to understand the client’s perspective. The
trainee’s schemata related to this aspect of practice within this clinical situa-
tion are not sufficiently developed and integrated (that is, they lack activation
links) to allow for quick and easy access. As our review of learning theories
and cognitive processing suggests, adding facts and skills is not enough.
Procedures for utilizing information from memory in a way that impacts the
trainee’s implementation of effective therapeutic behaviors (pattern develop-
ment and matching) also tend to be limited and will only improve with
relevant experience, reflection, deliberate practice, and accurate feedback on
performance. Add to this the trainee’s concern with evaluation by the client
and the supervisor (fear of critical feedback or of making a mistake), and it
is easy to see how confusion can reign. We once heard a university football
coach, bemoaning the hesitation and mistakes made by his young charges,
refer to this effect as “analysis paralysis.”
Affective This component of self-awareness accompanies the cognitive
confusion. Developmentally, the state of disequilibrium caused by a percep-
tion of insufficient understanding often elicits conflict or discomfort in a
given situation. Add to this the fear and anxiety often associated with the
trainee’s perception that he or she is not meeting acceptable standards of
understanding or behavior (objective self-awareness) or anticipation of a neg-
ative evaluation by others (client and supervisor; evaluation apprehension),
and it is easy to understand the range of negative emotions that Level 1
therapists potentially experience (Hale & Stoltenberg, 1988).
Level 1 supervisees are characterized by a focus (one might say a preoc-
cupation) on the self, and it is often a negative focus rather than insight-
ful self-understanding. Although it is typical for trainees at this level to be
excited about learning how to engage in professional practice, even the more
mature and personally developed trainees tend to experience the confusion
and anxiety associated with this stage. In addition to the negative emotional
experiences associated with evaluations of his or her behavior, lack of knowl-
edge, and confusion, to the extent that the Level 1 trainee is able to attend
30 IDM Supervision: An Integrative Developmental Model
to the client, he or she may experience anxiety, fear, sadness, and a range of
other emotions that emanate from the client. Thus, the trainee may experi-
ence this “low-road” social processing of affect from the client with little or
no conscious awareness of the origins of these feelings, in addition to the
emotions stimulated by the “high-road” conscious cognitive processes that
are not yielding adequate results.
As Level 1 supervisees gain experience and are exposed to a facilitative
supervision environment, their confidence and skills increase, and they begin
to feel less of a need to focus so intently on their own performance. Their
comfort level in engaging in practice increases as their KIA becomes more
adequate, producing fewer “surprises” in sessions or situations of confusion,
eliciting less distracting RIA focused on their own behavior. In addition, sub-
sequent self-evaluations of their own behavior (ROA), typically focused on
how well they engage in particular fundamental counseling skills or behav-
iors, become more positive as they see their performance in these circum-
scribed interactions as more similar to models (other students, supervisors,
videos of counseling techniques). They then begin to switch their focus more
toward their clients and away from monitoring their own skills, anxiety, and
recall of clinical directives conveyed during the educational process. They are
now more able to notice the impact of the therapeutic process on the client,
as well as attend more carefully to the client’s communications.
Motivation Level 1 supervisees are typically highly motivated. Some of this
motivation is a function of their desire to become fully functioning clinicians.
Often some end-state model of a professional based on personal acquain-
tances or depictions of therapists in books or film serves as a developmental
goal for the beginning trainee. The desire to move quickly from neophyte
to expert can be a strong motivator. In addition, some of this early motiva-
tion is a function of wanting to grow beyond the uncertainty, confusion,
and anxiety associated with this stage. This motivation to learn and grow is
often reflected in a desire to learn the “best,” “correct,” or “favored” approach
to dealing with clinical problems. There is also often a desire to share this
understanding and expertise with clients, and the perception of professional
effectiveness can result in a measure of confidence and serve to reinforce the
person’s selection of career path.
Ryan and Deci’s Self-Determination Theory (2000) gives us some guid-
ance in understanding how motivation may influence trainee behavior. With
the demands for learning the work of the psychotherapist, Level 1 trainees
An Overview of the IDM 31
are likely to function at various levels of extrinsic motivation, particularly
with reference to behaviors that need to be learned in order to effectively per-
form counseling and psychotherapy (or assessment, and so on). One might
expect that the overall motivation for entering training and pursuing a career
in mental health work might well reflect intrinsic motivation, with some
sense of internal locus of causality for (at least) being in a training program,
and self-determined interest and inherent satisfaction with the idea or role
of practitioner. However, with regard to the specific intention to engage in
behaviors required by training programs (skill development and demonstra-
tion, work with clients, etc.), motivation may be more extrinsic, with the
perception that the locus of causality for the trainee’s behavioral intentions is
largely external (dictated by professors or supervisors). The trainee’s behavior
can be seen as significantly controlled by externally provided rewards and
punishments (from supervisors, professors, and even clients) and compliance
to training demands. As experience and proficiency increase, the level of per-
ceived internal causality and self-control, with more internal rewards and
punishments, is expected to develop.
Getting past the early perception of inadequacy and experiencing some
measure of success begins the transition to Level 2. Here we may see a reduced
desire to learn new approaches or techniques, as the supervisee may prefer to
enjoy a feeling of emerging self-efficacy as a clinician. The confidence that
comes with positive evaluations from others (and positive self-evaluations)
regarding the performance of skills and the ability to develop a sufficient
therapeutic relationship to keep the clients returning can result in consider-
able intrinsic motivation and less of a sense of the locus of causality residing
externally. The risk of, again, experiencing feelings of incompetence or con-
ceptual confusion can reduce trainees’ motivation to explore new approaches
and expand their therapeutic repertoire. They may be comfortable, for the
moment, in their perceptions of adequacy.
Autonomy Novice clinicians, whether across the board or in a specific
domain, tend to show considerable dependency on the supervisor; it is an
appropriate response to their lack of knowledge and experience and their scant
understanding of the processes involved. They typically rely on the supervi-
sor to provide structure in supervision and guidance for their behavior in the
focal domains. They are looking to the supervisor, other authority figures, or
other sources to provide information they can elaborate on and integrate into
an overall structure (a collection of schemata) from which to understand the
32 IDM Supervision: An Integrative Developmental Model
clinical process and direct therapeutic behavior (productions; KIA). Similarly,
good examples provided by supervisors and others can help in skill acquisition
and refine early pattern development and matching for the trainee.
Again, early successes tend to decrease the supervisees’ perception of the
need to depend on the supervisor and lead to a desire for more autonomy in
supervision and clinical practice. The developing perception of a more inter-
nal locus of causality for therapeutic behavior results in more self-control
and desire for greater independence, less compliance with directives from
supervisors or other authority figures, and less reliance on externally pro-
vided rewards (from the supervisor). Initially, clients returning for sessions
and appearing committed to the therapeutic relationship may suffice for pos-
itive evaluation from the client. A rather simplistic understanding of a com-
plex phenomenon may lead supervisees to desire more autonomy in practice
than is warranted. A reticence to experience a sense of incompetence with
new skills or approaches, or demands for a more complex view of the process
from the supervisor, can reduce the trainee’s motivation to learn and develop.
These supervisees will need to be encouraged to take risks beyond the point
where skill deficiencies would be considered a hindrance.
A Metaphor In conveying the model to trainees and others, we have some-
times found it useful to employ a simple metaphor to illuminate the devel-
opmental process conceptualized by the IDM. One of us has had experience
and training as a rock climber in his younger years. Imagine the client to be a
novice climber who has slipped into a crevasse (a hole) and is calling to the
supervisee for help. The Level 1 climber (the supervisee) may stand at the
edge of the crevasse, mountain-climbing manual in hand, and yell down
advice or focus primarily on emotionally supporting the stranded climber.
Alternatively, the supervisee may go off and seek guidance from the expe-
rienced team leader (the supervisor) concerning how to assist the stranded
person (client). In either case, the supervisee is attempting to assist the client
despite having had little or no experience with or personal understanding of
the process. He or she is standing on the edge, sending interventions down
to the client (“you feel stuck,” “reach for that rock,” “stretch for that hand-
hold,” “that’s how I’ve done it,” “you can do it”), hoping the client will find his
or her way out. Communicating a developing understanding of the climbing
process to the stranded climber or calming fears, and seeing that this can
have an impact (the climber might make some progress climbing out), is
sometimes sufficient. The supervisee’s perception of his or her understanding
of rock climbing is enhanced, and he or she feels the power of therapy and
An Overview of the IDM 33
begins to develop confidence. On the other hand, a lack of progress by the
climber in escaping the crevasse may be discounted by the supervisee as the
climber “not yet being ready to climb out.”
Level 2
Resolution of Level 1 issues allows the supervisee to move into Level 2. This
transition can be facilitated or hindered by the supervision environment. Of
course, we must not forget that this developmental sequence occurs within
domains, so we may expect to find differential growth across domains. This
differentiation may be a function of a greater focus on some domains rather
than others during prior supervision, resulting in greater growth in these
domains than others. Additional training opportunities may result in more
development in certain domains. Also, the trainee’s personal characteristics
may be better suited to particular domains of practice, and there may be more
rapid growth in those domains.
Self- and Other-Awareness Switching away from a primary focus on the super-
visee’s own thoughts and performance toward more of a focus on the client
enables movement into Level 2.
Cognitive With the freeing up of awareness from self-preoccupation, the
trainee has more attention available to direct toward the client and can begin
to more fully understand the client’s world, marking a structural shift in
the area of cognition. This additional perspective may, however, confuse the
supervisee. A trainee in late Level 1 may have a fairly naïve and simplistic view
of the client and clinical processes (schemata, patterns); now these processes
may seem complex, confusing, and overwhelming to the Level 2 supervisee.
As the trainee attends more to the reactions of the client in therapy, the inad-
equacy of applying skills to clients in certain contexts or a one-size-fits-all
approach will become more apparent to the trainee. The KIA now includes
sufficiently developed fundamental counseling skills to allow the trainee to
provide a safer environment for the client, which can stimulate more explora-
tion and disclosure. The trainee can now listen more carefully to the client
and, with encouragement, strive to more fully understand the world of the
client. The impact of trainee behaviors on the client will also become more
salient, if this is a focus of supervision, and the trainee will become more
aware of how the client responds and whether or not the client views his or
her situation as improving as a function of therapy.
34 IDM Supervision: An Integrative Developmental Model
By attending more completely to the client, the trainee may become more
aware of inadequacies in his or her KIA and, once again, experience confu-
sion and frustration when client behavior (verbal and nonverbal) suggests
less than satisfying responses or overall progress. At other times, the power of
relationship-enhancing skills, or learned structured interventions, will prove
to be sufficient and the trainee will exhibit confidence in his or her compe-
tence. If the supervisor has much control over the difficulty of clients assigned
to the supervisee, it is at this point that the supervisor will encourage work
with clients experiencing more challenging issues. The function of this is
often to push trainees to accommodate to new understandings when they are
no longer able to assimilate new experiences into existing schemata. This can
occur as a function of dealing with clients who have more complex mental
health issues or life circumstances, or who come from significantly different
cultural backgrounds than the trainee. Prior approaches perceived by the
trainee to have successfully worked in the past may now prove to be inad-
equate. More RIA is required, which can also prove confounding. The ROA
that occurs between sessions and in supervision can help the trainee refine
schemata, improve activation and retrieval of relevant information, and pro-
duce new pattern development and matching.
Affective The opportunity to develop empathy more fully with the cli-
ent now becomes possible. It is difficult for the therapist to feel the client’s
sadness, pain, or anger when the therapist is preoccupied with his or her
own anxiety or when the therapist is pleased with how well he or she has
just “reflected” back to the client. The supervisee’s newly developed ability
to focus on the client can yield a sensing of the emotional experience of the
client. Rather than guessing what emotions the client may be experiencing
at any given time, the Level 2 therapist can develop the ability to pick up on
verbal and nonverbal cues that communicate the inner emotional experience
of the client. This can add considerable depth to the supervisee’s understand-
ing of the client. It can also increase the likelihood of enmeshment, counter-
transference, or an “intervention paralysis” for the supervisee, who may now
be nearly as emotionally overwhelmed as is the client.
Goleman (2006) notes that if we are attuned to others, both pleasant and
unpleasant emotions are contagious. The amygdala, via low-road processing,
extracts meaning from others’ nonverbal behavior before we are consciously
aware of it. As this process is not directly connected to speech centers in the
brain, we can actually “feel” others’ emotions in a preconscious manner. Early
attempts by trainees to “empathize” with clients by reflecting feelings during
An Overview of the IDM 35
sessions often takes the form of looking at the client’s nonverbals or assess-
ing the situation described by the client and then guessing at the surface or
underlying feeling. Other times, the trainee will rely on pulling feeling words
from the client’s statements for reflections. However, now that the trainee
doesn’t need to focus on his or her own behavior as closely because many
counseling skills have become more natural, careful attention to the client
can allow the trainee to access emotions more directly. As noted by Goleman,
closely attending to another with intensive eye contact allows “mirror” neu-
rons in our brains to be activated, resulting in experiencing the same emo-
tions as the other person. Observers will note well-coordinated nonverbal
behavior where individuals tend to match postures, tone, and so forth with
another. For this to occur, an intense focus on the other person is required,
essentially shutting off, or at least reducing attention to, high-road cognitive
processes. Interestingly, this enables another mechanism for impacting the
client, as this possibility of attuned mutual attention goes in both directions.
The conscious high-road processing comes into play later when we examine
our emotions and label the feelings we are experiencing.
For the Level 2 supervisee, the lifting of the veil of anxious self-awareness
can result in a deeper and more accurate understanding of the client. Taken
to the extreme, it can also lead to an inability to get beyond the confusion
or intense emotion stimulated by a singular focus on the client. The transi-
tion beyond Level 2 to Level 3 consists of altering the focus to include more
high-road processing by the therapist regarding interactions with the client
and RIA on what is known by the supervisee regarding the clinical processes
at work. Tapping into relevant schemata while engaged in clinical activity
allows the trainee to adjust on the fly to events in therapy. Careful ROA
between sessions and during supervision enables more schema refinement
and better pattern development and matching by the trainee.
Motivation The confidence that accompanies perceptions of self-efficacy in
clinical practice has been shaken by an increased awareness of the complexity
of the enterprise. The effects on motivation can be significant. Some supervi-
sees react to this confusion by seeking additional support and guidance and
displaying high levels of motivation to learn, returning to a more extrinsic
motivation with a perceived external locus of causality, relying on guidance
and praise from the supervisor (and others) and focusing on compliance with
behavioral recommendations. For others, reacknowledging confusion and
frustration can reduce motivation to learn as well as to engage in clinical
activities. A state approaching amotivation in Self-Determination Theory
36 IDM Supervision: An Integrative Developmental Model
can exist when a sense of incompetence and lack of control inhibits growth in
the trainee. For some trainees, there ensues a questioning of their suitability
for the profession, particularly if peers are perceived to be progressing further
and more quickly. The confusion and, at times, fear of incompetence, con-
trasting with feelings of confidence and effectiveness, can be reflected in vac-
illating motivation in these supervisees. For some, the realization that a good
relationship with the client or utilizing techniques in therapy isn’t always
sufficient to bring about change results in disequilibrium and the uncomfort-
able feeling that they aren’t sufficiently accomplished as therapists.
The transition issues for this level of trainee revolve around the goal of
broadening and deepening the trainee’s understanding of the therapeutic
process, utilizing himself or herself as a therapeutic tool, and personalizing
an orientation to professional practice. A self-understanding that can develop
from learning how the trainee’s own personal characteristics interact with
clinical practice issues forms the basis for the work of Level 3. In addition,
effectively combining the ability to intensively focus on the client—allowing
the supervisee to understand the client’s perspective and empathize—with
in-session reflection that calls into working memory the emotional experi-
ences as well as relevant information signifies movement to Level 3.
Autonomy The dependency of the early Level 1 trainee has given way to
a sense of efficacy and a desire for some autonomy in the Level 2 supervi-
see. This will often take the shape of a dependency–autonomy conflict, not
unlike what is experienced in adolescence. At times confidence will be high
and the supervisee will want to assertively develop his or her own ideas. The
locus of causality for the trainee’s behavior moves toward more internality
and he or she feels more control over the therapy process. Here, a level of
independent functioning is possible, with rather specific requests for help
when confusion arises or choices among options need to be made. At other
times, when things are not going so well and the trainee experiences a lack
of control or a sense of incompetence, the supervisee may become dependent
or, on occasion, evasive. This person will show lowered confidence in clinical
work and, sometimes, behavior similar to early Level 1 trainees.
As the Level 2 therapist transitions to Level 3, a more consistent con-
ditional autonomy will appear as motivation becomes more intrinsic, with
fewer bouts of feelings of incompetence or lack of control. This supervisee is
better able to understand the parameters of his or her competence, and the
dependency–autonomy conflict will fade.
An Overview of the IDM 37
The Metaphor Our mountain climber has moved from standing on the edge
of the crevasse and sending down observations or instructions to climbing
down into the hole with the stranded climber (client). The stranded climber
now feels more understood, realizing that the supervisee can better see the
problem from his or her perspective. The new challenge is for someone to
figure a way out. The supervisee may become as stranded and fearful as the
client. They both may now be crying up to the supervisor to help them out,
or giving up on the possibility of rescue. Occasionally, the client will take the
lead in climbing out of the crevasse.
Level 3
The turbulence and uncertainty associated with Level 2 give way to a more
stable, autonomous, and reflective Level 3 therapist. The trainee has suc-
cessfully developed and refined declarative and production schemata that
more adequately reflect a broader perspective on the therapeutic process. In
addition, the increased experience, reflection on this experience, deliberate
practice, and facilitative feedback have enabled the therapist to move toward
greater expertise with more functional awareness of patterns and the abil-
ity to match patterns perceived in current practice with others encountered
in prior experiences. Thus, the therapist’s work becomes more efficient and
effective. In addition, “surprise” situations or unexpected events in practice
that would have previously required extensive ROA at a later time (often in
supervision) can now more readily be handled by RIA as events unfold. The
transition to Level 3 brings about more of a personalized approach to clinical
practice and a greater use and understanding of the self as psychotherapist.
Self- and Other-Awareness Some of the focus on the self that we saw in
Level 1 returns in Level 3, although the quality of the self-focus is remark-
ably different now. Rather than a self-preoccupation, the Level 3 therapist
exhibits more insightful self-awareness. From the cognitive perspective, the
therapist is able to alternate an intensive focus on the client and working to
understand the client’s world with the ability to activate and move into work-
ing memory relevant schemata regarding client processes and characteristics,
as well as knowledge of relevant information and productions related to the
process of therapy. The KIA is more adequate to handle a broader array of
practice events, and the therapist’s abilities in RIA allow for more effective
changes in strategies to occur on the fly in the therapeutic context. More chal-
lenging events, alternatives for action, and integration of knowledge across
38 IDM Supervision: An Integrative Developmental Model
contexts will be the focus of ROA both individually and in supervision. The
supervisee is more accepting of himself or herself, with a better understand-
ing of current professional strengths and weaknesses. The focus on empathy,
an important developmental milestone in Level 2, remains. However, the
therapist now is able to focus intensively on the client using low-road process-
ing and tapping into the emotional experience of the client, and then pull
back and engage in high-road processing, more effectively labeling the emo-
tions he or she is experiencing and conveying that back to the client. Thus,
the intensive cognitive and affective client focus that developed in Level 2 is
combined with and augmented by better skills in RIA and pattern matching,
enabling the therapist to be more effective. The competence and confidence
that have developed enable the therapist to be better able to use himself or
herself (personal characteristics, genuine responses) in sessions.
Motivation The fluctuating motivation we observed in Level 2 has been
replaced with a more stable high level of motivation for professional develop-
ment and practice. Motivation has moved from extrinsic (sometimes amotiva-
tional) to more intrinsic as the perceived locus of causality for the therapist’s
behavior and effectiveness in practice becomes increasingly internal. As
described by Ryan and Deci in general terms, the therapist’s behavior becomes
more self-determined, moving to greater congruence, awareness, and synthesis
with self. Periodic ups and downs will continue, but within a narrower range
of motivation and tending toward more internality. Remaining doubts about
clinical effectiveness are not disabling, and there is considerably more concern
for the total professional identity and how the therapist role fits into it.
Autonomy The therapist’s commitment to retaining responsibility for his
or her clinical work is characteristic of this stage. While there is a solid sense
of when consultation is necessary, the therapist’s firm belief in his or her
autonomy and professional judgment is not easily shaken. As the breadth
of knowledge and ability elicits more regular central route processing, the
therapist is less easily influenced by others (supervisors, designated experts),
and evaluates input from others to determine whether it passes the “it makes
sense from my framework” test. The notion of independent practice is now
less of a goal and more of a realization. Supervision is useful in solidifying
gains and broadening the therapist’s perspectives but tends to become more
collegial at this point, with less of a difference in levels of expertise between
supervisor and supervisee.
An Overview of the IDM 39
The Metaphor Our mountain-climbing guide (supervisee) in Level 3 is
able to lower himself or herself down into the crevasse and effectively
communicate to our stranded climber his or her understanding of the emo-
tional, cognitive, and contextual aspects of the problem. With calm and
confidence, our supervisee assists the stranded client in developing a plan
to climb out, examining options and working from experience as well as
a detailed understanding of the client’s strengths and weaknesses, of rock-
climbing technique, and of the environment. While success is not guaran-
teed, the likelihood of both climbers rising out of the crevasse is considerably
increased.
Level 3i (Integrative)
Once the therapist has reached Level 3 in a number of domains, the primary
goal becomes integrating across the domains, or generalizing knowledge and
skills from one domain to others and increasing the fluidity with which he or
she moves among various aspects of professional practice. The therapist now
learns to move smoothly from, for example, assessment through conceptual-
ization, developing treatment goals, and implementation of interventions.
Self- and Other-Awareness The transition to Level 3i is characterized by
a personalized understanding of clinical practice that spans domains. The
therapist is able to monitor the impact of personal life changes on profes-
sional identity and performance. This self-understanding is apparent from
the therapist’s awareness of how his or her personal characteristics affect vari-
ous clinical roles, as well as an integration and consistency of identity across
these roles.
Motivation Relatively high and stable intrinsic motivation will be evident
across a number of domains. The therapist is likely to be aware of domains
where this motivation is lacking and understand the reasons for it. Decisions
concerning professional and personal goals will dictate which domains and
professional roles will emerge as most important. A refocusing of the thera-
pist’s practice to new areas may occur, necessitating a revisiting of Level 1 or
Level 2 issues, depending on the similarity of the new domains to those in
which professional development is high as well as the ease of generalization
of knowledge and skills across these domains.
40 IDM Supervision: An Integrative Developmental Model
Table 2.1
Developmental Levels
Level Motivation Autonomy Self-/Other-Awareness
1 Motivated Dependent; need for Cognitive: self-focus but limited
structure self-awareness
Affective: performance anxiety
2 Fluctuating between high Dependency–autonomy Cognitive: focus on client; understand
and low; confident/ conflict; assertive vs. perspective
lacking confidence compliant Affective: empathy possible, also
overidentification
3 Stable; doubts not Conditional dependency; Cognitive: accepting and aware of
immobilizing; mostly autonomous strengths/weakness of self and client
professional identity is Affective: aware of own reactions and
primary focus empathy
3i Stable across domains; Autonomous across Personalized understanding crosses
professional identity domains domains; adjusted with experience
established and age
Autonomy The therapist is able to move conceptually and behaviorally from
one domain to another with a high degree of fluidity. The possibility of refo-
cusing the therapist’s practice to new domains will bring about changes in
autonomy consistent with the level of professional development in related
domains. However, professional identity is solid across most domains rel-
evant to the person’s practice.
The Metaphor Our Level 3 mountain-climbing guide was able to help our
stranded climber emerge from the crevasse. Perhaps we can extend our meta-
phor for the Level 3i guide to an ability to handle most types of emergencies
and challenges confronted by his or her charges on the mountain. Also, with
additional training and experience, this individual may be particularly adept
at training other guides to provide similar assistance to climbers who are
attempting to scale everything from rocks to glaciers to mountain summits.
Table 2.1 summarizes descriptions of the overriding structures by level of
development, including transitions between levels.
Interaction of Structures and Domains
We will leave a detailed discussion of the structures across domains for each
level of professional development for the next three chapters. Some general
An Overview of the IDM 41
discussion of this process here will help set the stage for subsequent details.
Once again, it is important to keep in mind that supervisees are typically
functioning at different levels of development for various domains at any
given point in time. The range of levels, of course, will tend to be smaller for
very inexperienced trainees versus professionals with more experience. The
novice therapist will be functioning largely at Level 1, while the therapist
with considerable relevant and supervised experience is expected to be func-
tioning primarily at Level 3. It would be an error, however, to assume that all
experienced clinicians function at Level 3 across domains. We know thera-
pists who seem to be unable to progress beyond Level 2 or, at times, Level 1
structures for particular domains.
The Level 1 Therapist
Across domains, the Level 1 therapist has skills to learn and needs opportuni-
ties to practice them. In the domain of intervention skills competence, the
Level 1 therapist tends to focus on how the skills should be performed and
when to use them. The therapist’s evaluation of his or her effectiveness will
be based primarily on self-perceptions of the adequacy of performing the
techniques. Little awareness exists as to the effects of these interventions on
the client.
The high motivation of the Level 1 therapist across relevant domains is
at least partially a function of the fear and anxiety present. There is a strong
desire to emulate experienced therapists, often the supervisor, as a means of
developing skill and confidence and moving beyond the anxious neophyte
role. The theoretical orientation beginners adopt is often directly tied into
the perceived orientation of a role model. Often the more easily understood
or unambiguous models are those to which these therapists are initially
drawn. At other times, rather complex theories are abstracted by the Level 1
therapist into some fairly simple and understandable constructs to make the
information more digestible. Another common approach is to be attracted
to whichever theory fits most closely with the therapist’s own personal (often
informal) theory of human behavior. This has the advantage of allowing
beginners to fill in the blanks in their knowledge of the theory with common
sense, as they perceive it.
Typically, the Level 1 trainee is quite dependent on the supervisor or oth-
ers in authority. This is, of course, quite acceptable and usually imperative.
The supervisor is the source of answers to the many puzzling questions with
which beginners struggle. For example, producing a comprehensive, or even
42 IDM Supervision: An Integrative Developmental Model
marginally inclusive, conceptualization or diagnosis of a client is often quite
difficult for beginning therapists. Paging through a copy of the most recent
version of the DSM and trying to fit the client into appropriate categories can
be at best a hit-or-miss enterprise. The supervisor can provide or guide the
trainee toward the necessary insights, mechanisms for data collection, and
integration of information. As the trainee develops these skills, the supervisor
is still needed to validate or improve upon the initial versions.
In summary, across domains, the Level 1 therapist is characterized by
a predominant self-preoccupation, a strong motivation for learning how to
become as proficient as other professionals, and a desire to be instructed and
nurtured by a more experienced clinician.
The Level 2 Therapist
The change in focus from the self to the client that occurs with Level 2 has
many implications for practice across domains. In this stage, we can expect
to see a considerable increase in the therapist’s sensitivity to individual dif-
ferences across clients. The increased empathic focus on the client allows
the therapist to experience greater depth of emotional and cognitive under-
standing of the client, which increases the therapist’s appreciation for the
client’s personality, experiences, and life circumstances. This greater depth
and breadth of understanding of the client’s world can be quite useful to the
trainee in developing more adequate case conceptualizations. On the other
hand, this wealth of information, with all of its idiosyncratic nuances, can
present real problems for the therapist in wading through the data and reduc-
ing the information down to a concise conceptualization or diagnosis. At
times, we may find a negative reaction to diagnosing or “labeling” a client
because of the impersonal evaluation such processes can convey. This flood
of information may also cause the therapist to freeze up in terms of mak-
ing clinical decisions in treatment. By experiencing the client’s emotions and
thoughts, solutions that may have appeared quite workable at Level 1 may
now appear overly simplistic, naïve, or too impersonal. Indeed, in terms of
specific therapist behaviors and client progress, our Level 2 therapist may
sometimes be less effective than our naïvely confident late Level 1 therapist.
This increase in perceived complexity of clinical practice and confusion
concerning the therapist’s ability to function as a professional can pro-
duce day-to-day (and sometimes hour-to-hour) fluctuations in motivation.
While our early Level 1 therapists may lack sufficient clinical knowledge
to make decisions, our Level 2 therapist may perceive too many options, or
An Overview of the IDM 43
none at all, and become immobilized. The domain of individual differences
often remains quite relevant and has implications across the other domains.
The desire to know and understand the client’s situation and view of the
world is typically high, except when the confusion or emotions get too strong
and the Level 2 therapist retreats to the relative safety of inactivity.
Regular reminders of professional ethics are important for Level 2 thera-
pists. The dependency–autonomy conflict can create tension in the super-
visory relationship that may limit the willingness of the therapist to share
feelings and thoughts with the supervisor. Becoming too enmeshed with a
client or assuming too much responsibility for the client’s well-being can
result in unfortunate consequences.
The Level 3 Therapist
The Level 3 therapist is more able to use insightful self-awareness in addi-
tion to the awareness of the client’s experience developed during Level 2.
Both come into play in practice, giving a depth and breadth of perspec
tive to the therapist. His or her treatment goals and plans may reflect this
integration of sources of information. Knowledge of one or more guiding
theories, conceptualization of the client’s difficulties, and confidence
in his or her own abilities will result in more adequate treatment plans.
The Level 3 therapist is able to integrate information acquired through
empathic listening to and skillful assessment of the client, monitor his or
her own responses in the clinical situation, and separate from the process
in order to make more objective third-person observations. This results in
an improved ability to plan and carry out effective treatments. In addition,
we find little variation in how this individual functions across different
professional roles in domains where development has reached Level 3. In
other words, the integration of personal characteristics with professional
behavior is high.
Motivation is stable and relatively high as the therapist makes great strides
toward developing a personalized therapeutic style. This personalization of
clinical practice allows for considerable autonomy for the Level 3 therapist.
The therapist’s developed schemata and integration of prior experiences
reflects an understanding of theory and implementation of interventions that
makes supervision consultative rather than didactic. Recommendations for
changes or observations of other effective therapists are sifted through the
Level 3 therapist’s understanding of self and how this translates into his or
her therapeutic behavior. This will appear not as defensiveness in supervision
44 IDM Supervision: An Integrative Developmental Model
but rather as a thoughtful translation of one person’s strengths and under-
standings into another’s repertoire.
The Level 3i Therapist
This therapist is fully functioning across domains relevant to her or
his practice. Level 3 structures are in play, and a fluidity of movement
among them is apparent. In our experience, Level 3i is not often fully
achieved, but clinicians who reach this point are considered experts by
their colleagues.
The growth experienced as movement into Level 3i is less vertical (mov-
ing up the levels) and more horizontal in spreading understanding across
domains and linking relevant schemata. Piaget’s notion of horizontal décal-
age, the unfolding from within, characterizes this level. Development within
each domain is utilized to generate new awareness through integration and
linking of schemata, as well as learning in response to input from others.
The Level 3i therapist is creative—able to integrate previously retained
knowledge across areas, learn from others, and evolve strong and appropriate
accommodations and assimilations throughout the life cycle. The ongoing
work of this therapist is to reestablish networks of knowledge with self-under
standings that change as the individual continues to mature.
This brief description of the IDM introduced some of the characteristics of
the levels of professional development and provided some general examples.
The next three chapters examine in detail each of the levels across domains,
with considerable attention paid to how the supervisor can augment devel-
opment of the supervisee. They provide specific examples of how therapist
characteristics are evident in therapy and in supervision, and they offer
guidance in providing supervisory interventions. Each chapter describes the
protot ypical therapist at each level, with particular attention to identification
of status on the three overriding structures. How the structures are assessed
across domains will be presented, with examples of therapists who exemplify
these characteristics. Finally, specific guidance for supervisors who are work-
ing with supervisees at each level will be addressed. A general framework for
providing a facilitative supervision environment will be augmented by spe-
cific recommendations for supervisory interventions that can be effective for
each level of therapist. Again, examples of implementation of some of these
interventions with supervisees will be examined to give life to the model.
3
The Level 1 Therapist
•
After we have discussed the characteristics of the Level 1 therapist, we
will turn our attention to the supervision environment most suited for
this level of trainee. General orienting assumptions as well as specific
useful techniques will be explored. We will also spend a little time exam-
ining examples of trainees who often have difficulty developing beyond
entry-level status. These Sub–level 1 trainees (Eichenfield & Stoltenberg,
1996) pose challenges to trainers that may not be solved by tradit ional
training methods.
Finally, we will address transitional issues that the Level 1 trainee will
face just prior to moving on to Level 2. Identification of these issues signals
to the supervisor that the Level 1 therapist is poised to begin dealing with
Level 2 issues.
The Entry-Level Trainee
When talking about Level 1 trainees, the entry-level therapist is often the
person who comes to mind. Those of us involved in training programs have
the opportunity to work with a new group of beginning therapists-in-
training on a yearly basis. These trainees’ excitement (and anxiety), fresh
perspectives, and zest for learning are always a welcome reminder of the opti-
mism and promise that can characterize our profession.
Backgrounds of entry-level trainees vary considerably depending on the
type of training program they are entering (psychology, social work, men-
tal health counseling, psychiatry, and so on), but typically they have some
knowledge of the content of the psychotherapy process, personality theory,
45
46 IDM Supervision: An Integrative Developmental Model
systems theory, or other relevant areas. Their actual applied experience is usu-
ally limited, however, and may simply reflect an interest in human nature,
being labeled a good listener by friends, having been in therapy as a client, or
having experienced (or observed) critical life events that have emphasized for
them the importance of psychotherapy and related practice.
Learning and Cognition
Most programs that train mental health professionals typically expose new
students to course work and some type of prepracticum experience before
they begin working with clients. This work provides the initial basis for
understanding the process (therapy, assessment, and so on) and controlled
opportunities for practice. In terms of cognitive models of learning, declara-
tive verbal or image representation of the process begins here, allowing for a
simple initial understanding of what is to be accomplished. These early con-
cepts and the linkages created between them provide the initial framework
from which trainees develop schemata. These schemata are derived from clas-
sifications of similarities across examples of processes, client types, assess-
ment devices, and so on, addressed in training.
Trainees evaluate much of the information provided in early course work
against their personal experience. Where similarities exist, schemata will
more quickly be developed that will provide the early basis of understanding.
Information less congruent with their prior experience may take longer to
integrate or may be inaccurately integrated into existing schemata. It is use-
ful to keep in mind that an initial schema will tend to be overly general and
cannot accommodate numerous characteristics.
Another way of describing this process is to note that beginning trainees
typically develop rather simplistic understandings of complex constructs and
processes. Exceptionally bright trainees may learn complex material rather
quickly and be able to regurgitate it on demand, but the actual ties to clinical
processes will be weak at best. Once the schema of “hammer” is developed,
nails are seen everywhere. Integrating the learning sufficiently well to trans-
late into KIA takes time.
Motivations for Entering the Field
The reasons for entering training can have an impact on early development.
A number of new trainees have a strong desire to help others in need. They
The Level 1 Therapist 47
want to gain the skills necessary to reduce the suffering of others and con-
sequently have a tendency to prioritize their learning experiences directly
related to psychotherapy interventions. Their interest in studying research
methods, assessment techniques, or research on biological, cognitive, emo-
tional, or social processes may be limited. Those attracted to the field because
they found the issues and processes intellectually stimulating may be less
concerned initially with allaying the pain or problems of potential clients and
more with the challenge of understanding human nature.
Depending on the focus of the training program, some new trainees are
primarily interested in the science associated with clinical issues. They may
prioritize learning experiences associated with research methodologies, statis-
tics, and examination of empirical literatures on particular clinical issues.
Another rather common initial motivation for entering the field is the
desire to learn more about oneself or another important figure in one’s life.
This can be in response to childhood experience, relationship issues, or any
number of other life experiences. These trainees have a strong interest in
issues most closely associated with aspects of personal experience and less
interest in areas they perceive as unrelated.
Finally, there are new trainees whose primary motivation appears to be
prestige or status. They are sometimes quite motivated to learn the breadth
of knowledge and skills needed to earn the prestige or status to which they
aspire. Others quite simply want the degree that leads to the license so they
can begin the lifestyle they envision.
In our experience, no single initial motivational framework ensures suc-
cess. Often these trainees’ initial views of the field will change, sometimes
radically, over the course of training. And some trainees may be more resis-
tant than others or unable to benefit from training.
Advanced Supervisees
Although most people typically think of entry-level trainees when con-
sidering Level 1, much supervisory work will be with therapists who are
functioning at Level 2 or 3 in one or more domains but remain at Level 1 for
others. The characteristics, needs, and exemplification of structures for these
trainees still fit the Level 1 classification, but the professional development
and experience may mask some of the naïveté apparent in true beginners.
48 IDM Supervision: An Integrative Developmental Model
Sam was an experienced therapist who had worked as a master’s-level
counselor in a community mental health center for a number of years
prior to returning to school for advanced training. His supervisor was
pleased with Sam’s ability to work with clients in individual therapy. He
could quickly assess his clients and provide accurate diagnoses, as well as
develop and carry out thoughtful treatment plans. It became apparent to
the supervisor, however, that Sam lacked experience and understanding
regarding the modality of marital therapy. Couples who were assigned
to Sam inevitably were moved into individual therapy to deal with per-
sonal issues rather than seen in marital therapy to address relationship
problems. When this tendency was explored in supervision, Sam noted
that there always seemed to be a number of personal issues that each per-
son could benefit from addressing and, frankly, he felt more comfortable
doing this than trying to engage in couples work.
A danger with advanced trainees who remain at Level 1 in domains in
which they practice is that they may reconceptualize issues, clients, or pro-
cesses to fit modalities or theories and intervention approaches with which
they believe they can comfortably perform at a higher level. This is, of course,
not always the case. Fortunately, a majority of therapists seek out training for
new domains or areas of practice and work diligently with the supervisor to
develop in these new areas.
Level 1 Structures
Let’s now move our attention to the overriding structures discussed in the
prior chapter. After we examine how each of these three structures character-
izes Level 1 therapists, we will see how they are evident across the domains
of professional practice.
Self- and Other-Awareness
Recall that Level 1 therapists are characterized by a primary focus on them-
selves. In contrast to the rather enlightened self-focus or self-understanding
that we will see with Level 3 therapists, the early Level 1 supervisee’s aware-
ness is primarily focused on his or her own anxiety, his or her lack of skills
and knowledge, and the likelihood that he or she is being regularly evaluated
(negatively, it is feared). These preoccupations interfere with the supervisee’s
The Level 1 Therapist 49
ability to adequately perform the tasks associated with clinical practice and
to focus on the task at hand or the client.
Prior research has consistently documented the anxiety and uncertainty
of beginning trainees (Stoltenberg, McNeill, & Crethar, 1994). Hale and
Stoltenberg (1988) conducted a study of new trainees and were able to parcel
out the anxiety they felt into two types. Students interested in counseling were
offered the opportunity to work with a client concerning a relationship prob-
lem. They all were shown a videotape presentation of rather simple fundamen
tal counseling skills to give them some exposure to the counseling process.
Conditions were varied so that some trainees saw the client (a confederate) in
a room with a visible video camera (and were alerted to this), while others
used a room with no visible camera (and were unaware of one). Half of each of
these groups were told that their counseling would be critiqued by a supervi-
sor after the session, and the other half were told that such supervision would
be available to them at some future time should they desire it. Students were
told to use as many of the skills they observed on the training tape as possible.
Students who were to see the supervisor were told that their session would be
critiqued according to the skills demonstrated in the training videotape.
The results of this study indicated that the lowest level of anxiety was
reported by students who were in rooms with no visible video camera and
were not scheduled to see a supervisor after the session. These students also
tended to stay in the counseling session longer (which was left open-ended)
than other students. The students who were in rooms with visible video cam-
eras and were scheduled to see a supervisor after the session reported the
highest levels of anxiety and tended to stay the shortest time in the counsel-
ing session. The other two groups fell in between and were similar in levels
of reported anxiety.
The authors concluded that some of the anxiety the students experienced
was associated with evaluation apprehension, or the concern of being nega-
tively evaluated by the supervisor. Another component of the anxiety for some
was a function of a process referred to as objective self-awareness (Duval &
Wicklund, 1972), or a personal negative appraisal of the self by an individual
who does not think he or she is meeting acceptable standards of practice.
Both of these components fit well with the cognitive and emotional aspects
of self-awareness as it pertains to Level 1 therapists.
In the cognitive area, these supervisees are concerned with learning infor-
mation, understanding the process, and performing the skills in an appro-
priate manner. Their attention tends to be directed toward searching their
memories for clues about what to do (scanning relevant schemata), monitoring
50 IDM Supervision: An Integrative Developmental Model
their own behavior in performing newly learned skills, and trying to fit what
the client is telling them (in assessment and psychotherapy) into a meaning-
ful category for conceptualization purposes. This concerted effort leaves little
attentional space available for focusing their thoughts directly on the client
and understanding his or her perspective. Occasionally, we’ll find that this
desire to learn can be overly focused on only one perspective. We’ve noticed
some students, after taking an initial overview course on theories, choosing
to lock in on a particular theoretical orientation and the associated therapeu-
tic behaviors to the exclusion of others. If not addressed early, this can slow
trainees’ learning and development and lead to resistance in supervision if
other approaches are entertained.
Affectively, supervisees in the early phase of Level 1 experience con
siderable anxiety, and sometimes fear, related to their lack of confidence in
knowing what to do, being able to do it, and being negatively evaluated by
the client or the supervisor, or both, for doing it poorly. It is difficult, if not
impossible, for the trainee who is suffering through performance anxiety to
experience empathy for the client and truly resonate with his or her emo-
tional experience.
On the other hand, some trainees will exhibit little or no anxiety related to
early experiences in learning counseling and psychotherapy. We view this as
often an indication of problematic motivation and sometimes an inadequate
assessment of their own skill level. This can be a function of either amotiva-
tion, where they believe they are unable to effectively learn the necessary
skills (external locus of control), or too high a level of confidence in their
abilities, resulting in an internal locus of control that exceeds what is war-
ranted for their skills and understanding of the process.
Although the characteristic early confusion and uncomfortable levels of
anxiety lighten as the trainee gains experience, this progress does not signal
an end to Level 1. The self-focus and lack of other awareness will continue
for a while. The trainee’s initial negative assessment of his or her own per-
formance will usually give way to more confidence in the ability to exer-
cise certain skills and understand certain processes. The focus nevertheless
remains on how the therapist is performing and understanding rather than
on insightful perceptions of the client’s reactions to the process.
Motivation
Early in the training experience, Level 1 therapists will be characterized by
fairly high levels of motivation, though tempered, of course, by the anxiety
The Level 1 Therapist 51
associated with this stage (for example, relief or feeling off the hook when a
client cancels or is a no-show). Nonetheless, embarking on a new career and
learning a new profession is an exciting time, and most new trainees want
to learn quickly. This autonomous motivation (Vansteenkiste, Lens, & Deci,
2006) is characterized by the trainee experiencing a sense of choice and will-
ingly engaging in the learning process. The motivation can be intrinsic (inher-
ent interest in learning) or a function of a desire to attain a particular outcome
(extrinsic) such as becoming a proficient therapist. For most supervisees, the
first practicum experience after preparatory initial course work represents the
first experience relevant to the “real work” in terms of becoming a therapist.
Thus, a significant investment in the learning of therapeutic skills adds to the
beginner’s high autonomous motivation. No doubt some of this motivation is
related to wanting the anxiety to end and the confidence to take over (extrin-
sic), but the impact remains. The early Level 1 therapist is typically enthusi-
astic, committed, and attentive, and his or her goals are consistent with what
are considered in Self-Determination Theory as intrinsic goals (e.g., growth,
relationships, community, as posited by Vansteenkiste et al., 2006). These
characteristics facilitate the quick learning of material and skills and, for most,
fairly rapid progress in learning and performing some fundamental tasks.
On the other hand, some students enter training with extrinsic goals (e.g.,
wealth, fame, status) that negatively impact their motivation to learn. The
motivation to learn can be perceived as controlled motivation where students
feel they are coerced or pressured to learn (Vansteenkiste et al., 2006). These
supervisees may experience an increased risk of dropping out, lower achieve-
ment, and more superficial information processing, among other outcomes.
Even when all goes well, the early intrinsic motivation to learn may
dissipate somewhat as trainees hit the latter phase of Level 1. Although
extrinsic motivation to eventually engage in professional practice usually
remains high, overconfidence may emerge from a perception of competence
in performing fundamental tasks and confidence in one’s grasp of limited
information. Positive evaluations by the supervisor may add to this state of
overconfidence (higher than warranted self-efficacy), which is not tempered
by the more complex understanding of clinical processes characteristic of
later stages of professional development.
Autonomy
Level 1 therapists are usually, and appropriately, highly dependent on the
supervisor, primarily during the early phase of training. The supervisor and
52 IDM Supervision: An Integrative Developmental Model
other authority figures are seen as sources of support and knowledge and
viewed as crucial to the trainee’s desire to get beyond the lack of knowl-
edge and anxiety. The supervisor is, at least to some degree, a role model for
the beginner. Thus, supervision is an opportunity to receive support, direct
information, specific advice, and training aimed toward helping the trainee
negotiate clinical practice, which is all appropriate for the Level 1 trainee,
who, by definition, lacks the knowledge and skills necessary to perform as an
autonomous professional.
Toward the end of Level 1, trainees tend to become less openly dependent
on supervisors. If the training experience has been structured in such a way
to allow the therapist to achieve success in early attempts at interventions,
he or she may develop sufficient, although unjustified, confidence and desire
more autonomous functioning. Therapists who are functioning at advanced
levels in other domains may demonstrate relatively high levels of initial con-
fidence in functioning in the new domain based primarily on the assumption
that their other clinical knowledge and skills will carry them through.
Structures Across Domains
General descriptions of Level 1 supervisees are inadequate bases for con-
ducting a careful assessment. It is necessary to evaluate the therapist across
domains that are relevant to his or her practice under supervision. To do this,
supervisors must be cognizant of the structural status for each of the domains
of interest. As we have noticed, there are also transitions between levels that
mark development that occurs prior to a stage change. Although a thera-
pist will usually be functioning at more than one level across a number of
domains, he or she should be at similar levels across closely related domains
if sufficient experience and training have occurred. We have described in
our earlier work (Stoltenberg & Delworth, 1987; Stoltenberg, McNeill, &
Delworth, 1998) how Level 1 trainees exemplify the overriding structures
across eight domains.
Intervention Skills Competence
This rather broad domain reflects many different skills associated with
numerous types of interventions flowing from various theoretical frame-
works. In addition, different modes of delivery necessitate the use of a range
of skills. Supervisors must consider the specific therapeutic activity of focus
The Level 1 Therapist 53
when assessing a therapist in this domain. Are they evaluating intervention
skills from a cognitive-behavioral framework in working with an individual
depressed woman? Or are they evaluating intervention skills from an object
relations framework in working with a narcissistic man? Perhaps supervisory
attention focuses on marital therapy, where conjoint sessions with the couple
are the modality. It is important to consider the supervisee’s level of devel-
opment for this domain in context and realize that he or she may be quite
developed within a given theoretical framework, working with a particular
type of client and within a certain modality, yet be considerably less devel
oped when one or more of these conditions is altered.
Beginning therapists usually desire training in some understandable set
of skills, preferably within a fairly structured framework, that will provide
some guidelines for working with clients. If, for example, some variation on
fundamental listening skills is the initial focus of training, the supervisee will
strive to understand how to perform these skills in sessions and self-evaluate
how effectively they have been implemented. This situation fits rather well
with the initial self-focus of Level 1 trainees, who tend to imitate another
therapist or apply a cursory understanding of the process to their sessions.
They will try to remember how to implement a skill and decide when to use
it, focusing primarily on their own internal frame of reference. This reflects
the cognitive focus.
The affective dimension of this self-preoccupation is anxiety or feelings of
apprehension. There can be a real lack of self-efficacy in a trainee’s ability to
perform a skill adequately or time it appropriately. Should the supervisor be
unaware of or unresponsive to this anxiety and create more ambiguity, the
trainee’s anxiety will accelerate.
It is not unusual for beginning therapists to latch on to a particular ori-
entation and become a devotee. Although expert experienced therapists also
often work from a primary orientation (although most tend to be eclectic),
novices are likely to make a less well-informed decision. They find it easier to
select an approach, often one of the first to which they are exposed, and stay
with it than to learn more than one and stay confused that much longer. This
approach is not a bad one. Developing a therapeutic base can allow the trainee
to move more quickly to advanced Level 1, feeling comfortable and opening
up awareness to the client, which in turn may stimulate more exploration into
other approaches and techniques. This sense of power or mastery can open
the trainee up for more challenging experiences, eliciting more growth.
Still, it is fairly common for novices to take a given set of skills and under-
standing to the limit before investing themselves in learning new or more
54 IDM Supervision: An Integrative Developmental Model
comprehensive frameworks. For example, in our training clinic at the Uni
versity of Oklahoma, there is a strong initial focus on relationship skill devel-
opment for our beginning trainees. Consistent with some models of skill
development (Hill, 2004), this is useful in forming a foundation from which
students can advance to additional skills such as interpretation and action
interventions. Additionally, as noted in Chapter 1, given the movement to
EBPP, it is especially important at this early stage that trainees gain skills
in relationship/alliance building and understand, as well as appreciate, the
empirical link to evidence for the support of common factors across ther-
apeutic approaches (Wampold, 2001). It is not uncommon for beginning
trainees, in their anxiety to perform, to prematurely move beyond basic skills
implementation in attempting to implement a therapeutic technique. On the
other hand, for some students, developing fundamental relationship skills
can lead to overconfidence in, or lack of understanding of the limitations of,
these skills as they impact a variety of clients. Consistent with this limited
focus are the challenges experienced by some students in our programs. For
example, our master’s students may find themselves seeing couples fairly soon
after they begin to feel somewhat comfortable with individual clients and
often before any formal didactic course work in couples therapy. Usually the
trainees begin by using fundamental listening skills, taking turns if there are
two therapists, focusing on one client at a time. They often show some initial
resistance to learning a mode of therapy more suited to couples because this
necessitates a step back to uncertainty and learning new skills. Thus, an early
motivation to learn can be inhibited by moving the trainee too quickly and
demanding too much.
Early dependence on the supervisor is to be expected, and even encour-
aged, within limits. The therapist relies on the supervisor to show how to
apply skills learned in laboratories or discussed in class. Expansion of new
skills to move the therapy process along is expected to come from the super-
visor when needed. Occasionally this dependency can be extreme and non-
facilitative. Nearly every year we seem to have one or more new trainees
who have the need to call the supervisor at nearly any hour, day or night,
to check out what to do with a client or request other resources for learning
techniques. If the supervisor is an advanced student, this dependence can be
annoying. If the supervisor is a senior psychologist, this is often viewed as
intolerable. However, therapeutic ego strength is quite limited, and construc-
tive ways to redirect the trainee’s energies are needed to keep the situation
from becoming aversive. Positive reinforcement and rewarding appropriate
The Level 1 Therapist 55
behavior go a long way in making trainees feel effective and confident in
their potential for growth.
Assessment Techniques
Early course work in assessment approaches and instruments, along with
intake training, marks the beginning of work in this domain. It is common
for trainees to initially assume that assessment information is unequivocal
rather than indicating a certain likelihood of personality characteristics,
cognitive styles, career interests, and so on. Some trainees may pursue an
early preference for interview data as the primary source of information for
assessment, while others may become intrigued with objective, norm-based
assessments or projective assessments. The strong cognitive self-focus can be
quite useful in this stage as novices learn to administer assessment devices
in a standardized way, but it can present problems when they have to lis-
ten carefully to responses, decide when to push for elaborations, and code
according to criteria. There can be a tendency to want to fit clients into neatly
defined categories, which reduces some of the ambiguity of therapy. Indeed,
we find that an assessment clinic, in which we focus primarily on conducting
contract assessments, is quite popular with newer students. Some seem to
be initially more attracted to what they perceive as the more structured and
straightforward process of assessment than the “fuzzy,” less structured process
of therapy. Nonetheless, their motivation is usua lly high, as expected. The
supervisor is expected to be there to help decide on the assessment strategy,
train in administration and scoring, and interpret results.
Other students react negatively to the idea of diagnosis or assessment.
Some see this as unnecessary or even harmful, believing that labeling or
classifying clients indicates a lack of appreciation for individual differences
in the way clients express themselves. Objective assessments can be viewed as
lacking cultural sensitivity to the point of being irrelevant or even damaging
in working with ethnic or cultural minorities. Thus, trainees may experi-
ence controlled motivation, where they feel pressured or coerced to engage
in learning.
Interpersonal Assessment
Somewhere in between intervention skills and assessment techniques is the
process of interpersonal assessment. Here the therapist must learn to use
56 IDM Supervision: An Integrative Developmental Model
himself or herself in the session to elicit responses from the client that aid
the assessment process, or to use his or her own reactions to the client as an
indication of social skills status or the presence or absence of certain person-
ality characteristics. In the early phases of focus on this domain, the therapist
is inclined either to ignore certain processes that are occurring in therapy or
attribute too much pathology to reasonable responses by the client to envi-
ronmental and interpersonal contexts. A therapist’s self-focus limits his or her
ability to take the perspective of the client as well as to accurately monitor
his or her own reactions (due to the uncertainty the therapist feels). Getting
locked into a set of expectations concerning client responses will make it
diffi cult for the trainee to respond to unexpected statements or recognize
clues to client characteristics that were unanticipated, thus limiting his or her
ability to effectively engage in RIA. The motivation to learn to assess clients
is high, but again, the supervisor plays a crucial role in serving to validate,
redirect, and interpret information, and in offering alternative conceptualiza-
tions for the therapist.
Goleman (2006) describes aspects of social intelligence that we believe
have direct relevance for the domain of interpersonal assessment. He dis-
cusses four aspects of social awareness that affect the ability to understand
and experience others’ emotions and cognitions in interpersonal interactions.
Primal empathy is the process of sensing emotions through nonverbal signals
communicated by others. Attunement is listening with full receptivity to
others, which we believe is very difficult for beginning therapists and rather
easier for more advanced ones. Empathic accuracy is the level of understand-
ing someone’s thoughts, emotions, and intentions; we believe it can vary
substantially in terms of how closely the therapist’s understanding actually
matches the experience of the client. Interference from the therapist’s own
emotional experience, apart from empathy, can occur. Finally, social cogni-
tion includes an understanding of how the social world works and, of course,
will significantly vary by cultural context.
The accuracy and relevance of the therapist’s ability to utilize primal
empathy and attunement will affect empathic accuracy (or lack thereof). In
addition, how knowledgeable and experienced the therapist is regarding the
relevant social worlds in which the client functions will affect his or her
ability to understand and intervene. From our perspective, it can at times
be difficult for beginners to sort out the origin of emotions they experience
in therapy. These emotions can reflect at least three processes, and probably
combinations of them. A therapist’s emotional reaction through interactions
with a client can be a function of primal empathy that he or she experiences
The Level 1 Therapist 57
(low-road) and processes through high-road (rational, language-based) mech-
anisms to effectively label and understand the emotions. Emotions can also
reflect personal feelings from the therapist’s own life experiences that are
tapped by the interaction. These may be fairly idiosyncratic to the therapist
and are a function of his or her life experiences and how they have been
processed. Finally, the therapist may be reacting emotionally to the client
in a manner that is reasonably consistent with how others in the client’s
world might respond to him or her. We have found that helping beginning
supervisees sort out these emotional experiences is important for them to be
able to effectively utilize affect in the therapeutic process. Often, this comes
from ROA in the supervision session and will, ideally, lead to broadening the
supervisee’s understanding of self and others (schemata) that can be tapped
through RIA in subsequent therapy sessions. We should note, though, that
this is the beginning of a process that will take some time to reach fruition.
From a developmental perspective, too much of a focus on interpersonal pro-
cesses in therapy (e.g., Teyber, 2006) is premature for the beginning thera-
pist, and risks increasing anxiety that can interfere with the learning of basic
empathic listening skills. As we will see, the important role of interpersonal
process and its application in counseling can be more fully understood and
utilized by more experienced and advanced therapists in training.
While the role of empathic attunement and the use of emotion in psycho-
therapy should not be undervalued (Greenberg & Paivio, 1997), empathy
and understanding another’s experience are only part of social intelligence, as
Goleman (2006) notes. One also needs to be able to effectively interact with
others to intervene or bring about a facilitative relationship. Social facility
is the term Goleman uses to describe how smooth and effective interactions
occur. This process includes synchrony, which is smooth interactions at the
nonverbal level. When working well, an observer can notice a kind of dance
or reflection of nonverbal behaviors between people. Self-presentation is also
important so that one can effectively communicate what one intends within
understandable cultural standards. He argues that an important ability
related to this is to control and mask how one expresses emotion to meet the
demands of the situation. While this might at first blush appear to be at odds
with the value of authenticity in the interactions that therapists often aspire
to in their practice, for optimal effectiveness therapists often need to balance
spontaneity in interactions with sensitivity to others. Goleman’s notion of
influence is consistent with the social psychological literature we have dis-
cussed. Some approaches to therapy (particularly some relational ones) might
argue that therapists should avoid the expert role and the power differentials
58 IDM Supervision: An Integrative Developmental Model
that are reflected in it. However, believing that therapists don’t attempt to
influence their clients in facilitative ways that add to their understanding of
self and others and to improve their ability to function in their lives is disin-
genuous, we think. This use of influence, according to Goleman, is tempered
by one’s concern or caring about the needs of others and organizing one’s
efforts to support them.
Client Conceptualization
Formal case conceptualizations can take many forms, often varying
according to the theoretical model the therapist uses (Eells, 2007). This
process should not be confused with diagnosis (for example, using the
DSM). Although trainees need to learn the process and utility of an accu-
rate DSM diagnosis, reference to the manual often does not advance an
understanding of the client that leads to a subsequent treatment plan
(another domain). The literature is fairly clear on the limitations of diag-
nostic classifications in making treatment decisions (Beutler & Clarkin,
1990), so it is important not to limit the focus on client conceptual-
izations to simple diagnoses. We use a rather detailed format to guide
therapists in developing a more complex understanding of their client’s
dynamics as well as forcing them to attend to and integrate relevant data
(see Appendix A).
Novice therapists tend to focus on specific aspects of the client’s history,
current situation, or assessment data and exclude consideration of other rel-
evant information. This can be a function of seeing the world through their
own experiences or simply of forcing a familiar template on all new situa-
tions. They may make rather grand conceptualizations based on somewhat
sparse information or discrete observations. Diagnostic criteria can be bent
to the will of a therapist in search of a parsimonious diagnosis. Consistency
of diagnosis, or of information congruent with a given orientation, may
direct thinking rather than a search for information and a conceptualization
salient to the client’s presenting problem and life circumstances. There can
be a tendency to either psychopathologize fairly functional responses by the
client or normalize fairly pathological ones. Early on, there is a strong interest
in learning about clients and understanding them, so novices’ motivation is
high. Their initial attempts at conceptualizations may be inordinately long
(but lacking in organization and integration) or incredibly brief (while overly
simplistic and concrete). Nonetheless, they rely on the supervisor to provide
direction, affirmation, and confirmation of therapist conceptualizations.
The Level 1 Therapist 59
Individual Differences
Schneider (1990) asserts that the time has come for educational models to
include the “unselfconscious integration” of issues of gender, sexual, ethnic,
and socioeconomic diversity as a simple reflection of the way the world is.
Many training programs have attempted to address this issue by including
more course work on the counseling issues of diverse populations, along with
the infusion of diversity issues across courses. Although it is increasingly
likely that Level 1 trainees are being exposed to these issues early in their
training experiences, they still often rely too heavily on their own idiosyn-
cratic experiences and perceptions of the world in attempting to understand
their clients. Their own cultural background may serve as the “ground” on
which a given client is viewed as the “figure.” Although it is probably advan
tageous for therapists to have had broad experiences across various cultures,
this is not the norm. Additionally, the impact of gender is salient for many
issues, and an understanding of this issue may initially be lacking, unar-
ticulated, or biased. Many trainees, even with today’s strong emphasis on
multicultural issues, may assume that their worldview is similar to that of
most of their clients, therefore not acknowledging the importance of differ-
ences in background, culture, gender, sexual orientation, physical or mental
abilities, and so on. On the other hand, trainees are often highly motivated
to learn about other cultures, genders, people with disabilities, and other
important individual differences. In therapy, however, these therapists may
see themselves as having little or nothing in common with clients from dif-
ferent backgrounds or life circumstances, which can make therapy appear to
be an overwhelming task. On the other hand, they may attempt to use what
they have learned in multicultural courses and apply fairly rigid, although
often positive, stereotypes to their clients.
EBPP also “involves consideration of the client’s values, religious beliefs,
world views, goals, and preferences for treatment with the psycholo-
gist’s experiences and understanding of the available research” (American
Psychological Association [APA], 2006, p. 278). This encompasses individual
client characteristics such as gender, gender identity, culture, ethnicity, race,
age, family context, religious beliefs, and sexual orientation, as well as the
impact of these variables on the treatment process, relationship, and outcome
(APA, 2000, 2003). Ridley and Lingle (1996, p. 32) define cultural empathy
as “a learned ability of counselors to accurately gain an understanding of the
self-experience of clients from other cultures—an understanding informed
by counselors’ interpretations of cultural data.” More recently, Vasquez
60 IDM Supervision: An Integrative Developmental Model
(2007) and Comas-Díaz (2006) have examined the cultural variation in the
therapist-client relationship within an EBPP perspective in terms of differ-
ences apparent across cultures in expressions of affect, hierarchical relation-
ships, and personal attributes leading to the development and enhancement
of cultural empathy. Consequently, it is crucial for beginning therapists to
gain early exposure to such variations.
Cheryl had not worked with many ethnic minority clients before she was
assigned a fairly traditional American Indian boy as a client. After the
initial session, she remarked to her supervisor that she did not feel com-
fortable with the boy. “He’s awfully quiet, and I think he’s keeping some
important things from me. He never looked me directly in the eye dur-
ing the entire session and offered very little without prompting. I almost
wonder if he wasn’t high on something.” Cheryl’s supervisor explored
with her other aspects of the client’s behavior and noted that it is often
considered disrespectful for American Indian children to maintain eye
contact with adults. “His quiet demeanor and lack of eye contact might
well be a function of his respect for you rather than a sign of resistance,
inattentiveness, or substance abuse.”
Personality characteristics form another factor in individual differences
that can create challenges for the therapist. Classification of clients into vari-
ous “disorders” can immobilize the trainee (“How can I work with a crazy
person?”), or these differences may be minimized as one approach to therapy
is assumed to work in all cases. If the therapist relies primarily on his or her
own life experiences or the authority of a given theoretical orientation to ther-
apy, the important information that can be provided by the client is lost. The
supervisor provides a useful resource in learning how to collect important
information and integrate individual differences into the therapy process.
Theoretical Orientation
Training programs approach teaching theoretical orientations differently.
Some are closely identified with a particular orientation, while others are
more diverse. However this training occurs, it is unusual for beginning
therapists to have a detailed and integrative knowledge of any orientation
when work begins with clients. Even in programs that attempt to expose
The Level 1 Therapist 61
trainees to diverse models, there is a tendency for novice therapists to wish
to discover the “best” or most correct orientation. Once they have identified
such an approach, they can expend considerable effort in disciple-like fervor
to learn all about it. On the other hand, selecting a specific orientation can
also be seen as rendering unnecessary the practice of seeking guidance in the
research and theoretical literatures in psychology and related areas for work
with clients, thus oversimplifying the learning process by fiat.
Some of our students have responded quite well to a focus on an evidence-
based practice approach to therapy, thinking initially that this would sim-
plify the process of learning therapy. As they come to realize that no one
approach works in all cases and that there is no specific guidance available as
to which approach is superior across many situations, they can become dis-
heartened. Even when a particular theoretical orientation shows promise
for being effective with a variety of clients and presenting problems, the
moderating factors that need to be considered in planning and carrying out
treatment often defy simple solutions. Nonetheless, in Level 1, ease of under-
standing and conservation of effort can be the rule. Thus, some trainees will
select an approach that has some empirical support (however indirect) rather
than invest the necessary time and energy into locating and utilizing the best
available research.
Generally, however, motivation is high and energy expended in learning
is significant, so supervisors can provide direction that can result in a firm
foundation in a particular approach or the basis for using and evaluating
various approaches (e.g., common factors; Hubble, Duncan, & Miller, 1999).
Although knowledge based in a single approach will subsequently encourage
some tunnel vision and can limit flexibility, it also serves to reduce anx-
iety and provide a cognitive structure for understanding the process. The
early dependence may result in strong imitation of the supervisor’s orienta-
tion, but it may also reflect adherence to course work or other sources of infor-
mation available to the therapist. The danger here is in premature foreclosure
of learning and evaluation of options in favor of simple understandings and a
limited range of skills and interventions (Stoltenberg & Pace, 2007).
Treatment Plans and Goals
Many supervisors have had the experience of asking a supervisee after four
or five sessions to give a detailed explanation of the treatment plan and find-
ing that none exists. In one of our training clinics, we require a treatment
plan by the third session, but with beginning therapists the plan can be very
62 IDM Supervision: An Integrative Developmental Model
brief and very general, or it may be more of a work of fiction than a guide for
therapy. It is difficult for Level 1 therapists to conceptualize the treatment
process from intake through termination. Frankly, their initial focus is often
more on keeping the clients coming than on expecting facilitative change.
It is common to find treatment plans where there are limited short-term or
long-term goals, outcome criteria, or intervention approaches tied to any of
these. Sometimes the trainee has techniques in mind but none tied to any
of these goals or criteria. For example, an early exclusive relationship focus
may result in case notes summarizing treatment as “asking open- and closed-
ended questions and reflections.”
Therapist behaviors within a given session may stand independent of
behaviors in prior or subsequent sessions and may be a response to situational
influences as opposed to being part of an overall plan. The treatment plans
and goals may not have a direct impact on the KIA used in specific therapy
sessions. While it is not uncommon for an experienced therapist to “shoot
from the hip” in a given session, he or she is relying on a wealth of infor-
mation available in the session, in addition to prior knowledge and experi-
ence, and the seemingly spontaneous behaviors will often reflect the overall
treatment plan and goals. This is the difference between novice and expert
productions and behavior. The beginner’s approach is likely to be more ran-
dom or based more on a rigid implementation of a manualized treatment
as part of a structured program with little attention to relationship issues or
client experience. In either situation, the self-focus inhibits using all available
client data, and the reaction to any ambiguous information will often reflect
a less than optimal RIA and either elicit a more highly structured response
or a retreat to the supervisor for direction (ROA).
Professional Ethics
All mental health service providers are exposed to professional guidelines of
ethical behavior and relevant state laws as part of their training programs.
Initial utilization of these guidelines follows a fairly rigid application of rote
memorization, or at least learning to look up specific guidelines for particular
situations. If they are not emphasized, however, a laissez-faire approach can
emerge in which the guidelines are viewed as being for the guidance of oth-
ers and not for the therapist. More often, however, the guidelines are taken
seriously to the extent that they are understood. Integrating ethics with per-
sonal and professional values and identity will come more slowly during later
development. When details are lacking in the guidelines, ethical dilemmas
The Level 1 Therapist 63
can ensue, and the trainee usually consults with colleagues, the supervisor,
and others in authority. If the guidelines are not adequately discussed and
continuously highlighted, and used as a constant resource, however, they
may not be seen as relevant across all situations where they should guide
professional behavior. In these situations, a lack of clarity or understanding
can result in an ethical bind for therapists.
Supervising the Level 1 Therapist
In this examination of approaches to supervising Level 1 therapists, guid-
ing assumptions will form a framework within which we consider some
specific techniques that have proved helpful. We prefer to provide an ori-
enting structure and concepts rather than attempt to develop a cookbook
approach to supervision. The latter approach initially may be easier to grasp
and provide more specific direction, but it tends to wear thin and lose its
utility as more complicated issues take center stage. For example, interper-
sonal process recall and microcounseling were originally developed to guide
the training of skills for new counselors (Ivey, 1971; Kagan, 1975). These
approaches and their variations have proved useful in this regard. In addi-
tion, resources exist for beginning supervisors that include activities, tables,
and charts to help the novice approach the supervision of beginning trainees
(Boylan & Scott, 2009).
Our approach is to provide a “map” for the “territory” of clinical supervi-
sion across developmental and experience levels. Thus, certain techniques
take precedence at given points in time, while others prove more useful in
different situations. Also, because therapists will be simultaneously at dif-
ferent levels of development, one approach may prove inadequate across
domains, perhaps even within a given supervision session.
We have described in some detail how we view the Level 1 therapist accord-
ing to the overriding structures and how these characteristics will make
themselves evident across different domains. Considerable support exists
for aspects of this view within the empirical literature. For example, Guest
and Beutler (1988) examined trainees over time during a training program.
They noted that beginning therapists valued support and technical direction
from their supervisors. Similarly, Krause and Allen (1988) found that super-
visors viewed themselves as varying their supervisory approach for trainees
at various levels in ways quite similar to Stoltenberg’s (1981) developmen-
tal model. Although trainees appeared not to be aware of this difference in
64 IDM Supervision: An Integrative Developmental Model
approach, supervisor–supervisee dyads who agreed on the supervisee’s devel-
opmental level showed the greatest satisfaction and impact of supervision for
the trainees.
Other studies have examined the supervision process and have provided
evidence consistent with our developmental view. Studies have reported that
supervisors tend to vary their approach to supervising therapists by provid-
ing more structure and instruction during the early phases (Ellis & Dell,
1986; Stoltenberg, Pierce, & McNeill, 1987; Wiley & Ray, 1986). Beginning
therapists tend to want greater structure provided by their supervisors
(McNeill, Stoltenberg, & Romans, 1992; McNeill, Stoltenberg, & Pierce,
1985; Stoltenberg et al., 1987; Tracey, Ellickson, & Sherry, 1989), are less
self-aware (McNeill et al., 1985), and feel more uncertainty regarding expec-
tations and evaluations in supervision (Olk & Friedlander, 1992; Winter &
Holloway, 1991).
General Considerations
A consistent finding in the empirical literature on clinical supervision, and a
basic tenet of our developmental model since its inception, is that the super-
visor of Level 1 therapists needs to provide structure for the supervision expe-
rience, as well as assist the supervisees in structuring their clinical work. This
structure removes some of the uncertainty from the process and helps limit
the anxiety associated with early training.
One of the advantages of being associated with a clinical training pro-
gram is having the opportunity to teach courses on clinical supervision and
supervise doctoral students who are learning to supervise. In our program at
Oklahoma, our second-year doctoral students (who often have a master’s degree
before beginning the doctoral program) supervise beginning master’s stu-
dents over two semesters. One of the issues commonly addressed is the need
to organize the supervision sessions for the supervisees. Taking a nondirec-
tive approach in this early phase is often problematic and raises the already
significantly high anxiety level of the new supervisees.
This level of therapist typically views the supervisor as a role model and,
perhaps, an expert. Minimally, the supervisor will usually be seen as knowing
more about clinical practice than do the supervisees. This is, of course, usu-
ally a positive experience for our student supervisors. It can also be reward-
ing for experienced supervisors, although the degree of dependency of some
beginning therapists can become tiresome for the supervisor who is continu-
ally working with this level of therapist.
The Level 1 Therapist 65
Janet was a first-year master’s student in a community counseling pro-
gram whose direct supervisor was Kim, a second-year doctoral student in
counseling psychology. Janet was particularly anxious, even for a novice,
about beginning her first practicum in the clinic. Janet and Kim spent
the initial supervision sessions getting to know each other. Kim described
her orientation to therapy and supervision (which, frankly, was just devel-
oping), and Janet discussed what she had learned thus far and how her
interest in counseling had developed. They covered how to do intake
assessments and the format for the initial counseling session Janet would
have with her first client. Kim role-played the client and then the therapist
with Janet to give her practice in using the fundamental counseling skills
she had been studying. As time for the initial session approached, Janet
asked for additional supervision time and called Kim at home nearly
every day to discuss issues that had occurred to her. After the initial ses-
sion, Janet wanted an extended supervision session to study the video of
the session completely. As was common in this setting, other first-year
students observed the counseling session live via video and gave Janet
some feedback after the session. This resulted in more phone calls to Kim
to process the feelings of inadequacy and anger Janet felt in response to
this feedback from her colleagues.
Confidence can build slowly with Level 1 trainees (although sometimes it
comes far too quickly). Becoming a therapist can be viewed as something more
threatening and as much more an extension of one’s personality than other
learning experiences. Thus, for some trainees, criticism of their therapy skills is
viewed as criticism of them and their level of maturity rather than a comment
on what they have learned and what they have left to learn. This perspective
can be attenuated somewhat by approaching this early training as a process of
learning skills and behaviors. By breaking down the process into fairly discrete
and observable actions, it becomes less threatening and more easily learned.
On the other hand, occasionally we will experience supervisees who begin
by treating supervision sessions as optional (as they do with class, unfortu-
nately). If they have other commitments, or if their client is a no-show, they
will cancel their supervision session the way they would a haircut appoint-
ment. Some of these students appear to be insufficiently intrinsically moti-
vated to learn skills and acquire knowledge, or are unaware of how limited
their current professional training is. It is imperative to emphasize the impor-
tance of the training process and the need to develop knowledge and skills in
66 IDM Supervision: An Integrative Developmental Model
order to become proficient. The extrinsic goal orientation must move toward
more intrinsic goal orientation, where a sense of community contribution,
personal growth, and professional affiliation is enhanced.
As the clarity of understanding concerning at least some of the processes
associated with clinical practice develops, the trainee’s confidence will build. It
is often facilitative to work from a fairly consistent and rudimentary framework
to allow understanding of theory and skills to proceed at an acceptable speed
to enable the trainee to function adequately in the domain of interest. For
example, an initial focus on fundamental counseling skills can reduce the com-
plexity of the therapeutic process to an understandable level. Behaviors that
communicate the therapist’s attentiveness and concern can encourage the cli-
ent to explore issues and may help move the therapy process along, even if these
behaviors are performed without the optimal level of underlying understand-
ing. It is possible, of course, for a novice therapist to learn to reflect content and
some client feelings without a deep understanding of the client’s experience or
true empathy. In fact, this is most likely. True empathy can come later.
It is also important early on to encourage the therapist to take responsi-
bility for his or her role in the therapeutic process. Although considerable
information will need to be conveyed to the Level 1 therapist by the supervi-
sor through fairly didactic means, supervisors should remain alert for oppor
tunities to encourage the supervisee to engage in problem solving about his
or her clinical work and engage in a self-examination. This process needs to
be carefully monitored so that it facilitates early attempts at autonomy with-
out endangering the client or confusing the therapist or frustrating his or her
development. Appropriate risk taking should also be encouraged. The trainee
may tend to stay with what he or she knows rather than explore new skills
or interventions. On the other hand, fools often go gladly where the expe-
rienced would fear to tread. Risk taking is not always good or appropriate,
and the experience of the supervisor needs to be brought to bear in clinical
decision making. Remember that a facilitative level of discomfort or disequi-
librium is necessary for growth. On the other hand, sufficient information
and experience need to be assimilated for the trainee to be able to develop
useful and relevant schemata related to clinical practice. A careful balance
must be maintained.
Client Assignment
It is not always possible to exert total control over the types of clinical experi-
ences available to Level 1 supervisees. In the best of all worlds, which is rarely
The Level 1 Therapist 67
possible, it is probably most beneficial for clients with fairly mild presenting
problems (certain V-codes, problems in living, mild depression) to be assigned
to beginning therapists. Sometimes maintenance cases are appropriate, even
if the level of pathology is significant. In these latter cases, the primary goal
may be monitoring the client with limited expectations for improvement.
The goal is to assign to therapists clients who will present minimal risks and
have some potential for positive therapeutic experiences. With mildly trou-
bled clients who have adequate personal resources, fundamental counseling
skills implemented by the therapist can result in significant improvement.
Other clients whose problems are fairly specific, such as simple phobias, can
benefit from a structured approach to therapy (systematic desensitization,
exposure therapies) that can be quickly learned and adequately implemented
by the beginning therapist. Clients with whom the therapist can develop a
degree of comfort in the therapy situation, and with whom he or she can
practice some fundamental skills, are ideal for beginners. In the absence of
such clients, very careful intensive supervision with considerable instruction
(or even co-therapy) may be necessary to ensure client welfare and protect the
supervisee from early failure. In our program at Washington State University,
all beginning practicum students in their second year start their experience
in our university Counseling and Testing Service, affording the opportunity
to work with clients appropriate for early successful development, and also to
experience the full range of client pathology at later stages.
Interventions
Loganbill, Hardy, and Delworth (1982) described supervision interventions
that can form a useful basis for understanding the supervision process. For
Level 1 therapists, facilitative interventions are perhaps the most important.
These interventions are intended to communicate support to the supervisee and
encourage development. Praise, reinforcement of appropriate demonstrations
of skills, careful and attentive listening, and other indications of appreciation
of and consideration for the supervisee are particularly useful at this time.
Prescriptive interventions are also very necessary for Level 1 therapists.
These supervisees will have limited knowledge of therapeutic orientations,
interventions, and client dynamics. It is important that the supervisor be
prepared to advise the therapist concerning what might be done at a given
point with a particular client. It is best, when possible, to present the super-
visee with alternatives, in order to encourage central route processing and
support early attempts at autonomy. By presenting options from which the
68 IDM Supervision: An Integrative Developmental Model
therapist can select an intervention, supervisors encourage the assumption of
responsibility for treatment and the critical evaluation of alternatives.
In some cases, a direct prescriptive intervention for novices, such as “Do
not ask any questions in the next session,” is helpful and takes advantage of
their need for structure. Phrasing this directive as a challenge may be consid-
ered a catalytic intervention (see below) but serves to take advantage of the
beginning therapist’s high level of motivation.
Another useful class of supervision interventions for Level 1 therapists is
conceptual interventions. Remember that the self-focused (or self-conscious)
Level 1 trainee will tend to focus primarily on what he or she should do with
the client, or how anxious he or she is, rather than thinking through a ratio-
nale for a given intervention. This therapist’s ability to make conceptual ties
between theory and practice will be limited, so the supervisor should begin
the process of linking the two together for the supervisee when the oppor-
tunity exists. The sooner a therapist is able to begin to think of the theory,
diagnosis (or conceptualization), and treatment continuum, the more quickly
he or she will develop autonomy. Engaging in ROA in supervision will lead
to better RIA (when necessary) and to a more adequate KIA in sessions.
This process will help the trainee develop more comprehensive schemata and
strengthen the links between them.
Confrontive interventions are sometimes appropriate for Level 1 therapists,
but they are usually best used when the early anxiety has lifted and some con-
fidence in ability has developed. Recall that as the therapist becomes com-
fortably established in Level 1, he or she can adequately perform (at least by
his or her own standards) certain skills and feels confident about understand-
ing the process. At this point an increase in the desire for autonomy will be
noted. Therapists who have had the opportunity to experience success in their
clinical work and have found that they can be effective may become quite
confident and comfortable with their level of understanding and skills. This
is the time when confrontation can be effectively used. Earlier in the training
experience, confrontation may freeze the supervisee and halt development.
Once the comfort level has grown, however, confrontation may be necessary
to move the therapist beyond what is safe and to try new interventions or
work with more challenging clients. We find that the use of video is often
important at this stage. This technology enables the supervisee to critically
evaluate his or her work and begin the process of focusing attention more on
the client and seeing the impact of the interventions. These confrontations
shouldn’t typically be dramatic or, especially, inflammatory. Simply point-
ing out mistakes, miscues, or things overlooked by the therapist can provide
The Level 1 Therapist 69
suffi cient confrontation. As suggested previously, confrontation is sometimes
necessary when the trainee isn’t intrinsically motivated to learn or grow and
has prematurely foreclosed on learning new approaches to therapy. It can
also be useful when the supervisee resists using broad therapy skills (e.g., the
supervisee prefers insight, so he or she interprets too soon) or prefers to stay
in the relationship-building stage rather than moving on. Again, this can
stimulate ROA, leading to more effective RIA and KIA.
Catalytic interventions are typically reserved for late Level 1 trainees rather
than beginning therapists. Catalytic interventions are intended to expand
the awareness of the therapist in aspects of clinical practice that have escaped
his or her attention, due to limitations in available awareness as a function
of the person’s self-absorption. While we will use these interventions liber-
ally in Level 2, they can also be useful in redirecting the attention of the
advanced Level 1 trainee. Catalytic interventions challenge the comfort level
of the supervisee. Again, this is often made easier by having access to video
of the supervisee’s work with clients. Commenting on the therapeutic pro-
cess, focusing the therapist’s attention on the client’s reactions, or focusing
attention on the therapist’s thoughts and feelings at a given point in the ses-
sion (ROA) are examples of interventions that can broaden the view of the
trainee. We might also highlight the potential for, or the exhibiting of any,
countertransference reactions by the therapist. The therapist’s emotional
reactions to the client, or the supervisor, can be highlighted and pursued
as avenues for exploration of the therapeutic and supervision processes. By
pushing the therapist to attend more to the client as well as understand the
clinical process at a more complex level, the supervisor is setting the stage for
movement into Level 2.
A few words of caution are warranted here. It is important to remember
that facilitative conditions or interventions in supervision should not be mis-
taken for engaging in supportive counseling with the supervisee. Although
some approaches to supervision have described a role of the supervisor as
“counselor” (Bernard, 1979; Bradley & Ladany, 2001), engaging in the coun-
seling process with supervisees is inappropriate and unethical. For a number
of reasons, this can put trainees in a bind. We believe that personal knowl-
edge and self-understanding are very important for effective therapy. The bet-
ter therapists know their “instrument” (who they are, how they are impacted
by and impact others), the better they can play (conduct therapy). Implicit or
explicit demand from the supervisor for the supervisee to disclose sensitive
personal issues in supervision, however, redirects the focus away from the cli-
ent and the learning process and toward personal therapy. Understandably,
70 IDM Supervision: An Integrative Developmental Model
supervisees can be concerned how these self-disclosures will be used in the
evaluation process as well as other contexts. This can have a negative impact
on trust and can affect supervisees’ willingness to share important aspects of
their reactions to their clients that are relevant to the process of supervision
(Ladany, Hill, Corbett, & Nutt, 1996). As we have noted elsewhere, supervi-
sors need to be careful not to drop into counseling or therapy behavior in
supervision simply because it is more comfortable, more familiar, or a more
fully developed skill set. Supervision is a different process (with some overlap)
and should not be confused with counseling or therapy.
In a similar vein, prescriptive interventions should be aimed at the supervi-
see’s learning and interactions with the client and not focused on intervening
with regard to the supervisee’s personal adjustment issues. Also, confrontive
and catalytic interventions shouldn’t digress to “character readings” or regu-
lar interpretations of the trainee’s dynamics.
We have noted that a supervisor who does counseling or therapy as part
of supervision can make the supervisee feel uncomfortable or even threat-
ened. It is also important to note that some supervisees will prefer a personal
therapy focus by the supervisor to one where the intent is to develop therapy
skills. As some supervisors will drop into therapy mode with supervisees
because of comfort or familiarity (or interest), some supervisees will feel more
comfortable when their personal issues are the focus and they can assume
the role of the client rather than that of the trainee. Again, the process and
benefits of therapy are best left to the therapist–client relationship and not
the supervisor–supervisee relationship.
Supervisory Mechanisms
There are a number of techniques or mechanisms that the effective supervi-
sor can draw on in clinical supervision. In our opinion, the power is usually
not in the technique but rather in how effectively it is used and for what
specific intent. No one technique or mechanism is adequate for all situations.
Skilled supervisors will use a breadth of mechanisms to further supervisory
goals and encourage the growth of the trainee. We will discuss a number of
mechanisms, but our list is neither exhaustive nor prescriptive. The mecha-
nism chosen at any given point in time for work with a particular therapist
depends on available resources, the current needs of the situation, and the
personal attributes of the supervisor and supervisee.
In working with Level 1 (and Level 2) therapists, observation of their
clinical work is imperative. Although some training settings rely heavily on
The Level 1 Therapist 71
verbatims (attempts by the trainee to write down everything that was said
during a given session) or other variations on self-report, these are inadequate.
Level 1 therapists are not able to perceive accurately what they are doing in the
session, let alone what is going on with the client. Supervisors who rely on train-
ees’ perceptions and memories will be supervising in the dark. Observation is
crucial, whether it is by video or direct observation, delayed or immediate. To
know what went on in a session, supervisors need to see it or at least hear it.
Live observation, sometimes with what is called “consultation” or “reflect-
ing teams,” is an approach that has grown in popularity, particularly in mar-
riage and family training programs. This approach is increasingly viewed
as a strong modality in professional psychology programs as well (Romans,
Boswell, Carlozzi, & Ferguson, 1995). Live observation—whether phone
consultations, “bug-in-the-ear” technology, or pulling the therapist out of
the room for a consultation—has much to offer. The advantages include pro-
viding immediate structure for the session for the supervisee, being present
to provide support and feedback, giving immediate advice or prescriptions,
providing different perspectives on the client and/or the process, and see-
ing the process unfold as it happens. There are also some drawbacks to this
approach. The time investment by the supervisor and disruption of the flow
of the session can be significant. In addition, these approaches tend to take
the responsibility away from the supervisee and give it to the supervisor or
consultants. There is some advantage to having the supervisee struggle to
deal with a clinical situation without the security blanket of the consultant or
supervisor being immediately available. Nonetheless, if used with care, there
can be real benefits. If used inappropriately, growth can be stagnated.
Skills training is necessary in the early stages of development for nearly
any domain. One of our students was fond of saying that “Fake it until you
make it” was his model of therapy. This slogan can be useful for supervision
of the therapist as well. As Alfred Korzybski (1948) said, the map is not the
territory. In a similar vein, the skill is not the intervention. Therapists can
learn the behavior but not understand the intent, timing issues, or nuances of
its application or implementation. This is consistent with Wampold’s (2006)
work on the lack of variance accounted for by specific techniques in therapy.
Nonetheless, the skills provide mechanisms for moving therapy along. Prac
tice of skills in supervision, role-playing therapy interactions, reversing roles,
and playing those interactions out again can be very useful in building the
skills necessary for early work in therapy.
Perhaps introducing a sports analogy here will be helpful. Many of us have
had the opportunity to teach our children, or other people’s children, how
72 IDM Supervision: An Integrative Developmental Model
to play baseball or softball. If left to their own devices, children will learn
how to hit a ball with some degree of effectiveness. However, when a coach
steps in and begins to instruct the child on how to hold a bat, pay attention
to the strike zone, or watch for a curve ball, the ability of the child to hit the
ball may initially be compromised. Nonetheless, some of these skills may
need to be developed (even overlearned) before the child can anticipate the
pitch and hit to the opposite field, advancing a base runner. We might also
note that when observing more advanced ball players, children will pick up
on certain behaviors that have little, if anything, to do with effective hitting.
One of our nephews was soundly convinced that tapping the bat on home
plate was the most important part of being a batter. The behavior was learned
before the meaning became evident.
Supervisees also tend to rely on their supervisors to interpret dynamics for
them in their work with clients. This is useful and appropriate as long as it is
done within the confines of their understanding of the process. The supervi-
sor who “takes off” on hypothesizing about the client’s interpersonal or fam-
ily dynamics may leave the therapist in the dust. The supervisee may still be
wondering how to get the client to talk; a suggestion to consider other, more
esoteric material may fall on deaf ears or add to the confusion.
Level 1 therapists have limited information regarding clinical practice at
their disposal. They are often eager to learn and respond well to lists of read-
ings or other resources the supervisor provides to them. It is important, how-
ever, to keep the breadth of this material somewhat limited. For example, the
novice therapist may have difficulty integrating cognitive therapy material
with object relations readings. It may be better to initially stay largely within
a given orientation or a common factors framework and expand the range of
information and resources as the therapist is able to implement material that
has already been presented.
Group supervision can be a good mechanism for learning for the Level 1
trainee. We discuss this subject in more detail in Chapter 7, but suffice it to
say at this point that this presents another opportunity to learn by example
from colleagues. Appropriately handled group supervision can present the
therapist with additional options for interventions, other conceptualization
perspectives, and additional skills to practice. It can also serve as a supportive
atmosphere for exploring the clinical process and one’s understanding of it.
If not handled carefully, however, it can become an aversive situation that
adds to the level of anxiety of the therapists. The supervisor must take care to
encourage positive feedback and constructive comments while normalizing
the growth process for the supervisees. Competition is common and, if left
The Level 1 Therapist 73
Table 3.1
Level 1 Supervision Environment
General considerations: Provide structure and keep anxiety at manageable levels
Client assignment: Mild presenting problems or maintenance cases
Interventions: Facilitative (supportive, encouraging), prescriptive (suggest approaches, etc.),
conceptual (some; tie together theory, diagnosis, and treatment), catalytic
(late Level 1; see Level 2)
Mechanisms: Observation (video or live)
Skills training
Role playing
Interpret dynamics (limited; client or trainee)
Readings
Group supervision
Appropriate balance of ambiguity/conflict
Address strengths, then weaknesses
Closely monitor clients
unfettered, can create a negative environment that does more harm than
good. Similarly, allowing or encouraging group supervision to morph into
group counseling can be destructive or, minimally, nonfacilitative of growth
and learning. We have summarized some of the points of this discussion in
Table 3.1.
Final Considerations
Supervisors need to constantly strive for a facilitative balance of ambiguity
and conflict versus clarity and comfort. Too much ambiguity, anxiety, or
disequilibrium will frustrate trainees and inhibit their growth. Too much
perceived clarity or naïve understanding of the process, comfort, and con-
fidence will also stagnate growth. The balance must be struck and restruck
throughout the supervision process.
It has been demonstrated in related research that perhaps the optimal
approach to providing feedback for a beginning therapist is to highlight
strengths and positive behaviors first, then move on to areas where growth
has yet to occur or corrective feedback is necessary (Stoltenberg & Delworth,
1987). This process sets up the supervisee to hear what the supervisor has to
say. By first acknowledging areas of strength, the supervisor reinforces the
trainee’s initial attempts at competence and early development of confidence,
informing the supervisee that he or she is aware of the progress the supervisee
has made and the skills already developed. Then focusing on areas for growth
74 IDM Supervision: An Integrative Developmental Model
can build on these strengths and remind the therapist-in-training that devel-
opment is not complete and there is more to learn.
Finally, supervisors must always take great care to monitor client welfare.
They have the dual responsibilities of encouraging and enhancing supervisee
growth while maintaining quality control of the services provided to clients.
We make it very clear that the purpose of our clinic is to train therapists.
Thus, most therapy will be provided by students under the supervision of
licensed professionals. The fact is that most clients would benefit more, and
benefit more quickly, from therapy provided by a skilled and seasoned pro-
fessional than they will by working with a trainee. Our fee schedule reflects
an awareness of this. However, we would quickly run out of skilled, experi
enced, seasoned professionals if supervisees were not allowed to work with
clients or were merely used as extensions of the supervisor’s clinical expertise.
Nonetheless, we should be sure that no harm is done and that, as far as pos-
sible, quality services are provided by our supervisees, regardless of level of
therapist development.
Sublevel 1 Trainees
Some aspiring therapists, new to the field and lacking in experience, do not
seem to be able to progress in their development. Sometimes these problems
arise early in prepracticum experiences, but they can surface later when these
young (in terms of experience) therapists are working with clients in the clin-
ical setting. Although occasionally selection procedures are lacking and stu-
dents with serious disorders enter training programs, this remains rare. More
common are situations where there appears to be developmental stagnation
or personal blocks that preclude effective growth as a therapist.
Eichenfield and Stoltenberg (1996) have described these trainees as
Sublevel 1. These individuals are unable to meet entry-level expectations in
training as psychotherapists. For some, it appears to be a lack of prerequi-
site skills in interpersonal relationships, communication, ability to attend or
listen to others, language adequacy, or cultural awareness and knowledge.
This is a greater risk in programs that rely heavily on Graduate Record Exam
(GRE) scores and college grade-point averages to the exclusion of personal
interviews and informative letters of recommendation. Occasionally these
difficulties are transient and become problems only because the progress of
the student is slower than what is expected by the faculty. Additional time, if
permitted, may be sufficient for this person to progress to acceptable levels.
The Level 1 Therapist 75
Some supervisees may suffer from an inability or lack of motivation to learn
about and develop skills in therapeutic interventions. Although the number
of mental health professionals continues to grow and, some believe, may have
already reached the point of saturation, applications to many training pro-
grams remain strong. Generally, one can assume that the intellectual poten-
tial of most students will be sufficient to enable them to meet the demands
of graduate school. Development as a therapist, however, goes beyond the
ability to memorize facts, work calculus problems, and do well on admis-
sions exams. It also requires an ability to develop interpersonal sensitivity,
read nonverbal communications, and develop empathy skills not adequately
measured by the GRE or required to excel in most college course work.
One of the major sources of lack of progress in clinical training is train-
ees’ unresolved interpersonal or intrapersonal concerns. Eichenfield and
Stoltenberg (1996) have described some categories of these types of students,
and we have added others. The following scenarios illustrate some of the
characteristics of these trainees.
The Reincarnated Trainee
Jan’s supervisor had noted that she was assuming too much responsibility
for her clients. She was a new student in the program in her first practi-
cum in the clinic. Although it was not particularly uncommon for new
trainees to become perhaps too involved with their clients, Jan seemed to
take more of an active role in “mothering” her clients than was apparent
in the work of others in her class. Upon exploring this issue in supervi-
sion, Jan explained that she felt an inadequate childhood was the primary
reason her clients were experiencing difficulties: “If they can just find the
kind of nurturing that they should have gotten from their parents, I’m
sure they will be fine. My own parents didn’t give me the love and sup-
port I needed, and I’m not going to let that happen to my clients.”
The Savior Trainee
Jack had experienced a powerful “reawakening” a couple of years before
entering the program. As he noted to his supervisor, he had been without
direction and feeling lonely and depressed when he had a profound reli-
gious experience. For him, this allowed his attention to move away from
his distressing life and focus on more “positive” emotions. The conversion
experience had been very effective for him, he noted, and he was sure it
76 IDM Supervision: An Integrative Developmental Model
would work as well for others. “How can I work with a distressed client
and not show them the way to eternal salvation?” he would ask in super-
vision. “If they would just let go of their negative emotions and think
more positively, they wouldn’t need to be in here talking to a stranger.”
Unfinished Client/Denying Trainee
Kate was a mature woman in her early 50s who had decided to return to
school to learn more about helping people work through their problems.
She had always been a good listener and was able to develop high levels
of trust in people rather quickly: “Folks always seem to open up to me
and tell me their problems. I thought I should learn more about how to
help them work through these difficulties.” Kate’s supervisor, an advanced
doctoral student, had noticed a troubling change in her behavior while
observing a videotape of a couples counseling session. Kate had devel-
oped good rapport with the couple during their initial sessions, but half-
way through this one, the wife disclosed that her husband had slapped
her in the face twice over the past 2 years. After hearing this in the ses-
sion, Kate became very directive, telling the wife she needed to “get out
of the relationship before you really get hurt.” She became very protec-
tive of the wife and quite aggressive toward the husband. In reviewing
the videotape with Kate, the supervisor paused at one point and asked
Kate what she was feeling and if she had felt this way in other situations.
Kate broke down in tears and stated that her 23-year-old daughter was in
an abusive relationship and refused to take action to change it or leave.
Indeed, her own first marriage had been plagued with violence. “I guess
I just see my sweet daughter sitting there in the room and I need to save
her. I just can’t help it. It’s wrong and something must be done.”
Suspicious, Distrustful Trainee
Bruce’s supervisor had quickly noticed a tendency toward being judg-
mental and quite selective concerning the kinds of clients with whom
Bruce was willing to work. In group supervision one day, Bruce had chal-
lenged a colleague who was working with a lesbian client to “force this
girl to face up to how she is hurting her family and reconsider pursuing
this kind of lifestyle.” Problems occurred again shortly after when one of
Bruce’s clients came to session very distressed because his wife was leav-
ing him “for another man.” Bruce responded with anger and suggested
that it is difficult to trust women because “you never know when you’ll
get burned; you just know it will happen sometime.” Exploration of this
The Level 1 Therapist 77
reaction in supervision yielded information about a series of unsuccessful
relationships in Bruce’s past and anger toward women as being unworthy
of trust and vindictive.
Addicted or Nonpracticing Addicted Trainee
Jack had spent years struggling to overcome a serious addiction to alco-
hol. His past was a series of starts and stops concerning his dependency
on alcohol. He began his training program after having stayed sober for
three years. It was obvious that he was a bright and motivated student
who had made great strides toward reaching his goal of abstinence and
success. The major problem with Jack’s professional development was his
reliance on his perspective that “an addictive personality” was at the root
of most of his clients’ problems and that the 12-step approach was always
the best way to address these problems. Jack’s supervisor was constantly
exploring this perspective with Jack and discouraging him from referring
most of his clients to Alcoholics Anonymous, Narcotics Anonymous, and
other twelve-step programs whether or not substance abuse appeared to
be a predominant problem.
Ideological Trainee
Jill had experienced a life-changing shift in her understanding of the
world through a course in women’s studies and interactions with a fac-
ulty member who had become a role model for her. Her relationship
with her father had been poor. The perspective she gained from her class
concerning how women have been oppressed by men and how this con-
tinues in present society angered and activated her. In work with her
female clients, the focus of therapy always quickly went to how her cli-
ents have been and are being oppressed by the men in their lives and
the institutions in which they exist. For her male clients, the emerging
focus was challenging them to understand their privileged position in
society and how they are oppressing women in their lives (including the
therapist). Jill’s supervisor experienced frustration in helping her focus
on the client’s experience without always moving so quickly to a victim–
perpetrator frame of reference.
Very few therapists are so well adjusted that their own personal limitations
or blocks never present problems in their clinical work. However, when these
issues inhibit professional growth and affect work with clients, care needs to be
78 IDM Supervision: An Integrative Developmental Model
taken to mobilize resources to deal with them. We have previously noted in this
book that supervision is not psychotherapy, and supervisors are ill advised to
engage in therapy with supervisees. Nonetheless, supervisors must be sensitive
to the presence of therapists’ blocks or disorders that will put either the thera-
pists or their clients at risk. Sometimes these issues can be adequately addressed
in a reasonably short period of time in therapy, allowing the therapists to limit
the focus of their clinical work for a while or take a short sabbatical from seeing
clients. If the focus on the issue goes beyond a session or two, the supervisor
may need to consider referring the supervisee to therapy. This decision should
be made in consultation (if possible) with a training team or other professional,
not in isolation. In these situations, more time is necessary to allow the ther-
apists to work through these difficulties (often in their own therapy) before
they can be allowed to resume (or begin) clinical work. Sometimes a complete
termination of training is required and a new career is warranted. Thus, the
power of the supervisory relationship cannot be assumed to be sufficient to cor-
rect all deficiencies or problems brought to training by supervisees. Taking an
active role in addressing these problems and pushing for the appropriate plan
of action is one of the many responsibilities of clinical supervisors.
Of course, it is imperative that care be taken to protect confidentiality for
the supervisee as well as address issues preventing him or her from providing
effective services to clients. Although personal therapy has been identified as the
most common approach to remediation for students (Forrest, Elman, Gizara,
& Vacha-Haase, 1999) and it has been thought to be effective, particularly
when compared to a “hands-off” approach (Elman & Forrest, 2004), recent
work has focused primarily on conceptualizing these difficulties as issues of
competence (Kaslow et al., 2007). In the latter case, care in assessment, plan-
ning, and intervention may lead more readily to addressing training issues
for the supervisee than psychotherapy would, especially with the lack of hard
evidence for its effectiveness in remediation. As we address elsewhere in this
book, ethical standards have moved toward protecting trainees from intrusive
probing by trainers without clear informed consent regarding expectations for
disclosure of personal issues (American Psychological Association, 2002b).
Other Considerations
Numerous sources of influence exist in the supervision relationship. Some
of these have been investigated in research, while others remain untested.
Some are based on theory and are consistent with clinical experience and
The Level 1 Therapist 79
anecdotal reports; among these are issues of power and routes to persuasion.
Social psychological research has long been suggestive in terms of relevance
for clinical practice with some support emerging over the years for its clinical
relevance (Kowalski & Leary, 1999; Maddux, Stoltenberg, & Rosenwein,
1987; Snyder & Forsyth, 1991).
We have argued in other contexts that the Interpersonal Influence Model
and the Elaboration Likelihood Model provide some conceptual clarity
regarding how the supervisor can have an impact on the trainee within the
supervision relationship (Dixon & Claiborn, 1987; Petty & Cacioppo, 1986;
Stoltenberg, McNeill, & Crethar, 1995; Strong & Matross, 1973). This per-
suasive power can have a positive impact, or it can inhibit the kind of devel-
opment the supervisor hopes to encourage in the therapist.
To varying degrees, the supervisor will have certain social power bases (expert,
referent, reward, legitimate, and informational) that can be used to influence
the supervisee. The ELM provides some guidance regarding how to utilize these
power bases effectively. The danger presented in implementing the social power
inherent in supervision is that the supervisee may not engage in sufficient infor-
mation processing in evaluating and integrating supervisor recommendations.
Remember that a trainee must have sufficient motivation and ability to cri-
tique input from others (that is, engage in central route processing). Level 1
therapists will generally be highly motivated to learn about clinical processes
and improve their performance. However, their ability to adequately evaluate
input will be limited. Few relevant schemata will exist from which the thera-
pist can draw information to compare and contrast recommendations offered
by the supervisor. Thus, the risk exists that supervisor recommendations, per-
spectives, and information will be uncritically accepted and not sufficiently
processed to allow for conceptual integration. In short, the supervisee may
buy into what the supervisor says, but without sufficient understanding as to
why and how these recommendations should be implemented.
This effect can be seen in supervisees who continually seek advice from
the supervisor, often for situations similar to ones previously addressed in
supervision. They may also display a tendency to use recommended skills
or interventions appropriate for one situation across a number of others for
which they are inappropriate. This reflects a lack of understanding or inad-
equate elaboration of information; the emerging schema lacks sufficient com-
plexity to effectively guide behavior. Of course, this level of understanding
will come slowly, but it can be enhanced by encouraging a critical evalua-
tion and processing of material covered in supervision. Prescriptive interven-
tions in supervision are appropriate for this level of supervisee. Using these
80 IDM Supervision: An Integrative Developmental Model
interventions without adequate elaboration and processing is likely to result
in poor understanding and short-term impact on the supervisee. Without
developing an understanding of the processes involved, the therapist is more
likely to seek out additional advice in the future and not be able to critically
evaluate that information. Perhaps an example is in order.
Betty was fairly young when she began the program. She was a very
bright undergraduate student who had graduated early and was accepted
into a counseling program. Her first supervisor worked from a cognitive
therapy orientation, which made some sense to Betty. Their supervision
sessions generally followed a skills training format in which Betty would
ask what to do each week with her clients and would receive specific
directives from her supervisor. Her performance was evaluated as ade
quate over the semester, largely because she would work from her notes
(taken in supervision) and implement the recommendations in the next
counseling sessions. The following semester Betty was assigned to a super-
visor whose therapeutic orientation was object relations. Being the eager
student that she was, Betty was soon requesting specific guidance for
interventions consistent with the object relations framework and would
diligently attempt to implement them in the next counseling session.
Negative feedback from clients came quickly as they became puzzled
regarding the rather dramatic shift in the focus of their sessions. Betty
was confused and initially had trouble seeing any inconsistencies.
Theoretical arguments aside, one can see the benefit of being exposed to var-
ious orientations and techniques during a training experience. However, when
the therapist is serving primarily as a vehicle for carrying out the recommenda-
tions of the supervisor, inadequate learning occurs. The benefits of the different
perspectives are not processed, evaluated, or integrated, and a learning oppor-
tunity is lost. Supervisors who take the time and make the effort to use their
interpersonal influence to encourage the therapist to elaborate on and integrate
information and perspectives provided in therapy are enabling the develop-
ment of a professional and setting the stage for Level 2 issues to emerge.
Transition Issues
Success in supervision of Level 1 therapists will result in increased confidence
in their ability to understand and implement interventions. Although this
The Level 1 Therapist 81
understanding is limited in terms of complexity and breadth, the troublesome
anxiety has diminished while motivation remains good, the self-focus has
lessened, and the movement toward some autonomy has begun. It is at this
point that some Level 1 therapists may appear overconfident or even cocky
to their supervisors. Here is where the increasing attention to client reactions,
assigning more difficult cases, and expanding the therapists’ views of clini-
cal processes are crucial. In our training clinic, this is the time when we are
most likely to assign a client with a personality disorder to the therapist. It
is time to “shake the tree” and move the therapist to the next level. There is
often some resistance to the realization that therapy is complex and simple
solutions are few, but the change is necessary for the therapist to continue
to develop and not stagnate at a rather perfunctory stage of development.
We have experienced some resistance from trainees at this point when their
early understanding of the therapy process is challenged through attempts to
broaden their understanding. Most respond positively, but for some the dis-
comfort from experiencing disequilibrium is difficult. For example, when one
of us was discussing how relationship skills in therapy are necessary but not
sufficient, a student responded, “You’re challenging everything I’ve learned!”
Yes, the need to challenge is there. How the supervisor goes about doing that
is also important. We will address this more in the next chapter.
Within the domain of individual differences, it is important at this stage
to broaden the experience of supervisees with culturally diverse clientele.
Lopez and colleagues (1989), in an examination of multicultural aspects
of developmental supervision, stress the importance of exposure to cultural
differences through supervision and course work (if possible) at this stage of
therapist training. This breadth of experience will facilitate the transition
of these therapists to Level 2.
There is sometimes a manifest desire on the part of the trainee to skip
the complexity of Level 2 issues and move directly to the self-aware, confi-
dent effectiveness we see in Level 3 therapists. Unfortunately, this is no more
likely than skipping adolescence and moving directly into adulthood. The
turbulence of Level 2 is necessary for the therapist to develop the next level
of skills, understanding, and perspective required to reach his or her profes-
sional potential.
4
The Level 2 Therapist
•
At the point of reaching what we conceptualize as Level 2, supervisees are
making the transition away from an appropriately highly structured, sup-
portive, and largely instructional supervisory environment in which they
were highly dependent, imitative, and relatively unaware. If supervision has
been appropriate and the experience facilitative, the trainee has experienced
some success and growth. With successful counseling experience the thera-
pist develops an increased desire and confidence to make his or her own deci-
sions concerning client cases. An increasing mastery of basic facilitative and
attending skills or skills in applying manualized treatments results in less of
a self-focus, reduced anxiety, and more of an ability to attend to the client’s
experience. At the same time, however, difficult and unsuccessful cases may
cause supervisees to question their effectiveness as therapists, affecting their
previously high levels of motivation.
The Level 2 therapist is making a transition across the various domains
from dependence on the supervisor to a sense of more independent function-
ing, from primarily a self-focus to more of a focus on the client experience,
and from a previously high and fairly stable level of motivation to more fluc-
tuating levels. Unless this transition is successfully negotiated, this period
can be a difficult, conflictual time for supervisee and supervisor alike, char-
acterized by disruption, resistance, ambivalence, and instability. It is during
this stage that many supervisors experience failures. However, it is also a
time when the supervisor can effectively resolve these conflicts, resulting in
a deeper understanding of the supervisees’ skills and personal characteristics,
and use this understanding to mentor the supervisees, leading to significant
professional growth.
83
84 IDM Supervision: An Integrative Developmental Model
In our experience, therapists who have gone through at least two or three
semesters of practica, or a year or so of post-master’s-degree work primarily in
agencies dealing directly with clients, often begin to demonstrate characteris-
tics of Level 2 structures in one or more domains. By this point, the therapist
has been assigned clients who afford the opportunity for mastering basic listen-
ing and attending skills, along with some rudimentary (sometimes structured)
intervention strategies and methods. Consequently, the therapist has experi-
enced some success in work. As you will recall, we recommend the assignment
of more difficult clients (for example, personality disorders) during the latter
part of Level 1. As a result, the supervision process has identified not only the
supervisee’s strengths but also weaknesses, as the therapist struggles to under-
stand why he or she is unable to be effective with some clients. Therapists now
begin to realize the complexity and the very real limitations of the therapy
process, and these struggles may have a negative effect on their level of motiva-
tion. Increasing awareness of client reactions in therapy can stimulate more
RIA as trainees realize their KIA isn’t creating the desired impact. What had
been considered effective by the supervisee now may be recognized as only
somewhat adequate, and RIA may fail to suggest effective alternatives. This
can result in lowered perceptions of self-efficacy and reduced motivation. ROA
with a skilled supervisor can assist the supervisee in growing through this
sense of disequilibrium and continuing to progress across domains.
It is important to note that supervision plays an important role in helping
trainees understand their limits and recognize when progress hasn’t occurred
with their clients. As we discussed in Chapter 1, Anderson (2005) suggests
that one does not automatically discover that one’s schemata are not adequate.
Thus, without discriminating feedback and prompting through the supervi-
sion process, trainees may remain rather naïve regarding their effectiveness.
Lambert and Hawkins (2004) have noted that only about 33% of therapists
actually monitor client progress. Arguably, experienced therapists will be
more aware of progress and stagnation (or regression) being made by clients
as a function of their developed expertise, even when they don’t regularly use
formal assessments. Unless prompted to systematically evaluate their effec-
tiveness, trainees may judge their progress (and that of their clients) based
on fairly narrow criteria. For example, we have noted a tendency in some of
our own trainees who have had about two years of practicum experience to
judge their effectiveness largely on whether their clients continue to come in
for therapy or on clients’ stated satisfaction with the therapeutic relationship.
Of course, these are useful indices of continuity, but they are inadequate in
determining client progress on treatment goals and improved functioning
The Level 2 Therapist 85
in daily life. As we will discuss in more detail later in this book, evaluation
mechanisms for therapy and supervision are important in assessing the level
of professional development and proficiency of our trainees.
Of additional importance is supervisees’ continuing growth in under-
standing the nature of the therapeutic process. Early training that focuses
on the development of attending and listening skills can be quite effective in
helping trainees build an initial therapeutic relationship and encourage cli-
ent exploration (Hill, 2004). Similarly, although initial training that utilizes
structured, manualized treatments can be useful in helping trainees learn the
skills necessary for interventions from these frameworks (Addis & Cardemil,
2006), Wampold (2001) notes that adherence to manualized treatments does
not yield superior results to treatments delivered without manuals. In addi-
tion, the research on common factors in therapy (Hubble, Duncan, & Miller,
1999), consisting of the treatment method (Chambless & Crits-Christoph,
2006), psychotherapist factors (Wampold, 2006), the therapy relationship
(Norcross & Lambert, 2006), client factors (Bohart, 2006), and principles of
change (Beutler & Johannsen, 2006), presents a more complex view of the
process than what is typically understood by many trainees. Continuing to
assist supervisees to understand and implement treatments sensitive to these
issues is important to their professional development and to the success of
their clients.
The Level 2 therapist’s manifestations of structures are highly dependent
on previous experience across the eight domains, exposure to a variety and
diversity of client types and problems, and quality as well as quantity of
previous individual and group supervision. Previous supervision consisting
of only brief meetings every other week simply to monitor caseloads may
indeed force a therapist to function independently but will not necessarily
allow him or her to function effectively. Thus, it is entirely possible that a
given supervisee may demonstrate a high level of autonomy in the assessment
domain after working for a number of years administering and interpreting
assessment instruments. However, in beginning to focus more on therapy,
the supervisee may exhibit fluctuating levels of autonomy and motivation
in regard to this less developed domain of intervention skills. Consequently,
given the various practica and experiential requirements across training pro-
grams and state regulating agencies, supervisors cannot simply assume that
a given supervisee truly represents Level 2 on the basis of previous global
experience, especially when this experience has been unsupervised.
We can expect therapists who have just reached Level 2 in a particular
domain of practice to be functioning at Level 1 in others and perhaps Level 3
86 IDM Supervision: An Integrative Developmental Model
in one or more domains. As a result, supervisors must make a thorough assess-
ment across the various domains to ascertain an accurate picture of the range
in levels of supervisee functioning. In order to facilitate assessment of the
Level 2 therapist, we will now turn to our discussion of the attributes and
structures characteristic of these therapists, descriptions of Level 2 behaviors
within the eight domains, and recommendations for the supervisory envi-
ronment and interventions.
Learning and Cognition
The Level 1 therapist has worked to develop some simple understand-
ings and relevant schemata in an initial response to the multilayered and
complex process we know as psychotherapy and its attendant functions
across the eight domains. However, the increase in complexity and diver-
sity in clientele, along with the realization that a single approach to all
problems is inadequate, provides more information that is discrepant with
previous simple and somewhat tentative formulations and resultant sche-
mata. If the supervisor is providing effective supervision at this stage, the
Level 2 therapist is being exposed more to multifaceted conceptualizations
and diagnoses of client processes along with a wider array of treatment
approaches and orientations while at the same time being challenged to
function more independently. The supervisor’s role is also to encourage
the therapist to explore and understand the limitations of the therapist’s
existing schemata.
The supervisee at this level is seemingly being bombarded by information
from a number of fronts, including client perceptions, supervisor interven-
tions, and colleagues’ diverse viewpoints. These sources of new information
and feedback are often discrepant with existing productions (declarative ver-
bal or image representations of information) in overly general schemata, con-
tributing to a state of confusion (or general associative stage) for the therapist,
and a major task now is integrating and synthesizing these diverse view-
points. As we will see, supervisees can easily become overwhelmed by these
challenges. However, the openness that Level 2 supervisees generally dem-
onstrate toward seeking new information helps in successfully resolving and
comprehending these complex processes. This work leads to a more complete
integration and synthesis as they strive to develop a personalized approach in
their therapeutic work.
The Level 2 Therapist 87
Level 2 Structures
We will now focus on the three overriding structures and examine how
changes in these structures mark development in Level 2.
Self- and Other-Awareness
At this stage, the supervisee exhibits less self-preoccupation, and this frees
up attentional capacity to focus on the client. Thus, rather than attending
primarily to his or her own emotional state and worrying about how he or she
is being evaluated by the client, the supervisor, or peers, the trainee can focus
more on empathizing with the client. To the extent that the trainee can tap
into primal empathy, attunement, and empathic accuracy (Goleman, 2006),
this may add to the distraction and discomfort of facilitating client improve-
ment. Also, the trainee’s need to monitor his or her own performance of skills
is reduced as fundamental attending and other skills become more natural
and “mindless.” This enables a more concerted attempt to understand the
client’s perceptions of the world and what he or she is experiencing. The addi-
tional cognitive focus on seeing the client’s perspective can introduce confu-
sion and result in frustration for the trainee, as the complexity of the therapy
process has now been increased and the supervisee struggles to more fully
understand the client’s world.
Within the affective realm, the therapist exhibits an increased capacity to
empathize with the client that did not previously exist because of the predom-
inant self-focus. The supervisee, if encouraged to do so, shows an increased
sensitivity to the verbal and nonverbal behaviors that communicate clients’
inner emotional experiencing, adding considerably to the depth of the super-
visee’s accurate empathic understanding of the client. Goleman (2006) has
discussed low-road processing, which allows us to tap into another’s internal
experience. The thoughts and self-focus of the Level 1 trainee would appear
to interfere with this process. As the Level 2 trainee focuses more intently
on the client, the potential to become attuned to the client and tap into (at a
preconscious level) microexpressions (nonverbal behavior) can lead to a bet-
ter understanding of the client’s experience. Similarly, a type of “empathic
resonance” can occur in the therapist in response to the client if the former
closely focuses on the client without engaging in a cognitive analysis of what
is occurring (high-road). In essence, the trainee needs to shut down his or her
internal dialogue in order to be open, at the low-road preconscious level, to the
88 IDM Supervision: An Integrative Developmental Model
emotional experience of the client. Later, high-road or conscious processing of
this experience can be helpful in labeling the emotions, placing them into an
understandable context, and communicating them back to the client.
As we have previously discussed, trainees often need assistance in sorting
through their emotional experiences in therapy. Emotional reactions can be a
function of primal empathy that is enabled by attunement with the client (as
noted above). They can also be a function of the trainee’s personal learning
history as it is tapped by interactions with the client. In this case, the thera-
pist’s affective experience may reflect more about his or her own emotional
experiencing than it does about the client’s. Finally, the therapist’s emotions
in response to the client may reflect how others react to the client in contexts
outside of therapy. This latter example would be consistent with experiencing
aspects of client “pull” (Cashdan, 1988) or responding with process com-
ments or immediacy interventions in the here and now with clients (Teyber,
2006), among other examples.
A danger for the therapist at this point is becoming overwhelmed by the
client’s affective experience and the ability to effectively deal with the emo-
tions that may be serving to disable the client’s functioning. Another risk
at this point is overidentification with the client, to the extent of being unable
to provide effective interventions. Overidentification also increases the poten-
tial to engage in countertransference reactions. The supervisee may become
enmeshed in the client’s viewpoint, losing the objectivity necessary to provide
effective treatment. Common general manifestations of this overidentifica-
tion include strong beliefs in the veracity of the client’s subjective reporting
of presenting concerns, a desire to advocate strongly for the client in various
realms, or taking the client’s position regarding attitudes toward significant
others. Finally, the emotional, yet nonempathic, response to the client can be
so strong that the supervisee is unable to fully appreciate the client’s experience
and, instead, responds from his or her own personal reactions. Supervisees at
this stage can become so affectively overwhelmed by immersing themselves
in the client’s perspective that they may freeze up and be unable to make clin-
ical decisions in treatment. Recalling the metaphor we used in Chapter 2, the
therapist has entered the crevasse with the client and neither can climb out.
Although not completely distinct from the affective experience, the cogni-
tive realm of awareness has also undergone change as the therapist moves into
Level 2. The relatively simple or idiosyncratic perspective of the less experi-
enced trainee will often be inadequate in understanding clients’ perspective
and life circumstances. In other work (Stoltenberg & Pace, 2008), we have
discussed how trainees often initially approach therapy from a culturally
The Level 2 Therapist 89
encapsulated frame of reference where their experiences and worldview
reflect their own learning environments and cultural themes but may not be
adequate to understand clients coming from significantly different worlds.
In addition, the developing schemata regarding client, therapist, and rela-
tionship factors are still becoming more elaborate and comprehensive, and
the links between them are still being strengthened. Similarly, theories and
research evidence specific to psychotherapy, assessment, and so on, as well
as broad theories of psychology, are still being learned, and their relevance
may yet elude the trainee. Regarding social intelligence in general, Goleman
(2006) has described the importance of social cognition, or understanding
how the social world works; of course, this will be impacted by numerous
cultural considerations. In addition, the trainee needs to understand how to
be authentic or genuine in a therapeutic manner, which relates to issues of
self-presentation. Goleman also notes that influence, or shaping the outcome
of social interactions, is important in social facilitation. We have already dis-
cussed how the Elaboration Likelihood Model (Petty & Cacioppo, 1986)
and the Interpersonal Influence Model (Strong, 1968), among others, address
these issues. Finally, Goleman’s notion of concern, or caring about others’
needs and acting accordingly, is consistent with the goal of prioritizing client
welfare over focusing on the therapist’s personal needs.
Anecdotal evidence and gender research suggest that gender differences
may emerge in the tendency of therapists to rely on either a cognitive or
affective focus on the client. Some male therapists, through socialization,
may tend to want to resolve the client’s problems and focus more on cogni-
tive problem-solving aspects of therapy. On the other hand, perhaps due to
a greater learned focus on relationships, some female therapists may dem-
onstrate more of a focus on the emotional experience of the client (Gilligan,
1982). In terms of challenges, some therapists may need to be encouraged
to focus more on the client’s affect (empathy) rather than attending only to
solving problems and understanding the client’s worldview. Other therapists
may need to be encouraged to focus more on cognition and problem solv-
ing and resist the temptation to overidentify emotionally with the client. In
other words, some trainees may tend to retreat to tight constructs and assimi
lations, while others may tend to overaccommodate to the client’s world.
Evidence indicates that both men and women have the capacity to empathize
and engage within a relational perspective as well as utilize rational problem-
solving orientations (Jaffee & Hyde, 2000). From a common factors or an
evidence-based psychology practice perspective, neither alone is adequate
(Hubble, Duncan, & Miller, 1999; Norcross, Beutler, & Levant, 2006).
90 IDM Supervision: An Integrative Developmental Model
Autonomy
The primary conflict for the therapist at this level is a vacillation between
autonomy and dependency. On one hand, supervisees are developing their
own ideas and gaining knowledge through experience, individual and group
supervision, and workshops or course work (if students) regarding effective
interventions with clients. Thus they tend, appropriately, to move away from
imitating the supervisor. Supervisees become more confident, and sometimes
reactive, in asserting their independence in intervening with clients. In addi-
tion, they may resist discussing certain cases if they suspect that the supervi-
sor will disagree or suggest an alternative approach. This can be particularly
true if they have recently transferred to a new supervisor who takes a dif-
ferent perspective than the prior one did. There can be a loyalty factor, or a
fear of returning to Level 1 uncertainty if forced to think differently about,
or behave differently in, the therapy process. Essentially, supervisees desire
to function independently in counseling situations concerning certain cli-
ent types and problems and engaging in therapy behaviors with which they
believe they have experienced success. In these cases, they can often function
quite capably and appropriately on their own (or, at least, believe they can).
On the other hand, however, they remain dependent on the supervisor for
advice and direction at various times or for certain domains where they lack
experience or confidence. At these times, the supervisee still functions as a
Level 1 therapist. The Level 2 therapist may also resemble the Level 1 super-
visee when the added complexity associated with an increased focus on the
client reduces the level of certainty and creates confusion regarding issues
that may have seemed clear during Level 1.
Thus, we expect the supervisee to oscillate between independent func-
tioning and continuing dependence on the supervisor. The range displayed
in dependency and autonomy will vary according to the previous counsel-
ing experience and the effectiveness of supervision the therapist has been
exposed to, as well as the personal characteristics of the supervisee (for exam-
ple, openness to feedback). This effect is illustrated in a study by Tracey,
Ellickson, and Sherry (1989) in which beginning students, in contrast to
advanced students, preferred a more highly structured supervision environ-
ment overall, and advanced students who were high on reactance preferred
a low-structure environment more than did advanced students low on reac-
tance. However, under crisis therapeutic conditions (such as with suicidal
clients), where advanced trainees lacked experience and anxiety remained
high, they still preferred the structured supervision regardless of their level
The Level 2 Therapist 91
of reactance. Lack of experience with an unfamiliar domain (suicidal cli-
ents) appears to have resulted in these advanced therapists’ functioning in
Level 1 with this clientele. In response, they appropriately preferred a highly
structured supervision environment. Similar results for another therapeutic
condition (child abuse) were reported by Leach, Stoltenberg, McNeill, and
Eichenfield (1997).
At this point, with proper feedback in supervision and other educational
experiences, therapists are struggling with the complexity of the therapeutic
process and resultant confusion while attempting to consolidate the gains
they made during the first stage. Some may resist appropriate dependency
at times because they believe they should be able to function autonomously.
Conversely, they may become overwhelmed and react negatively to super-
visors who suggest new ways of conceptualization or intervention as an
expression of their frustration in resolving the confusion surrounding this
dependency–autonomy conflict. Other therapists who have been led to over-
estimate their skill level through previous laissez-faire supervision may view
any dependency on the supervisor as a weakness and resist sharing their
thoughts and feelings in supervision as an expression of autonomy. In some
cases, supervisees ignore supervisor suggestions and directives and may inap-
propriately intervene in cases where they lack expertise, negatively affecting
client welfare. Finally, some supervisees with fluctuating levels of confidence
or assertiveness will operate in a predominantly dependent mode, constantly
seeking supervisor approval when in fact they have the knowledge and ability
to function more independently.
Recall that current theories of learning note that one does not necessarily
develop more refined schemata and resultant expertise without evaluative
feedback (Anderson, 2005). In training, this can come from a number of
sources, the primary ones being the supervisor and the client. We will discuss
ways of assisting trainees to get feedback from their clients through evaluat-
ing the therapy process in later chapters. For now, though, it is important to
remember that trainees may not be aware of the extent of their knowledge
and expertise without specific and informed input from their supervisors.
The more attention we encourage the supervisees to focus on their clients,
the more likely it is that discrepancies between what they believe is occurring
in session and what actually is occurring will be highlighted. Thus, through
ROA via the supervision process (observing and processing videos of ses-
sions), supervisees may become more aware during sessions (RIA) of the limi-
tations of (at least some of) their interventions (KIA). This sets the stage for a
type of growth in understanding that was not possible in Level 1.
92 IDM Supervision: An Integrative Developmental Model
Motivation
The dependency–autonomy struggle also affects the motivation level of
Level 2 therapists. They desire to function independently, but when they
are exposed to more difficult client types and problems and more complex
theories, methods of intervention, and diagnostic categories, they may not
be or feel effective with some clients. They may start questioning their skills,
and the experience may shake their level of confidence and sense of thera-
peutic efficacy. For some therapists, this confusion manifests itself in high
levels of motivation to learn as they seek additional guidance and support.
Others will wallow in confusion and frustration, and sometimes despair,
which can reduce their motivation to learn and engage in clinical activities.
Most commonly, their motivation level fluctuates as they vacillate between
these feelings of confusion and discouragement versus personal efficacy and
confidence when experiencing success. Therapists may become discouraged
or distant in their work one week and exhibit a high level of enthusiasm the
following week.
These fluctuations typically manifest themselves as “forgetting” tasks dis-
cussed and agreed on in previous supervision sessions or as a lack of prepara-
tion for current supervision sessions. Fluctuations in the quality of recorded
sessions will also be apparent from client to client or on a week-to-week basis.
At this time, trainees in graduate school settings may begin to question their
career decision to become a therapist and distance themselves cognitively
or affectively from the therapeutic process. Instead they may immerse
themselves in other forms of activity, such as research or teaching, while
shortchanging therapeutic responsibilities. Therapists in postgraduate work
settings may manifest more overt signs of discouragement by “giving up” on
certain clients, facilitating referrals, or expressing the need for a vacation or a
break from clients. Nevertheless, in most cases, the therapist who is discour-
aged or distant one week returns the next week with increased enthusiasm
for clinical work.
Self-determination theory provides a way to further examine the impact
on motivation of Level 2 processes (for a review of self-determination theory,
see Vansteenkiste, Lens, and Deci, 2006). Although some supervisee learning
and behavior will probably be a function of intrinsic motivation (for interest
or enjoyment), other motivations will also play a role. Autonomous motiva-
tion, which includes intrinsic and identified regulation, has been shown to
result in superior outcomes when compared to controlled motivation. It is
The Level 2 Therapist 93
reasonable to assume that not all learning necessary for supervisees will occur
primarily due to interest or enjoyment in the experience. Some will be a func-
tion of the supervisee identifying with the value and importance of learning
about and developing skills in therapy-related activities. The regulation of
this behavior is still seen as extrinsic (imposed from the outside), but the
importance of it has been internalized and seen as relevant to the self-selected
goal of becoming an effective therapist. Thus, the supervisee who is primarily
interested in conducting therapy and becoming an independently practicing
psychotherapist will expend effort to learn about personality theory, diagno-
sis, multiple theories of therapy, ethics, research, and so on if these have been
internalized as important to achieving the overall goal.
Of course, sometimes the learning associated with clinical training and
supervision is viewed by supervisees as externally regulated, as a function of
contingencies controlled by others (supervisors, professors, employers) or as
coerced through rewards, punishment, assignments, and so on. These instances
of controlled motivation may still result in learning, but outcomes appear to be
less positive. If a supervisee is engaging in (or refusing to engage in) learning
due to contingencies imposed by others, he or she will gain less from the expe-
rience. The supervisee may be compliant (or resistant), assuming the role of the
“good student” (or rebel), but he or she is less likely to engage in the type of
effortful central route processing (Petty & Cacioppo, 1986) that we have dis-
cussed as important. In essence, the supervisees may have not been sufficiently
persuaded as to the relevance of the learning process; they will tend to engage
in more superficial information processing, and learning will be limited.
In some circumstances, supervisees will lack the self-efficacy or confidence
in their abilities to engage in the therapeutic behavior or achieve the desired
outcomes. This amotivation likely would result either in strong dependence
on the supervisor to take control or in avoidance of any client or context that
elicits this response.
Interaction of Domains and Structures
The complexity of learning psychotherapeutic skills is such that we should
not expect a Level 2 therapist to consistently demonstrate effective perfor-
mance across all of the domains. Experience or past exposure to training in
any one domain, as well as the personal characteristics of a given supervisee,
interact to influence progression through the levels for each domain.
94 IDM Supervision: An Integrative Developmental Model
Intervention Skills Competence
The characteristics of the Level 2 therapist are especially apparent in this
domain as the supervisee is increasingly comfortable with an array of inter-
vention skills (sometimes broad, sometimes limited), although these skills are
not well integrated within an overriding theoretical orientation or conceptual
scheme. Exploration of various approaches and the most current develop-
ments in the psychotherapy research and practice arenas may be pursued and
attempted, including the latest fads. It is fairly common to see the Level 2
therapist intentionally seeking to learn interventions and approaches dissimi
lar from those used by the supervisors. The supervisee will make repeated
requests for more experience with diverse client types and problems, yet may
not acknowledge or may even resist supervisor recommendations to expand
his or her repertoire. Given the strong cognitive and affective focus on the
client’s experience, the therapist may become enmeshed and demonstrate
a temporary inability to make decisions regarding client welfare or treat-
ment. With the intent of establishing the therapeutic alliance, the Level 2
supervisee also will readily express support to clients in appropriate ways.
Unfortunately, the supervisee may also cross the line in terms of what is
therapeutic by overidentifying and expressing overt agreement with client
viewpoints through summaries, reflections of feeling, content, and so on.
In addition, the therapist may be affectively overwhelmed and confused by
the seemingly insurmountable complexity of the counseling process and be
unable to progress.
Assessment Techniques
In this domain the Level 2 therapist demonstrates an increased knowledge
of diagnostic classifications and assessment instruments. However, with the
increased focus on the client’s perspective, the supervisee often has difficulty
integrating information from assessments and interviews that are inconsis-
tent or discrepant with his or her view of the client. As a result, the therapist
may demonstrate a confirmatory bias in gathering information in clinical
interviews, asking leading questions, or directing the interview toward infor-
mation that the therapist believes fits the client’s worldview. This bias may
also be demonstrated in the therapist’s interpretation of psychological instru-
ments and other assessments. There is often a tendency to heavily weight cer-
tain pieces or types of information in the formation of pet hypotheses that fit
The Level 2 Therapist 95
the client’s perspective or the supervisee’s bias, to the exclusion of disconfirm-
ing or inconsistent information. The Level 2 therapist may also lose interest
in or reject assessment instruments, or even view their use as somehow harm-
ful to clients. In addition, DSM diagnostic categories may be viewed as cold,
impersonal, or irrelevant in providing useful information or implications for
treatment. The formal, unflattering description included in diagnostic cat-
egories can seem too harsh or pessimistic when applied to the client.
Interpersonal Assessment
The ability of the therapist to be self-aware and to monitor his or her cogni-
tive and affective reactions toward clients is also severely limited due to the
strong focus on the client’s perspective. In essence, the therapist may be over-
accommodating to the client’s worldview. Thus, the therapist may be unable
to separate responses to clients based on accurate perceptions of the client’s
interpersonal interactions versus countertransference reactions outside of
immediate awareness.
A Level 2 therapist may exhibit a naïve lack of insight regarding this pro-
cess. The supervisor is often initially surprised when attempts to increase the
supervisee’s awareness in this domain are met with confusion or disbelief by
the supervisee. This may appear as a reticence to consider his or her reaction,
but also can manifest as simple surprise that this information may be relevant
at this time.
Client Conceptualization
While the supervisee’s written and verbal conceptualizations of therapeutic
dynamics and processes are based on a more complete understanding of the
client’s perspective, they may also be largely based on the client’s viewpoint,
without integration of other sources of information (for example, objective or
projective psychological testing). Again, obvious discrepancies or inconsisten-
cies in information gathered are often ignored or overlooked. The therapist
may make a case for exceptions to specific diagnostic classifications, or argue
that the client has been misclassified, largely based on his or her perception
of the client’s worldview. Many times, obvious discrepancies between parts of
the client’s story are overlooked and not integrated into the diagnosis or con-
ceptualization. For example, the ruminations and negativistic thinking pat-
terns associated with various forms of depression may be misinterpreted as the
96 IDM Supervision: An Integrative Developmental Model
recurrent thoughts demonstrated in obsessive-compulsive disorder, because
the therapist is convinced by the client that the latter is really the problem
and outside his or her control. During these times the therapist may fail to
acknowledge the manipulative behaviors of a client with antisocial personal-
ity disorder or may be easily charmed by the attention-seeking qualities of a
client exhibiting features associated with histrionic personality disorders.
Susan was considered to be a very strong advanced trainee in her gradu-
ate program and was consistently viewed by most supervisors as having
strengths in relationship-building skills, as evidenced by her low no-show
and premature termination rates. Early in her contact with an ongoing
client who expressed difficulty in choosing between two romantic rela-
tionships, Susan was convinced that his strongly avowed guilt and anx-
iety were sincere. Her written conceptualization prepared for a group
case conference emphasized nonpathological aspects and the concerns
that the client expressed regarding interpersonal relationships, while
results of the client’s recent Minnesota Multiphasic Personality Inventory
(MMPI) indicated high antisocial tendencies with a current low level of
state anxiety. Presumably Susan had reviewed the MMPI results prior to
the case conference presentation. However, when confronted again with
these discrepant findings, Susan replied, “I just know he would not lie
to me. After all, he shows up every week, and he just tries so hard in our
sessions.”
Individual Differences
In terms of awareness of issues surrounding lifestyle, gender, SES, and cul
ture or ethnicity, the Level 2 supervisee is more willing to acknowledge the
influence of sociocultural and environmental variables on behavior and
the limitations of conventional counseling modalities for working with a
diverse clientele. However, the supervisee is still vacillating between general
culture-specific characteristics believed to apply to all individual members of
various groups (for example, women or Asian Americans) and the idea that
every client is so unique that defining cultural values, attitudes, and behav-
iors may be ignored. As a manifestation of this confusion, the therapist may
tend to apply this new information garnered from other training experiences
(for example, in-service training, workshops, course work) in a rigid and
The Level 2 Therapist 97
stereotypical fashion. As supervisors, we have regularly been provided with
basic information regarding a client’s gender and ethnic background with a
look from the supervisee that seems to say, “So, now what do I do?”
Alternatively, despite attempts to understand a diverse clientele, the
Level 2 therapist may be overwhelmed with what is perceived as yet another
dimension of behavior that needs to be understood and integrated into his
or her work. Thus, the supervisee may feel that differences between cultural
groups are so vast that he or she is incapable of understanding the experience
of a client with a background different from the therapist’s own. Lopez and
colleagues (1989) suggest that therapists at this level feel “overburdened” by
issues of culture or individual differences as an extension of the search for
culture-specific or ethnic components and that feeling this burden is a nec-
essary step characteristic of the Level 2 supervisee’s struggle with confusion
and ambivalence. It is within this domain, however, that some of the most
crucial and productive work in Level 2 is done. Although the therapist may
be confused and vacillating, he or she simultaneously has greater openness to
and interest in learning about other groups and exhibits a genuine attempt
to understand the varieties of human experience and the effects on the coun
seling process. Thus, in addition to other types of training experiences that
the Level 2 therapist is being exposed to in the realm of individual differ-
ences, it becomes crucial for the supervisor to strike while the iron is hot,
encouraging the supervisee’s attempts to understand and intervene to resolve
conflicts and increase knowledge in this important domain.
Theoretical Orientation
Therapists at this stage often demonstrate movement away from a strict alle-
giance to a specific theoretical orientation identified with the program, a fac-
ulty member, or the supervisor to more experimentation with a wider variety
of techniques and strategies. Similar to the domain of intervention skills,
supervisees may be seeking the most current therapeutic developments to
learn and may be susceptible to faddish approaches lacking empirical or con-
sistent theoretical support. The therapist at this point is attempting to find a
perspective or approach that fits with his or her own view of human behavior
and personal counseling style, but runs the risk of forcing clients to fit into
a particular theoretical model. As a result, a Level 2 therapist often has dif-
ficulty explaining why he or she used a certain orientation or technique and
justifying this choice. The therapist will also tend to have questions regarding
how the supervisor derived his or her own working approaches in searching
98 IDM Supervision: An Integrative Developmental Model
for a personal orientation. This search is a necessary task for all effective
psychotherapists and should be encouraged in Level 2 supervisees, although
within the bounds of concern for client welfare.
Treatment Plans and Goals
Setting basic treatment goals and plans seems functional and concrete for the
Level 1 supervisee and serves to reduce anxiety. However, the overaccommo-
dation demonstrated by the Level 2 therapist may result in anxiety or despair
concerning the difficulty of providing effective treatment or discouragement
when initial treatment plans fail. The Level 2 therapist may lose sight of the
necessity and practicality of jointly formulating treatment plans with clients
by attempting to experiment with alternative treatment strategies and theo-
retical orientations. Thus, treatment goals may reflect experimentation with
a new approach or be overly vague or general (for example, “working on the
relationship”), may be ignored because the trainee views open-ended sessions
with clients as sufficient, or may be deferred until the client articulates con-
cern over the direction of therapy. Finally, in the act of overaccommodating
to the client’s perspective, treatment goals may simply reflect the client’s ini
tial reasons for seeking counseling, ignoring the relevance of therapist assess-
ment and conceptualization in the goal-setting process.
Professional Ethics
The implications and ramifications of formal professional ethical guidelines
are generally better understood by Level 2 therapists. At this level, however,
supervisees may place more emphasis on client welfare in situations where
both client welfare and counselor welfare may be at stake. They may some-
times view ethical standards as imposed limitations on practice that may be
violated and justified by exceptions to the rule. For example, one of us was
shocked to learn one day that a supervisee who would have been considered
a Level 2 or Level 3 therapist across any number of domains had scheduled a
lunch date with a current client diagnosed with borderline personality disor-
der, in order to foster a successful termination.
In situations concerning the welfare of two or more clients, such as in fam-
ily or group work, supervisees may be torn by their allegiance to one of the
clients versus the necessity to behave ethically (for example, reporting child
abuse). For example, one of our supervisees was in a therapeutic relationship
The Level 2 Therapist 99
with a man desiring help with controlling his anger. The supervisee had
gained an appreciation for this man’s past experiences of being beaten by his
father and ignored by his mother. The therapist had begun to understand
how this man saw the world and could feel the depth of his pain and anger.
During one session, the client reported that he had struck his child the night
before, resulting in some bruises but no permanent physical harm. The cli-
ent felt awful and was experiencing considerable guilt and fear. He asked
the therapist to help him find ways to avoid such behavior in the future. The
supervisee felt caught between his legal responsibility to report the actions
to child protective services and his caring and empathy for the client. After
processing his reactions in supervision the following day, the therapist alerted
the client that he needed to call child protective services, and then did.
In many instances in discussions of professional ethics with Level 2 train-
ees, we have heard the justification that potential violation of an ethical
principle may be warranted because a supervisor, faculty member, or other
professional committed the same act (for example, dual-role relationships).
Consequently, supervisors should be well aware of the necessity to behave as
a role model for all levels of supervisees in the domain of professional ethics.
This consideration is especially relevant to Level 2 supervisees in the midst of
ambivalence and confusion.
Supervising the Level 2 Therapist
One of the basic tenets of the IDM is that the supervision environment
should change in response to the differing needs, issues, and perceptions
of the developing supervisee. The supervisor must be extremely vigilant in
early supervision sessions in order to (1) carefully assess the therapist’s cur-
rent level of functioning in the particular domain of interest, (2) be prepared
to make a shift in supervisory style in order to respond effectively to the
changing needs of the Level 2 therapist, and (3) facilitate development to
the higher levels. Many of the research studies cited in Chapter 3 also exam-
ined characteristics of advanced trainees. These studies provide support for
the notion that effective supervisors vary their supervisory styles and alter
the supervision environment to meet the changing needs of more advanced
trainees (Stoltenberg, Pierce, & McNeill, 1987; Wiley & Ray, 1986), and that
supervisees increase in their level of independence (McNeill, Stoltenberg, &
Romans, 1992; Rabinowitz, Heppner, & Roehlke, 1986) and thus require
100 IDM Supervision: An Integrative Developmental Model
less structure within the supervision environment (McNeill et al., 1992;
McNeill, Stoltenberg, & Pierce, 1985; Tracey et al., 1989). Indeed, other
studies of developmental supervision processes mirror the conclusions of
early research regarding changes that occur in supervisor and supervisee
behaviors across developmental levels (Stoltenberg, McNeill, & Crethar,
1994; Worthington, 1987). However, although the research literature has
been able to identify the changing needs and characteristics of therapists as
they increase in experience, what has been more difficult is the identification
of specific characteristics descriptive of the Level 2 supervisee. This difficulty
appears to be reflective of the complexity associated with Level 2 as train-
ees address the issues confronting them across multiple domains. In addi-
tion, the ambivalence, confusion, and fluctuation that supervisees exhibit
during Level 2 add to the challenge of researching this level. As in working
with Level 1 trainees, the cookbook approach may seem appealing in dealing
with the conflicts, complexities, and transitions demonstrated by the Level 2
supervisee, especially for readers who have experienced supervision with this
level of therapist. However, such an approach remains unrealistic; instead,
flexibility on the part of the supervisor characterizes the approach to the
Level 2 supervision environment. Consequently, let us now turn to discus-
sion of supervision approaches and guidelines with the Level 2 therapist.
Therapeutic Adolescence
The characteristics of the Level 2 therapist have led Stoltenberg and Delworth
(1987) to characterize this stage as one of “trial and tribulation” and liken it
to a period of “therapist adolescence.” Thus, the task of the supervisor with
Level 2 supervisees is to provide a fine balance between guidance and support,
and a degree of autonomy and challenge in fostering the independence and
confidence of the therapist. Supervisors must recognize and provide a super-
visory environment that is qualitatively different from that of the Level 1
therapist by increasing autonomy and decreasing structure. Highly structured
directives and didactic advice appropriate for Level 1 supervisees are likely to
be met by resistance and even anger by the Level 2 therapist. Of course, the
supervisor must always be aware of the overriding concern regarding issues
of client welfare by providing appropriate structure and guidance in domains
where the supervisee is in need of further development. Although Level 2
characteristics may be in play, it is important for the supervisor to assess
the adequacy of the breadth and depth of supervisee understanding of the
processes associated with the domain of interest. Expanding the repertoire of
The Level 2 Therapist 101
the trainee’s skills and understanding may also be in order. Because Level 2
therapists will not always be receptive to the kind of guidance supervisors
provide to Level 1 therapists, even when it is necessary, the supervisor must
be prepared to articulate his or her rationale for providing direction in certain
situations and respond to supervisee resistance and anger in a nondefensive,
facilitative manner. As we noted in discussing self-determination theory, the
trainee will benefit most from learning if the need for new knowledge and
skills is internalized and not merely seen as a less-than-relevant demand by
the supervisor. For introducing new conceptualizations and interventions
coming from orientations with which the supervisee isn’t as familiar, these
introductions can be viewed as merely extensions of the supervisor’s prefer-
ences, and not as important skills and knowledge for professional develop-
ment. For neophyte supervisors, Level 2 therapists often provide the first
difficult test of their supervisory skills as well as their patience.
Client Assignment
Recall that our recommendation in Chapter 3 was to shake up the late Level 1
therapist and help him or her make the transition to Level 2 by assigning
more difficult and complex client cases. Indeed, in most training agencies,
Level 2 supervisees, because of the amount of their prior experience, are typi-
cally assigned clients displaying higher degrees of psychopathology or exhib-
iting other challenges to the therapist, and they may be less amenable to
change through the facilitative skills and structured approaches applied dur-
ing Level 1. The Level 2 therapist may also be receiving training and experi-
ence in a wider variety of domains—individual, group, marital, and family
counseling—some of which may be unfamiliar. In postgraduate job settings,
however, therapists may not be receiving training and exposure across vari-
ous domains, and they may exhibit Level 2 structures in only a couple of
the broader domains (for example, intervention skills) consistent with job
requirements. Additionally, in these settings, therapists may be functioning
at Level 3 in any number of domains, but in seeking additional expertise in a
new modality, they may function at Level 2 (or lower) in the newer domain.
An increased diversity of clientele and presenting concerns is exciting and
challenging, as well as frustrating and anxiety producing. Previously effec-
tive counseling behavior (or behavior perceived as such) may prove less than
adequate in ameliorating more complex client problems. As a result, client
assignment should reflect a blend of cases with which the therapist exhibits
confidence and independence along with more difficult challenging cases
102 IDM Supervision: An Integrative Developmental Model
requiring the application of underdeveloped skills. This allows the supervi-
see to consolidate previously learned skills while challenging the supervisee’s
ability to respond in a flexible manner to new problem situations. Training
agencies that assign clients exclusively on a “space available” or “next-in-line”
basis miss crucial opportunities to attend to or enhance the development of
the Level 2 supervisee and may actually impede growth.
Supervisor Interventions
Research investigations appear to indicate that support is a necessary ingre-
dient across all developmental levels (Kennard, Stewart, & Gluck, 1987;
Rabinowitz et al., 1986; Worthen & McNeill, 1996). Thus, facilitative inter
ventions that express ongoing support and concern for supervisee devel-
opment continue to remain important for the Level 2 therapist, especially
during times of supervisor–supervisee conflict. A little added support and
overt expression of this support does wonders for the fluctuating motivation
level of the Level 2 therapist. Sharing or disclosing one’s own past experiences
or difficulties with similar issues can serve to accomplish this function, par-
ticularly if the supervisee sees the supervisor’s experiences as relevant.
Prescriptive interventions, although slightly less frequent for Level 2 thera-
pists than for Level 1 therapists, are also necessary at times to encourage
growth across the domains. That is, the Level 2 therapist will require supervi-
sor knowledge and expertise across relevant domains. Although prescriptive
interventions run the risk of eliciting extrinsic motivation, if care is taken to
encourage identification and internalization of the learning, the trainee will
respond positively and engage in careful information processing regarding
the experience. However, prescriptive interventions suggested for domains
in which Level 2 therapists function adequately, and which are thus seen as
simply supervisor preference for an approach, run the risk of eliciting trainee
reactance and defensiveness and impeding supervisee growth and progress.
Also, even with the lack of active resistance, reduced learning may occur that
will frustrate the development of the trainee. “Going through the motions”
isn’t adequate for facilitative learning to occur. It is especially important in
utilizing prescriptive interventions with Level 2 supervisees to offer multiple
alternatives and encourage some collaborative decision making while allow-
ing for some autonomous choices. Conflicts over supervisor prescriptions are
usually defused when the supervisor is able to articulate a clear, cogent ratio-
nale, underscoring the importance of the interventions for client welfare.
As we will discuss in more detail later in this book, educating trainees as to
The Level 2 Therapist 103
the importance of the principles of evidence-based practice and the value of
seeking relevant research can be helpful in internalizing motivation as well as
providing specific content and skills for learning.
In order to enhance growth, Level 2 therapists must also be challenged
to provide their rationales for responding to various client concerns. This
is especially true for cases where supervisees may resist input, feel uncer-
tain, or become angry and impatient (amotivation or controlled motivation).
Thus, for Level 2 supervisees, conceptual interventions can be effective in
encouraging them to articulate their own or alternative intervention plans.
In addition, introducing different conceptualizations of the same client and
associated treatment approaches by supervisors serves to challenge the super-
visees and expand their level of understanding. It is important, however,
that conceptual interventions be accompanied by high levels of support and
empathy so that they are not misinterpreted by supervisees as covert or dis-
guised prescriptive interventions or demonstrations of the supervisor’s supe-
rior conceptual or diagnostic skills (that is, seen as controlled motivation).
This could elicit defensive (resistant or avoidant) reactions.
Level 2 therapists may be most susceptible to overt or covert client manip-
ulations due to their tendency to overaccommodate to the client’s perspec-
tive, setting the stage for countertransference reactions. Thus, the increased
use of catalytic interventions with Level 2 therapists, in the form of pro-
cess comments by supervisors, can increase the supervisees’ self-awareness
when they are enmeshed in only the client’s viewpoint. Supervisors’ com-
ments are often directed to the therapists’ reactions and feelings toward cli-
ents in moment-to-moment session interactions of which they may be only
marginally aware. Helping supervisees sort out their emotional reactions to
clients (e.g., empathy, idiosyncratic emotional reactions, generalized emo-
tional reactions) can be productive through ROA. Encouraging supervisees
to increase the focus on clients with a goal of experiencing primal empathy
and attunement may help them develop better empathic accuracy in their
work. This can significantly broaden their understanding of their clients and
yield important perceptions for conceptualization and treatment. Process
comments may also be issued in the form of a direct challenge to stir things
up in Level 2 therapists and, in essence, force them to focus on and moni-
tor their feelings and reactions during an interpersonal interaction. This can
help provide an impetus to move away from an exclusive focus on the client’s
perspective and toward a consideration of the adequacy of the client’s social
cognition and social facility. Examination of moment-to-moment reactions
is best achieved through the review of recorded counseling session excerpts
104 IDM Supervision: An Integrative Developmental Model
in a search for expanded learning and increased self-insight and understand-
ing of the client. Process-type comments may also be employed to assist the
supervisee in examining the dynamics of the supervisory relationship (see
Chapter 6).
Lorraine was a fourth-semester trainee who was generally well regarded
by the training faculty in her program, and she had received positive eval-
uations of her clinical performance. During the first meeting with her
new supervisor, she acted somewhat surprised when he informed her that
she needed to record all counseling sessions and bring them to her weekly
supervision sessions. The supervisor inquired about the availability of
recorded sessions during the next couple of supervision sessions. Lorraine
reported that none of her clients had provided her with written permission
to record, and she quickly moved to a discussion of clients and a focus
on her perceptions of her work with them. It became clear that Lorraine
had definite ideas regarding the way she believed therapy should be con-
ducted, even while she seemed to accept supervisor recommendations. In
addition, it became evident that she preferred talking about her work and
herself to examining through direct observation how she engaged in it.
Attempts to process possible evaluation anxiety as resistance to record-
ing were brushed aside as Lorraine demonstrated little insight into the
reasons more of her clients were not providing permission to record. At
this point, the supervisor strongly reaffirmed the necessity of obtaining
session recordings as relevant to both client welfare and supervisee evalu-
ation and development. An intervention was employed that contained
prescriptive as well as catalytic elements. Lorraine was told that she must
provide a recorded counseling session at the next supervisory meeting.
The intervention was prescriptive in the sense that it was made clear that
there was no negotiation on this requirement. It was catalytic in that it
was strongly presented to Lorraine in order to get things moving and
promote a behavioral change.
At the next supervisory meeting, Lorraine did indeed provide a record-
ing, and she was overtly anxious about playing it in the presence of the
supervisor. Prior to viewing the recording, the supervisor processed with
Lorraine his observations of her present as well as recent reactions and
behavior related to this issue of recording. It turned out that Lorraine
was indeed anxious regarding issues of evaluation and believed that she
The Level 2 Therapist 105
was going to be challenged on skills that she thought she performed very
well. It soon became very apparent that the rationale presented to clients
in obtaining permission to record was negatively biased, such that most
clients would not routinely provide permission. Lorraine also reported
that she had never provided a recording to her previous supervisor but
had simply responded with various excuses during the entire supervisory
relationship, which allowed her to simply provide self-report perspectives
on her work and keep the focus of supervision on aspects with which she
felt most comfortable. Lorraine began bringing recordings on an ongoing
basis, and, with continued processing of her evaluation anxiety, she was
soon able to relax and review recordings with the supervisor. As Lorraine
came to appreciate the role of interpersonal process within counseling,
the supervisor reviewed the examples of this process within the supervi-
sion sessions as a conceptual intervention designed to illustrate the value
of process interventions in counseling.
Consistent with the ELM (Petty & Cacioppo, 1986; Petty & Wegener,
1999), Level 2 therapists are likely to be less predisposed to engage in the
peripheral route processing characteristic of Level 1 therapists, who often
uncritically accept supervisor recommendations (submitting to extrinsic
regulation). Thus, the Level 2 supervisee will often need to be convinced of,
or challenged regarding, the usefulness of an intervention suggested by the
supervisor. This challenge should result in a better understanding of the coun-
seling process with an increased likelihood of lasting effects on the therapist’s
counseling and supervision behavior. This occurs because the information is
effortfully evaluated and elaborated, and thus more centrally processed and
integrated into relevant schemata (Stoltenberg, McNeill, & Crethar, 1995).
However, if the therapist strongly adheres to a particular approach or per-
spective, biased processing may occur, and the supervisee may be unwill-
ing to entertain alternatives (lacking autonomous motivation). Although the
purpose of clinical supervision is not to indoctrinate therapists into a par-
ticular approach or orientation, in our view it is inappropriate for supervisees
to remain closed-minded toward alternative methods of intervention simply
because they may be unfamiliar with them. Thus, in order to facilitate more
central processing and address possible biased processing, supervisors must
expose therapists to diverse approaches that have been demonstrated to be
effective with certain client populations and problems. Because not all super-
visors can work comfortably within all theoretical orientations, the Level 2
106 IDM Supervision: An Integrative Developmental Model
supervisee may benefit from exposure to supervisors who adhere to differing
approaches to therapy (Stoltenberg & Delworth, 1987). However, a focus on
evidence-based practice principles (reference to research, self-evaluation, and
client evaluation) can also help supervisees (and supervisors) broaden and/or
refine their understanding and implementation of therapeutic interventions.
Challenging catalytic or conceptual types of supervisor interventions can
be uncomfortable for supervisees who are sensitive to evaluation, because
they may perceive that the supervisor is questioning their skills or knowl-
edge. Nevertheless, what is comfortable, reassuring, or viewed positively by
supervisees is often not what produces further growth. Challenge within a
supportive supervisory environment is needed for the Level 2 supervisee to
progress to higher levels of competence. Supervisors who use what the trainee
may perceive as confrontational types of interventions do not need to present
them in a punitive, aggressive, or superior manner. In our experience, power
ful confrontations can be presented to supervisees in a low-key, straightfor-
ward manner. In most cases, the content of the confrontation is sufficient to
produce the needed challenge or internal conflict in the supervisee, which
may be facilitated by an honest discussion of therapist strengths and weak-
nesses across the domains. Level 2 therapists, however, often will be caught
off guard by or initially react defensively to confrontational interventions,
perceiving them as a threat to their autonomy. Thus, it is important for super-
visors to process these reactions in the here and now, while at other times, it
is more effective to back off and let understanding occur more slowly. Some
less sensitive or less reactive trainees require more forceful confrontations in
which supervisors challenge the trainees and directly follow up on recom-
mendations in order to produce the conflict necessary to stimulate growth.
However, it is not unusual for Level 2 therapists to return to a subsequent
supervision session having carefully considered and processed the supervisor’s
confrontational intervention. One of us had the opportunity to follow our
own advice (acknowledging others’ credibility to enhance one’s own credibil-
ity) in working with an experienced, potentially reactive Level 2 therapist.
Mel was an experienced therapist who held a master’s degree and had
returned to school for his doctorate. His supervisor was new to the pro-
gram, although not inexperienced. They began their year of supervision
with Mel informing the supervisor that he preferred to consider their
weekly meetings as “consultation” rather than supervision. He noted his
The Level 2 Therapist 107
rather extensive experience and said he felt less a need to be supervised
than simply to have someone available for periodic consultations should
the need arise. The supervisor fought the urge to use his legitimate power
and inform Mel that he would be required to be supervised because he
was now a student in a training program. Instead, the supervisor invested
considerable time in having Mel describe for him the extent of his experi-
ence and encouraged him to provide significant detail regarding Mel’s
theoretical orientation (which happened to be different from the supervi-
sor’s). The supervisor noted that his approach differed somewhat and that
it should be interesting for both of them to learn more about each other’s
views of therapy over the coming year.
In subsequent supervision sessions, the supervisor continued to show
interest in understanding Mel’s approach and asked for clarification when
he did not understand an intervention or interpretation or, frankly, when
he disagreed with one. He also asked to see recordings of Mel’s work with
clients so that he could better understand Mel’s approach to therapy. This
inquisitive (as opposed to inquisition-like) approach seemed to put Mel
at ease, and fairly soon he was noting his confusion with certain clients,
commenting on his dissatisfaction with his work with some, and ask-
ing for direct input regarding other options. The supervisory relationship
ended after a year with Mel remarking about his surprising growth as a
therapist and his appreciation for all he had learned from his supervisor.
Despite the difficult issues that supervisees at Level 2 experience, research
studies suggest that therapists at this level begin to demonstrate an increased
readiness and openness to discussion and processing of personal issues of
self-awareness, defensiveness, transference and countertransference, and the
supervisory relationship (Heppner & Roehlke, 1984; McNeill & Worthen,
1989). A phenomenological investigation of “good supervision” events by
Worthen and McNeill (1996) with intermediate to advanced trainees seems
to capture from the perspective of supervisees much of what we consider
descriptive of Level 2 therapists. This study also indicates support for the
ability of Level 2 supervisees to respond positively to process issues in super-
vision and provides some suggestions for intervention with these therapists.
In this investigation, intermediate supervisees indeed experienced and
expressed a fragile and fluctuating level of confidence, a generalized state of
disillusionment, and demoralization with the efficacy of providing therapeu-
tic interventions, and they were anxious about and sensitive to supervisor
108 IDM Supervision: An Integrative Developmental Model
evaluation. They felt that their anxiety level decreased when supervisors
helped to normalize their struggles as part of their ongoing development; this
type of intervention was often communicated in the form of a personal self-
disclosure. They also characterized the optimal supervisory relationship as
one experienced as empathic, nonjudgmental, and validating, with encour
agement to explore and experiment. These conditions appeared to set the
stage for nondefensive analysis as their confidence strengthened. In addition,
participants reported an increased perception of therapeutic complexity, an
expanded ability for therapeutic conceptualizing and intervening, a positive
anticipation about reengaging in previous difficulties and issues they had
struggled with, and a resultant strengthening of the supervisory alliance.
Normalizing the Level 2 Experience
Supervisors must exhibit skill and courage to address these issues as they
arise. Although therapists may initially struggle with these issues, later
they are often viewed as a “critical incident” important to their growth and
therapeutic competence (Heppner & Roehlke, 1984). The style or manner in
which a supervisor points out or confronts these issues may vary depending
on the level of sensitivity or defensiveness of the supervisee and, in this sense,
requires more advanced skills or experience on the part of the supervisor.
This is perhaps analogous to the development of therapeutic timing and acu-
men by therapists.
Supervisory Mechanisms
It is during this stage of development that the therapist is likely to engage
in the most pronounced resistance toward the supervisor. A supervisee may
selectively present cases with which he or she feels successful and avoid those
with which he or she has difficulties. This choice is often a manifestation of
confusion, a premature sense of autonomy, an inadequate understanding
of the therapy process, or a lack of insightful self-awareness. In asserting
independence, the therapist in some situations may avoid discussion of cases
if he or she suspects the supervisor will challenge the therapist’s choice of
interventions (controlled motivation or amotivation). This growing desire for
independence, however, may limit the therapist’s awareness of what should
be addressed in supervisory sessions, leading to avoidance of discussing cli-
ents with whom the supervisee has become impatient or angry. At times the
The Level 2 Therapist 109
only way to fully assess therapist functioning is to require, at a minimum,
recording of all ongoing clients so that the supervisor can monitor all cases
at any time within the supervision session. In other words, identifying the
difficult cases and issues that are impeding growth in the supervisee at this
stage is paramount to the Level 2 therapist’s overall development. It is also
important, however, to remain sensitive to his or her uncertain confidence,
motivation, and fear of negative evaluation.
Thus, it is extremely important to monitor the therapist’s progress during
this stage primarily through live supervision formats or reviewing session
recordings. In our experience, it is not uncommon for supervisors to back
off these activities at Level 2, as advanced therapists are viewed as “knowing
what they are doing.” At this stage it is not adequate simply to respond to what
supervisees may present in session or request direction on. Supervisors should
not allow too much autonomy across cases by simply discussing clients, rely-
ing on therapists’ self-reports of ongoing client interactions, or monitoring
progress notes. Although recording of ongoing sessions is somewhat normal
procedure within many academic training settings, supervisors working in
hospitals or agency settings may view recording of ongoing sessions as an
unnecessary burden on experienced therapists as well as clients. In addition,
many settings do not have the physical facilities necessary for video or direct
observation from anywhere other than within the therapy room.
In our experience, both supervisees and clients across settings for the most
part do not view recording procedures as a burden or barrier when the issue
and procedures are presented in a straightforward, ethical manner (for exam-
ple, informed consent). Our preference is to conceptualize this issue as a bal-
ance between training considerations and client welfare through monitoring
of therapist and client concerns and behaviors. That is, it is inappropriate to
allow the Level 2 therapist a completely free hand in working with clients.
Although we want to support trainees in their independence at this stage and
encourage risk taking with clients, we still need to be very careful in how we
protect clients while encouraging therapist growth. Providing this delicate
balance of challenge, autonomy, and growth in the trainee, along with atten-
tion to issues of client welfare, is truly one of the most diffi cult tasks in the
practice of clinical supervision.
Group supervision in the form of ongoing case conferences utilizing the
case conceptualization format (see Chapter 7) for formal presentations by
Level 2 supervisees also serves to augment and increase exposure to, and dis-
cussion of, a variety of client concerns, populations, and treatment approaches.
It also provides for appropriate questioning and challenge from colleagues,
110 IDM Supervision: An Integrative Developmental Model
peers, and other professional personnel. The written case conceptualization
format in particular serves as an excellent formal conceptual intervention in
which the Level 2 trainee is required to pull information from diverse sources
(for example, client reports, objective psychological instruments, and thera-
pist perceptions) and integrate and synthesize this information into a coher-
ent conceptualization of a client leading to a diagnosis and treatment plan.
(See appendix A for a model format.) Relevant prescriptive as well as concep-
tual adjuncts to this exercise include the requirement of at least one objective
instrument assessing personality functioning (for example, the MMPI-2),
along with research articles from the recent literature that provide some
empirical support for the supervisee’s proposed treatment goals and plans.
The goal of these assignments is to facilitate exposure to a wider array of
information, treatment approaches, and procedures. This is intended to elicit
a broader perspective from the Level 2 therapist who is focusing too much
on the client’s view. Other useful approaches include N = 1, case studies,
or process studies conducted by supervisees on their clients. These have the
added advantage of being consistent with evidence-based psychology practice
principles and helping the trainees become more aware of their impact on
clients and how their clients are progressing (see Stoltenberg & Pace, 2007).
We will discuss these mechanisms in more detail later in this book. Table 4.1
summarizes the important considerations in supervising Level 2 therapists.
Table 4.1
Level 2 Supervision Environment
General considerations: Less structure provided; more autonomy encouraged,
particularly during periods of regression or stress
Client assignment: More difficult clients with more severe presenting problems
(for example, personality disorders), confidence shaken
Interventions: Facilitative
Prescriptive: used only occasionally compared to Level I
Confrontational: now able to handle confrontation
Conceptual: introduce more alternative views
Catalytic: process comments, highlight countertransference
and affective reactions to client or supervisor
Mechanisms: Observation (video or live)
Role playing (although less important than at Level 1)
Interpret dynamics (see “Catalytic,” above)
Parallel process
Group supervision
Broader clientele
The Level 2 Therapist 111
Transitional Issues
The primary objective of supervision with Level 2 trainees is to set the stage
for the transition to Level 3 by promoting a sense of conditional autonomy
and confidence in domains where they exhibit competence. We also want
to stimulate a sense of responsibility and acceptance of the need to seek
direction in less well-developed domains. By the end of Level 2, supervisees
come to the realization that some fluctuations in motivation levels are a nor-
mal reaction to the realization of the complexities and confusion they are
encountering. This results in a stabilization of motivation at a higher level
as they enter into Level 3. Finally, supervisees at this point are more open to
self-exploration and able to consider perspectives other than the client’s by
recognizing and acknowledging their own personal reactions and counter-
transference manifestations as well as social cognition and facilitation char-
acteristics of the client. These therapists, however, may still find it difficult to
identify and act on these reactions in a therapeutic manner within the here
and now of a therapy session (RIA). Thus, the Level 2 therapist continues to
build on these foundations toward an orientation to practice in Level 3 that
includes elements of personal and professional development.
The transition to Level 3, like the transition from Level 1 to Level 2,
is extremely dependent on the quality of the supervision received. Lack of
attention to the variety of issues characteristic of the Level 2 supervisee or
laissez-faire supervision during this important stage leads to what we char-
acterize as the pseudo–Level 3 therapist. This individual is able to talk a
good game and perhaps write convincing reports. However, close examina-
tion of in-session behavior of this type of therapist indicates that he or she
has avoided dealing with the necessary development of an intensive focus on
the client. Insuffi cient understanding of the client’s world and a lack of true
empathy keep this therapist functioning more at an advanced Level 1 than
either Level 2 or 3.
Developmental stages cannot be skipped. Therapists must pass through
the levels of professional development to move on toward excellence. Those
who attempt to bypass a stage will be left with insuffi cient knowledge, skills,
and structures to move on to higher levels. Although a significant knowledge
of theory is critical to development as a therapist, it cannot fully replace
the need to collect essential data from the client. This can be accomplished
only by an intensive focus on the client’s behavior and experience in ses-
sion. Without this information and perspective, the pseudo–Level 3 therapist
112 IDM Supervision: An Integrative Developmental Model
merely provides canned diagnoses and conceptualizations, although they
may be quite articulate and detailed. Nonetheless, we will find with close
scrutiny that difficult clients do not progress and the therapist knows little
about the idiosyncrasies of the case.
Supervision of the Level 2 therapist provides quite a contrast to that of
the Level 1 supervisee, requiring considerable skill, flexibility, and perhaps
a sense of humor to successfully negotiate this difficult stage. As a result,
the Level 2 supervisee may provide too much of a challenge for inexperi-
enced supervisors or as an initial supervisory assignment for supervisors-in-
training. However, a successful transition by a Level 2 therapist to Level 3
can result in some of the most rewarding experiences supervisors may have.
5
The Level 3 Therapist
•
Supervisors who have the opportunity to work with more advanced train-
ees are those most likely to encounter Level 3 therapists. We consistently
note throughout this book that levels of therapist development are not syn-
onymous with a particular number of practica, years of experience, or age.
Trainees (old and young, highly experienced and inexperienced) move at their
own speed through the developmental levels. One can, however, encourage
this growth by providing appropriate supervision. Recall that Wiley and Ray
(1986) found that supervised experience influences trainee growth, while
unsupervised therapy experience is unrelated. A stimulating environment
and corrective feedback are necessary for therapists to continue to develop
and improve at their trade, a result that is consistent with the research litera-
ture on learning (Anderson, 2005).
Thus, we cannot say that all therapists will reach Level 3 at a particular
point in their training or at some time after completion of formal training.
Indeed, some therapists never fully integrate into Level 3 in many, if any,
domains of practice. Nevertheless, most therapists enter Level 3 in at least
one or two domains after a few years of supervised experience. We believe
that in doctoral programs, this occurs with some regularity during the pre-
doctoral internship year. In master’s or educational specialist programs, we
expect initial entry into Level 3 in some domains after two or three years of
postdegree supervision. It is important to keep in mind, however, that the
quality of the supervision provided, as well as the type of clinical experience,
will have an impact on both the speed and extent of professional develop-
ment. Thus, some therapists will not reach these benchmarks in the noted
periods of time, while others may attain them more quickly.
113
114 IDM Supervision: An Integrative Developmental Model
The format of this chapter is consistent with that of the prior two chapters.
We examine typical characteristics of individuals just moving into Level 3
in an initial domain, as well as those who have functioned in Level 3 in one
or more domains and are now moving into this level in additional domains
of practice. The overriding structures and domains we have used thus far to
evaluate development will be discussed for this level of therapist.
We also discuss therapists who, for various reasons, do not complete the
work required in Level 2 or try to circumvent these developmental steps, and
imitate Level 3 behaviors without achieving Level 3 in the overriding struc-
tures. These pseudo–Level 3 therapists present challenges for supervisors in
both assessment and supervisory interventions.
Although the IDM assumes Level 3 as the highest point of development
within any domain, there is still considerable room for growth in one’s clini-
cal practice. The task for the therapist who is predominantly functioning at
Level 3 is to integrate this level of skill and understanding across domains of
practice. Thus, functioning as a Level 3i (integrative) therapist becomes the
goal of professional development.
Finally, we explore the notion of lifelong professional development. Earlier
models of therapist development (Stoltenberg, 1981) suggested that develop-
ment essentially stopped at the “master” therapist stage. However, we know
that, consistent with models of adult development (Smolak, 1993), profes-
sional development never really stops. Biology, experience, and the environ-
ment continue to exert influences on us as long as we live. Similarly, the
processes of learning new information, improving skills and understanding,
and developing more extensive and linked schemata need not stop either. In
addition, integrating personal changes that occur as a function of life experi-
ence and maturity with professional development is a moving target. We are
constantly changing, as are (or should be) our professional skills, perspec-
tives, and understanding.
Constraints on Supervision
Stoltenberg and Delworth’s (1987) description of Level 3 as “the calm after
the storm” highlights the resolution of some of the turbulence associated with
Level 2. As we will see in examining the structures, this therapist is charac-
terized by greater self-knowledge, an understanding of the nuances of clinical
practice, skill in taking the perspective of the client, and therapeutic effec-
tiveness. Although the utility of supervision remains, in implementation it
The Level 3 Therapist 115
becomes considerably more collegial, and less differentiation of expertise and
power is apparent.
Due to real-world constraints (such as budget and time), many thera-
pists who have reached or are approaching Level 3 are no longer rigorously
supervised. (Indeed, some therapists may never have been rigorously super-
vised and are likely to never reach Level 3.) Therapists who are still in for-
mal training programs as they enter Level 3—for example, predoctoral
internship, residency, or postdoctoral programs—are more likely to receive
intensive supervision that will continue to encourage growth and integration.
Unfortunately, some of these training environments are limited in the use of
video, or even audio, recording of sessions, and live supervision may be non-
existent; these diffi culties severely impair the supervisor’s ability to evaluate
and educate the supervisee, even at Level 3. Others who are limited to post-
degree supervision may experience little or no guidance whatsoever. This may
be a function of high expectations for clinical expertise or merely a result of
the economic pressures to focus one’s efforts on providing billable services.
Learning and Cognition
By the time a therapist reaches Level 3 in any given domain, the associated
skills will have become familiar and a level of proficiency is attained that
allows for nearly automatic performance under certain conditions. Relation
ship skills, the fundamentals of setting up a session, assessment procedures,
exploratory probes, and so on have been learned, practiced, and are now
implemented as the situation demands. Little energy is spent on mentally
rehearsing a response or struggling with uncertainty concerning what to
do when engaged in practice. Rather, the skills necessary to engage the cli-
ent, collect essential information, encourage exploration and insight, and
facilitate functional behavior will flow more naturally from the therapist.
The therapist’s procedural knowledge has become more refined (Anderson,
2005), as has his or her KIA (Schön, 1987). In addition, if adequate training
and learning have occurred, this level of therapist is more able to demonstrate
an effective use of social intelligence (Goleman, 2006), including becoming
attuned with the client and achieving empathic accuracy as well as effectively
utilizing an understanding of culturally anchored social cognition.
Sets or patterns of characteristics of the client, environmental context, and
personal reactions will be more readily recognized, leading to quicker, more
accurate, and useful diagnoses and conceptualizations. The forward thinking
concerning possible paths to problem resolution is more characteristic of this
116 IDM Supervision: An Integrative Developmental Model
level of therapist than of Level 1 or 2. Memory retrieval and pattern matching
can result in insights and understandings of the therapeutic experience that
would appear to be intuitive or prescient to less experienced therapists (con-
sistent with the development of expertise as described by Anderson, 2005).
The Level 3 therapist is better able to make decisions fairly quickly con-
cerning which avenues to explore and which to abandon. By efficiently
assessing a number of factors that may initially seem unrelated to the client’s
presenting problem or issues relevant to the case, the therapist can move
more quickly and effectively in pursuing avenues of assessment and treat-
ment. This integration across domains of practice is characteristic of the
Level 3i therapist. Integration of perceptions, information, and knowledge
within a domain is the strength of the Level 3 therapist. Thus, it is not just
the acquisition of more knowledge or discrete pieces of information that
results in the effectiveness of the Level 3 therapist; rather, it is the emergence
of expertise, including more developed schemata and the links between
them, that allows for the activation of related concepts in memory. The ther-
apist can now identify what is and is not important in a situation and move
toward productive interventions.
Supervised experience can be helpful in identifying misinformation or
irrelevant connections via effective feedback, and it strengthens the links or
relationships among concepts that form relevant schemata. These schemata
can then be readily accessed by the skilled therapist, who is more likely to
activate useful propositions that will lead to effective decision making.
Intensive supervision over a period of time, in combination with extensive
clinical experience, allows the therapist to learn to integrate information and
skills relevant to the work of therapy. Therapeutic skills, information about
personality theory, theories of therapy, and an understanding of the self
become integrated in the therapist’s memory. Linkages are developed that
allow the therapist to quickly accept certain information and impressions
as relevant, while discarding considerable information that is irrelevant or
not directly related to the issues at hand. This is a fairly dramatic difference
between the Level 3 therapist and less developed ones. Information collected
from the client and related sources is combined with information about peo-
ple in general and clinical processes. This is combined with insightful self-
knowledge to yield a considerably greater array of data from which the skilled
therapist can make decisions and pursue interventions.
More advanced therapists are able to use Level 3 structures developed in
certain domains to move more quickly into Level 3 in other closely related
domains. This is what Loevinger (1976) referred to as the “ameboid” model
The Level 3 Therapist 117
of development. As always, however, it is important not to assume Level 3
development across domains but rather to focus on evaluating the therapist’s
level of development for each domain relevant to supervised practice at any
given time.
Level 3 Structures
The changes in the overriding structures we have examined over the prior
two chapters will continue for Level 3. The nature of these changes differs
for Level 3 as the increasing skills, focus on others, and knowledge of the
field culminate in a more aware, consistently motivated, and conditionally
autonomous therapist.
Self- and Other-Awareness
In moving from an anxious self-awareness of weaknesses and then strengths
through a phase of greater focus on the client, the trainee has developed
an ability to empathize and understand the client’s perspective. His or her
self-knowledge has grown considerably and is useful in augmenting the
knowledge about the client gained through careful attention and empathic
understanding. The therapist’s ability to focus intently on the client, devel-
oped in Level 2, now yields important information that can be compared
and contrasted with the therapist’s growing knowledge of personality theory,
theories of therapy, and research.
In the latter phases of Level 2, the therapist learned to monitor his or her
own reactions to the client and process this information. An emphasis on
encouraging self-exploration and self-understanding has enabled the thera-
pist to assess the impact the client is having on him or her, as well as the
therapist’s impact on the client. Exploration of personal reactions as well as
countertransference issues has provided important perspectives regarding the
interpersonal impact certain clients can have on others, as well as how the
therapist’s own history can influence perspectives and behavior.
In contrast to the uninsightful self-consciousness of the Level 1 therapist
and the Level 2 therapist’s primary focus on the client, the Level 3 therapist is
able to focus intently on the client and collect important data and perspec-
tives. He or she can pull back in session and effectively reflect on his or her
own prior experiences, personal reactions, the interaction between therapist
and client, and professional knowledge (RIA). A third important attribute
118 IDM Supervision: An Integrative Developmental Model
of the Level 3 therapist is the ability to take a more objective third-person
perspective on the therapeutic process. This allows the therapist to observe
and reflect on the interaction between client and therapist, sorting out client
perspectives from therapist reactions and engaging in an examination of the
process. As Goleman (2006) and Greenberg (2002) have noted, experiencing
a range of emotions, even primal empathy, adds an important depth to our
experiencing, but without high-road processing, we don’t necessarily gain an
understanding of our experience and learn much about ourselves or how to
impact our environments. The Level 3 therapist is more able to move seam-
lessly between low-road emotional experiencing and empathy and high-road
processing and the labeling of these emotions through an RIA process.
As we have previously discussed, three general sources of information are
available for the Level 3 therapist that were not adequately available to (or
processed by) less developed therapists. The recognition of this information
and the ability to process it is now more refined. The high level of therapy
skills allows this supervisee to pursue and collect relevant information from
the client at a level of understanding that was not possible earlier in the devel-
opmental process. The skills allow the client to feel free to explore important
issues and the therapist to communicate caring and understanding (attune-
ment). The second source of information for the therapist is based on his
or her cognitive and emotional awareness of personal and therapeutic reac-
tions to the client. These reactions are processed into an understanding of
the therapist’s own inclinations based on a recognition and processing of his
or her own individual learning history and knowledge of his or her own per-
sonality characteristics. Thus, the therapist’s reactions to specific “pulls” from
the client may be judged as consistent with how people in general respond
to this individual or as idiosyncratic to the therapist. The third source of
information is professional knowledge based on an understanding of human
behavior (culturally informed social cognition, personality, etc.), the thera-
peutic process, and other resources developed over the course of training in
science and professional practice as well as experience. The highly function-
ing Level 3 therapist will access all of this information to inform decision
making and selection and implementation of therapeutic interventions.
Jeremy was a predoctoral intern who was working at an outpatient clinic
as a rotation in his clinical internship. During one of his supervision ses-
sions, he discussed his impressions of a depressed woman whom he had
seen for a couple of sessions. The client had complained, among a number
The Level 3 Therapist 119
of things, about her inability to maintain romantic relationships. Jeremy
shared with his supervisor his sense of the pain and hopelessness his cli-
ent was experiencing, and her strong desire for him to help her change
her life. Jeremy explained how he felt a very strong pull by the client to
“take charge” of her life, tell her what to do, and make things better. He
remarked to his supervisor how similar this feeling was to a situation he
had experienced a number of years ago in a relationship that had ended
badly: “I recall feeling trapped in the relationship and unable to meet
the needs of my female friend. She was a very nice person, but I found
myself frustrated and angry with her neediness.” Jeremy went on to dis-
cuss the similarities between the current client and another with whom
he had worked and diagnosed with a dependent personality disorder. The
remainder of the supervision session was spent comparing and contrast-
ing characteristics across these experiences and planning mechanisms to
assess his current client further.
Motivation
The fluctuation in motivation that we saw with the Level 2 therapist has
been replaced with more stable motivation in Level 3. The vacillations in
feeling effective versus ineffective that characterized Level 2 have subsided.
A more complex understanding of the therapeutic process allows the Level 3
therapist to tolerate temporary states of confusion or lack of direction. Past
successes have allowed the supervisee to develop greater confidence, and an
acceptance of personal strengths and weaknesses makes occasional setbacks
less threatening.
The motivation is high and more autonomous (consistent with the descrip-
tion in Vansteenkiste, Lens, and Deci, 2006) than before, no longer as naïve,
extrinsic, or based on anxiety. The Level 3 therapist remains interested in
learning and in seeking out new experiences but is much less likely to become
enthralled with “new and improved” or fad approaches to clinical practice.
In ELM terminology (Petty & Cacioppo, 1986), the therapist is less sus-
ceptible to peripheral route processing or “buying in to” an idea because a
credible source (supervisor or other acknowledged expert) promotes it, but
is more likely to centrally process how new information, perspectives, inter-
ventions, or orientations fit with an existing understanding. The motivation
is to build on present knowledge and expand his or her repertoire of abili-
ties. A focus in terms of professional practice is important at this stage, and
120 IDM Supervision: An Integrative Developmental Model
considerable time and energy tend to be invested in decision making about
professional goals and development. Motivation to learn new approaches or
work with different populations is usually based on a sense of professional
direction and the need to refine practice skills.
The therapist who has reached Level 3 in one or more domains is more
likely to assess his or her developmental level in other domains accurately
than are less experienced therapists. In other words, therapists who have
reached Level 3 in certain domains are better able to recognize domains
where they are functioning at Level 1 or 2. Indeed, as part of the increased
focus on professional direction, they may decide after reflection that certain
domains of professional practice are less important to them, and so they may
not be motivated to improve their skills and knowledge in these areas or
pursue practice opportunities.
Anna was finishing her internship at a medical center and entertaining
career options.
In processing her interests and goals with one of her supervisors, she
mentioned that a postdoctoral fellowship had been offered to her in the
department of pediatrics. She had recently completed a rotation through
that department and had received high marks for her work with parents
and families. The fellowship was to be grant funded and would focus pri-
marily on working with children who had experienced abuse and neglect.
The training opportunity, she noted, was excellent and would provide her
with skills and experience that would be quite marketable down the road.
On the other hand, she really was not interested in working specifically
with children, but preferred working with adults or more within a family
context. Anna concluded after much deliberation that she would pursue
positions in either a department of family medicine or psychiatry and
continue her focus on adults and family units.
Autonomy
The Level 3 therapist begins with an assumption of conditional autonomy
and grows into increasingly autonomous functioning. In the early phases, a
desire to further integrate skills and understanding while expanding his or her
experiential base elicits a sense of responsibility and level of self-understand-
ing that supports autonomous functioning. At the same time, an awareness
The Level 3 Therapist 121
of the utility of additional perspectives, evaluation, and resources that super-
vision provides typically motivates this therapist to continue to seek input.
Professional development issues also may come to be increasingly important,
and opportunities to process these issues in supervision are valued.
The Level 3 therapist is more aware of areas where he or she is not func-
tioning at Level 3 and typically seeks to bring these domains up to similar
levels of performance with his or her areas of strength. Of course, supervision
within these domains would necessitate working with Level 2, or sometimes
Level 1, structures. The overall focus of supervision will tend to be on con-
solidating growth or integrating across domains. In addition, the degree of
responsibility for clients assumed by the therapist will be consistently higher
than what we would encounter with therapists primarily functioning at lower
levels. This responsibility, however, is reflected in the therapist’s conditional
dependency, or seeking out of advice and direction when needed, in contrast
to the occasional counterdependency seen in Level 2 therapists.
The focus of supervision here is often on fine-tuning existing knowledge
and skills rather than breaking new ground. The comfortable autonomy
of the Level 3 therapist allows him or her to consider input without either
uncritically accepting it or being overly critical in rejecting it.
Structures Across Domains
The advanced nature of Level 3 seems to encourage development in other
areas if sufficient attention is paid to them in the supervision context. The
Level 3 therapist’s informed knowledge of his or her strengths and weak-
nesses enables the therapist to acknowledge more readily where additional
growth is necessary. Thus, the supervisor of a Level 3 therapist can use the
supervisee’s structural development to push him or her to develop to this
level in other domains where functioning remains at Level 2, or move more
quickly from Level 1 to Level 2 in other domains. Anderson (2005) reminds
us, though, that this generalization of knowledge and skills across domains
is not an automatic process, but needs to be focused upon and encouraged.
This is an important role for the supervisor of Level 3 therapists.
Intervention Skills Competence
Within a particular focus of therapeutic practice, and perhaps across a
range of practice, Level 3 therapists demonstrate well-developed skills. The
122 IDM Supervision: An Integrative Developmental Model
therapeutic behaviors associated with the particular orientation being used
will be performed in an effective and non-self-conscious manner. The skills
are used like tools in the hands of an artisan, selected with sensitivity for
appropriate timing and effect. The skills become less visible, in a way, because
they are becoming integrated with the therapist’s use of self in the session.
Thus, rather than applying an intervention in a particular situation, interven-
tions flow from the therapist’s understanding of the client, self-knowledge,
and understanding of the therapeutic process. This integration, which was
not possible at earlier levels, here becomes increasingly blended across clien-
tele and contexts. Expertise has been developed.
Skills useful for building a therapeutic alliance with the client flow from
the therapist in an idiosyncratic manner consistent with his or her person-
ality characteristics. Indeed, the therapist may not even be aware of when
skills are being used versus when he or she is simply being therapeutic. The
cognitive, affective, and interpersonal information and perspectives yielded
by the client are used to decide a direction for therapy and select subsequent
interventions. Understanding and empathy are communicated to the client
in a genuine and authentic manner. Here the astute supervisor will recognize
the difference between making an educated guess at the client’s thoughts
and feelings, on one hand, and true understanding of the client’s world
and accurate empathy, on the other. This flow of therapy is consistent with
research on common factors of therapy that appear to be constant across
most successful therapists regardless of theoretical orientation (Beutler &
Clarkin, 1990; Goldfried, 1980; Hubble, Duncan, & Miller, 1999).
This use of the therapeutic self will be evident even when standard pro
tocols or treatment manuals are being implemented. Evidence exists that
experienced therapists are able to adapt to the needs of the client and the
therapeutic situation in ways that enhance the effects of standard procedures
(Jacobson, 1991; Norcross & Lambert, 2006). Here the Level 3 therapist
is able to alter treatment in ways that satisfy the idiosyncrasies of a given cli-
ent’s needs and characteristics.
Assessment Techniques
The Level 3 therapist has a solid sense of the role of assessment, the strengths
and limitations of various strategies and instruments, and a personal under-
standing of how to use this information to advance knowledge of the client.
This therapist is past a cookbook approach to interpretation and is more likely
to understand how various assessment devices yield a breadth of information
The Level 3 Therapist 123
about clients. In addition, observations and impressions of client behavior
during the assessment period are used to validate or modify information
provided by the devices themselves. This information is integrated into a
comprehensive picture of client functioning appropriate to the assessment
issues. Assessment conclusions, diagnostic classifications, and so on are influ
enced by the assessment setting and the client’s environment.
Interpersonal Assessment
The Level 3 therapist does not rely on stereotypes, either positive or negative,
as the Level 1 therapist might do. Becoming confused or engulfed in emo-
tion or countertransference, as might occur with the Level 2 therapist, is also
uncommon for the Level 3 therapist. This individual will more effectively
use interpersonal assessment. The ability to focus on the client and the ability
to reflect on personal reactions to the client enables this therapist to use the
interpersonal nature of therapy to generate an in-depth understanding of
the client’s interpersonal world (Teyber, 2006).
The self-understanding developed over time by this therapist, and his or
her knowledge of the therapeutic self, allows for valid processing of reactions
to the client. Minuchin has used the term client pull to identify the manner by
which clients attempt to get needs met by the therapist or move the therapist
toward a particular path (Minuchin & Fishman, 1981). Similarly, Cashdan
(1988) has described how clients attempt to recapitulate interpersonal pat-
terns, and responses from others, in therapy. Goleman (2006) and Greenberg
(2002) note the importance of low-road emotional experiencing and empa-
thy, with subsequent high-road processing of these emotions. The Level 3
therapist is sensitive to this pull from the client and is able to assess how this
expresses a client need or personality style, as well as acknowledge any coun-
tertransference issues that could, if unidentified, affect the path of therapy.
Supervisors of Level 3 therapists often find that the supervisee has a con-
siderably more complete understanding of the client than does the supervi-
sor. There is less need to seek help during supervision in order to understand
the effect the client is having on the therapist and more of a desire for an
opportunity to process this information verbally with input from another.
Jay was a master’s-level therapist who was finishing his third year as a staff
therapist in a university counseling center. Jay’s therapy experience was
fairly extensive across late adolescent and adult populations, although he
124 IDM Supervision: An Integrative Developmental Model
had not worked with more mature clients (60 years of age and older). He
came to supervision one day (collegial with another staff member and
totally voluntary) wanting to discuss a recent session with an older female
client who had returned to school for an advanced degree. Jay commented
on his sense of reticence in confronting the client concerning some ill-
advised decisions she had recently made that had negative implications
for her continued success in school as well as her relationships with her
family. Jay’s self-reflection suggested to him that he usually would have
pointed out to other clients how these decisions were self-defeating and
congruent with the distorted thinking that had produced problems for
her in the past. Instead, Jay found himself merely being supportive and
politely listening to her story. He commented to his colleague that toward
the end of the session, he realized that he was tying his own hands with
a desire to be courteous to the client. As he reflected on this situation,
Jay came to the conclusion that his upbringing may have played a role in
his inhibitions. He had been raised to be respectful of older women and
not to overtly disagree with them, as this would communicate a lack of
courtesy. This “courteous” behavior, Jay reasoned, was getting in the way
of his ability to assist his client in reality-checking her recent decision
making. This insight in hand, Jay felt more comfortable in the next ses-
sion and was able to move his client toward a more intensive examination
of her behavior.
Client Conceptualization
The tendency to focus on discrete pieces of information or overaccom
modating to the client, as less developed therapists might do, has given
way to an understanding of how diverse client variables interact to yield a
complex conceptualization of the whole person. Diagnostic categories are
no longer viewed as a collection of criteria that, once they meet the critical
number, yield a label. Instead, the focus is on the pattern of characteristics
that is relevant for the particular client, the contexts when those character-
istics are salient, and the intervention they suggest. Diagnoses are compared
against templates of understanding developed through professional growth.
Thus, implications for prognosis and treatment are more readily apparent.
Westen and Weinberger (2004) have articulated how therapists can avoid
falling into biased information processing by focusing on how information is
The Level 3 Therapist 125
collected and used. This careful and informed data collection and processing
is consistent with what we expect in Level 3 therapists. In addition, commu-
nication to others of this conceptualization and implications becomes clearer
and more meaningful.
Individual Differences
The Level 3 therapist has developed an understanding of the influences
of culture, gender, sexual orientation, and environment on the individual.
Stereotypic thinking has been replaced with a breadth of knowledge regard-
ing how various factors can affect an individual client’s behavior and devel-
opment. Knowing patterns of value structures and traditions for various
cultures, and differences that can occur between genders in terms of bio-
logical and social factors, enables this therapist to understand how circum-
stances or contexts serve as modifiers for diagnosis, treatment, and so on (see
Wampold, 2001, for a discussion of how context impacts these processes). In
addition, a therapist at this stage of development entertains more than one
interpretation of a client’s observed behavior and collects clinical data to test
his or her cultural hypotheses (Lopez et al., 1989).
Randy was a psychologist who was asked to see a young American Indian
boy, Chuck, who had been experiencing difficulties in school. The refer-
ral noted that Chuck had missed classes for a full week without a reason
or permission slip provided by his parents. The school counselor had tried
to contact the parents and found that neither was living at the address
listed as Chuck’s residence. It appeared that Chuck was living with his
grandparents, who noted only that he had had their permission to go
hunting for a week with his uncles and cousins. Chuck had also gotten
into trouble recently when he and some other American Indian boys had
walked out on a drug prevention presentation given by some representa-
tives of the administration office for the school district. Randy explored
Chuck’s view of these problem situations and learned that it was a cus-
tom of his tribe to take a hunting trip each year at this time. This was an
important tribal function, which included a number of Chuck’s extended
family members. He also learned that it was not unusual for children in
Chuck’s tribe to be raised primarily by their grandparents. Indeed, even
when the parents were readily available in the same household, primary
126 IDM Supervision: An Integrative Developmental Model
responsibility for raising the children often fell to the grandparents.
Finally, Randy learned that the drug prevention program was a puppet
show in which an owl (Mr. Wise Owl) was the primary character. In
Chuck’s tribe, the owl signifies death, and it is deeply offending to them
to display owls or use them in this manner. Randy subsequently met with
the school counselor and helped her understand how Chuck’s behavior
had been consistent with his tribal customs and consulted with her in edu-
cating other teachers and children about issues of cultural awareness.
Theoretical Orientation
The Level 3 therapist is knowledgeable and flexible in using theory and
research to guide practice. Rather than being driven by theory and forc-
ing the client to fit a given orientation, the therapist uses theory as a means
of generating a perspective on the world of the client. It is understood that
the role of a good theory is to reduce the amount of information the thera-
pist processes, limiting it to data related to conceptualization and treatment.
Thus, the intimate knowledge of theory allows the Level 3 therapist to ignore
certain paths of inquiry or intervention and focus on avenues more likely to
yield useful understandings and directions for treatment.
This therapist will also tend to enjoy exposure to other orientations
and will weigh an evaluation of the general advantages and disadvantages
against a solid understanding of a personalized therapeutic orientation.
This personalized orientation can take many forms, ranging from a primary
reliance on a particular complex theoretical model to an informed eclecti-
cism born of a diverse exploration of theory with subsequent validation in
practice and research. This therapist may add theoretical constructs from
other models or from empirical research to his or her working knowledge of
therapy but will not abandon one for another. Indeed, the focus is on inte-
gration and developing an increasingly complex and useful understanding
of human nature and the therapy process. This process is consistent with
the scientific method, where carefully processed professional experience
and new information from empirical research are constantly integrated
into an increasingly elaborate theoretical understanding. This evaluation
process will, over time, require changing views and assumptions, as well as
behavior, as the therapist grows in understanding and competence.
The Level 3 Therapist 127
Treatment Plans and Goals
For this level of therapist, there is a more fully articulated connection between
assessment and conceptualizations, which leads to more comprehensive and
effective treatment plans. Goals of therapy and treatment plans are more
focused and coherent, and they may be appropriately altered in response to
the level of effectiveness of interventions. Idiosyncrasies of the context and
the client are integrated into approaches to treatment. If formal or standard-
ized treatments are used, they are effectively modified in scope and inter
vention appropriate to the conditions and needs of the client.
Professional Ethics
The ethical behavior of the Level 3 therapist comes from a detailed knowledge
of ethical guidelines, often reflecting more than one profession, married to a
personalized professional code of ethics. Guidelines are not viewed as com-
mandments or imposed limitations on practice; rather, they are seen as exam-
ples or implications of a broader perspective on the rights of individuals and the
responsibility of the profession. Complex issues reflecting situations where little
direct guidance is provided by ethical standards can be dealt with in a manner
reflecting the professionalism of the therapist. In new areas or regarding issues
with multiple implications, the therapist will seek input and process alterna-
tives with colleagues who may have specialized knowledge or experience.
Supervising the Level 3 Therapist
We have been careful not to suggest a particular point in time when thera-
pists will be functioning primarily in Level 3. It is safe to assume, however,
that professional development takes time, and many therapists will be in a
position where formal clinical supervision is either more limited than earlier
in their development or nonexistent. Hospitals, agencies, and private practi-
tioners often find that insufficient time exists in their schedules to provide,
or otherwise make available, supervision for therapists other than those who,
by law or regulation, require formal supervision. Thus, many Level 3 ther
apists rely on collegial supervision or seek out other avenues for furthering
their professional development. (Chapter 8 discusses some of the issues that
impede professional development and other important aspects of the clinical
128 IDM Supervision: An Integrative Developmental Model
supervision process.) Many Level 3 therapists will still be in formal supervi-
sion as part of required postdegree supervision, in the context of pre- or post-
doctoral supervision, or as participants in collegial group supervision.
Less research exists examining the needs of experienced supervisees than
we have found for less developed therapists. Most studies of supervision, due
to ease of access to participant populations, focus on supervisees at or below
the predoctoral intern level. Few studies have examined postdoctoral or mas-
ter’s level therapists who have extensive experience in the field. Indications
with this truncated range of experience, however, are that more advanced
supervisees are likely to behave more autonomously and show greater concep-
tual understanding and more desire for consultation than instruction (Ellis
& Dell, 1986; Rabinowitz, Heppner, & Roehlke, 1986). Results consistent
with expectations for experienced therapists were reported by Hillerbrand
and Claiborn (1990), who found that expert clinicians considered themselves
more knowledgeable and confident and rated their presented cases as clearer
than did novices. In a series of studies, McNeill, Stoltenberg, and colleagues
found advanced trainees less in need of structure in supervision and exhib-
iting increased perceptions of self-awareness, autonomy, and motivation
(McNeill, Stoltenberg, & Pierce, 1985; McNeill, Stoltenberg, & Romans,
1992; Stoltenberg, Pierce, & McNeill, 1987).
In one of the few studies to include postdoctoral fellows in the sample,
Olk and Friedlander (1992) found reduced levels of role ambiguity or uncer-
tainty regarding expectations and evaluation in supervision for experienced
therapists. On the other hand, role conflict or expectations across the roles of
trainee, counselor, and colleague tended to increase with higher levels of experi-
ence. This suggests the increased focus on professional development and deci-
sions about career direction that can be seen in more advanced therapists.
General Considerations
For the Level 3 therapist, most of the structure is typically provided by the
supervisee rather than the supervisor. This level of therapist more accurately
knows what he or she needs from supervision at any given time and can effec-
tively use this consultation to advance his or her professional development.
Supervisors will see an increasing focus on personal and professional inte-
gration for therapists who are functioning at Level 3 in at least a couple of
domains. If the therapist is still in a training setting, considerable attention
may be paid to career decisions, although seasoned therapists will also often
The Level 3 Therapist 129
experience a change in professional direction and may choose to process this
issue in collegial supervision.
It is important, as always, not to assume that a therapist who is function-
ing at Level 3 in one or more domains is necessarily functioning at that level
across other domains. Also, effective evaluation of supervisees is needed to
be certain that they have indeed reached Level 3 and are not merely pseudo–
Level 3. Even when Level 3 is apparent across a number of domains, the
work of integration and movement to Level 3i remains an important focus
of supervision.
For the more experienced therapist, it becomes increasingly common to be
involved in supervising other professionals. This introduces another domain
of professional development that interacts with therapist development in a
number of ways. (We examine this process in more detail in Chapter 9.)
The Level 3 therapist is more inclined to view the supervisor as a senior col-
league than as an unassailable expert or perfect role model. Supervision becomes
more of a process of give-and-take, with the role of “expert” occasionally
switching from the supervisor to the supervisee, depending on the issues being
addressed. Many advanced supervisees have had extensive experience before
they begin working with a supervisor, and some of this experience is likely to be
in areas where the supervisor’s own skills and knowledge are limited.
Daniel was assigned as a supervisor–mentor to a new therapist at the
agency. They spent the first few meetings getting to know each other and
the extent of their respective clinical knowledge and experiences. Daniel
took considerable time assisting his colleague in learning about agency
procedures and mapping the political climate. After a couple of months,
Daniel brought up in discussion a child who had recently been assigned
to him. He mentioned in passing some of the puzzling aspects of the case
and noted that he suspected the possibility of some abuse, even though
that was not part of the presenting problem or reason for referral. Most of
the supervision session was spent in discussing this case, with considerable
helpful input given by Daniel’s supervisee, who, he discovered, had had
extensive training and experience in issues of child abuse and neglect.
When the opportunity is available, supervision of Level 3 therapists can
productively reflect a mentoring relationship, characterized by a fairly non-
directive consultative role for the supervisor, who is attentive to and invested
130 IDM Supervision: An Integrative Developmental Model
in the general professional development of the supervisee as well as assist-
ing him or her to acclimate to the particular clinical environment. It is not
uncommon for some regression to occur when even experienced therapists
enter a new environment. Support and availability of a supervisor or men-
tor can make this transition brief and allow the therapist to reestablish prior
levels of functioning within the new environment.
Before we examine specific interventions and mechanisms for supervising
Level 3 therapists, it is useful to recall some of the important characteristics of
this level of supervisee. As we have previously noted in this chapter, the Level 3
therapist is able to build an effective therapeutic alliance with the client and
gather extensive therapy-related information. The effortless use of therapy skills
creates a facilitative environment and encourages candid client disclosures.
The therapist’s ability to focus intently on the client (attunement), first devel-
oped in Level 2, enables a deep understanding of the client’s perceptual world,
as well as an empathic awareness of the client’s emotional experience. Unlike
the Level 2 therapist, these data are more accessible to the Level 3 therapist
because of his or her ability to pull back and reflect during the therapy process
(RIA) and assess his or her own reactions to the client (high-road processing).
Thus, this therapist can take a personal inventory of his or her cognitive and
affective reactions to the client and use this information therapeutically, with
an awareness of the possible influences of countertransference issues. Finally,
the Level 3 therapist is able to take a more objective third-person perspec-
tive on the therapeutic process as well as access memory to retrieve relevant
clinically related information learned over the years. This ability allows the
therapist to integrate important sources of information in his or her work:
the client, the therapist’s reactions, the interaction between therapist and cli-
ent, and professional knowledge. Attending to these aspects of the therapeutic
process is consistent with the emerging focus on common factors (Hubble,
Duncan, & Miller, 1999; Norcross, Beutler, & Levant, 2006).
A word of caution is in order here. Recall the discussion of the pseudo–
Level 3 therapist in the preceding chapter. Only adequate assessment by the
supervisor, or some other person administratively over this therapist, can
effectively identify this individual. The pseudo–Level 3 therapist will often
sound knowledgeable (often he or she is) and may appear to be an effective
therapist if judged only on unsupervised descriptions of clients and therapy
or case reports. It is when this individual’s work is observed that the lack of
congruence between description and action can be noted. It is best to take
the opportunity to observe a supervisee’s work before assuming the level of
therapeutic development.
The Level 3 Therapist 131
Client Assignment
Deciding which types of clients are most suitable for the continued develop-
ment of Level 3 therapists becomes less of an issue than it previously was.
This therapist, at least in the domains within which he or she is functioning
at Level 3, will have considerable ability to work effectively with a range of
clients. Still, if possible, selection of clients with whom the therapist has less
experience, or who reflect different cultural backgrounds, diagnostic classifi-
cations, and so on, will help consolidate gains and set the stage for his or her
movement into Level 3i.
Because Level 3 therapists are unlikely to be functioning at this level across
all domains, including modalities of therapy and various types of clients, it
is particularly important to be aware of areas where the therapist is function-
ing at lower levels and work to encourage growth to bring him or her up to
Level 3. Thus, client assignment may focus on areas where Level 3 has not
yet been attained.
Interventions
The types of interventions discussed in the preceding two chapters remain
useful categories for examining how supervisors can most effectively work
with Level 3 therapists. Facilitative interventions remain useful. Therapists
never really grow out of an appreciation for support and caring within the
supervision environment. They are less crucial in terms of protecting frag-
ile therapeutic egos, as the Level 3 therapist has developed considerable
confidence based on understanding and abilities, but they remain effective
in moving the relationship along and promoting self-disclosure and self-
examination. Motivation has become more autonomous, representing intrin-
sic and internalized extrinsic motivations.
Prescriptive interventions are rarely used in domains where the therapist
has reached Level 3 but may be used with respect to other domains where the
therapist has not yet developed to that degree. In general, however, this level
of therapist is able to select among options and usually will seek consultation
in determining alternatives rather than asking for specific directions.
Confrontational interventions are still occasionally necessary. All thera-
pists are susceptible to making mistakes, being misguided, or putting their
own needs first from time to time. The supervisor can feel free to confront
the supervisee across nearly any issue and expect that the confrontation will
be met with a careful analysis. Recall that Level 3 therapists will be able to
132 IDM Supervision: An Integrative Developmental Model
engage in central route processing regarding most issues in therapy, so a criti-
cal examination of recommendations or input will be the norm. Uncritical
acceptance of advice will be rare, unless it is congruent with the therapist’s
primary orientation and understanding of the situation. On the other hand,
defensiveness will usually be limited. Some Level 3 therapists may feel so con-
fident or knowledgeable that they focus little on certain input, particularly if
it is dramatically different from their own perspective, and thus they may be
resistant to criticism or engage in biased processing. At these times, confron-
tation may be necessary to encourage the therapist to engage in central route
processes, scan relevant schemata, and carefully examine alternatives.
Catalytic interpretations will most often be used in response to blocks or
stagnation. As skilled as the Level 3 therapist is, he or she may still have issues
that can interfere with effective therapy. These may be unresolved historical
issues, or they may be a function of recent life events. It is more likely, however,
that the Level 3 therapist will be aware of these and the need to address them
in supervision or therapy than will either the Level 1 or Level 2 therapist.
Eduardo had just heard over the radio that there was a terrible explo-
sion at the Murrah Federal Building in Oklahoma City. Reports were
still vague, but it was clear that the workday had begun and there were a
number of people in the building when the explosion occurred. He got
in his car and headed downtown to see if he could be of assistance. He
had had training, both as a psychologist and in the military, to work with
trauma victims. As he approached downtown, he felt a strong feeling of
fear and aversion. Images of Beirut flashed in his mind, and he remem-
bered helping to clear debris and bodies from the military base after the
terrorist bombing there years before. He tried to fight off the feelings but
decided to turn the car around and head back to work. He was not yet
ready to face those fears and that kind of tragedy again.
Supervisory Mechanisms
The careful reader will have noticed that the range and number of spe
cific mechanisms used in supervision have been reduced as we moved from
Level 1 to Level 2 and now to Level 3 therapists. A primary reason is that
tricks or techniques are less necessary and specific instructional technology
less important as the skill level increases and the information base expands.
The Level 3 Therapist 133
With Level 3 therapists, the most common approach to supervision is col-
legial, which relies less on monitoring the therapist’s behavior with clients or
engaging in direct observation. Many of the mechanisms we have discussed
will remain useful but are less crucial at this point.
Therapists still benefit from observing their work on video or having it
observed by others live and getting input from a colleague or supervisor con-
cerning interventions. As skilled as the Level 3 therapist is at pulling back
in the session and taking an objective view of the process (RIA), it is still
helpful to augment that perspective by watching him- or herself work on
video (allowing for ROA). Observing others can be helpful, too, particu-
larly as it relates to expanding the therapist’s repertoire of skills and orienta-
tions. In addition, using video or direct observation is crucial in identifying
pseudo–Level 3 therapists who may be able to talk a good game but have not
progressed beyond late Level 1 or early Level 2 structures.
A common form of supervision with experienced Level 3 therapists is
informal, collegial group supervision. Here the opportunity exists for
colleagues to consult and challenge each other, as well as provide support.
The primary advantage to this continued supervision is to work toward inte-
gration across domains and to share clinical experiences, insights, and prob-
lems with colleagues. Unfortunately, what often passes for group supervision
is such activities as grand rounds, in-service training seminars, or workshops.
Although these can be quite helpful in gaining new knowledge and keeping
abreast of the field, a limitation is that the therapist rarely gets much of an
opportunity to work on clinical issues directly related to his or her clientele
or address personal and professional issues.
Some settings are not conducive to open sharing and self-disclosure. This is
unfortunate, as it sets up an adversarial relationship among the staff or a sense
of isolation that inhibits growth and does little to make the work environ-
ment enjoyable. In addition, some settings are so concerned with bottom-line
economic issues that supervision, either individual or group, consists of little
more than checking the number of billable hours and advising on ways to
increase them. Although we understand economic pressures, this has a nega-
tive impact on the quality of clinical services and professional development.
Striving for integration across domains to move toward Level 3i is the goal
of supervision with Level 3 therapists and should be the goal of the supervisees
as well. Therapists who reach this level within domains now focus on develop-
ing the ability to move seamlessly from one domain to another. The supervi-
sor can benefit the therapist by eliciting this focus in supervision and pushing
the therapist to build stronger linkages between the schemata developed in
134 IDM Supervision: An Integrative Developmental Model
Table 5.1
Level 3 Supervision Environment
General considerations: Most structure provided by trainee, more focus on personal and professional
integration and career decisions
Interventions: Facilitative
Confrontational: Occasionally necessary
Conceptual: From personal orientation
Catalytic: In response to blocks or stagnation
Mechanisms: Peer supervision
Group supervision
Strive for integration
response to training and experience within given domains, in order to make
them more accessible across domains. In other words, the goal is to reduce
the compartmentalization of knowledge and information so that it becomes
readily activated in numerous clinical situations. The Level 3i therapist is
able to, for example, consider the assessment process and the information it
yields (diagnostic impressions and data), develop useful conceptualizations,
and effectively use these in a supervisory or consultation context.
The interpersonal power of the supervisor will rest on the therapist’s per-
ception of his or her therapeutic expertise and supervisory skills. Level 3
therapists will readily evaluate the skills of the supervisor; should they fall
short, the supervisee will ignore, circumvent, or actively challenge the super-
visor’s authority. Remember that central route processing encourages careful
and effortful scrutiny. An ineffective supervisor may fool a Level 1 therapist
much of the time and a Level 2 therapist some of the time, but rarely a
Level 3 therapist for very long. Although the amount of structure to be pro-
vided and the responsibility for active supervision are reduced for this level
of therapist, effective supervision requires a deep knowledge base and a high
level of integration. Thus, a Level 3 therapist can be supervised effectively
only by another Level 3 therapist, and it is done best by a Level 3 supervisor.
Table 5.1 summarizes relevant issues and supervision interventions for the
Level 3 therapist.
Beyond Levels
In our earlier models of therapist development, we posited the existence of
master therapists who have reached the pinnacle of development across the
The Level 3 Therapist 135
domains of clinical practice. Very few therapists will ever reach this point.
Indeed, we can safely say that no one will be able to function equally well
across all the domains and subdomains of clinical practice. Do any of us
know therapists who are highly proficient with all populations and working
from any and all orientations across practice issues and contexts? A quali-
tative study by Jennings and Skovholt (1999) examined self-described cog-
nitive, emotional, and relational characteristics of peer-nominated “master
therapists.” Of course, few of us really know the in-session behavior, or even
the outcomes, of our professional peers, but it is safe to assume that these
10 therapists represent individuals from this particular city who are held in
high esteem. Interviews with these therapists yielded self-perceptions indicat-
ing they view themselves as voracious learners, rely on accumulated experi-
ences, value cognitive complexity and embrace ambiguity, are emotionally
receptive, are mentally healthy and mature, monitor how their emotional
health affects their work, have good relationship skills and are able to use
these skills in therapy, and believe in the importance of a strong working alli-
ance. This suggests the importance of being a perpetual learner who reflects
on and processes experience as well as keeping abreast of developments in the
field. Personal adjustment facilitates assisting others, and the therapist uses
his or her significant interpersonal skills effectively in therapy.
Consistent with the picture presented above is the importance of contin-
ued development. We know that development never stops. Life goes on, and
the associated changes affect individuals and their environment. We have
worked with a number of parents over the years who have lamented that by
the time they learn how to parent their child effectively at a given stage of
childhood, he or she had matured to a new stage, requiring different per-
spectives and skills. Similarly, when therapists believe they have reached the
point in their practice where they understand their clients, their work, and
themselves, they grow older, meet new challenges, and have to face the reality
that they are no longer the same person. We have watched trainees become
colleagues over the years and adjust to dealing with the effects of their age
on their perceptions of clients and on their therapy. As they mature, the
youthfulness fades, family status often alters, and life experiences affect their
views of the world. These changes must be integrated on a professional level
as well as a personal one. The therapeutic self changes as the physical and
psychological selves change in response to experience and aging. Thus, the
task of development is never complete. Therapists constantly face new chal-
lenges, new frontiers, and new personal changes that pose new implications
for professional development.
136 IDM Supervision: An Integrative Developmental Model
We maintain that some form of supervision remains beneficial
throughout professional life to assist therapists in integrating changes in
the profession, changes in society, and changes in themselves. Indeed,
this is one of the most inspiring and exciting aspects of a mental health
career. Therapists should not hope to maintain the status quo. In devel
opment, staying the same is regression. If one does not move ahead, one
falls behind.
6
The Supervisory Relationship
•
Central to the master–apprentice approach to the training and super-
vision of psychotherapists is the supervisory relat ionship that develops
and evolves over time between the participants. This relationship involves
personal as well as professional aspects that encompass the roles of teach-
ing, mentoring, consultation, and evaluation. The moment-to-moment
interactions of the participants also constitute a meaningful, intimate
interpersonal relationship that contributes to the increased self-awareness
of the supervisee and serves to encourage furt her learning of psycho-
therapeutic skills. In our view, the supervisory relationship serves as the
base of all effective teaching and training. Indeed, as Loganbill, Hardy,
and Delworth (1982) suggested in the early theorizing of developmen-
tal approaches, the supervisory relat ionship is essential in supervision, as
is the counseling relationship in psychotherapy, though quite different.
Consequently, we believe that exploring the recent literature examining
the supervisory relationship in theory and research is warranted as rel-
evant to a developmental perspective.
This chapter briefly reviews some recent research regarding the super-
visory relationship and provides some guidelines and examples in working
with supervisory relationships across developmental levels. In addition, it is
of crucial importance that supervisors possess knowledge about individual
differences, especially in responding to the increasing diversity of supervisees
in terms of gender, ethnicity, and sexual orientation, among other important
characteristics. Consequently, we address the unique needs of a diverse group
of therapists within the context of the supervisory relationship. In this way
we hope to make the case for a more central role for the relationship in pre-
senting a comprehensive theory of supervision.
137
138 IDM Supervision: An Integrative Developmental Model
Theory and Research in Supervisory Relationships
It appears that most past theory building in supervision has simply assumed
and acknowledged the inherent importance of the supervisory relationship.
Some theorists, such as Ekstein and Wallerstein (1972) and Mueller and Kell
(1972), have hypothesized stages in the supervisory relationship as it grows
and develops. The beginning stages in these models emphasize the devel-
opment of trust and familiarity with the expectations of the participants.
Other issues, including more unconscious or unarticulated expectations, are
seen as coming into play in the second or middle stage. The end phases deal
with various aspects of termination. Mueller and Kell also place primary
emphasis on the inevitability and resolution of conflict within the supervi-
sory relationship.
Research investigating satisfaction with supervision supports the idea that
supervisees at different developmental levels differ in their needs and expec-
tations regarding supervisory tasks. Beginning trainees prefer more attention
to be devoted to the development of intake skills (Heppner & Roehlke,
1984), a greater focus on didactic training in counseling (Worthington &
Roehlke, 1979), and more time spent on developing self-awareness (Nelson,
1978). Intermediate supervisees desire assistance with developing alterna-
tive conceptualization skills (Heppner & Roehlke, 1984), more emphasis
on personal development than on technical skills, working within a cohe-
sive theory, and clear communication about expectations (Allen, Szollos,
& Williams, 1986). Advanced therapists prefer to examine more complex
issues of personal development, transference and countertransference, paral-
lel processes, and client and counselor resistance and defensiveness (McNeill
& Worthen, 1989; Shanfield, Hetherly, & Matthews, 2001). Investigations
by Winter and Holloway (1991) and Burke, Goodyear, and Guzzardo (1998)
also provide support for these developmental differences. In addition, it
appears that trainees at higher developmental levels report better working
alliances with their supervisors than do beginners, and trainees who experi-
ence previous negative events in supervision report that this experience nega-
tively impacted not only their current supervisory experience but also their
general experience in training programs (Ramos-Sanchez et al., 2002).
Across developmental levels, good supervisory relationships encompass
warmth, acceptance, respect, understanding, and trust (Hutt, Scott, &
King, 1983). In addition, it appears that good supervisors self-disclose and
create an atmosphere of experimentation and allowance for mistakes (Black,
The Supervisory Relationship 139
1988; Hutt et al., 1983; Nelson, 1978). Nelson also found that trainees pre-
fer supervisors who show interest in supervision, have experience as a thera-
pist, or currently provide psychotherapeutic services and possess technical
or theoretical knowledge. Significantly, Rabinowitz, Heppner, and Roehlke
(1986) identified the clarification of the supervisory relationship in the first
three weeks as a major issue across all levels of therapist experience, while
an investigation by Shanfield, Mohl, Matthews, and Hetherly (1992) found
supervisor empathy to account for 72% of the variance in rater-perceived
excellence of supervision. Thus, the supervisory relationship appears to be
one of the most influential factors in trainees’ level of satisfaction with their
training (Ramos-Sanchez et al., 2002).
Bordin (1983) extrapolates from the therapeutic alliance in psychother
apy and has perhaps been the theoretician who focuses most strongly on the
development of the relationship or working alliance in supervision. In addi-
tion to the basic tasks and goals of supervision, Bordin stresses the process of
building a strong working alliance, or “bonding,” between the therapist and
supervisor encompassing trust, liking, and caring. He believes that this alli-
ance potentially counteracts the “inescapable” tension associated with status
differences between supervisors and supervisees.
Efstation, Patton, and Kardash (1990) attempted to develop an instru-
ment, based on the work of Bordin (1983) and others, designed to measure
the strength of the working alliance. They conceptua lized the supervisory
relationship as an interactive process by which supervisors influence and
facilitate the learning of the therapist. In the Supervisory Working Alliance
Inventory (SWAI), Efstation and colleagues identified a factor structure
that both supervisees and supervisors perceived as involving client focus, or
working to understand the client, and rapport as common dimensions of the
supervisory relationship. Additionally, supervisors identified the dimension
of trainee identification with the supervisor. The SWAI demonstrated some
initial reliability and validity; however, only limited follow-up investigations
have been conducted to develop the promise of the SWAI. In addition, this
initial development of the SWAI is limited to the sample of therapists at the
advanced practicum and internship levels. As the authors acknowledge,
the factor or subscale structure of the SWAI may differ developmentally with
beginning- and intermediate-level supervisees and may indeed vary over
time. Other investigations (e.g., Bahrick, 1990) have similarly attempted to
adapt measures of the therapeutic relationship such as the Working Alliance
Inventory (Horvath & Greenberg, 1989) to the supervisory environment,
140 IDM Supervision: An Integrative Developmental Model
albeit with little consideration given to the validity of using relationship con-
structs from one domain (psychotherapy) in another (supervision).
While there are many variables that affect the supervisory relationship
(see Bernard & Goodyear, 2009), there appears to be a lesser focus on the
qualitative aspects of the supervisory relationship in the supervision research
literature. One of the early investigations to use a qualitative methodology in
the supervision domain, by Worthen and McNeill (1996), illustrates the pri
macy of the supervisory relationship in the view of supervisees and serves to
highlight the lack of attention paid to the development and processes of the
supervisory relationship by researchers. In this investigation, they deviated
from traditional research design by utilizing a phenomenological research
methodology in order to investigate the experience of “good” supervision
from the perspective of therapists by conducting in-depth interviews with
eight intermediate to advanced therapists. The initial statement made to
participants was simple: “Please describe for me as completely, clearly, and
concretely as you can an experience during this semester when you felt you
received good psychotherapy supervision.” Participants were then invited to
elaborate on the comment, and the interviewer’s role was limited to facilitat-
ing the articulation of the description of good supervision by focusing on
understanding the experience as the trainee related it.
Qualitative analyses yielded a general meaning structure for the experience
of good supervision events. Identification of the salient themes that reflected
good supervision events within the general meaning structure resulted in
four distinct supervision phases: the existential baseline, setting the stage,
a good supervision experience, and outcomes of good supervision. The exis-
tential baseline reflected a fluctuating to grounded level of confidence and a
sense of disillusionment to a sense of efficacy with the therapeutic process in
intermediate to advanced trainees. There was also a strong desire for reward-
ing supervision, and in most cases a previous experience with unrewarding
supervision, as well as an aversion to overt evaluation. Setting the stage
involved a perceived need and sensed inadequacy on the part of supervisees.
The most pivotal and crucial component of the good supervision experience
evident in every case studied was the quality of the supervisory relationship.
Therapists described effective supervisors as conveying an attitude that mani-
fested empathy, a nonjudgmental stance toward them, a sense of validation or
affirmation, and encouragement to explore and experiment. These dynamics
are illustrated by the comments of one participant:
The Supervisory Relationship 141
And what was so great was that my supervisor was really affirming of
and validating of my ability to speak clearly. I felt very much understood
by her and I felt also like she appreciated those abilities that I had taken
pride in the past and which I had felt, I just hadn’t felt were being rec-
ognized at all, at any level.
The findings also suggested that the desire and need for a supportive
supervisory relationship are ever present in supervision. Supervisees believed
that their supervisors helped to normalize their struggle, a task that often
was accomplished through a personal self-disclosure by the supervisor. Other
themes at this stage included a sense of “freeing,” consisting of reduced self-
protectiveness and receptivity to supervisory input, nondefensive analy-
sis, reexamination of assumptions, and acquisition of a meta-perspective.
Finally, the outcomes of good supervision included a strengthened supervisory
a lliance, along with strengthened confidence, refined professional identity,
increased therapeutic perception, and an expanded ability to conceptualize
and intervene.
Recent investigations of the qualitative aspects of the supervisory rela-
tionship serve to further elucidate the importance of the supervisory rela-
tionship. For example, Nelson, Barnes, Evans, and Triggiano (2008) found
that highly competent supervisors working from a developmental orienta-
tion viewed supervision as more than simple oversight of client care; supervi-
sors also highlighted the significance of the supervisory relationship in their
ability to provide feedback and engage in relational processing when nec-
essary. These supervisors focused on creating strong supervisory alliances,
discussing evaluation early on, and modeling openness to conflict. They also
took a reflective stance, thinking a great deal about challenges in their work
with trainees, coaching themselves to empathize with supervisees, exercis-
ing patience, clarifying developmental needs, appreciating trainee strengths,
and identifying both interpersonal and contextual factors that contributed
to disagreements or misunderstandings they experienced. From the supervi-
see perspective, Gray, Ladany, Walker, and Ancis (2001) found that trainees
attributed their experiences of counterproductive events in supervision to
their supervisors dismissing their thoughts and feelings, leading to a weaken-
ing of the supervisory relationship. Trainees were also reluctant to disclose
their experience of counterproductive events in supervision with their super-
visors, despite their desire to address the event in the moment. Similar find-
ings were noted by Nelson and Friedlander (2001) in their study of negative
142 IDM Supervision: An Integrative Developmental Model
supervision experiences, as supervisees reported that they did not experi-
ence enough attention, warmth, or understanding to maintain a sense of
trust in their supervisors. Supervisors were viewed by trainees as not being
invested in the supervisory relationship and unwilling to own their own role
in conflicts.
Supervisees in various training settings experience numerous short-term
supervisory relationships as they progress through the stages of development.
Hence, their expectations regarding the supervisory relationship will vary
given their developmental level and previous experience with the supervision
process. Consequently, in our view, previous theorists’ hypotheses of stages
of the supervisory relationship that are applicable across all levels of train-
ing are somewhat problematic. For example, most academic settings value
the assignment of trainees to a variety of supervisors over the duration of
an academic career in order to expose supervisees to a diversity of training
approaches and models. The result is that trainees experience many short-
term supervisory relationships, each rarely lasting more than a quarter or a
semester (4 to 6 months). Internship, post–master’s-degree, and doctoral job
settings may allow for longer-term supervisory relationships to develop (6 to
12 months).
The fact that supervisees experience numerous supervisory relationships
affects the experience and expectations that they bring to the next relation-
ship. In addition, the idea of a transition to the next supervisor may more
accurately reflect most relationships than does the concept of terminating
relationships extrapolated from the psychotherapeutic domain. Our devel-
opmental conceptualization of supervision suggests that therapists at vary-
ing levels bring different expectations to the supervisory relationship, based
in part on previous supervisory experiences. Finally, although conflicts may
occur in many supervisory relationships, according to the IDM they may
be more likely with Level 2 supervisees. Thus, an overemphasis or exclusive
focus on perceived supervisory or interpersonal conflict in therapists is not
always appropriate and detracts from the many elements that constitute good
supervisory relationships.
It appears for the supervisees in the investigation by Worthen and McNeill
(1996) that the supervisory relationship served as the base of all good thera-
peutic and professional training. This conclusion suggests that the learning
and acquisition of professional skills and identity may be delayed, hampered,
or not fully developed outside the context of an effective supervisory rela-
tionship. As Allen et al. (1986) have suggested, the didactic and structural
components of supervision are not as influential in determining quality as are
The Supervisory Relationship 143
clear communication and respect. In addition, Black (1988) concluded that
the largest and most structurally similar factor found in both effective and
ineffective supervision was that of the supervisory relationship. Supervisory
relationships in effective supervision were responsive and supportive, whereas
they were insensitive and judgmental in ineffective supervision.
A surprising as well as disturbing aspect of the Worthen and McNeill
(1996) study was that six of the eight participants, in expressing a desire
for a qualitatively different supervisory relationship, indicated that they
had experienced some previous supervisory relationships as less than ful-
filling. This result is consistent with Galante’s (1988) finding that 47%
of trainees reported that they had experienced at least one ineffective
supervisory relationship, and Ramos-Sanchez et al.’s (2002) findings on
the impact of previous negative supervision on the supervisory relation-
ship. It is extremely unfortunate and problematic that, two decades after
Galante’s work, negative supervision events still appear to be common, as
demonstrated most recently by Ellis, Siembor, Woods, Moore, and Blanco
(2008) in a comprehensive study of trainee experiences across a variety of
training settings and developmental levels. Results of this investigation
indicated that 59% of trainees reported that they had received inadequate
supervision in ether current or previous supervisory relationships. More
disturbing is that 36% of supervisees experienced “harmful” supervision,
defined as supervisory practices that result in psychological, emotional,
and/or physical harm or trauma in current or later supervisory relation-
ships. Thus, it appears that supervisors may need much more extensive
training in supervisory models and relationship processes, exclusive of
therapeutic training and experience, to increase their effectiveness. We
strongly believe that when supervisors attend to supervisee needs and pro-
vide the appropriate supervisory environment corresponding to a given
developmental level, the supervisory relationship is strengthened and the
potential for conflict is reduced.
The interpersonal styles of supervisors vary in the manner in which they
choose to attend to the various supervisory tasks across developmental stages.
Some prefer to take a primary role as mentor, expert, consultant, or teacher.
The research, as well as our experience as practicing supervisors, suggests
that these roles may vary, serving different functions at different times. What
may be lacking as a priority, however, are the interpersonal characteristics
and expressions of warmth, acceptance, understanding, respect, support, and
empathy across developmental levels and supervisor styles, much the same
way as the basis of all therapeutic intervention across varying theoretical
144 IDM Supervision: An Integrative Developmental Model
orientations is commonly considered to be a therapeutic relationship or alli-
ance characterized by trust, warmth, respect, and understanding.
Supervisory Relationships Across Levels
Because supervisees of varying developmental levels bring differing expecta
tions to the supervisory relationship, there are various ways to strengthen the
supervisory relationship.
Level 1
Beginning Level 1 supervisees are experiencing supervision for the first time;
their previous experiences with faculty members within the educational envi-
ronment may be limited to the formal student–professor relationship. As a
result, the more informal and unstructured aspects of the supervisory relation-
ship are novel to them and may need to be clarified. In addition to the anxiety
that is typical of the Level 1 therapist, beginning trainees may also experience
anxiety related to engaging in a more interpersonally focused relationship
with a supervisor. Also, their evaluation anxiety is high and may manifest
in a trepidation to reveal too much of themselves as individuals beyond the
role of a supervisee’s willingness to learn. In essence, the beginning Level 1
supervisee is not sure what to expect in the supervisory relationship.
It is important for the supervisor of the beginning supervisee to com-
municate empathy and understanding of the journey toward becoming a
therapist. Recalling and sharing the supervisor’s own experiences at this
stage may help reduce the supervisee’s anxiety and provide needed affirma-
tion and validation. Clarifying expectations and slowly establishing trust
are the primary initial relationship-building skills. Creating an atmosphere
of support, acceptance, and acknowledgment of the inevitability of making
mistakes helps to build trust. Recall that the Level 1 therapist demonstrates
limited self- and other-awareness. Thus, interpersonal processing of relation-
ship dynamics between the supervisor and supervisee, as well as commenting
on personality characteristics of the therapist, is best limited to situations in
which there are obvious implications for very concrete interventions. A more
intense focus on these dynamics is best left for supervisees who are making
the transition into Level 2, with attention paid to ethical supervisor behavior
and the need to address these issues in terms of competencies rather than
from a therapeutic perspective (Kaslow et al., 2007).
The Supervisory Relationship 145
Mark was a beginning trainee who possessed a bachelor’s degree in psy-
chology, performed at the top of his first-year class academically, and
was highly motivated to be an effective psychotherapist. Like most other
beginning-level trainees, Mark was extremely self-conscious regarding
evaluation, the relatively unstructured format of the individual supervi-
sion session, and the subjectiveness of evaluation in supervision. Similar
to many other early trainees, these dynamics appeared to be manifested
in a reluctance and inability to secure an audible tape of his therapy ses-
sions. He proffered the gamut of excuses: forgetting to turn the machine
on, poor-quality tapes, and clients’ reluctance to provide permission to
tape. To confront, interpret, and process these dynamics would only have
served to exacerbate Mark’s high level of anxiety. Instead, his supervi-
sor provided a clear, cogent rationale to Mark regarding the importance
of taping in relation to client welfare and assessment, and he issued a
simple directive to Mark to have a tape ready by the following week. This
intervention, designed to clarify the expectations of the supervisor, was
effective; Mark was then able to obtain taped sessions consistently. Later,
as an advanced student enrolled in a course on clinical supervision, Mark
was able to understand and place the experience within the context of his
personal dynamics.
Level 2
Due to the trials and tribulations associated with the Level 2 supervisee, the
therapist–supervisor relationship at this stage is perhaps the most likely to undergo
significant conflict and stress. At this point, the supervisee has also experienced
other supervisory relationships and thus brings a set of expectations to the cur-
rent relationship. Prior expectations may also have evolved by previous contact
with a supervisor in another capacity (for example, in a classroom setting).
In clarifying expectations for supervisory sessions at this level, the super-
visor may find it helpful to assess the therapist’s perception of the nature
of previous supervisory relationships. The supervisee who has experienced
an unsatisfying relationship may express a desire for a qualitatively differ-
ent experience. In contrast, the therapist who has experienced a satisfying,
facilitative relationship with a previous supervisor may have similarly high
expectations for the current supervisor. Due to the high dependence on
the supervisor at Level 1, the supervisee may have come to idolize a previ-
ous supervisor. That is, the positive or negative interpersonal dynamics that
146 IDM Supervision: An Integrative Developmental Model
characterized the previous relationship influence the present relationship, as
the earlier supervisor may come to set the standard for comparison to the
current developing supervisory relationship.
In assessing the nature of a previous supervisory relationship, the supervi-
sor should show respect for and understanding of the expectations that the
supervisee brings to the new relationship. This intervention also sets the stage
for clarification of expectations, discussion of differing supervisory styles,
and anticipation of the potential impact of possible stylistic and procedural
differences.
Recall that one of the primary tasks of the supervisor of the Level 2
therapist is to foster a sense of independence that, coupled with the super-
visee’s developing sense of competence but lack of experience, results in a
dependency–autonomy conflict. As a result, Level 2 therapists may resist or
resent supervisors’ lack of direction in fostering the supervisee’s autonomy or
directives concerning client welfare. These may be viewed as “overmonitor-
ing” by confident supervisees. Such resistance or resentment places a strain
on the supervisory relationship that is all too often left unaddressed by both
supervisors and therapists.
This covert conflict seethes below the surface, resulting in passive-
aggressive behaviors on the part of supervisees, who may selectively present
successful cases or actively avoid discussion of cases for which they suspect
the supervisor will challenge their skills or choice of intervention. The super-
visee may passively agree with supervisor directives but not carry them out.
As a result, the supervisor becomes increasingly frustrated by the perceived
lack of respect for his or her power or clinical skills. Supervisors may first
need to normalize the struggle in the form of a personal self-disclosure or
acknowledge the supervisee’s strengths and weaknesses in terms of multiple
levels of development across various domains in order to defuse the situation
and reduce supervisee defensiveness.
Despite the conflicts that supervisees at Level 2 experience, research
indicates that at this level they begin to demonstrate an increased readiness
and openness to processing of personal issues of self-awareness, defensive-
ness, transference and countertransference, and the supervisory relationship.
Thus, at this point it may be necessary for the supervisor to confront and
process the dysfunctional aspects of the supervisory relationship in the here
and now. This process orientation has the added benefit of demonstrating or
modeling important aspects of interpersonal process as applied to the psy-
chotherapeutic arena.
The Supervisory Relationship 147
The parallels between the supervisory and counseling relationships may
become evident as a function of the development of the Level 2 supervisee’s
self- and other-awareness. Thus, confronting and processing the immediate
aspects of the supervisory relationship can resolve impasses in the relationship,
and has the added benefit of modeling the interpersonal process aspects of
the therapeutic relationship. Because the Level 2 therapist is fluctuating in
terms of developing a consistent sense of self- and other-awareness, process-
type interventions may not always break through and resolve relationship
issues. At this time, however, the supervisor may be planting the seed for
later processing of the supervisory relationship as the supervisee moves to
Level 3.
Michelle had completed her master’s degree in counseling and thus had
a year of supervised counseling experience. In her doctoral program,
she had identified strongly with a female faculty member and arranged
for this individual to provide her individual supervision over the course
of two semesters. Her evaluations had been generally positive, but they
lacked specificity in terms of strengths and weaknesses. Thus, Michelle
felt confident in her ability to function independently as a counselor in
most therapeutic situations.
After Michelle had provided some tapes to her current male supervi-
sor, she received some critical feedback highlighting some deficits in her
skills and specific areas in need of improvement. During the feedback
session, Michelle was visibly upset, cried, and expressed her shock and
dismay at receiving such criticism. At this point the supervisor attempted
to normalize the process by pointing out her strengths, which she ini-
tially accepted. In subsequent supervisory sessions, however, it became
clear that Michelle presented her cases in a distant, detached manner
and simply acquiesced to the supervisor’s suggestions and feedback, even
when it was positive. The supervisory sessions lacked a vitality and sense
of engagement. The supervisor noted his perception of a problem or lack
of engagement in the supervisory relationship and process by Michelle.
In her defense, she cited an inability to identify with the supervisor as
a male and indicated that he did not understand her and was too harsh
in his presentation of feedback. Although this discussion resulted in an
increased openness and involvement in supervision, the relationship
improved only in the sense of a working relationship in which Michelle
148 IDM Supervision: An Integrative Developmental Model
implemented the supervisor’s suggested interventions but did not value
them. Later Michelle did not view process-type interventions as relevant.
Although she was able to improve steadily in her skills, this impasse and
the distance in her relationship with the supervisor was not resolved dur-
ing her graduate career.
Level 3
Level 3 and Level 3i therapists have progressed through training and vari-
ous employment settings and thus have experienced a number of supervisory
relationships. It remains important for supervisors of Level 3 therapists to
assess the impact of previous positive and negative supervisory relationships
and the potential impact on the current relationship. Previously unreward-
ing supervision experiences appear to result in an aversion to overt evaluation
and a strong desire for more rewarding supervision by higher-level thera-
pists. These supervisees also view good supervision as characterized by an
empathic, nonjudgmental relationship, with encouragement to experiment
and explore, and they are satisfied when their struggles are normalized.
Therapists who are entering Level 3 in a first domain are often making
a transition to a new and unfamiliar setting, perhaps encountering unfa-
miliar personnel and policies. Although it is common for these therapists
to experience temporary regression, their highly developed skills and sense
of self-awareness usually allow for the transition to the new setting to occur
quickly. This transition is aided by a supportive and safe environment in
which the supervisee is able to establish an effective supervisory alliance. It is
at this stage that the supervisee is most willing to explore personal dynamics
and issues as related to the impact on client work. Now the supervisor may
use the therapeutic relationship to increase the insight of supervisees regard-
ing the impact on the therapeutic process of personal characteristics and
reactions to clients. Use of parallel process interventions, or process checks,
will attend to the therapist’s need and willingness to examine these issues.
The mutual respect and collegial exploration of these issues that now
characterize the supervisory relationship lead to new insights by the ther-
apist and take on a special significance, depth, and satisfaction associated
with mentoring and observing the progress of a competent supervisee. It
is not unusual for these relationships to continue long past the supervisory
experience. Additional time may be spent attending to the supervisee’s pro-
fessional development needs at this point, including job search and future
The Supervisory Relationship 149
goals. This process is apparent in the comments of one of the participants in
the Worthen and McNeill (1996) study.
When I talk about that process, when we play with these process
pieces or when we would stop the tape at whatever times, that
couldn’t have happened, I don’t think, if it didn’t feel like a real col-
legial relationship, if I didn’t feel like I was respected at a level that,
I guess, I wanted to be respected at, or if I was going to move on as
a professional.
Damage to the supervisory alliance at this point primarily occurs through
misassessment of the supervisee’s developmental level or rigidity by supervi-
sors who apply similar techniques to all levels of therapists by not attending to
the Level 3 supervisee’s needs. Although processing of relationship dynamics
can be extremely valuable at this stage, a constant or overly intrusive focus
on process or relationship dynamics to the exclusion of other tasks important
to the development of the supervisee can result in high levels of anxiety and
dissatisfaction for therapists.
Debbie, the top choice of the predoctoral internship site she had cho-
sen to attend, clearly exhibited strong clinical skills in her first couple of
months. However, her supervisor demonstrated a strong psychodynamic
supervisory focus and chose to devote the majority of supervisory sessions
to the relationship dynamics between himself and Debbie, searching
for the implications of conflict and potential transference and counter-
transference reactions in both supervision and counseling environments.
Debbie soon became weary of this exclusive focus; she felt that the super-
visor was not attending to the further development of her overall clinical
skills, but rather was overly concerned with her interpersonal dynamics.
She raised the issue with him, but the impasse could not be resolved, and
Debbie was assigned to another supervisor. Immediately, Debbie took
the initiative to process with the new supervisor her previous difficulties
and discuss the implications for their current relationship. She exhib-
ited a continued openness to examining supervisory relationship dynam-
ics, and she appreciated her current supervisor’s balance in attending to
client issues and clinical skills while raising these issues, when relevant,
within a supportive and open atmosphere. Thus, despite a negative super-
visory experience, Debbie was able to value the supervisory relationship
and benefit from the intense interpersonal nature of the relationship to
improve both personally and professionally.
150 IDM Supervision: An Integrative Developmental Model
Supervisory Relationships With
Diverse Therapists
In prior chapters we focused on the domain of individual differences as
an area of training that supervisees must master. Indeed, in the last two
decades, the need to prepare and train mental health personnel to work with
diverse populations has been addressed through an ever-increasing theoreti-
cal and empirical literature (see Constantine, Miville, & Kindaichi, 2008).
As a result, the so-called multicultural movement has been referred to as
the “fourth force” in psychology (Pedersen, 1998). Because of this increased
awareness, traditional training programs in professional psychology spend
much of their time attempting to increase students’ cultural responsive-
ness in terms of knowledge, skills, and awareness of biases and stereotypes
as they relate to underrepresented and underserved populations. There are
many excellent preparatory textbooks that can help increase trainees’ under-
standing in each of these three domains (e.g., Pedersen, Draguns, Lonner,
& Trimble, 2008; Sue & Sue, 2008). Yet despite the increasing attention
given to issues of diversity in graduate training programs, there is a dearth of
information available on the unique training and supervisory needs and/or
perceptions of diverse supervisees.
In 1995, McNeill, Horn, and Perez examined the sparse literature con-
cerning the unique and common experiences of ethnic and racial minority
students in professional psychology programs. These experiences unfortu-
nately included exposure to stereotypes about multiculturalism, affirmative
action, and recruitment issues. Culturally diverse trainees often question the
knowledge and flexibility of white faculty and peers when important mod-
erator variables such as SES, ethnic identification, and acculturation are not
deemed as relevant as biological factors and models of pathology. In addi-
tion, Vasquez and McKinley (1982) suggest that racial and ethnic minority
trainees may be struggling with their own ethnic identity development in
attempting to reconcile the Eurocentric culture of psychology with their own
cultural background. These authors view the solidification of a bicultural
identity as a crucial developmental task for ethnic minority trainees.
As a result, culturally diverse therapists often struggle to assert their unique
needs and make others aware of the multicultural implications of course mate-
rial, counseling theories, and interventions, especially in response to notions
of color blindness in psychological intervention and assessment. It also
appears that many culturally diverse therapists experience varying degrees of
The Supervisory Relationship 151
discrimination, isolation, racism, and differential treatment, resulting in feel
ings of confusion, anger, outrage, and discouragement. These therapists may
or may not choose to disclose these experiences and feelings, and program
faculty, directors of training, and clinical supervisors may remain unaware
of the problem.
In reviewing the literature in this area, McNeill et al. (1995) found that
previous authors consistently recommended that the variety of issues that
racial and ethnic minority therapists face should be addressed within the
supervisory relationship. Although we believe that program advisers, direc-
tors, or mentors could also serve this role in their relationships with cul-
turally diverse students, it seems that the intensive, interpersonally focused
nature of the supervisory relationship lends itself well to the personal devel-
opmental issues of the ethnic minority supervisee. As Vasquez and McKinley
(1982) point out, these issues include supervisees’ own struggles with their
ethnic identity, issues of discrimination, pressure from their own community
to “work in the trenches,” and resultant feelings of confusion, frustration,
and anger. Hunt (1987) states that for African American supervisees, ethnic
identity and expressions of anger and hostility as reactions to white theories
and various other patterns of relating to white and black peers and clients are
best dealt with in individual supervision. Zuniga (1987) described a graduate
social work program with Chicano students that emphasized a supervisory
focus on ethnic identity, family history, acculturation, and the processing
of experiences of racism, especially within the educational environment,
as a crucial component in the development of clinical skills in therapists.
American Indian students express a desire for supervision environments char-
acterized by respect for individual differences and patience with the learning
process, and they prefer supervisors who take a personal interest and with
whom the supervisees feel a connection (Geddes, 2004). Duan and Roehlke
(2001) found that 93% of supervisors surveyed had no experience supervis-
ing trainees who were racially or culturally different from themselves, and
Cook and Helms (1988) suggest that supervisors who ignore racial issues in
supervision may unknowingly develop reputations for being racially insen-
sitive and providing inadequate supervision. More recently, Burkard et al.
(2006) found that culturally diverse trainees experienced more incidents of
“culturally unresponsive” supervision where cultural issues were ignored,
actively discounted, or dismissed by supervisors with adverse consequences
for the supervisee, the supervisory relationship, and/or client outcomes than
did their European American counterparts. In contrast, in culturally respon-
sive supervision, trainees of all backgrounds felt supported, which positively
152 IDM Supervision: An Integrative Developmental Model
affected the supervisee, the supervisory relationship, and client outcomes.
For both majority and minority trainees, Gomez (2003) found, the overall
quality of the relationship related to satisfaction with supervision. Evidence
presented by Constantine and Sue (2007) indicates that culturally diverse
trainees, in this case African Americans, continue to experience racial micro-
aggressions from White supervisors in the form of invalidating racial-cultural
issues, making stereotypic assumptions about Black clients and Black super-
visees, and offering culturally insensitive treatment recommendations, again
with detrimental effects on the trainee and supervisory relationship.
Although there is also a lack of an extensive literature surrounding the
training and supervisory needs of female trainees and gay and lesbian trainees,
it appears that for these groups, issues similar to those of cultural diversity
may exist and manifest themselves within the supervisory relationship. For
example, potential conflicts in the supervisory relationship may stem from
supervisors’ and supervisees’ sexual identification and attitudes toward homo-
sexuality (Buhrke, 1989); trainees may experience homophobic attitudes in
programs and practicum sites (Messinger, 2004, 2007; Pilkington & Cantor,
1996). In one of the few empirical investigations to explore the impact of sex-
ual orientation in the supervisory relationship, Gatmon et al. (2001) found
that supervisors were reluctant to initiate discussions about sexual orienta-
tion, though such discussions (which most often were initiated by trainees)
resulted in higher levels of satisfaction with supervision and perceived com-
petence of the supervisor. Stronger supervisory alliances were also associated
with greater frequency and depth of discussions about sexual orientation, and
integration of sexual orientation into intern-level training.
One of the few early investigations into the effects of gender on the
supervision relationship, by Worthington and Stern (1985), indicated that
male supervisees thought they had better relationships with their supervi-
sors, regardless of gender. For women, sexist attitudes manifested by male
supervisors may result in some preference for female supervisors, although
studies within the area of gender matching in the supervisory dyad are
mixed (Behling & Foster, 1982). Some studies suggest that gender match-
ing is related to student performance and/or perceptions of supervision
(Behling & Foster, 1982; Thyer, Sowers-Hoag, & Love, 1988), while others
do not (Nelson & Holloway, 1990; Putney, Worthington, & McCullough,
1992). Nelson and Holloway reported differences in the treatment of female
and male supervisees by both male and female supervisors, with supervi-
sors encouraging or supporting female supervisees’ assumption of power in
The Supervisory Relationship 153
relation to a more powerful authority figure less often than for male super-
visees. The authors concluded that supervisors in the expert role, regard-
less of gender, may assume more power in interactions with their female
supervisees than with their male supervisees, either by withholding support
for the female trainees’ attempts at exerting power or simply by exerting
stronger influence with female supervisees. Similar findings were reported by
Granello, Beamish, and Davis (1997) and Granello (2003), who noted that
male supervisees were asked for their opinion in supervision twice as much
as female supervisees, while female supervisees more often were told what
to do. While Sells, Goodyear, Lichtenberg, and Polkinghorne (1997) found
that gender was not related to trainee evaluation, an investigation by Chung,
Marshall, and Gorden (2001) found that male supervisors rated hypothetical
female supervisees more negatively than hypothetical male supervisees.
Drawing on the work of Gilligan (1982) regarding women’s moral devel
opment, Stoltenberg and Delworth (1987) suggested that female supervisees
may be more relationship oriented and bond more easily with supervisors,
whereas males tend to be more task oriented. Subsequent research on gen-
der issues have failed to support the proposed model of even moderate dif-
ferences in moral development (Jaffee & Hyde, 2000) or, in general, the
gender differences model for many psychological constructs (Hyde, 2005).
Consistent with this research, an investigation by Haviland (2001) revealed
no differences between male and female supervisees in terms of relational
bonds, goals, or tasks of supervision. In regard to supervisors, Sells et al.
(1997) found that female supervisors had a greater relational focus than male
supervisors, focusing more on the trainee in supervision; male supervisors,
by contrast, spent more time focused on the supervisee’s client. When male
supervisors worked with male supervisees, the trainees rated their techni-
cal skills higher. When female supervisors worked with female trainees, the
supervisees rated their personal awareness higher. Limited work with gender
issues within the ELM suggests that females may be more susceptible to
influence than males under certain conditions. Cacioppo and Petty (1980)
found females to be more agreeable than males, but only under conditions of
low prior knowledge (which affects ability to engage in central route process-
ing). Thus, due to gender roles and socialization, women at Level 1 (where
supervisees lack prior knowledge about the counseling process, despite being
highly involved and motivated) may be more susceptible to influence, in the
interest of maintaining a harmonious supervisory relationship, than males
at the same level. Because both male and female therapists gain knowledge
154 IDM Supervision: An Integrative Developmental Model
about therapy as they progress through Levels 2 and 3, we would not expect
gender differences in persuasion to occur at these later stages. All of these
possible differences, however, need to be validated empirically within the
supervision context (Stoltenberg, McNeill, & Crethar, 1995).
It is extremely important to acknowledge that supervisees lack power in
relationships with supervisors. As a result, they may be reluctant to express
their feelings in relation to issues of race, culture, gender, and lifestyle. For
supervisors, such discussions may be unfamiliar and uncomfortable, and
therefore they may seek to avoid these topics. Supervisors may also view
these issues as personal in nature and outside the traditional purview of clini-
cal supervision, which attends only to client issues and concerns. Thus, to
address diverse therapists’ needs, it is incumbent on supervisors to create a
supervisory relationship and environment in which these needs and issues are
viewed as relevant to supervisees’ personal and professional development and
openly dealt with and met. We are pleased to see that the literature appears
to reflect a growing consensus regarding the responsibility of the supervi-
sor in initiating such potentially difficult dialogues with diverse trainees
(e.g., Bernard & Goodyear, 2009; Gatmon et al. 2001; Pfohl, 2004).
In many circumstances, supervisors who are simply willing to listen are able
to create a conducive environment, as supervisees desire a confidential outlet to
express their feelings and perceptions. In other scenarios, the supervisor may
need to advocate on behalf of the supervisee to address blatant examples of
discrimination or negative prejudice that exists within academic departments
or work settings. To provide this relationship, supervisors must be knowledge-
able in both traditional counseling models (while recognizing the Eurocentric
influence on these models) and multicultural theory and interventions.
We are all too aware of clinical supervisors who lack up-to-date knowledge
of cultural intervention and depend on their diverse supervisees to educate
them on multicultural issues (see Constantine, 1997). As Gutierrez (1982)
stresses, supervisors also need to understand differences in therapists that
stem from cultural background and values, language, and socioeconomic sta-
tus. Stewart and McDermott (2004) remind us that all people have multiple
identities that cannot be neatly separated. Identities related to race, ethnicity,
SES, sexual orientation, age, religion, politics, and so on are often closely
bound within one’s personal identity and create overlapping influences. Some
characteristics may become more salient within certain contexts, while oth-
ers surface in different contexts. Thus it is important not to assume primacy
of some identity characteristics over others without carefully considering
The Supervisory Relationship 155
context issues. From an interpersonal influence viewpoint, we have previ
ously noted that cultural differences may result in ineffective communication
due to difficulties in message comprehensibility and subsequent processing,
and that the supervisory relationship is not immune to these potential dif-
ficulties (McNeill & Stoltenberg, 1989).
Diverse supervisees may perceive the credibility or quality of the supervi-
sor’s message as negatively affected by lack of understanding of multicultural
models and interventions, lack of experience with culturally diverse clients,
or lack of knowledge of individual differences due to culture, gender, and
sexual orientation. In addition, cultural differences in communication styles
between supervisors and trainees may limit the supervisor’s influence. Failure
to deal with these differences may negatively affect supervisors’ credibility
and ability to present messages of high quality to diverse supervisees, poten-
tially resulting in lower motivation or involvement of diverse therapists at all
developmental levels.
Mateo was a second-year trainee of Chicano ethnic background and
was one of two minority trainees enrolled in the program’s multicul-
tural counseling course. In his weekly individual supervision, he seemed
impatient and irritated. In taped excerpts, he appeared very unfocused in
his clinical work, only going through the motions. When the supervisor
commented on this lack of focus, as well as his current level of irritation
within the supervision session, Mateo let loose with a tirade against his
peers and their remarks in class regarding the issue of affirmative action
and the perceptions of minorities in this country. He referred to a pro-
fessor’s comments on the “lack of validity” for multicultural counseling
models and to the stereotypical role playing of ethnic counseling issues
in class. He also expressed the concern that he had been recruited to the
program not for his skills but rather for his ethnic minority status. The
supervisor listened carefully as Mateo ventilated, and provided validation
for Mateo’s experience as one of the few culturally diverse trainees in the
program. They explored ways of dealing with insensitive peer comments
in class, as well as the possibility of connecting with student minority
groups on campus for support. Subsequent supervision sessions addressed
similar issues as they arose. A few weeks later, Mateo confided in his
supervisor that he had come very close to dropping out of the program
before finding a formal outlet for his frustrations.
156 IDM Supervision: An Integrative Developmental Model
In this chapter we have focused on the importance of the interpersonal
aspects of the supervisory relationship that underlie the process of effective
clinical supervision and the ways in which it may vary across developmental
levels of supervisees. Consequently, it appears that, analogous to the thera-
peutic alliance, the supervisory relationship may be important to the profes-
sional development of all supervisees. In particular, it provides an outlet for
the unique and sometimes unaddressed issues of female, gay and lesbian, and
cultura lly diverse supervisees.
7
Nuts and Bolts of Supervision
•
The previous chapters have explicated the structure and assumptions of
the IDM, giving specific guidelines and recommendations for supervising
therapists of different developmental levels. This chapter addresses a col-
lection of issues that together make up some of the nuts and bolts of the
supervision process. The focus is on elements of supervision that are some-
what separate from the overarching model but nevertheless important to
consider in facilitating the clinical supervision process: the importance of
knowing the licensure and certification standards for a given field in men-
tal health, the importance of documentation, the various foci of supervi-
sion, group supervision, and differential supervision responsibilities. In
addition, we address setting up the initial supervision session, assessing
the status of the supervisee, and other incidentals of the clinical supervi-
sion process.
Supervision Standards
Mental health services are provided by a broad (and growing) spectrum of
professionals, each with its own specific requirements regarding who can pro-
vide prelicensure or precertification supervision, how many hours of supervi-
sion are required, what type of direct clinical services qualify, and necessary
documentation. Summaries of these requirements for various professional
groups are provided elsewhere, and we will not examine them in detail. We
strongly recommend that clinical supervisors, or aspiring supervisors, remain
in contact with the appropriate licensure board or professional organization
so they can keep up to date on the relevant requirements and standards.
157
158 IDM Supervision: An Integrative Developmental Model
Who Can Supervise?
This question is different from “Who should supervise?” which we address
in more detail in Chapter 9. All supervisors need to be aware of state and
professional requirements before engaging in a supervision relationship. For
example, states typically require pre- and postdoctoral supervision for profes-
sional psychologists to be provided by psychologists licensed within that state.
The American Psychological Association accreditation guidelines note that
practicum supervision should be provided by a licensed psychologist and that
accredited programs in professional psychology include formal knowledge of
supervision as a minimum component of education for professional practice
(American Psychological Association, 2002a). Similarly, postdegree super-
vision of licensed professional counselors (LPCs) is also typically provided
by LPCs. An increasing number of states are requiring marriage and family
therapists to be supervised by a certified clinical supervisor (an additional cre-
dential beyond licensure) to qualify for licensure. A similar requirement often
exists for pastoral counselors. It is also an ethical requirement for psycholo-
gists who serve as supervisors to have acquired the competence to supervise
(Harrar, VandeCreek, & Knapp, 1990; Sherry, 1991; Vasquez, 1992).
Although some professions accept supervision by an individual with a
degree in a counseling-related field (such as an LPC), it is becoming increas-
ingly common for specific professional groups to accept only prelicensure
or precertification supervision provided by individuals who are licensed or
certified in that field. It is important to research the specific requirements for
the particular professional association the supervisee is entering.
Over the past few years there has been an increasing focus on what compe-
tencies are necessary for effective clinical supervision (Falender et al., 2004;
Stoltenberg, Kaslow, et al., 2003). We will discuss these proposed competen-
cies, among other issues, in Chapter 9.
What Constitutes an Acceptable Activity?
Most mental health professions recognize a breadth of activities as appropriate
for supervised clinical practice. However, increasingly states and associations
are specifying what constitutes the direct service component of profes-
sional practice and how much is required for pre- and postdegree supervised
experience. Thus, it is important to examine the guidelines for the specific
field of practice to be certain that standards are being met and the supervised
experience will be acceptable to the accrediting organizations. For example,
Nuts and Bolts of Supervision 159
internship experiences for individuals pursuing licensure as professional
counselors are often less than full-time for part of a year. Predoctoral intern-
ships for psychology trainees, however, are typically full-time experiences for
a full year (although they may be half-time for two years). Postdegree super-
vised experience required for licensure or certification is typically established
around guidelines based on a given number of client hours or related profes-
sional activity over a period of time that usually incorporates an intensive
clinical practice.
The amount of clinical supervision required for various training experi-
ences across disciplines varies. However, a supervisor can expect to provide a
minimum of one hour of individual supervision per week and, usually, addi-
tional time for in-service training, professional development, grand rounds, or
case conferences. It is important not only to focus on the minimum require-
ments but also to examine the needs of the supervisee for a given setting. For
example, there are usually considerable administrative activities required of
supervisees and their supervisors to meet requirements for agency documen-
tation, organizational procedures, or third-party payment. It is desirable to
allow additional time for supervision of administrative activities apart from
clinical activities or to have these responsibilities divided among two or more
supervisors (Falvey, 1987).
Managed care and other third-party reimbursement present a challenge
in accommodating this extra time investment in supervision. Managed care
organizations are reluctant to reimburse for much (if any) supervision time,
so funding can be a problem. Nonetheless, if training is the focus, as opposed
to simply monitoring performance, this investment of time is necessary.
We have already discussed in considerable detail the importance of
addressing a number of professional and personal issues within the context
of clinical supervision. These issues must be explored for the supervisee to
develop as a professional and to be able to provide the best possible clini-
cal services to clients. Although administrative tasks such as reading and
critiquing case notes, reports, assessments, and so on are crucially important
to the supervisory experience (in addition to their role in managing liability
concerns), conducting these tasks within the limited supervision session may
result in little or no time available for dealing with important clinical, profes-
sional, or personal issues that may directly have an impact on the growth and
performance of the supervisee.
With full appreciation for the economic and time constraints, we believe
that it is best for the supervisor to examine notes, reports, and documenta-
tion outside the supervision session and bring in issues related to these only
160 IDM Supervision: An Integrative Developmental Model
when there is a problem or the information is helpful in discussing the super-
visee’s clinical work. We have observed a distressing number of situations
where clinical supervision consists primarily of completing and reviewing
paperwork, handling billable hours, or other instrumental aspects of profes-
sional practice. This focus does little for the growth of the supervisee or the
quality of services provided to patients or clients.
Documentation and Formats
The supervisor should carefully attend to documentation requirements for
approved supervised clinical experiences. Documentation of direct service
hours provided by the supervisee is required by many licensure boards, as
is documentation of the number of hours of direct supervision. Supervisors
should also be aware of the types of activities considered acceptable as direct
service and monitor the amount of time spent in each. The beginning and
ending dates of the supervisory relationship are also usually required by
licensing boards. Increasingly, internship settings require greater precision
and specificity of information concerning numbers and types of clients,
assessments, and so on completed by students during practica.
There has been a recent dramatic increase in the number of unplaced psy-
chology internship applicants. As we write, the results of the 2008 match
indicate that more than 700 psychology students did not receive a predoc-
toral internship offer. Of those who do find internship slots, some will be at
sites not accredited by the American Psychological Association, a situation
that can have a negative impact on these therapists’ subsequent attempts to
qualify for licensure in some states. Others will be offered internship posi-
tions with no stipend attached and will spend a year without pay. This level
of competition makes it very important to keep accurate records regarding
supervised clinical experiences. Accurate records can make the difference
between a successful internship application and an unsuccessful one.
We recommend keeping supervision session notes for reasons similar to
keeping therapy session notes. We have encountered situations in the past
when accurate supervision session notes proved helpful in dealing with ethi-
cal concerns as well as serving as evidence of the adequacy of supervision
provided (see Chapter 10 for a detailed discussion of legal and ethical issues
in supervision). Session notes should include the following information:
1. Date and session number
2. Identification of cases discussed
Nuts and Bolts of Supervision 161
3. Clients’ progress and problems
4. Assessment data
5. Suggestions for further treatment or adjustments to the established
treatment plan(s)
6. Supervisee progress and problems
7. Training or remediation objectives and plans for the supervisee
Supervisors should also be aware of the nature of required supervision
experiences. For example, is individual supervision the only acceptable
modality, or is group supervision of a number of supervisees also acceptable?
As we will examine later in this chapter, group supervision has some unique
aspects that can have a significantly positive effect on the growth of the psy-
chotherapist or inhibit that growth.
Supervisor Responsibilities
Supervisors need sufficient knowledge and experience to effectively super-
vise the therapist’s work across clinical activities and clients. For adequate
supervision to occur, the supervisor must have expertise in the domains for
which he or she is providing supervision. If this is not possible, supervision
responsibilities should be divided among supervisors who do have sufficient
expertise, or supervision of supervision by a qualified person should be made
available. Responsibilities in such arrangements must be clearly articulated to
avoid conflicts between supervisors.
The supervisor also needs sufficient knowledge of each client with whom
the therapist is working to assist in developing and monitoring the effective-
ness of treatment plans. The supervisor will often need to cosign therapy
progress notes and reports. This is not a perfunctory task; it necessitates suf-
ficient information to evaluate the adequacy of this documentation.
The most recent Ethical Guidelines from the American Psychological
Association call for students and interns to identify themselves as such to cli-
ents at the beginning of clinical activity (APA, 2002b). In addition, the name
of the supervisor should be provided so that the client is aware of who is
ultimately responsible for his or her care. Similar guidelines exist for other
professions; for example, the California Association of Marriage and Family
Therapists also requires students and interns to identify themselves as such.
We are aware of a number of cases where prelicensed therapists contract for
supervision with licensed therapists who do not work at the same agency or do
not have access to client files and other important information regarding client
162 IDM Supervision: An Integrative Developmental Model
treatment and therapist competence. This is risky at best, and anyone who ven-
tures into such an arrangement runs the risk of providing inadequate supervi-
sion and monitoring of client progress, with the associated legal exposure.
This notion of ultimate responsibility necessitates that supervisors be
available for emergency consultation with the supervisee. In addition, if the
situation requires, the supervisor should be prepared to provide direct inter-
vention with the supervisee’s clients.
In certain settings, it is common for the supervisee to have more than one
supervisor. We previously noted the advantages of having different supervi-
sors for clinical as opposed to administrative responsibilities. Occasionally
there are situations where more than one supervisor is assigned to a super
visee. For example, many predoctoral internships in psychology assign a pri-
mary supervisor to an intern for the entire training experience, while other
supervisors have responsibilities for given rotations. It is important to deter-
mine who will assume specific supervisory responsibility for which aspects of
the supervisee’s practice in such arrangements. Similarly, in our own train-
ing clinic, we have doctoral students supervise master’s-level students; group
supervision, and the ultimate responsibility for client welfare, rests with a
faculty supervisor.
Ethically, no one should engage in psychotherapy concerning a given issue
with a client who is under the care of another professional examining the same
issue. Similarly, there are ethical problems when two supervisors provide super-
vision to a trainee for the same clinical activity. The likelihood is too great that
the supervisee will be put into a bind by differing expectations or guidance
provided by more than one supervisor. In addition, the lines of professional
and legal responsibility can become blurred in such an arrangement.
We occasionally encounter other situations where more than one supervi-
sor may be responsible for the services provided to clients. In our own clinic,
it is common for trainees to engage in cotherapy with couples and families,
usually a valuable learning experience. Here, it must be clarified who has
supervisory responsibility for the therapy if each trainee has a different pri-
mary supervisor. Once lines of authority are established, it is important that
the supervision be left to the supervisor who has been assigned the responsi-
bility; the other supervisor must avoid assuming responsibility for this case.
Consistent with our focus on nuts and bolts in this chapter, it is impor-
tant to examine certain instrumental aspects of clinical supervision. Various
resources examining the practice of clinical supervision differ in regard to the
amount of attention they devote to specific procedural aspects of supervision
versus an overall orientation or model of psychotherapist development and
Nuts and Bolts of Supervision 163
training. In this book, we have chosen to articulate a model of professional
development and training while providing specific guidance for dealing with
supervisees of various developmental levels for different domains of clinical
activity. Other resources focus more on specific tools or mechanisms useful
for learning particular skills, instrumental supervisory tasks, documenta-
tion of activities, and prototypical forms. Although we have chosen to limit
our focus on these resources in this book, we recognize the utility of this
approach, particularly for beginning supervisors. One excellent source for
some of these materials is Practicum and Internship: Textbook and Resource
Guide for Counseling and Psychotherapy by Boylan and Scott (2009).
Consistent with our format of integrating research and theory from other
areas to the training and supervision of therapists, we will now expand upon
some issues we have addressed in prior chapters. Specifically, we will look at
ways to enhance trainees’ understanding and utilization of empathy, social
facilitation, reflection, and motivation.
Enhancing General Skill Development
Duan and Hill (1996) describe empathy as understanding what clients are
thinking, saying, and feeling. Although empathy is often associated with cer-
tain counseling skills, such as reflection of feelings, the therapist can “guess”
at a client’s feelings (sometimes correctly) without actually empathizing with
the client. We have noticed in skills training with beginning counselors that
the process of learning the behavior of reflecting feelings can sometimes
interfere with or replace actually sensing the client’s emotional experience.
As we have previously noted, this is typically a greater problem for Level 1
therapists, who tend to be more self-focused. One of us distinctly remembers
sitting in a counseling session early in our training experience trying to think
of a feeling to reflect to the client.
Goleman (2006) has explicated in considerable detail how emotion is
experienced and processed, delineating the cognitive processing (low-road
and high-road) that enables us to empathize with others. Considering these
processes can be helpful in assisting trainees to more fully develop these abili-
ties. For Goleman, primal empathy is the process by which we feel with oth-
ers by sensing nonverbal signals and allowing our own mirror neurons to be
activated in interaction with others. Traditionally, eye contact is considered
an important way to communicate to clients that they are being attended
to (in association with other attending and listening skills), though this
varies according to culture (Hill, 2004). For primal empathy, however, eye
164 IDM Supervision: An Integrative Developmental Model
contact enables therapists to actually experience the same emotions as clients
by activating mirror neurons if they focus intently on the client and shut
down their own internal dialogue (that is, they avoid self-focus, or RIA).
When therapists attune to the client, they listen with full receptivity in a
sustained manner that reflects a lack of agenda on their part and facilitates
rapport (Goleman, 2006). The stage is set for empathic accuracy if therapists
have successfully tuned in to the client’s experience, effectively processed the
low-road emotional reactions they have had, and labeled them accordingly.
Here, again, note the importance of the interplay of an intensive focus on the
client with the necessary (high-road or conscious) processing of the client’s
emotional experience and helping the client symbolize it through words and
integrate it with his or her cognitive experience. The effective therapist will
sort through his or her emotional experience with the client and appropri-
ately label the feelings and their origin. To review, a therapist may experience
primal empathy, or resonate with the client, and the therapist’s emotions are
those currently experienced by the client; the therapist may be experienc-
ing his or her own idiosyncratic emotional reaction to the client (primary
or secondary) that is a function of the therapist’s own life/learning experi-
ences but not necessarily reflective of the client’s emotional experience; or
the therapist may be having a more generalized emotional reaction to the
client (general interpersonal), similar to what others experience in interac-
tion with this person. Accurate assessment of this emotional experience has
important implications for successful therapy with clients as well as ramifica-
tions for the effective implementation of certain therapeutic approaches. For
example, Teyber (2006) argues from a relational perspective, and Cashdan
(1988) from an object relations one, that the therapist should recognize the
emotional pull of the client and, essentially, describe his or her reaction to
it, providing (somewhat differently depending on orientation) feedback on
the client’s behavior. To do this effectively and honestly for the client, the
therapist needs to accurately assess what he or she is reacting to (whether the
reaction is empathy, a personal reaction, or a general reaction). The therapist’s
own primary or secondary emotions may be more a function of his or her
own experiential history and how he or she has processed it than what is
actually being provided by the client. Similarly, if the therapist has a cultur-
ally narrow or ill-defined understanding of social cognition (how the social
world works), the feedback provided to the client can be misleading, harm-
ful, or self-serving.
One role of the supervisor is to assist the trainee in developing his or her
therapeutic “instrument” so that the trainee’s emotions and cognition can
Nuts and Bolts of Supervision 165
work synergistically in enhancing understanding of the client and communi-
cating that understanding. (Of course, as noted by Greenberg, 2002, emotions
and cognitions are, in a sense, somewhat arbitrary distinctions and are inti-
mately interconnected.) For a Level 1 trainee, the challenge will be to get the
therapist to focus sufficiently intently upon the client to enable some degree of
empathy and attunement. Given that this level of trainee is still struggling to
understand the therapy process and his or her role in it, as well as master some
of the fundamental counseling and assessment skills, the supervisor should
not expect much more than sympathy, or effective imitation with occasional
empathy. Nonetheless, encouraging the intensive focus on the client, good
eye contact, and an openness to receptivity is necessary (but not sufficient).
Again, sorting out any resulting emotional experiencing or understanding
will be important, and fitting that into a more comprehensive conceptualiza-
tion of the client will require considerable ROA during supervision.
For Level 2 trainees, who have shifted away from the Level 1 trainee’s dom-
inant self-focus, an intensive focus on the client is more possible. Still, this
doesn’t automatically result in more empathic accuracy; it may still elicit iden-
tification with or sympathy for the client. The emotional resonance with the
client’s affect may not be effectively processed through RIA, or the therapist’s
idiosyncratic or general emotional reactions to the client may take precedence.
Although these latter emotional experiences are still quite useful for assess-
ment and for the therapist’s understanding of him- or herself and the client,
misattribution of the origin of these emotions or mislabeling them can inhibit
work with the client as well as growth of the trainee. ROA and processing the
therapist’s own reactions, thoughts, and feelings in session and in response
to the client will be necessary to enhance learning and the development of
expertise. If training has proceeded according to our model, Level 3 therapists
should have a solid foundation upon which to build further integration and
development across domains. As we have regularly noted, during supervision
it is important to not let the focus change from the client or the therapeutic
development of the supervisee to one of therapy with the supervisee.
As we have consistently noted throughout this book, simply discussing
clients with the supervisee isn’t sufficient to understand what actually occurs
in sessions or to effectively evaluate the developmental level of the supervi-
see. We will discuss other mechanisms for evaluation later, but the role of
observing and processing video of therapy sessions with supervisees cannot
be overemphasized. Although reviewing videotape in supervision has been
shown to both enhance and detract from a trainee’s performance, Huhra,
Yamokoski-Maynhart, and Prieto (2008) have argued that this inconsistent
166 IDM Supervision: An Integrative Developmental Model
effect is due to the atheoretical nature of the research in this area. They have
recommended differential intentions and use of videotape with respect to
developmental differences in trainees based on the IDM.
To enhance trainees’ processing of their interactions with clients and learn-
ing from these experiences, supervisors tend to heavily rely on reviewing video
of sessions. Often supervisors will find themselves asking questions to stimu-
late ROA by the supervisee with regard to particular interactions with clients
or segments of sessions. These can lead to confrontive, conceptual, or catalytic
interventions as well as prescriptive ones, if necessary. If a supervisor’s goal is
to enhance processing of the emotional experiencing in a session, he or she
might use the following questions in response to specific video segments.
• What is the client feeling at this point in the session?
• How did you determine that?
• What are you feeling at this point in the session?
• What are those feelings in response to?
• What are you feeling now?
These questions, or variations of them, are intended to guide trainees to
more intently focus on the emotional experiencing of the client as well as the
trainee’s own affect. Although the intensive eye contact that enables acti-
vation of mirror neurons is absent in viewing video, verbal and nonverbal
cues can still be examined for their emotional content (see Hall & Bernieri,
2001, for a discussion of sensitivity to nonverbal cues in understanding emo-
tions). Using sensitivity in asking about and pursuing understanding of
emotional content in sessions (and in supervision), the supervisor can help the
trainee sort through both the client’s experience and the origin of emotions
experienced by the therapist in reaction to the client (see Greenberg, 2002,
for a detailed discussion of the role of emotions in integrated approaches
to therapy).
Beyond encouraging a recognition and labeling of emotion in sessions,
processing how the therapist deals with these and incorporates them into a
conceptual framework for therapy is also important. A trainee with limited
experience is still developing an understanding of the overall therapy process
and how his or her minute-by-minute and session-by-session behaviors fit in
and contribute to success. Helping the trainee examine his or her own behav-
ior and putting it into a context can be very helpful. Additionally, train-
ees of all levels can fall into patterns of habitual responding during therapy
(overreliance on KIA and insufficient attention to client responses) and not
Nuts and Bolts of Supervision 167
remain cognizant of where they are in the process and how their actions are
advancing (or retarding) progress. When doing video review of therapy ses-
sions, we have found that addressing critical incidents or examining certain
segments using the following questions can be useful in assisting the super-
visee to process what occurred in specific sessions as well as fitting that into
the overall therapeutic plan:
• What are you doing here?
• What purpose does it serve?
• Is it working?
• How do you know?
• How does this fit into your overall plan?
Of course, the behaviors being highlighted and the responses that can
be expected from trainees will vary by developmental level. As noted by
Vansteenkiste, Lens, and Deci (2006), it is also important to enhance the
goal framing of the supervision process by providing a rationale for the
learning process that enhances intrinsic goals. Supervisors should adopt an
autonomy-supportive style of supervision as opposed to a more controlling
one that would tend to elicit more extrinsic motivation or amotivation on
the part of the trainee. The process questions listed above should be used to
stimulate discussion and understanding of how specific supervisee behaviors
during any given segment of a session fit into an overall plan for therapy
(enhancing schema development). Responses and subsequent follow-through
will vary according to therapeutic orientation and the stage of therapy, but
this ROA process can help supervisees explore and articulate their under-
standing of the process and how they are engaging in it.
An example of the positive impact of supervision in an applied setting is a
recent study on community-based interventions for child neglect that exam-
ined another important mechanism related to skill development (Aarons,
Sommerfeld, Hecht, Silovsky, & Chaffin, 2009). The concern addressed by
the study was that implementation of a structured evidence-based practice
(EBP) approach in community agencies would have a negative effect on staff
retention. The researchers examined the EBP approach with and without
ongoing fidelity monitoring (consultation/supervision) in addition to a “ser-
vices as usual” approach with and without ongoing fidelity monitoring. The
participants (153 home-based service providers in 21 teams) were followed for
29 months; the fidelity monitoring took the form of supportive consultation/
supervision consistent with the IDM approach to supervision. The EBP with
168 IDM Supervision: An Integrative Developmental Model
fidelity monitoring condition produced the best retention rates for social ser-
vices staff, indicating that introduction of structure through implementa-
tion of an EBP need not have a negative effect on retention of staff if they
are provided with supportive ongoing consultation/supervision. In fact, such
supervision can actually enhance retention, reducing the need for regular
recruitment of social services providers and increasing program continuity.
Scientist–Practitioner Methods of Supervision
Stoltenberg and Pace (2008) have suggested a three-stage approach to super-
vising that includes: “(1) assessment of modifying factors relevant to process
goals (including ongoing evaluation of supervisee effectiveness); (2) formula-
tion of a supervision plan; and (3) implementation and on-going evaluation
of supervision” (p. 80). Two major goals must be balanced in supervision:
monitoring client welfare and enhancing supervisee development. The devel-
opmental level of the supervisee will affect the degree of ongoing attention
to monitoring client well-being, although this is always important. Preferred
mechanisms to enhance supervisee professional development will also vary
depending on the current state of development for the domains of focus in
supervision. A variety of methods are typically used to monitor client prog-
ress, including regular review and discussion in supervision of client symp-
toms, background and risk factors, and personal goals; observation of sessions
(live or video); formal assessments; and (sometimes) supervisor interaction
with the client (Stoltenberg & Pace, 2008).
Early in training, the focus of supervision is often more on developing
basic skills and attitudes toward therapy. We believe that the scientific and
professional literatures are important resources for trainees to learn to access
early in their training so that the habit of keeping up with advances in the
field can continue throughout professional practice. Consistent with research
on learning and the development of expertise (Anderson, 2005), early skill
development is facilitated by incorporating considerable opportunity for
guided practice, modeling and coaching by the supervisor, and specific feed-
back to the supervisees concerning their performance and sequencing of the
skills being learned (Stoltenberg & Pace, 2008). As these skills become more
natural and are integrated into supervisees’ KIA, more focus on developing
advanced critical thinking abilities as well as a broader and deeper under-
standing of the theoretical and research literatures is in order. Therapist bias
Nuts and Bolts of Supervision 169
and premature closure to sources of information (Westen & Weinberger,
2004) can be attenuated by assisting trainees to focus on sources of informa-
tion and input that can improve the reliability and validity of their obser
vations and therapeutic decisions. Broad and exhaustive case presentations
(see the Case Conceptualization Format, appendix A), case conferences,
targeted literature reviews, extensive reading and discussion of theory, and
so on can increase trainees’ knowledge, understanding, and integration of
important concepts and processes in the field. As previously noted, develop-
ing empathy and emotional competence (Goleman, 1995) is also important
theoretically, conceptually, and behaviorally in conducting therapy. Empathy
training, multicultural awareness exercises and experiences, appropriately
focused exploration of the trainee’s personal life experiences, and referral for
personal therapy can be important mechanisms for augmenting this growth
(Stoltenberg & Pace, 2008).
Over the course of training, supervisors can help supervisees recognize
their strengths and limitations by carefully assessing trainee skills, knowl-
edge, and development; by encouraging RIA during therapy sessions; and by
encouraging productive ROA during supervision sessions as well as between
sessions. Recall that there can be a tendency for early trainees to want to latch
on to and identify with a specific theoretical orientation. This serves to sim-
plify the learning process, make therapy and clients seem less complex and
more understandable, and reduce a sense of amotivation or extrinsic motiva-
tion. Stoltenberg and Pace (2008) warn “that too early of an emphasis on a
single theoretical model or set of techniques may foster premature closure of
exploration of alternatives, thus, effectively creating attitudinal and emotional
blocks inhibiting supervisees from considering and exploring other perspec-
tives” (p. 83). Consistent with Schön’s (1987) description of schema refine-
ment, careful attention in supervision to the process of therapy engaged in by
supervisees (observation) can help them become aware of limitations in the
KIA and augment RIA to respond on the fly to events in therapy. As experi-
ence grows and therapy events are processed, limitations in supervisees’ RIA
ability become apparent, and intensive ROA (some of which occurs in super-
vision) can sensitize the trainee to gaps in knowledge, understanding, and
skills that can then be addressed. If these inadequacies are not recognized, the
need for improvement is not acknowledged and development stalls. If they are
recognized and processed within an autonomy-supportive supervision envi-
ronment, the motivation to focus on additional (or develop a more articu-
lated understanding of) theoretical models, advanced techniques, and other
170 IDM Supervision: An Integrative Developmental Model
evidence-based practices can be enhanced. This will enable the elaboration
and refinement of relevant schemata and translate into an ability to respond to
more complexity in the therapeutic process by the developing supervisee.
Supervisee Qualities
We discussed in some detail in Chapter 1 how motivation or readiness for
change affects learning across domains and settings. Supervisees’ sense of
competence, autonomy, and relatedness (Ryan & Deci, 2000) will impact
their ability to perform and their motivation to learn and develop. The range
in motivation and associated regulation mechanisms as well as goal orien-
tation (Vansteenkiste, Lens, & Deci, 2006) that supervisors are likely to
see necessitates flexibility and broad skills on the part of the supervisor. As
Stoltenberg and Pace (2008) note, the goals of early trainees, or ones mov-
ing into new domains of practice, may be quite narrow and simplistic due
to a reliance on limited prior experiences and their self-efficacy in aspects of
professional practice. Change and development can be slow, and the supervi-
sor is advised to be patient, establish a trusting supervisory relationship, and
slowly build skills and enhance knowledge in the trainee, which will lead to
improved confidence and self-efficacy.
All supervisees (and supervisors) will have had limited life experiences
upon which to draw in dealing with clients in professional practice. Each
person’s worldview will largely be determined by his or her range of life
experiences and how they have been processed. The cultural encapsulation
(Ridley, Mendoza, Kanitz, Angermeier, & Zenk, 1994; Wrenn, 1962) that
will characterize many trainees will necessarily limit their worldview. A
focus of supervision, then, should be to assist supervisees to explore their
own perspective and learn about other views of the world that are likely to
be reflected in their clients and colleagues. The schemata that supervisees
have developed over their lives reflect the sociocultural perspectives they have
experienced and incorporated (McVee, Dunsmore, & Gavelek, 2005). These
can be expanded and altered through additional exposure and processing of
experiences (broadening schemata). Bernard and Goodyear (2004) recom-
mend an openness to exploring multicultural issues with supervisees in order
to enhance the supervisory relationship. Stoltenberg and Pace (2008) sug-
gest a broad examination of these issues, noting that relevant “dimensions
may include gender, race-ethnicity, SES, rural-urban backgrounds, relational
and family status (marriage, children …), sexual orientation, spiritual and/or
religious differences, age, life-stage, career-stage, health, personality, and
Nuts and Bolts of Supervision 171
situational demands or stressors” (p. 85). We might note that this range of
dimensions of diversity is considerably broader than what many supervisees
might consider.
Supervision Plan
As we have discussed, deciding upon a supervision plan for trainees necessitates
assessing developmental levels for the specific domains of practice that will
be focused upon in the supervision relationship. This assessment will address
supervisees’ status on the overriding structures we addressed in prior chapters
as well as competencies (Fouad et al., in press; Falender & Shafranske, 2004;
Hatcher & Lassiter, 2007; Kaslow, Borden, et al., 2004; Rodolfa et al., 2005)
that reflect the given domains of focus within the supervised domains (see
appendix B for a practicum of competencies).
Stoltenberg and Pace (2008) recommend that the second level of planning
take into account a contextual as well as multicultural perspective where
situational and individual factors (relevant for supervisees and supervisee/
supervisor interactions) are considered in order to intentionally engage super-
visees in ways that draw on their experiences and cultural background to
expand their strengths and address areas of growth. This focus is directly on
supervisees’ clinical work as well as their professional development. Similarly,
a third level of planning should consider characteristics of the supervisor,
including personal and professional beliefs, interests, expertise, and biases.
It is important for supervisors to avoid relying on doing what is comfort-
able or habitual rather than attuning to the specific person and needs of
supervisees, their clients, and the contexts in which they function. A cul-
tural self-assessment by the supervisor can help him or her remain open and
engaged in the learning process (for both supervisee and supervisor) that is
clinical supervision.
The last level of the supervision plan or formulation should directly
acknowledge agency culture, needs, and policies and how they impact the
addressing of specific client needs. Professional and ethical standards should
be intentionally considered within the framework of the agency setting as
well as legal considerations (which can vary by state). Also important to con-
sider are the strengths and limitations of resources (including competencies)
of the agency and the specific needs and standards of the community in
which it functions. For example, it is often the case that nonuniversity com-
munity training sites lack adequate video resources to allow for the direct
observation and monitoring of clinical work that is required for effective
172 IDM Supervision: An Integrative Developmental Model
supervision. Given these limitations at certain sites, it would be ill advised
to rely on these settings for the majority of clinical training, but they could
be utilized by advanced trainees desiring particular professional experiences
that are available only at these sites. In our own training programs we recog-
nize the need for our master’s students to gain experience with agencies and
client populations that may differ from the nature of our own training clinics
and the clientele who are served by them. Nonetheless, we require a year of
supervised experience in our own clinic, under direct and video observation,
prior to allowing our students to gain experience in external settings where
such observation isn’t always available.
Evaluation
The aspects of the supervision plan we discussed above can be formally writ-
ten and agreed upon by all parties (essentially, a supervision contract) or
they can be informally addressed through discussion by the involved par-
ties (supervisee, supervisor, supervisor of supervisor, etc.). Although written
contracts can reduce confusion and conflicts, focusing too much on constant
documentation or rigidly adhering to an initial plan can be counterproduc-
tive. Ongoing assessment is important, however, for initial and emerging
perspectives to be recognized and evaluated. As we have noted, supervisee
developmental level across domains should be continuously assessed (self-
other awareness, motivation, autonomy) with attention paid to specific com-
petencies. The effectiveness of the supervisor in responding to supervisee
(and client) needs and in providing appropriate supervision environments
to encourage development is important to monitor. The unique cultural and
contextual factors that make up any given supervisory relationship within a
particular agency context need to be focused upon, and the changing sta-
tus of the supervisory alliance (Efstation, Patton, & Kardash, 1990) should
be monitored. Crucial to all assessments of supervision effectiveness is an
ongoing evaluation of the clinical effectiveness of the supervisee, which
necessitates evaluation of client outcomes (Lambert & Hawkins, 2004). The
impact, positive and inhibiting, of the educational resources and climate
in the training agency also needs to be assessed so that informed decisions
about the need for resources or for expanding or limiting the training mis-
sion can be made.
Various approaches exist for evaluating supervision. We will now move
into a more specific discussion of some of them.
Nuts and Bolts of Supervision 173
Setting the Stage in Initial Sessions
The initial meetings between the supervisor and supervisee set the stage for
a positive working relationship. Some authors have described this process as
the development of the supervision alliance, similar in concept to the thera
peutic alliance (Bordin, 1983; Efstation, Patton, & Kardash, 1990). The
importance of this relationship and its development is the primary focus of
Chapter 6 in this book.
It is important for each participant to gain an early understanding of the
professional experience and background of the other. Although the primary
focus will be on the training needs of the therapist, the supervisor should
provide information on his or her theoretical orientation(s), professional
experience across domains, and approach to supervision. This information
allows the supervisee to develop an initial sense of the expertise and cred-
ibility of the supervisor and an impression about the domains for which the
supervisor will be able to provide effective supervision. The supervisor should
collect, either formally or informally, information from the therapist con-
cerning the extent of prior therapy, assessment, consultation experience, and
any other experiences relevant to the domains to be addressed in supervision.
It is also important to assess the expectations of the supervisee regarding
supervisor availability, how the sessions will be conducted, who is responsible
for what level of structure, and so on. These expectations are generally subject
to change as the supervision relationship develops, but clarifying them early
on can help avoid disappointment or resentment should the experience differ
from expectations.
Ethical guidelines note the importance of establishing an appropriate
process for providing feedback to students and supervisees. They should
be informed about the expectations for performance, how their work will be
evaluated, how feedback will be provided, and the responsibilities associated
with the clinical practice experience. It is important to attend carefully to the
mechanisms for evaluation and feedback in supervision. Therapists should be
evaluated on the basis of actual performance or established training require-
ments, not on subjective perceptions of personal characteristics or unsubstan-
tiated negative impressions of the theoretical orientation implemented.
We have found it useful to share with the supervisee the specific criteria
for evaluation. This usually takes the form of an evaluation instrument that
is reviewed in supervision every couple of months and completed at the end
of the supervision relationship or periodically during extended supervisory
174 IDM Supervision: An Integrative Developmental Model
relationships. The instrument, or series of criteria, should reflect expectations
and standards relevant to the goals and objectives of the training experience
or job description.
No one form suffices across all settings, so it is important to take some
time and develop criteria targeted for a particular supervisory experience. If
possible, it can be useful to have the supervisee participate in the articulation
of goals and objectives and the related performance criteria.
Supervision is not a one-way street. It should also be made clear that
ongoing evaluation and feedback concerning the utility of the supervision
provided will be collected. We recognize that there is an obvious power dif-
ferential present in most supervisory relationships that can inhibit honest
evaluation of the supervision or result in retribution by the supervisor. Still,
it is difficult for supervisors to improve or effectively evaluate their own per-
formance without detailed feedback from their supervisees. It is most helpful
if an organizational climate can be established within a mental health facility
that values candid and regular feedback across roles. Although it is difficult to
completely rule out negative fallout from supervision evaluation procedures,
structural protections should be developed to allow all parties the opportu-
nity to evaluate the experience without undue fear or apprehension.
Finally, a review of current cases and clinical responsibilities of the super-
visee should be conducted. This will usually need to be quite brief, given the
other issues to be addressed in the initial session. More extensive information
regarding clients and activities can be acquired by an examination of relevant
case notes, reports, and so on by the supervisor outside the supervision ses-
sion. However, the stage should be set for the continuation of monitored
treatment by the supervisee with informed input by the supervisor. Also,
the schedule for subsequent supervision sessions, expectations for channeling
paperwork, and so on should be established by the end of the session.
Supervisee Assessment and Evaluation
Assessment and evaluation of therapists play an ongoing and fundamental
role in the supervisory process. It is necessary to alter the approach to super-
vision to meet the changing needs of supervisees across developmental lev-
els and contexts, and to provide the appropriate supervision environment to
encourage and facilitate growth. By exposing supervisees to an environment
that is too advanced, supervisors run the risk of inducing confusion and
anxiety, as well as negatively affecting client welfare. If therapists are exposed
Nuts and Bolts of Supervision 175
to an overly structured environment, their growth is frustrated, and they may
become bored, inattentive, and resistant.
By identifying the eight domains of development across the three struc-
tures, we have stressed the need to examine a number of areas within a
particular level of development in order to accurately assess supervisees.
Also inherent within the IDM is the assumption that assessment is an ongo-
ing process and intimately related to the process of evaluation. Consistent
with this is the provision of timely feedback to developing therapists in
which their strengths and areas of weakness or improvement are clearly
articulated and discussed in the context of the supervisory relationship.
Across supervisory settings and developmental levels, therapists are under-
standably sensitive to evaluation. The implications of evaluation for grades,
recommendations for internship, professional advancement and compensa-
tion, or licensure or certification information required by regulatory bodies
are substantial. Consequently, the power differential that exists between
supervisor and supervisee, as well as the threat to the personal and profes-
sional development of therapists, adds to the anxiety associated with the
evaluative process.
Unfortunately, supervisors, because of concurrent trepidation, negative
connotations, and anxiety associated with evaluative procedures, all too often
avoid what they perceive as negative feedback or instead give only vague and
overly general feedback to developing therapists. This sort of evaluation does
little to strengthen supervisee skills. Indeed, it is often the failure in identify-
ing areas of weakness during the evaluative process that inhibits the develop-
ment of therapists, resulting in the pseudo–Level 3 therapist.
From our perspective, the process of assessment and evaluation need not be
characterized by these difficulties. The IDM provides a conceptualization where
identification of domains in which therapists demonstrate areas of strength and
need for improvement is normalized. Referencing performance across levels
according to supervisees’ previous training and experience in various domains
reduces the negative aspects of evaluation. The overriding structures also pro-
vide a context for normalizing the issues and struggles that supervisees can
expect to encounter along the road toward development as a therapist.
Therapeutic Effectiveness of Supervisees
Stoltenberg and Pace (2008) have discussed how evidence-based practice
in psychology (EBPP) principles can be applied to clinical supervision.
176 IDM Supervision: An Integrative Developmental Model
“Ultimately, if, as supervisors, we are unaware of the impact of our super-
visees on their clients, it is difficult to consider what should be emphasized
in supervision beyond simply attending to the requests or reactions of the
supervisees in supervision sessions, or professional development concerns
that become apparent in our interactions with them” (p. 79). Additionally,
supervisors may fall into the habit of largely promoting their own theoreti-
cal orientation, or understanding of the therapy process, through discussion
rather than focusing on the impact of the supervisee-as-therapist in interac-
tion with the client. Much of the following is based on the observations and
recommendations of Stoltenberg and Pace (2008).
Previously in this chapter we noted the importance of helping the super-
visee remain aware of the overall therapy process, plans, and goals when
addressing specific issues in supervision. Fitting the session-by-session thera-
peutic process into a framework is an important part of understanding and
facilitating the process. In her three-stage model of helping, Hill (2004)
presents a framework that is readily understandable for beginning trainees.
Similarly, the literature on empirically validated and supported treatments
(EVTs, ESTs; Chambless, Baker, et al., 1998; Chambless, Sanderson, et al.,
1996) provides a framework for assessment, intervention, and evaluation that
addresses the entire process of therapy from initial session to termination
(and sometimes follow-up). Although reactions to these approaches and their
utility are not uniformly positive and considerable discussion now centers
on the role of common factors across approaches (see Norcross, Beutler, &
Levant, 2006, for varying perspectives), the importance of seeing therapy as
a sequential process and of measuring progress remains. Similarly, issues of
generalizability and portability of approaches are useful to consider (Jacobson
& Christensen, 1996; Jacobson, Roberts, Berns, & McGlinchey, 1999).
It is not our purpose to encourage the use of manualized treatments or
to dictate what evaluation criteria are used to assess the impact of therapy.
Indeed, there is considerable debate about the relative merit of these fac-
tors (Addis & Cardemil, 2006; Duncan & Miller, 2006; Ollendick &
King, 2006; Stricker, 2006; Wampold, 2006). However, assisting trainees
in evaluating their impact on clients and collecting evidence of effectiveness
remains important. Often discussions in supervision center on the particular
theoretical orientation being used by supervisees in their work with given
clients. Some orientations are more amenable to certain types of data collec-
tion than others (e.g., thought measures for cognitive therapies, behavioral
frequencies for behavioral interventions, and so on). An approach to evaluat-
ing therapeutic effectiveness that we have found useful is case studies, when
Nuts and Bolts of Supervision 177
one is interested in examining his or her own behavior and that of the client,
against constructs deemed relevant for a given theory. Sometimes, as with
certain relational approaches, particular process variables are thought to be
crucial in having an impact on outcomes, so identifying and measuring these
(e.g., therapeutic alliance) can be enlightening (process research). Also, if
the focus is on identifying and measuring discrete client behaviors before,
during, and after interventions, N = 1 or single-participant studies are appro-
priate (see Stoltenberg & Pace, 2007 for a more detailed discussion of the
use of these mechanisms in supervision). Heppner, Wampold, and Kivlighan
(2008) and Norcross, Beutler, and Levant (2006) provide detailed discussion
and examples of these approaches to research.
This focus on evaluating the effectiveness of supervisees with their clients
is consistent with EBPP principles and can be very helpful in illuminating
relative areas of strength and weakness for the trainee across various con-
texts. Further, part of the rationale for EVTs and ESTs is that the therapist
is using approaches that have met certain criteria for effectiveness. However,
these approaches do not necessarily translate into effective therapy when they
are implemented by a given therapist. This can be determined only by eval
uation of each therapist with each client. “The results of nomothetic research
are to be complemented by idiographic research in which practitioners study
their own outcomes” (Reed, Kihlstrom, & Messer, 2006, p. 44). Additionally,
process and outcome evaluation interacts with and informs assessment of client
needs, which in turn impacts the therapy process. Inculcating a value of self-
evaluation in supervisees sets into motion a framework that will allow them to
continue to develop professionally beyond a particular supervision experience.
Qualitative Assessment Across Domains
In previous chapters we outlined in detail the characteristic thoughts, feel-
ings, and behaviors associated with each of the developmental levels in terms
of the overriding structures across the eight domains of therapist experience.
The complexity of our model is such that evaluation of therapists encom-
passes accurate assessment across domains. Although this type of qualitative
assessment involves the clinical judgment of the supervisor, it is necessary
to move beyond global clinical impressions related to general developmen-
tal level. Figure 7.1 provides a method of organizing supervisor impressions
according to developmental level and overriding structures across the eight
domains of counselor development.
178
Figure 7.1
Counselor Development Profile
s
i lls n ce
Sk l n re
n t tio e s l
io na a iff al t lan na
nt nce en r so nt l iz D ic
e e s m ue s e e ua u al r et tion m
en d P
s sio
rv t es q rp nt t id t n e
te pe ss ni te ssm i e ep iv eo ta ea s a of s
In om A ech In sse C l onc d Th rien Tr oal Pr thic
C T A C In O G E
Three
Two
One
IDM Supervision: An Integrative Developmental Model
M A DA M A DA M A DA M A DA M A DA M A DA M A DA M A DA
Note: M = Motivation, A = Awareness, DA = Dependency/Autonomy
Nuts and Bolts of Supervision 179
Methods of Assessment
Stoltenberg and Delworth (1987) reviewed and evaluated a number of meth
ods used to quantify supervisee behaviors through various rating scales and
measures, supervisee and supervisor perceptions, behavioral observations,
coding systems, and client ratings. Some of these scales have been updated
or revised and more recent measures developed (Bernard & Goodyear, 2004;
Stoltenberg, McNeill, & Crethar, 1994). Although these scales provide valu-
able information related to the characteristics of therapists, most are pri-
marily used to gather information and quantify certain specific supervisee
behaviors for the purpose of research investigations. Thus, they are usually
limited to a single perspective or a range of characteristics associated with
a particular research topic, and tend to be less practical in conducting the
ongoing comprehensive assessment process of developmental supervision
associated with the IDM.
Although measures of client outcome are crucial to the identification of
factors related to effective training, they tend to be less readily accessible in
the ongoing process of assessment and evaluation (Stein & Lambert, 1995).
Thus, our focus is on the procedures that are most practical and available
to working supervisors across settings in assessment and evaluation from a
developmental standpoint. We also discuss useful information from instru-
mentation, work samples, and reports from supervisees and supervisors that
are relevant to qualitative assessment and evaluation.
Work Samples
Direct access to therapists’ working skills and behaviors by means of live
observation or videotapes or audiotapes of sessions is crucial to an accurate
assessment of current supervisee functioning. Similarly, in the provision
of feedback, behaviorally grounded impressions and observations provide
the specificity that supervisees most often desire. Replayed video excerpts
provide concrete examples of therapists’ interventions and immediate
client reactions. This record enables the supervisor to point out the impact
or lack of effectiveness of certain strategies or interventions. A discussion of
alternative strategies may then ensue; these strategies can be rehearsed or
role-played within the supervision session. There is no substitute for direct
access to sessions in order to obtain examples of supervisee behavior across
all eight domains. This is important for an accurate developmental qualita
tive assessment. In addition, we find the modified Case Conceptualization
180 IDM Supervision: An Integrative Developmental Model
Format a useful work sample directly indicative of therapist development
within the domains of client conceptualization, assessment, and treatment
goals. Psychological reports and case notes also provide examples of therapist
performance in various domains. It is very important, however, to assess a
variety of work samples from supervisees. Certain samples may be selected
based on perceived effectiveness, or they may be reflective of only limited
skills. In addition, work samples for one client may not be indicative of a
trainee’s work with another client. For example, it is not unusual for super-
visees to demonstrate skills in written activities (for example, diagnosis) but
have trouble implementing other skills in therapy sessions. Work samples
should not be limited to one modality if the goal is an accurate picture of a
therapist across domains.
Supervisee Perceptions
When supervisors and supervisees initially discuss and clarify their expecta-
tions regarding the supervisory process, supervisees will elaborate on their
perceived areas of strength and weaknesses across domains, along with previ-
ous supervised experiences with certain types of clientele and settings. This
manner of information gathering, probably most often performed informally
within the initial supervisory meetings, can be supplemented by more formal
methods and procedures.
The Supervisee Information Form (appendix C) can be completed by the
supervisee and provides information regarding therapy and assessment expe-
rience, supervision, preferred theoretical orientation, and perceived areas of
strengths and weaknesses. The completed form can be used with individual
supervisees as a springboard for discussion and further information gather-
ing. It can also be used as a quick assessment device in group supervision
contexts to gather information from a number of supervisees.
The Supervisee Levels Questionnaire—Revised (SLQ-R; McNeill,
Stoltenberg, & Pierce, 1985) was developed to measure the general con-
structs associated with the IDM (McNeill, Stoltenberg, & Romans, 1992). It
consists of thirty items divided into three subscales intended to measure the
overriding structures of dependency–autonomy, self- and other-awareness,
and motivation. Cronbach alpha reliability coefficients for the three subscales
have yielded reliability estimates of .83, .74, .64, and .88 for the self- and
other-awareness subscale, motivation subscale, dependency–autonomy sub-
scale, and total score, respectively. In addition, scores on the SLQ-R have
Nuts and Bolts of Supervision 181
been demonstrated to differ for trainees varying in global levels of coun
seling, supervision, and educational experience.
The response format for the SLQ-R is a seven-point Likert scale with
“never” and “always” as polar anchors. Higher scores reflect higher levels of
development, as described in the IDM. Although the SLQ-R has been used
primarily as a research tool, it can also serve as an assessment device to give a
global indication of where supervisees fall within the three overriding struc-
tures. Examination of individual items with supervisees can also yield useful
information for assessment of issues surrounding dependency–autonomy (for
example, “At times I wish my supervisor could be in the counseling/therapy
session to lend a hand”), motivation (for example, “Sometimes I question
how suited I am to be a counselor/therapist”), and self- and other-awareness
(for example, “I am able to assess my interpersonal impact on clients ade-
quately and use that knowledge therapeutically”).
As we have previously noted, supervisee perceptions and self-reports yield
some of the richest and most important data regarding therapist attitudes,
thoughts, feelings, and behaviors. Nevertheless, particularly during Level 1
and at times during Level 2, supervisees may not be sufficiently self-aware or
resistance free to respond to questions in an accurate manner. At times, they
may be subject to the demand characteristics of the supervision environment,
resulting in responses that reflect more what the therapist believes he or she
is supposed to think or feel or a reaction against such a demand. Thus, super-
visees’ perceptions of their own development are valuable, but supervisors
must also consider the wide spectrum of information available in conducting
a thorough assessment.
Supervisor Perceptions
At the start of a supervisory relationship, supervisors often must rely on eval-
uations of supervisees provided by previous supervisors. These evaluations,
in written and oral formats, are typically based primarily on the percep-
tions of a previous individual supervisor, although they may also include
the perceptions of other staff members who have worked with the therapist
in other activities. Often, however, these evaluations tend not to be based
on systematic criteria and may provide only vague general assessments of
overall positive and negative aspects of a therapist’s current functioning in
a limited number of domains. As supervisors working from the IDM, we
find that many times evaluations based primarily on supervisor perceptions
182 IDM Supervision: An Integrative Developmental Model
are overinflated in terms of positive attributes or overly negative in terms of
unrealistic expectations given a supervisee’s expected and demonstrated level
of development. In addition, supervisor impressions can be overly subjective
and biased in favor of a particular theoretical orientation. Such a report does
not provide a fair, objective evaluation of a supervisee working from a differ-
ing theoretical orientation.
Supervisor evaluations can also be somewhat limited depending on the
focus of previous individual supervision. Evaluations of overall skills are some-
what suspect if a supervisor has not required recording of all ongoing clients
and failed to review supervisee performance periodically by some form of
direct access. If evaluations primarily rely on case notes or supervisee reports
of client sessions, they are likely to be incomplete.
In order to gain more useful information from supervisor perceptions, we
believe, it is necessary to obtain descriptions of therapist skills and charac-
teristics that are based on actual behavior. By seeking and obtaining more
behaviorally anchored descriptions of supervisees, supervisors are better able
to sort out what may have been an interpretation of a supervisee’s behav-
ior, and place those into a developmental context. In this manner current
supervisors can verify previous reports from supervisors as accurate, or place
supervisee behaviors that may have been reported as overly positive or nega-
tive in the proper developmental context. This, combined with other sources
of information, contributes to a more accurate overall assessment. As argued
by Westen and Weinberger (2004), our professional judgment surpasses the
layperson’s judgment only when they carefully attend to a systematic utiliza-
tion of objective and subjective data. Otherwise, they are as susceptible to
bias as anyone.
Providing Therapist Feedback
In order to set the context for ongoing assessment and feedback, supervisors
need to conceptualize for supervisees the overall process of development,
including expectations for developing skills within certain levels. For
example, new supervisees typically are expected to begin developing basic
facilitative listening and attending skills in the first semester of an organized
practicum. The purposes of assessment should be presented at the beginning
of the supervisory relationship so that the issue of evaluation is open and
discussed before problems or misperceptions are formed. Supervisees need
Nuts and Bolts of Supervision 183
to understand that it is in their best interests for assessment and evaluation
to occur on an ongoing basis. Feedback to trainees concerning their perfor-
mance should be provided in an ongoing manner during the supervisory
process. The qualitative assessment process requires collecting information
from a variety of sources. Once the assessment is completed, it is extremely
important to provide direct concrete feedback to the supervisee in the form
of a written or oral evaluation of skills at least once or twice during the super-
visory relationship. Typically, across training settings such formal evaluations
all too often lack a systematic format and may be limited to global impres-
sions or lack coverage of the various domains. In addition, the anxiety or dis-
comfort that some supervisors feel in providing an evaluation of a supervisee
and, in some cases, a grade or employment evaluation of therapeutic skills
causes them to avoid this activity.
We believe that the use of the IDM provides a system of assessment and
evaluation that helps to normalize the process of therapist development
in a nonthreatening manner. By conceptualizing supervisee strengths and
weaknesses in terms of levels of performance within various domains, the
emphasis is on the growth of the developing therapist. Although there are
skills associated with various approaches to therapy that must be learned
in order to provide effective service to clients, the IDM places skills and
techniques in a context of progressive movement toward a desired end state.
Thus, being at a particular level of development need not be viewed as
negative, but rather can be seen as the culmination of training to this point
in time.
Consequently, there is nothing wrong with being a Level 1 or 2 thera-
pist. Rather, it is a reflection of the individual’s development to date given
the growth-inducing experiences provided during the course of training and
how they have been integrated. Supervisees will experience different rates
of growth, and even with those who develop more slowly than others, the
rate of development need not be considered a limiting factor in potential
development. Thus, conceptualizing and communicating the process of eval-
uation and assessment to supervisees in this manner and remaining open
to discussion of feedback and areas of clarification or disagreement from
supervisees reduces the anxiety associated with evaluation. Feedback is pre-
sented within the context of the normal developmental process of becoming
a therapist.
The anxiety supervisees feel about evaluation can never be eliminated
entirely. However, normalizing the process through developmental assessment
184 IDM Supervision: An Integrative Developmental Model
and placing strengths and weaknesses in the context of the normal progres-
sion provides less tension for the examination of therapist strengths and
weaknesses.
Supervisors have the opportunity to model acceptance of and openness to
the evaluative process by seeking ongoing feedback and evaluation regarding
their own supervisory style. Evaluation of supervisors can also be performed
on a formal basis and communicated to supervisors at the termination of a
supervisory relationship.
Group Supervision
The supervision of psychotherapists in a group context is widely used and
has been a key component in training for a number of years (Bradley &
Richardson, 1987; Prieto, 1996). This format allows for a focus on the
interactions among trainees that is not possible in individual supervision
(Rosenberg, Medini, & Lomranz, 1982). Prieto has identified a number
of possible advantages of using the group supervision format, among them
the possibility of the supervisor’s observing shifting coalitions among mem-
bers, peer interactive learning, and various approaches to clinical (and inter-
personal) problem solving (Prieto, 1996). In addition, group processes such
as the development of goals, norms, roles, cohesiveness, and communication
patterns and structures can be apparent. Changes across time in these factors
may have a strong impact on the growth of the psychotherapist.
Our own experiences suggest that the relative advantages and disadvantages
of this approach vary with the constellation of the therapists who participate
in the group supervision context. For example, having therapists of varying
developmental levels may have some advantages. Less developed therapists
can learn by observation from their more advanced colleagues, and the more
experienced therapists may benefit from the didactic role they play in work-
ing with their less advanced colleagues. On the other hand, frustration may
develop when supervisees see others as considerably more advanced or, con
versely, requiring more of a focus on fundamental skills. The blend of person-
alities in the group may affect the nature of the process in positive and negative
ways. Some of our group supervision seminars have been characterized by a
warm and supportive environment and lighthearted challenges. Groups that
stay together for a year or more, as is customary in some training programs,
can benefit from knowing each other and each other’s styles rather well and
providing informed insights and observations. On the other hand, we have
Nuts and Bolts of Supervision 185
experienced groups where two or more therapists clashed on a regular basis.
In the most potentially damaging of these instances, the process can become
uncomfortably close to group therapy rather than group supervision.
In general, it appears that using more structured or didactic formats
with beginning trainees can be effective (Savickas, Marquart, & Supinski,
1986; Wilbur, Roberts-Wilbur, Morris, Betz, & Hart, 1991). However, we
have litt le solid empirical evidence for establishing strong assertions for
the effectiveness of group supervision, or reliable guidelines for conduct
ing it (Prieto, 1996). Nonetheless, we believe that perceptive supervisors
can facilit ate the development of their supervisees by using the learning
and group process possibilities of group supervision. They must carefully
attend to ethical guidelines and use their clinical skills to keep the process
functional and guard against damaging interactions. The focus should
remain on the supervisees’ professional development and their work with
clients and should not digress to group counseling with supervisees.
It is also quite common for training sites (for example, internship set-
tings) to arrange support groups for trainees. These experiences appear help-
ful in encouraging interactions, reducing stress, and increasing support for
therapists-in-training. Of course, it is important to provide a leader for these
support groups who is appropriately trained and credentialed and is not
directly affiliated (in any evaluative role) with the training program.
8
Supervision Across Settings
•
Ursula Delworth
In this chapter we describe a model of supervision across settings that was
originally presented in our first book (Stoltenberg & Delworth, 1987). The
Supervision-in-Context (SIC) model describes a way to conceptualize the
differential influences on the supervisee of the training agency, the clini-
cal supervisor, and (if the therapist is a student) the training program. This
model has proved particularly helpful for participants when they discuss var-
ious influences, responsibilities, and interactions across these contexts.
The Supervision-in-Context Model
Examining the role of supervision across contexts requires us to expand our
view of supervision beyond the dyad of supervisor and supervisee or the triad
of supervisor, supervisee, and client to an examination of the setting in which
supervision occurs. We must consider at least four entities:
Sr Se C St
Supervisor Supervisee Client Setting
187
188 IDM Supervision: An Integrative Developmental Model
For student trainees, a fifth entity, the professional training program,
is included:
TP
Training Program
Each of these elements is important in supervision, and all must func-
tion in the context of the setting, which is a mix of organizational policies,
procedures, people, and norms that allows the work to get done. The setting
demands certain behaviors from the supervisor, the supervisee, and the cli-
ent and, in return, (ideally) offers effective service and training. Although
the setting is usually represented by one administrator, in reality it includes
all those who develop, impart, and enforce its policies and norms. Generally
this includes a number of personnel, especially support (clerical) staff. For
students, the training program develops and enforces a set of expectations
and norms regarding the process and outcome of the supervisory enterprise.
None of this is unfamiliar to the trainee or to the experienced supervisor.
Supervisees often are aware of differences among settings that affect their
experience in supervision, regardless of their supervisor. Beginning supervi-
sors sometimes tell us stories of the ways in which the setting, often to their
surprise, limits or contributes to the work they do with their supervisees.
“War stories” abound, but in our experience, neither supervisees nor super-
visors typically possess the understanding or conceptual framework that
would allow them to make sense of the elements involved in supervision
across contexts and to use them to produce optimal supervisory experiences.
An important concept, we believe, is the realization that the supervisory set-
ting and (often) the training program are key components. The next step is to
conceptualize relationships among these and ways in which the relationships
get played out, for better or for worse. The SIC provides one method of doing
this.
The SIC is a perceptual instrument drawn by the supervisee or supervisor
to indicate his or her perceptions of the wider supervisory context. It is com-
posed of both components and functions.
Supervision Across Settings 189
Components
There are three components: circles representing elements in the process,
contents within elements, and arrows indicating interactions or transactions
among elements. We assume the five units or elements presented earlier:
1. Supervisor (Sr)
2. Supervisee (Se)
3. Client (C)
4. Setting (St)
5. Training (academic) program (TP) (may or may not be relevant)
Contents within units or elements vary according to theoretical frame-
work and specific purpose in using the model. The following contents are
generally relevant:
For all units: expectations, role, purpose
For units 1 and 2 (supervisor and supervisee): competencies, developmen-
tal level (including ethics)
For unit 3 (client): competencies, developmental level (for example, cogni-
tive, ego, moral), specific problem
For units 4 and 5 (setting and training program): structure, norms, facilities
Developmental level differs for units 1, 2, and 3. For unit 1 (supervisor),
it refers to level of development as a supervisor. As we explain in Chapter 9,
supervisors appear to develop through stages in a manner similar to the
development of therapists. Indeed, this constitutes another broad domain of
professional development. For unit 2 (supervisee), it refers to the level of ther-
apist development. For unit 3 (client), it refers to the level of development in
cognitive, ego, or moral spheres as defined by relevant theory. Unidirectional
arrows indicate interactions, and dual-directional arrows indicate transac-
tions. Thus, an interaction by the agency to the supervisee focusing on role
would look like this:
Setting Supervisee
(St) (Se)
Role
190 IDM Supervision: An Integrative Developmental Model
Function
Units, contents, and messages vary in saliency and relatedness. Saliency or
perceived importance is indicated by the size of circles and arrows. The rela-
tionship of units is represented by relative position. Thus, an important uni-
directional message regarding role from a distant and powerful setting would
be drawn in this way:
(St) (Se)
Role
Utility
This visual model can be used in a number of ways to clarify issues of person–
environment fit. One use is to have supervisees draw the units, relevant con-
tents, and arrows describing their total supervisory context. In completing
such an exercise, one student was able to understand and articulate his sense
of frustration for the first time. His SIC looked like this:
St Expectations
C Se
Expectations
Sr
Expectations
The trainee, who was a practicum student, perceived himself outside the
agency in which the client was encapsulated. In addition, his supervisor had
little contact with either the agency or the training program. Both the agency
and the supervisor were powerful, and both were seen as sending strong
Supervision Across Settings 191
messages regarding expectations. The training program, although more dis-
tant and less influential, was also perceived as sending unidirectional mes-
sages. It is no wonder that the student felt conflict and frustrated!
Another student depicted her situation as one in which she felt over-
whelmed by united and strong forces:
St TP
C
Se
Sr
In this case, the trainee felt captive in both the setting and the training
program and distant from both supervisor and client, who are perceived as
the setting’s property.
It can be very helpful for both supervisor and supervisee to draw their own
SIC. For one dyad, the drawings looked like this:
Supervisor
St TP
Se
Sr
Supervisee
sr
Sr
Se
In this case, the supervisor felt connected to both the supervisee and client in
a powerful setting, which was sending messages to a distant, smaller training
program. The supervisee, however, felt encapsulated in a powerful training
192 IDM Supervision: An Integrative Developmental Model
program that sent messages to the less salient setting where the supervisor and
the client resided. These perceptual scenarios allowed the supervisor and the
supervisee to identify how they saw the situation and then to work toward a
more mutually satisfactory arrangement. In this case, the supervisor acknowl-
edged the power of the training program and began to work more closely
with it. The supervisee was able to move into a more balanced relationship
with supervisor, client, and setting. Transactions replaced interactions.
The model can be used to deal with specific concerns. For example, a
supervisee who drew the following diagram in terms of the purpose content
only was able to identify his frustrations regarding the supervisor’s and set-
ting’s roles:
St TP
Sr
Se
Although discussion was needed to clarify specific issues, it was clear that
the trainee saw himself encapsulated by the setting and supervisory roles and
as functioning as a small and insignificant part of the context.
This model can also be used to examine contents from differing theo-
retical constructs, such as perceived Holland types. (As many readers will be
aware, Holland types are descriptions of categories of vocationally relevant
interests that are useful in career decision making.) One such rendition—
that of the “I” (investigative) student, who is interested in research, in an “S”
(social) setting, in which interpersonal relationships are primarily valued—
might look like this:
St
C
Investigative
Sr
Investigative
Social
Supervision Across Settings 193
In this case, the student feels mismatched with an environment that exerts
daily demands in one direction and quite distant from less salient allies—the
training program and the clinical supervisor, which more clearly share the
supervisee’s interests.
However used, the model is valuable in enabling supervisees and
supervisors to conceptualize the total supervisory context in a way that
can lead to a clearer and deeper understanding and creative action. It
may be useful for setting administrators as well. As a perceptual device,
it inherits the subjectivity of such procedures, but it can still be useful in
the clinical situation.
Settings
It is our experience that supervisees, especially as graduate students, spend
little time carefully considering the influence of the setting or agency in
which they are seeing clients. Agency policies on numbers of sessions allowed,
favored theoretical orientations or modalities of treatment, paperwork and
documentation requirements, and the amount of time committed to various
activities are some of the factors overlooked by supervisees in selecting train-
ing sites. They may complain about a specific procedure or facility, but rarely
do they consider the setting in any organized way. Yet at another level, they
are very aware of settings and the interactions among the units in the total
supervisory context. Thus, they tend to be acted upon by the setting (interac-
tion) and may react with confusion, withdrawal, or anger. Frequently some
of this affect is transferred to the supervisor if he or she is a staff member in
the setting or to the training program that placed the student in that setting.
Rarely is an attempt made to conceptualize the setting in some organized
and relevant fashion and thus enable the supervisee to understand the option
of a transactional relationship between setting and supervisee.
A number of models look at settings. Barker and colleagues’ (1978) behav-
ior-setting construct has been applied by Wicker (1979) to service settings.
As one part of the conceptual analysis, Wicker focuses on reactions of staff
and clients to the common problem of understaffing and overpopulation.
He notes that explanations for why the setting is not adequately staffed and
populated help determine what actions individuals take to deal with their
situations. Thus, a staff member who believes other workers are not doing
their part may urge them to do more. A manager may use a variety of strate-
gies to cope with the situation, including regulating clients’ entrances into
194 IDM Supervision: An Integrative Developmental Model
the setting or the time that clients may spend in the setting. Wicker notes
that the duration of such a condition affects people’s reactions. Wicker views
Maslach’s (1978) burned-out syndrome as the response of staff members to a
prolonged situation of understaffing and overpopulation.
Supervisees who enter such a setting may make a number of attributions
based on staff behavior. That is, they may perceive staff as lacking empathy for
clients and viewing clients in a stereotypical manner. A more careful analysis,
such as Wicker proposes, would allow the supervisee to view the situation as
a setting issue rather than as a problem of poorly motivated staff. This type of
analysis fosters more potentially productive transactions with the setting.
In addition to using a model to understand settings, there are specific
characteristics of settings that affect supervisees, which they should consider
carefully. Among the most important are disciplinary mix, staff roles, ease of
entrance and exit for clients, and amount of structure. Most often, in select-
ing a setting for field experience, supervisees focus on the types of clients
served. This is certainly an important variable but is by no means a total indi-
cator of fit. Some supervisees at some phases of training find a good match
in settings that are relatively open and unstructured. Others, because of their
individual characteristics or developmental level, are consistently frustrated
and overwhelmed in such settings.
Given our developmental approach, we choose to place Level 1 supervisees
in settings that are relatively structured, have a method to assign appropriate
clients to the supervisee, and probably have a limited number of professional
disciplines represented on the staff (for example, mostly psychologists, coun-
selors, social workers, or psychiatrists, depending on the training program).
Appropriate and fairly close transactions with the training program are
important here. A good fit for the Level 1 supervisee might look like this:
St TP
Sr
Se
The supervisor is somewhat larger than the supervisee, and both fit closely
together and with the client.
As the supervisee moves into Level 2, one or more of these components
can be altered. Placing a supervisee who is entering Level 2 in a highly
Supervision Across Settings 195
ambiguous, open, unstructured, and multidisciplinary setting will almost
certainly exacerbate the conflicts and confusion characteristic of this level.
The supervisee may be too overwhelmed to stick with it and may escape
back to the certainty of Level 1. Or the supervisee may become disenchanted
with counseling altogether. Thus, the training program should still be fairly
influential, although somewhat more distant. The supervisor and supervisee
become closer in size and overlap less, and the supervisor is less involved with
the client. The scenario might look like this:
TP
Sr
Se
At Level 3, a good fit might involve both more distance from the training
program and more separation between the supervisor and the supervisee:
Sr TP
Se
Matters of individual preference are also important. Some people enjoy
the give-and-take of a setting that employs people from diverse professions
or disciplines. Others prefer to work with colleagues with similar training.
What is important is that these issues are considered as selections and assign-
ments to settings are made.
Whatever conceptual model is adhered to, consideration of context pro-
vides for a more comprehensive and accurate picture of supervision. In fields
in which an intrapsychic focus is basic, such as professional psychology, look-
ing beyond the individual supervisee and the supervisor–supervisee dyad is
very rewarding. Supervisors need to be aware that they do not constitute
the total environment. Barker’s behavior settings, the subcultural approach,
Holland’s types, and transactional constructs can each prove useful in looking
at the total supervisory environment. We hope that these approaches used in
a clinical context will lead to research specific to the context of supervision.
196 IDM Supervision: An Integrative Developmental Model
Supervisors can often be of most help to supervisees by facilitating their
understanding of the total context. With such understanding, supervisors
and supervisees can formulate and implement transactions that are produc-
tive and rewarding, and, in Sarason’s (1972) words, “venture forth with a
sensitive grasp of social realities.”
Challenges of Managed Care
The growth in influence of managed care organizations (MCOs) has resulted
in a number of changes in the economics and practice of mental health care.
Although it is beyond the scope of this book to provide an assessment of the
pros and cons of managed care for mental health services delivery, others
have spoken to this issue at great length. The influence of MCOs is being
felt across a number of contexts, and the implications for clinical supervision
are becoming increasingly profound (Anonymous, 1995; Cummings, 1995;
Hersch, 1995; Sullivan, 1995). This discussion is based on our personal expe
riences with the changing economics of mental health care as well as the
observations of a number of our colleagues across the nation.
A few years ago, third-party payment guidelines and their effects on psy-
chotherapy trainees made it increasingly important for many training pro-
grams at the doctoral level to encourage students to earn a master’s degree on
their way to their doctoral degree. We discovered that a number of internship
training programs strongly preferred having interns with a master’s degree,
as opposed to only a bachelor’s degree, to enable them to bill third-party
payers for the services these trainees provided. Although this arrangement
still works in some settings, it is becoming increasingly common for third-
party payers to require the service provider to hold an appropriate license for
billable services. Indeed, some MCOs have instituted guidelines that require
as many as five years of postdegree experience, in addition to the appropri-
ate license, before a therapist can qualify to serve on the approved panel of
service providers.
The negative implications for clinical supervision and training under these
constraints are obvious. Hospitals and agencies that provide training oppor-
tunities for psychotherapists are being increasingly challenged to find alter-
native mechanisms for funding their training programs. Training agencies
must be alert to have trainee services written into contracts with vendors.
Of those MCOs that do allow billable services to be provided by interns or
other trainees, increasingly they do not pay for the clinical supervision of
Supervision Across Settings 197
these trainees. Indeed, some training sites have contracted with outside con
sultants to help them find a way to continue to fund their training programs
in a managed care environment.
The fluidity of the current situation in mental health care can have a
remarkably quick impact on agencies. A change in vendors for mental health
reimbursement can result in the institution of new (and often more restric-
tive) guidelines from one day to the next, a situation that can have devastat-
ing implications for agencies and hospitals with a training component.
In addition to difficulties encountered with getting prelicensed therapists
approved as reimbursable providers, the types of services covered by MCOs
are becoming limited, in turn affecting the kinds of training that can be
provided. New limitations in the number of therapy sessions that MCOs will
reimburse has increased the need to train and supervise therapists in brief
therapies or problem-solving approaches (critics would say symptom-focused
therapies). Thus, experiences in longer-term approaches to treatment are
becoming increasingly difficult to fund. Also, fewer MCOs are reimburs-
ing for psychological (even neuropsychological) assessments. This situation,
of course, can have a negative impact on the efficiency and effectiveness of
therapy, as well as on continuing to fund essential training experiences in
assessment. Finally, certain modalities of therapy, for example, marital and
family therapy, cannot be reimbursed if the decisions made by the MCO fol-
low a medical model.
These policies have direct ethical implications for clinical supervisors as
well as all therapists in general. Given a psychopathology-based model of
reimbursement, there exists a strong incentive to find greater pathology (more
severe diagnoses) and provide services (individual therapy) in situations where
other diagnoses (marital or family disorders) and forms of treatment (for
example, couples or family therapy) may be more appropriate. Additional
concerns regarding problems with confidentiality in working with MCOs
add to these challenges (Cantor, 1997).
Other changes necessitated in response to MCOs can have a negative
impact on the quality of clinical supervision provided to therapists. We have
already noted that the approaches to therapy that are reimbursable under
these arrangements can be limited in addition to the acceptability of other
clinical activities, such as psychological assessments and clinical supervision
(at least in terms of receiving reimbursement for these activities). The danger
of primarily focusing on completing forms and paperwork is greater still in
this context.
198 IDM Supervision: An Integrative Developmental Model
In addition to supervising the therapist’s documentation of case notes and
traditional reports, the supervisor must now also invest considerable time
in teaching supervisees how to fill out the forms required by the MCOs for
reimbursement. Many of our colleagues view these forms as separate from
(and not helpful to) the therapy process because the information requested
appears to have little to do with treatment issues. The requested information
often creates the potential of confidentiality issues for the therapist and the
client. Finally, supervisors increasingly are called on to teach therapists how
to advocate for the client to the MCO for authorization of additional or con-
tinued services. This can be rather time consuming and, of course, this time
is not reimbursable.
Managed care is now a fact of life and will, in all likelihood, continue
in some form or another into the foreseeable future (Tomes, 1997). In our
opinion, the final chapter has yet to be written concerning the economics
and practice of clinical supervision within this context. We cannot stress too
greatly, however, the importance of finding and supporting mechanisms that
allow for the continuation of effective forms of this most important aspect
of training in the future. Any significant limitation of the effective practice
of clinical supervision will have a strongly negative impact on the quality of
mental health training and services provided by therapists both prior to and
subsequent to licensure.
Note: This chapter was written for the 1998 version of this book by Ursula
Delworth. In tribute to her, we include this chapter in its original form.
9
Supervisor Development
and Training
•
Implicit throughout this book and the IDM is the idea that the training of
supervisors is an area of professional development that requires focused and
systematic procedures. It is no longer adequate to assume that skills used in
therapy are sufficient for supervision or that one’s experiences as a supervisee
constitute adequate training to become a supervisor, which, as Loganbill and
Hardy (1983) point out, have been the two basic approaches to supervisor
training in the past. Russell, Crimmings, and Lent (1984) have also noted
that just as therapists are required to be proficient in therapeutic theory and
intervention strategies, so too should they be required to have training in
clinical supervision and be offered training opportunities to develop supervi-
sion skills. Holloway (1992) has proposed that the learning and teaching of
supervision require specific knowledge of instructional methods appropri-
ate for supervision. Consequently, the process of supervision is increasingly
becoming recognized as perhaps the most crucial of activities associated with
the psychotherapeutic professions because the supervised training that devel-
oping therapists receive plays a formative role in establishing their therapeu-
tic competency and represents the cornerstone of applied graduate education
(Russell & Petrie, 1994). In anticipation of this growing demand for super-
visory skills, the American Psychological Association (2002a) has added the
area of supervision in its revised criteria for accreditation domains and stan-
dards. Also, ethical principles for psychologists require those who wish to
function as supervisors to acquire competence in this domain (American
Psychological Association, 2002b), as has been suggested by others (Harrar,
VandeCreek, & Knapp, 1990; Sherry, 1991; Vasquez, 1992).
199
200 IDM Supervision: An Integrative Developmental Model
Consequently, in this chapter we focus on the development of the supervi-
sor and related practicalities involved in the training of supervisors. We see
levels of supervisor development as analogous to our levels of supervisee devel-
opment, and we discuss issues of supervisor and supervisee match and super-
visor assessment (Stoltenberg, McNeill, & Delworth, 1998). We also provide
some recommendations for the types of experience necessary for the training
of effective supervisors in educational and other applied training settings.
Levels of Supervisor Development
Throughout this book, we have alluded to the various roles of the supervisor
and the role flexibility required, depending on the developmental level of
the therapist and the supervision environment. That is, the supervisor often
starts out in the familiar roles of teacher, consultant, or evaluator (and occa-
sionally counselor) and later develops the role of master supervisor for the
supervisee. Our model of supervisor development assumes that the greater
role flexibility required to meet the training environment needs of super-
visees distinguishes more advanced supervisors from others. Less advanced
supervisors tend to rely on one or two roles. Research regarding supervisor
development suggests that supervisors indeed perceive themselves as vary-
ing the supervision environments for different levels of trainees, consistent
with developmental theory, and that actual supervisory behaviors change
as counselors gain experience, although supervisees do not always perceive
these differences in supervisor behavior (Krause & Allen, 1988; Stoltenberg,
McNeill, & Crethar, 1994).
In our model of supervisor development, progression through the levels
assumes prior progression through the levels of therapist development. For
example, it does not appear possible for a therapist to be a Level 3 supervi-
sor while still functioning as a Level 1 therapist in a domain in which he
or she is providing supervision. This would be analogous to a Little League
baseball player coaching in the major leagues. However, Level 3 therapists
in their early supervisory experiences are likely to be at Level 1 or 2 in our
supervisor development model. Again, we propose that although supervi-
sion may at times share similarities with counseling or psychotherapy, it is
itself a distinct and unique domain for therapists. This is the case even for
those who may possess highly developed therapeutic skills. The supervi-
sion process requires specific knowledge, skills, and training. As a result,
Supervisor Development and Training 201
we hypothesize a three-level model for supervisors similar to the IDM
for therapists.
Level 1
Supervisors at this level tend to be either highly anxious or somewhat naïve.
Similar to Level 1 therapists, they are focused on doing the “right” thing
and are usually highly motivated to be effective in their new role. They tend
to apply a fairly mechanistic approach to supervisory tasks and may take a
strong “expert” role with supervisees. On the other hand, if the supervisor
is relatively new to the profession, still consolidating his or her growth as a
therapist, and not receiving supervision of supervision, it is also typical that
he or she will approach the process from a more collegial perspective and feel
uncomfortable in an “expert” role.
In our experience, in early attempts to supervise others, Level 1 supervi-
sors often depend heavily on their perceptions of their own recent or current
supervisors or their recollections of how they have been supervised in the
past, and they are generally more aware of their own reactions than those of
their supervisees. Level 1 supervisors take pride in providing their supervisees
with appropriate conceptualizations or intervention strategies, and they may
provide moderate to high structure, exhibiting a high level of concern with
the nurturance and success of their trainees. Additionally, depending on their
own level of therapist development, they are often invested in getting the
supervisee to adopt their preferred therapeutic orientations and techniques.
Level 1 supervisors are often uncomfortable and anxious about providing
feedback and may avoid this function or tend to be overly positive or vague
in their initial face-to-face evaluations. As a result, they may find it easier to
follow a structured format for provision of feedback (for example, evaluation
forms), such as checklists, as opposed to written narratives. Because of this
desire for structure, we have found Boylan and Scott’s (2009) collection of
forms, observation sheets, and exercises useful for beginning supervisors to
help them organize their early sessions.
In general, it is desirable for Level 1 supervisors to be functioning at Level 3
in relevant domains, but a therapist who is well established in Level 2 can also
adequately supervise Level 1 supervisees. In addition, the Level 2 therapist
benefits from this experience. The necessary task of aiding the trainee with
cognitive formulations is exceptionally helpful in inducing the supervisor to
work through some of his or her own Level 2 confusion. In addition, some
202 IDM Supervision: An Integrative Developmental Model
Level 2 trainees are better supervisors (if matched with Level 1 supervisees)
than they are therapists. Level 2 therapists who are Level 1 supervisors often
find that the need to provide basic structure for the beginning supervisee
helps to resolve some of their own confusion and ambivalence.
Level 1 supervisors have great difficulty with Level 2 trainees, and thus
this pairing should be avoided if at all possible. It is extremely difficult
for the Level 1 supervisor to deal with the conflicts and confusion of the
Level 2 supervisee. What often happens in this situation is that both parties
wait out the period of supervision just to get the experience over with, and
little progress occurs, resulting in negative experiences for both parties
and inhibited therapist and supervisor development. Similarly, we do not
recommend that Level 3 therapists be matched with Level 1 supervisors.
In this scenario, there is a danger that the therapists will regress to Level 2,
especially in terms of motivation. Advanced supervisees often report los-
ing their recently acquired consistent motivation when they are confronted
with insecure, highly structured, or inflexible Level 1 supervisors. Again,
the solution in this situation is often to wait it out to avoid political conse-
quences within training agencies or to seek additional informal supervision
from other staff members.
Cathy was an experienced and well-respected therapist whose skills
were reflective of late Level 2. However, she had received her only train-
ing in supervision theory and practice in a brief seminar format, and
soon she was responsible for the supervision of Julie, an early Level 2
practicum trainee, who exhibited the common Level 2 characteristics
of independence, fluctuating levels of motivation and confidence, and
resultant confusion and conflict. Problems in supervision started when
Julie administered a battery of psychological instruments to a client as
part of her routine assessment procedure. Cathy was immediately taken
aback and upset that Julie had proceeded without her direct permission.
Cathy accused her supervisee of a potential ethical violation, viewing
her as unqualified to administer assessment instruments and resistive
toward any feedback or supervision. Julie, in turn, was shocked at her
supervisor’s reaction to what she viewed as a routine procedure. Their
attempts to process this issue were unsuccessful, and it appeared that
Cathy’s direct supervisor was reluctant to intervene. Julie remained frus
trated and viewed the supervisory relationship as suffering irreparable
Supervisor Development and Training 203
damage. Yet she felt that as a trainee, she lacked the power to request
another supervisor (although eventually she communicated her difficul-
ties to her practicum instructor). It was only through the intervention
of Julie’s practicum instructor, who spoke to the agency’s director, that
an alternative supervisory assignment was made, unfortunately well into
the semester.
Level 2
The Level 2 supervisor resembles the Level 2 therapist in terms of confusion
and conflict. This supervisor now views the process of supervision as more
complex and multidimensional than he or she had initially perceived. As
a result, motivation fluctuates, especially in settings where the supervisory
function is not valued or rewarded. Level 2 supervisors may focus too much
on the supervisee and lose the objectivity required to provide necessary con-
frontation and guidance. The supervisor attempts to assert his or her inde-
pendence, with occasional lapses into dependency on a trusted supervisor or
colleague. Level 2 supervisors may also tend to get angry or withdraw from
their supervisees as a manifestation of their confusion and fluctuating levels
of motivation. Thus, therapists may find it difficult to arrange sessions with
supervisors, and a lack of investment by supervisors may be quite obvious.
Frustration on the part of the Level 2 supervisor may also be manifested in
evaluations and feedback focusing on supervisees’ global deficits and percep-
tions that the supervisee either is unable to implement supervisor feedback
or resists doing so.
Level 2 tends to be brief for most supervisors, as they are typically func-
tioning at Level 3 as counselors and use their skills with the help of their
own supervisor (if they have one) to work through and gain insight into the
conflict and confusion they may be experiencing. On the other hand, for
those who do not make the transition, the result may be withdrawal from
the supervisory role, or they may not be assigned supervisees as they gain
the reputation for not being sufficiently motivated and invested in the super-
visory task. We have heard of far too many supervisors who were caught
daydreaming or, worse, sleeping during supervision sessions (in a dark room
watching video). In such situations, the lack of motivation to conduct effec-
tive supervision should be recognized by the supervisor or others in the pro-
gram or agency, and steps to increase involvement or remove that person
from supervisory responsibility should be taken.
204 IDM Supervision: An Integrative Developmental Model
Another risk for Level 2 supervisors is dealing with frustration in their
supervisory role by engaging in counseling or therapy with their supervisees.
Therapy with supervisees is not ethical and is likely to result in more harm
than good. It may occur when the frustrated Level 2 supervisor retreats to a
domain where he or she feels more comfortable and effective, translating
a supervisee’s difficulty in conducting therapy into unresolved personal issues.
Although such personal issues certainly do occur and need to be addressed
when discovered, therapy with supervisees is best left to someone who can
function solely in the therapist role and not someone who is the assigned
clinical supervisor.
While the struggling Level 2 supervisor is a difficult match for any supervi-
see, the best assignment is with a Level 1 therapist, as this individual tends to
elicit a protective, nurturing stance that results in more consistent behavior by
the supervisor. Matches with a beginning Level 2 trainee are sometimes facili-
tative if the supervisor is aware of and consciously working through Level 2
supervisory issues. In this manner, a Level 2 supervisor may identify and empa-
thize with the Level 2 therapist’s struggles, facilitating their resolution.
Level 2 supervisors need ongoing and expert supervision to facilitate their
own development and provide for the welfare of their supervisees and clients.
As with the Level 2 therapist, this is not a time for laissez-faire supervision
of the Level 2 supervisor, regardless of the Level 2 supervisor’s level of thera-
peutic development. Without effective supervision of supervision, the Level 2
supervisor runs the risk of stagnation due to lack of feedback and observation
of his or her work. It is too easy to fool oneself into thinking that one is effec-
tive and skilled without ongoing objective feedback from others.
The power differential in supervisory dyads can inhibit corrective feedback
from supervisees. For example, one of us remembers hearing about a male
supervisor who regularly perceived his female supervisees as being sexually
attracted to him. His view apparently was that little could be accomplished
in supervision until his charges would admit to this attraction. It became a
running joke (although not a funny one) among women supervisees that they
needed to confess to being sexually attracted to this unfortunate character
early in the supervisory relationship so that other, more salient issues could
be dealt with.
Another potential pitfall of Level 2 supervisors is to turn the focus of
supervision to a domain or approach with which they feel more comfortable.
This can be good if a supervisee is interested in learning a different approach
Supervisor Development and Training 205
or orientation, but it can present real problems if there is not flexibility and
some negotiation involved in setting up the supervisory relationship.
Karen was a new staff member at the agency who had had some supervi-
sory experience prior to arriving. She was committed to a psychodynamic
model of therapy and informed her supervisee, Lana, during their initial
supervisory session that they would limit their focus to psychodynamic
psychotherapy and related issues: “We will speak psychodynamically,
interpret psychodynamically, and do therapy from a psychodynamic
framework.” Lana offered that she knew little about this approach and
was having some success with a predominantly cognitive-behavioral ori-
entation, which she had been studying for some time. She was also con-
cerned that her current clients would become confused by a dramatic
change in focus from the approach she had been using with them, to say
nothing of the fact that she would have to renegotiate their treatment
contracts to institute the new approach. Karen was immovable, and the
sparks began to fly. Lana complained to the agency director and asked for
reassignment. Karen was not enjoying the experience either, complaining
to the director that Lana was resistant to her feedback and recommen-
dations and not valuing what Karen had to offer. Unfortunately, reas-
signment was not possible, and the supervisory relationship remained
turbulent until Lana moved on to another agency.
Level 3
While some supervisors stagnate at Level 1 and others drop out at Level 2, in
our experience many go on to achieve the stable functioning characteristic of
Level 3. At this level, motivation again becomes stable and consistent, as the
supervisor is interested in improving his or her performance, while viewing
supervision as a highly valued activity among the many he or she experiences
as a professional. The supervisor at this point is functionally autonomous but
may seek consultation or regular supervision if needed. He or she is aware of
the trainee as well as of self, and is able to balance personal needs with those
of both the trainee and the setting.
The supervisor at this level is able to make an honest self-appraisal of
strengths and weaknesses as a supervisor and will articulate clear preferences
206 IDM Supervision: An Integrative Developmental Model
for types of supervisees with whom he or she works best. Those who have
difficulties with conflict, for example, may express a preference to work with
either Level 1 or Level 3 supervisees. The Level 3 supervisor is also comfort-
able with the process of evaluation and makes a thorough, objective attempt to
provide a balanced assessment of the supervisee’s strengths and limitations.
Kelvin, a senior psychologist at the agency, was meeting with Kim for
their last supervision session at the end of her advanced practicum experi-
ence. Kelvin had found Kim to be a sensitive, caring, and skilled thera-
pist who was easy to supervise. He had enjoyed the experience and was
sorry to see it end. After sharing his feedback with Kim concerning her
work over the prior months, he asked if she wanted to share any per-
ceptions of his supervision with him. He made it clear that he would
also carefully review the written evaluation she had prepared, to see how
the experience had been for her. Kim began describing her experience in
supervision with Kelvin: “I found this experience very powerful in terms
of my growth as a therapist. Sometimes I’d come in here not knowing
exactly what I wanted, and you would somehow pick something out off a
tape, or the way I would talk about a client, that would really hit a chord.
You have this way of saying things in an unthreatening, low-key way, but
with the force of a hammer. I learned more about myself as a therapist
and, I think, as a person than at any other time in my training. I hate to
see this end.”
Level 3i
This level represents mastery of the supervisory domain as supervisors at this
level are often referred to as master supervisors. What differentiates Level 3i
supervisors from those at Level 3 is that they can work equally well with
supervisees at any level and may not have definitive preferences. These super-
visors are especially adept in working with and helpful to Level 2 supervisees
and supervisors, and they are often asked to provide supervision to less expe-
rienced supervisors. They are noted for their integration of ideas and skills,
as is the 3i therapist. As such, the Level 3i supervisor must have attained
Level 3i as a therapist and add to that the integration of supervision with the
other domains. Clearly the number of such individuals is limited.
Supervisor Development and Training 207
The Level 3i supervisor has developed the skills necessary to assess and
monitor supervisee development across levels and domains while effectively
communicating to supervisees the expertise he or she has across domains.
This person can move with fluidity across domains in supervision, as well as
across supervision relationships with assorted supervisees. We can only hope
that these individuals are valued and well utilized in the settings in which
they work.
Recommendations for Supervisor Training
In Chapter 6 we suggested that certain interpersonal characteristics (warmth,
acceptance, empathy, etc.) serve as the basis for all effective supervision. In
their review of the research regarding supervisor training, Russell and Petrie
(1994) identify some general qualities of effective supervisors that may be
characterized as essential attitudes and behaviors, to be promoted and devel-
oped in the training of supervisors. These include high levels of supervisor
support, interest, and investment in (as well as commitment to) the super-
visory process, flexibility in the multiple roles and functions that effective
supervision requires, therapeutic experience, and avoidance of certain neg
ative attitudes and behaviors, such as disinterest in supervision, exploitation
of supervisees, and unsupportiveness.
In terms of more specific components and experiences for training effec-
tive supervisors, our recommendations overlap with those put forth by other
authors and reflect a growing consensus regarding the importance of system-
atic, focused training in the supervisory process (Borders et al., 1991; Russell
& Petrie, 1994). Consequently, we recommend that training in supervision
consist of two essential components: (1) formal course work comprising con-
ceptual and didactic training in supervision and (2) experiential training
in supervision consisting of practicum elements. We thoroughly agree with
Russell and Petrie’s recommendation that brief seminars or workshops, which
may be successful in presenting basic elements of supervision theory or prac-
tice, do not allow aspiring or practicing supervisors time or exposure to develop
a knowledge base or acquire applied skills. Recent work on competencies in
supervision (Falender et al., 2004; Stoltenberg et al., 2003) builds upon these
recommendations and proposes a supervision competencies framework (see
Table 9.1, below). This framework was developed with the assumption that
five supraordinate factors permeate the process of professional development:
208 IDM Supervision: An Integrative Developmental Model
Table 9.1
Supervision Competencies Framework
Knowledge
1. Knowledge of area being supervised (psychotherapy, research, assessment, etc.)
2. Knowledge of models, theories, modalities, and research on supervision
3. Knowledge of professional/supervisee development (how therapists develop, etc.)
4. Knowledge of ethics and legal issues specific to supervision
5. Knowledge of evaluation, process outcome
6. Awareness and knowledge of diversity in all of its forms
Skills
1. Supervision modalities
2. Relationship skills—ability to build supervisory relationship/alliance
3. Sensitivity to multiple roles with supervisee and ability to perform and balance multiple roles
4. Ability to provide effective formative and summative feedback
5. Ability to promote growth and self-assessment in the trainee
6. Ability to conduct own self-assessment process
7. Ability to assess the supervisee’s learning needs and developmental level
8. Ability to encourage and use evaluative feedback from the trainee
9. Teaching and didactic skills
10. Ability to set appropriate boundaries and seek consultation when supervisory issues outside the
domain of supervisory competence arise
11. Flexibility
12. Scientific thinking and the translation of scientific findings to practice throughout professional
development
Values
1. Acceptance of responsibility for client and supervisee
2. Respectfulness
3. Sensitivity to diversity in all its forms
4. Balance between support and challenging
5. Commitment to empowering others
6. Commitment to lifelong learning and professional growth
7. Balance between clinical and training needs
8. Valuing of ethical principles
9. Commitment to knowing and utilizing available psychological science related to supervision
10. Commitment to knowing one’s own limitations
Social Context
1. Diversity
2. Ethical and legal issues
3. Developmental process
4. Knowledge of the immediate system and expectations within which the supervision is conducted
5. Awareness of the sociopolitical context within which the supervision is conducted
6. Creation of climate in which honest feedback is the norm (both supportive and challenging)
Supervisor Development and Training 209
Table 9.1 (continued)
Supervision Competencies Framework
Training of Supervision Competencies
1. Coursework in supervision, including knowledge and skill areas listed
2. Supervision of supervision, including some form of observation (videotape or audiotape) with
critical feedback
Assessment of Supervision Competencies
1. Successful completion of course on supervision
2. Verification of previous supervision of supervision, documenting readiness to supervise
independently
3. Evidence of direct observation (e.g., audio or videotape)
4. Documentation of supervisory experience reflecting diversity
5. Documented supervisee feedback
6. Self-assessment and awareness of need for consultation when necessary
7. Assessment of supervision outcomes, both individual and group
Source: Falender et al., 2004, p. 778
(1) developing supervision competencies is a cumulative and lifelong process,
(2) all forms of diversity affect every aspect of supervision, (3) knowledge of
legal and ethical issues is imperative, (4) personal and professional factors
influence training, and (5) ongoing self-assessment by the supervisor and
assessment by peers is necessary.
Conceptual and Didactic Training
In terms of the conceptual and didactic component of training, supervisor
development is related to development as a therapist. Prospective supervisors
enrolled in a course or seminar dealing with supervision theory and practice
should have had adequate applied supervised experience and be functioning
as a late Level 2 or Level 3 therapist across relevant domains in preparing to
supervise Level 1 therapists. Thus, this type of course should be restricted
to advanced graduate trainees.
As Russell and Petrie (1994) suggest, three critical areas of the concep-
tual foundation of any supervision course are examination of theoretical
models of supervision, supervision research, and ethical and professional
issues. Coverage of these areas is accomplished through assigned readings,
lectures, discussion, and demonstrations. Many of the references included
in this book can serve as the basis for these activities. Other useful sources
210 IDM Supervision: An Integrative Developmental Model
of information and perspectives on the supervision process include
Bradley and Ladany (2001), Bernard and Goodyear (2009), Falender and
Shafranske (2004), and Ladany, Friedlander, and Nelson (2005), among
others. Audiotapes and videotapes of actual supervision sessions presented
by faculty and students, as well as the Goodyear (1982) tapes, are useful
in demonstrating hands-on supervision behaviors and interventions across
different supervisory theoretical approaches and stimu lating class discus-
sions. In our own classes, one of us has developed videotapes demon-
strating characteristics of the three levels of therapist development across
structures within supervision sessions. These have proved quite helpful
in stimulating discussion and making the issues of each level of therapist
more salient for supervisors-in-training.
Russell and Petrie (1994) recommend a required research proposal as a writ-
ten project for seminars in supervision in order to stimulate knowledge of the
empirical literature and provide students an opportunity to explore an interest
area in depth. We have also found it helpful to include other types of projects
as requirements for students, such as training tapes (for example, intake dem-
onstrations) or workshop proposals, providing students with opportunities to
design projects related to career goals or future work settings.
As we note in Chapter 10, ethics and related professional issues are crucial
to the training of supervisors, and they may be especially salient as begin-
ning supervisors find themselves responsible for the welfare of both the client
and supervisee for the first time. Examination of the implications for various
ethical standards and guidelines for supervisory functions should be covered
along with state guidelines and laws regulating the practice of supervision in
various postgraduate training and work settings.
Supervisor training in the area of diversity has improved, although, as
we noted in Chapter 6, it is still possible for trainees to encounter super-
visors who remain uninformed regarding multicultural counseling models
even while working with a diverse clientele and supervisees and who are not
necessarily open to addressing these issues within the supervisory context. As
Bernard and Goodyear (2004) note, it is necessary for both supervisor and
supervisee to be willing to explore diversity issues, as all interactions are mul-
ticultural. Although it is becoming less common, some practicing supervisors
may not have received such training in their graduate programs, but lack of
exposure to or lack of knowledge of issues of diversity due to gaps in previ-
ous training is not excusable. We certainly would not accept a lack of skills
in assessment merely because certain instruments are periodically revised. In
other words, there is a clear imperative for all practicing psychotherapists to
Supervisor Development and Training 211
be prepared to function in a diverse society with a spectrum of individual dif-
ferences reflecting culture, class, gender, sexual orientation, and so on. Thus,
within any conceptual and didactic component in supervision courses related
to ethics and professional issues, we recommend coverage of the developing
literature on multicultural training, including examples of training models,
methods, and environments related to the development of cultural aware-
ness and sensitivity and multicultural counseling competence (American
Psychological Association, 2002c; Arredondo et al., 1996; LaFromboise &
Foster, 1992).
Although many training programs at the graduate level offer separate
courses dealing with issues of multicultural counseling or working with
diverse populations, if true unselfconscious integration of these issues into
psychological theory and practice is to be achieved, multicultural content
and issues of diversity must be infused into all existing graduate-level course
work and training. The crucial components addressed in this so-called inte-
gration model are therapists’ knowledge of diverse cultures and lifestyles,
attitudes toward members of various groups, and acknowledgment of the
role and influence of differing cultural values and worldviews on psycho-
logical practice (Lefley, 1985b). Lefley, and Lefley and Bestman (1991), have
reported that an intensive eight-day cross-cultural training program for men-
tal health clinicians and administrators increased cross-cultural knowledge,
sensitivity, and skills and decreased social, attitudinal, and cognitive distance
(Lefley 1985a).
In applying the integration model within a developmental context, opti-
mally Level 1 therapists, who may have idiosyncratic and at times limited
exposure to diverse peoples, are beginning to be exposed to issues of social
and cultural diversity in beginning theory courses apart from idiosyncratic
and, at times, limited exposure to diverse peoples. Required intercultural
interactions as described by Mio (1989), where trainees interacted with immi-
grant students, may serve as a useful adjunct for initial exposure to diversity
at this developmental level. Level 2 therapists demonstrate a greater open-
ness and increased readiness to understand a diverse clientele and should be
exposed at this time to more specific courses and fieldwork experiences deal-
ing with issues of diversity. This type of exposure may be accomplished by
cultural learning experiences and exercises such as those described by Merta,
Stringham, and Ponterotto (1988). The goal is to move the trainee’s perspec-
tive beyond that developed within what is often a relatively narrow experien-
tial base (Stoltenberg & Pace, 2008). Level 3 therapists depend on continued
exposure to and work with ethnically and culturally diverse clients in order
212 IDM Supervision: An Integrative Developmental Model
to develop their ability to integrate cultural knowledge and hypotheses into
the diagnostic and treatment process. Training seminars that reinforce the
importance of issues of diversity and allow for fair and open discussion
around these issues augment this process and may also provide a nonthreat-
ening invitation and exposure to these issues for experienced supervisors who
lack knowledge of multicultural theory and intervention.
Many courses in supervision are essentially constructed as surveys that
skim across a number of models and issues, relying heavily on brief descrip-
tions presented in single chapters of a book or theoretical articles. Although
exposure to various approaches can be useful, if little or no time is invested
in assisting supervisors-in-training to thoroughly understand a particular
model, they will be left with insufficient knowledge and skills with which
to practice clinical supervision. We do not expect students to be effective
therapists after having only a survey course on therapy theories. Similarly,
we should not assume scant attention is sufficient for supervision training.
We have been clear throughout this book that we prefer a comprehensive
model of supervision. Naturally we think that the IDM is a good choice for
intensive training in clinical supervision.
Experiential Training
The second critical component in the training of supervisors concerns oppor-
tunities to engage in supervision of less experienced therapists-in-training and
receive supervision and guidance in relation to the actual supervisory func-
tion. If the scope of supervision training is limited to didactic presentations,
the supervisor-in-training will be ill prepared to engage in the supervision
process. Careful supervision of supervision is necessary for anyone to become
familiar with the intricacies of a given model and effective implementation.
The conceptual and didactic component of training may serve as a pre-
requisite to experiential training components. However, our preference is to
provide training in both concurrently. One format we apply is that advanced
students enrolled in the didactic portion of a supervision seminar are also
enrolled in an advanced practicum that provides opportunities for supervi-
sion of a therapist-in-training in which the developing supervisor trainee is
paired with an experienced supervisor for both supervision of supervision
as well as supervision of direct services provided by the trainee. The advan-
tage of this format is that developing supervisors are concurrently exposed to
supervision theory and research while engaging in actual supervisory prac-
tice. At least some supervisory sessions are recorded for training purposes
Supervisor Development and Training 213
(the more the better), and examples or descriptions and demonstrations of
current supervisory issues and cases may be integrated into the seminar com-
ponent. Having supervision case presentations, including written reports,
and showing portions of videotapes of supervision sessions give supervisors
the opportunity to demonstrate what they have learned and to get useful
feedback from colleagues.
Russell and Petrie (1994) describe another variation of the concurrent for-
mat, where trainees’ experiential training requires them to supervise one or
two therapists weekly, with one client per therapist. Each therapy session
is then observed by the supervisor, and a supervision session follows. The
supervision session is videotaped and may be presented as part of a two-
hour weekly supervision-of-supervision class meeting. This type of super-
vision case conference component, in which supervisors-in-training present
cases and discuss their experiences as supervisors, provides an atmosphere of
mutual support and trust that is particularly facilitative in the successful res
olution of the challenges that occur as supervisors progress through the levels
of supervisor development.
Supervisor Assessment
Similar to our conceptual model of supervisee development, assessment of
supervisors follows a format in which a variety of sources of information
relevant to the structures of motivation, self-awareness, and autonomy are
considered within the supervisory domain. This information is integrated
into a holistic picture of the supervisor who is functioning at a particular
level of supervisor development. As is true for therapist development, super-
visors may vary in level depending on the level of the supervisee with whom
they are working. For example, a supervisor who has attained a Level 3 mode
of functioning with most supervisees may find himself or herself operat-
ing more at Level 2 when confronted with an especially difficult Level 2
therapist. Primary in this assessment is an informal evaluation of the level
of supervisory development based on the attitudes and behaviors previously
described. For example, one of us who has primarily been supervising
Level 2 and Level 3 therapists over the past few years recently found him-
self less than optimally effective in supervising a Level 1 therapist. Again,
recorded supervision sessions are useful for review in supervision of super-
vision. They provide direct access to supervisory behaviors and should be
a required activity. Of course, assessment of previous supervisory training
214 IDM Supervision: An Integrative Developmental Model
experiences (both didactic and experiential), as well as previous experience
as a supervisor (both amount and type), is essential information in assessing
supervisor development. Finally, assessment of level of therapist development
(see Chapter 7) is also paramount to the complete assessment of the skills of
the developing supervisor.
Supervision in Field Settings
We have described a training format for clinical supervision that is close
to ideal. We realize that this arrangement is not possible for all therapists
who desire to learn to conduct clinical supervision or improve their skills
in this domain. Until recently, course work on supervision was not required
by many training programs for mental health professionals. Even now, the
training provided is often limited, due to the amount of other course work
and practicum experiences required by states and accreditation bodies.
Considerable opportunities can be created in nonacademic field settings if
the desire and administrative support exist to improve supervision services.
Unfortunately, funding for effective supervision and training is a challenge.
Nonetheless, it is clear that attention to supervision will have a positive effect
on clinical service delivery, as well as add to the professional development of
the staff.
Although in-service seminars and workshops are less than ideal in provid-
ing a sufficient informational and experiential background for therapists who
have not been exposed to the supervision literature, periodic and ongoing
in-service training and case conferences on supervisory issues can have a dra-
matic impact on the quality of supervision provided by the senior staff. We
have found it imperative to have the opportunity to discuss supervisory issues
with other supervisors in our programs. These arrangements need not be
formalized, although setting aside time for an activity increases the perceived
importance of it and the likelihood that it will actually occur.
These in-service seminars or ongoing case conferences can be facilitated
by an external consultant, or an agency staff member can assume organi-
zational responsibility. For therapists who invest much time in supervision,
these continuing-education opportunities can be time well spent.
In addition to serving as a useful adjunct to didactic seminars in supervi-
sion theory, the group supervision case conference may be particularly use-
ful as a training method in field, internship, or post-graduate supervision
settings for supervisors. Although a long-term didactic component is very
Supervisor Development and Training 215
beneficial, supervision case conferences can serve as an effective adjunct to
brief workshops or seminars offered in these settings.
The preparation and training of supervisors need to be both focused and
extensive. In the best of all worlds, this training starts with conceptual and
didactic course work in the graduate school setting concurrently with begin-
ning experiential supervision practice, and later with more supervised experi-
ences in providing supervision to therapists in internship, postgraduate, and
employment settings. The importance of such training is fundamental to the
training of psychotherapists and ultimately to the consumers of therapy, who
desire and deserve high-quality direct services.
10
Ethical and Legal Issues
•
Lamb, Cochran, and Jackson (1991) hold that supervisors are responsible
for training in three broad areas of the supervisee’s professional functioning:
(1) ethical knowledge and behavior, (2) competency, and (3) personal func-
tioning. Although the areas clearly overlap, each deserves separate consider-
ation. However, before we can examine these three areas, it is important to
consider relevant ethical codes and guidelines designed to provide direction
in regard to the conduct of supervision, and also related to the question of
who is qualified to supervise.
Ethical Codes and Guidelines
The current American Psychological Association Ethical Principles of Psy
chologists and Code of Conduct (APA, 2002b), while providing no explicit
guidelines regarding the conduct of supervision or qualifications of super-
visors, addresses the education and training of students. Ethical Standards
section 7.0 generally covers the education and training of students and super-
visees. Specifically, Standards 7.01–02 cover the design of education and
training programs in terms of providing appropriate knowledge and proper
training experiences, as well as accurate descriptions of program content.
Standard 7.06 addresses the need to establish timely and specific processes
for providing feedback to trainees, delineated at the beginning of supervision,
and based on “their actual performance on relevant and established program
requirements.” Standards 7.04–05 address student disclosure of personal
information and mandatory individual or group therapy as part of training
program requirements, Standard 7.07 explicitly prohibits sexual relationships
217
218 IDM Supervision: An Integrative Developmental Model
with students and supervisees, and Standard 3.08 prohibits exploitive rela-
tionships, which is applicable to supervisees. Standard 2.05 broadly covers
delegation of work to others, including supervisees, with expectations that
they are able to perform delegated activities on the basis of their education,
training, or experience, and that they perform these activities competently.
The APA Ethical Principles of Psychologists and Code of Conduct makes no
explicit statement regarding the qualifications or competencies of clinical
supervisors.
The Association of State and Provincial Psychology Boards in its Supervision
Guidelines (Association of State and Provincial Psychology Boards [ASPPB],
2003) provides a comprehensive document regarding the conduct of super-
vision. Various sections address the supervision of doctoral-level candidates
for licensure, credentialed nondoctoral personnel providing psychological
services, and uncredentialed personnel providing psychological services.
The setting, nature, and duration of supervisory contact, along with writ-
ten and oral evaluation in the form of direct feedback to supervisees, are all
explicitly addressed. It is also clear that supervisors are considered “ethically
and legally responsible for all of the professional activities of the supervi-
sees” (p. 3). Unfortunately, the ASPPB Supervision Guidelines along with the
recently released Guidelines for Practicum Experience (ASPPB, 2008) assume
only that a qualified supervisor is one who is licensed or certified to engage
in the practice of psychology, and that supervisors have “adequate training,
knowledge, and skill to render competently any psychological service which
their supervisees undertake” (p. 3). There are no requirements or guidelines
for previous training and/or experience as a supervisor. This assumes the fal-
lacy that experience solely as a clinician is sufficient for someone to be an
effective supervisor. This assumption continues to be promoted through the
various statutes of state boards of psychology, as evidenced in the states in
which we practice (Oklahoma, Washington, and Idaho), as well as many
others.
In contrast, the Association for Counselor Education and Supervision in
its Ethical Guidelines for Counseling Supervisors (1993) states that supervisors
should have training in supervision. The Approved Clinical Supervisor cre-
dential and the accompanying Code of Ethics (Center for Credentialing and
Education, 2001) require graduate training and/or experience in supervision
content areas, leading to certification as a clinical supervisor.
Ethical and Legal Issues 219
Ethical Knowledge and Behavior
Barnett, Cornish, Goodyear, and Lichtenberg (2007) assert that modeling
ethical and professional behavior with an emphasis on ethical practice in
supervision is an essential quality of effective supervisors. Indeed, formal
training in ethics is mandated in training programs in counseling, psy
chology, and related fields. However, as Welfel (1992) notes, research on
the outcomes of this training is still meager and demonstrates inconsistent
findings. It is also very disturbing that 50% of surveyed trainees perceived
their supervisors to have engaged in unethical practice during the course of
supervision (Ladany, Lehrman-Waterman, Molinaro, & Wolgast, 1999) and
that both supervisees and supervisors reported engaging in various types of
ethically questionable behaviors (Worthington, Tan, & Poulin, 2002). These
findings underscore the critical importance of attention to ethical decision-
making skills consistently across trainee developmental levels, as the inter-
personal and immediate nature of the supervisory relationship provides a
unique opportunity to address ethical and legal issues in depth, and perhaps
result in the central route processing discussed in this book.
To facilitate ethical knowledge and behavior in supervisees, supervisors
at a minimum must possess a thorough knowledge of the ethical and regu-
latory codes in their professions and jurisdictions. This may sound simple,
but these codes are subject to regular update, and it is not unheard of for
supervisors who have completed their formal training and certification to
neglect these essential updates. At this minimal level, then, the supervisor
is responsible for the knowledge and behavior expected of all practitioners
in the relevant setting. In situations in which state licensing applies, the
relevant codes are usually adopted as part of the statutory basis for regulat-
ing members of each profession. Thus, the ethical codes become part of the
regulatory or legal process.
As professionals assume the role of supervisor, they are responsible for
knowing and using the portions of the codes that deal with supervision.
Beyond codes and standards, practitioners and supervisors alike should be
familiar with at least several models that seek production of ethical behavior.
Such models are especially useful in dealing with more complex issues and in
cases in which the codes themselves are silent. For example, training issues
and client welfare issues are often intertwined. Also, what constitutes pro-
fessional competency, particularly in contexts in which referral options are
220 IDM Supervision: An Integrative Developmental Model
limited, can present difficult challenges. In addition, the codes speak to the
processes involved in making ethical choices.
One model that has demonstrated some efficacy in the research literature
is that of James Rest (1984). This model, based on Kohlberg’s model of moral
development (1969), identifies core abilities or competencies that the ethical
person must possess:
1. The ability to perceive, role take, and imagine consequences of action
and construct mental scenarios of probable causal chains of events.
2. The ability to decide which of the options in a dilemma is morally fair,
right, or closest to one’s ideals.
3. The ability to make a decision regarding a course of action by selecting
among competing values.
4. The ability to follow through on a course of action.
Karen Kitchener’s (1992) model is especially helpful in comparing and
choosing options for action. She identifies the following five critical ethical
principles for the evaluation of ethical dilemmas in professional practice:
1. Autonomy: responsibility for one’s behavior; freedom to choose that
does not interfere with the freedom of others.
2. Nonmaleficence: preventing or minimizing the infliction of harm.
3. Beneficence: attempting to contribute to the welfare of those with
whom we work.
4. Justice: fairness and equity.
5. Fidelity: honest, genuine, and consistent interaction.
Each of these principles can be examined in the context of a clinical issue
and related to both ethical codes and the context of the immediate situation.
John, a white male intern supervisor, found himself choosing not to
offer challenging but necessary feedback to his female African American
supervisee. He was concerned that the practicum student would view
him as “racist, or trying to be superior.” In discussing this problem with
his own supervisor, the intern acknowledged the ethical demand of fidel-
ity, that is, his obligation to provide honest and timely feedback to his
supervisee. With the ethical issue clear, he and his supervisor were able to
discuss possible approaches to convey the feedback.
Ethical and Legal Issues 221
Alice, an experienced supervisor, evaluated her practicum student
supervisee as not providing the quality of treatment necessary for effec-
tive work with a particular client. At the same time, the supervisee was
clearly learning a great deal in working with this client. Here the princi-
ples of beneficence and nonmaleficence required that the supervisor bal-
ance the achievement of positive goals and the avoidance of harm. Thus
the supervisor needed to assess the possible and probable harm, the good
to the client, and the potential growth of the therapist. Justice was also a
concern here, that is, the client’s right to treatment that meets acceptable
standards of care. In this situation, it was possible for the supervisor to
work as a co-therapist with the practicum student, a solution that allowed
for effective treatment as well as development for the supervisee.
Hansen and Goldberg (1999) provide a map for negotiating the complexi-
ties of ethical decision making illustrated above. Their considerations include
moral principles and personal values; clinical and cultural factors; professional
codes of ethics; agency or employer policies; federal, state, and local statutes;
rules and regulations; and case law. Knowledge of these complexities in train-
ing others is clearly a supervisor responsibility. As we will see later, in malprac-
tice actions, this responsibility is referred to as “vicarious liability.” It stems
from the doctrine of “respondent superior,” which holds the “master” respon-
sible for the acts of his or her “servants.” Thus, the next area in the Lamb et al.
(1991) model, competence, covers both the professional skills of the supervi-
sor and the supervisee and the supervisory abilities of the supervisor.
Competence
Professional Competencies
An important ethical mandate is that services provided must be within the
competence of the provider. This is an especially provocative issue in the case
of supervisees who are near the beginning of their professional education in
that they may have few competencies to offer. Supervisors are best advised to
be involved in the selection of clients for such supervisees, in order to match
client needs to counselor competencies as much as possible. Regardless,
supervisors are often called on to teach and model specific techniques for
such supervisees. Vigilant supervision is necessary to ensure client welfare
222 IDM Supervision: An Integrative Developmental Model
in these situations, and supervisors often need to be involved in decisions
regarding how many clients the supervisee should see at any one time. Dennis
Saccuzzo, who is both a licensed psychologist and a lawyer, provides an excel-
lent, comprehensive review of liability and standards of care in supervision
(2002, 2003; see also Recupero & Rainey, 2007; Hall, Macvaugh, Merideth,
& Montgomery, 2007). He reminds supervisors of the possible legal liability
of supervisees’ lack of competence in working with specific clients or client
issues, and recommends a level of monitoring based on the level of education
and experience of the supervisee. With beginning trainees, it is important
to review progress notes carefully, assess supervisees’ work on a continual
basis, and use videotapes or live observation, as opposed to relying on trainee
self-reports. The amount of supervisor time that has to be devoted to such
careful monitoring should be considered when deciding how many beginners
a supervisor can or should supervise at one time.
Even experienced clinicians often revert to Level 1 processing when learning
and implementing new techniques and dealing with unfamiliar client or ethical
issues. Supervisors should be alert for such events and provide focused supervision
until the new techniques or issues become more comfortable for the supervisee.
A related issue is that of supervisor competency regarding the indicated
clinical competency or client issue. It is assumed that supervisors possess com-
petencies in most of the areas for which they will be providing supervision.
However, there will always be circumstances in which a supervisor does not
have expertise in a given area. Additional training, reading, and consultation
can all be appropriate solutions, depending on the specific context. In some
instances, the supervisor may want to arrange supervision for the supervisee
with a colleague who possesses the needed experience and expertise.
There are also specific client issues with which supervisees, especially
advanced clinicians, may have more expertise than the supervisor. With con-
fident and experienced supervisors, this situation can provide an opportunity
to strengthen collegiality and gain additional competence. But certain of
these situations can be very problematic. An example would be the supervisee
whose cultural background and identity is different from that of the supervi-
sor. Such a supervisee may, even in the early stages of becoming a therapist,
claim expertise in dealing with a client of his or her background and reject
what the supervisor has to offer. This situation can be especially difficult with
supervisees at Level 2. On one hand, the supervisor needs to acknowledge
the insight that the supervisee has gained by virtue of cultural similarity to
the client. On the other hand, there may well be some universal conditions
that the supervisee is overlooking as a result of the similarities (Vasquez,
Ethical and Legal Issues 223
1992). While traditional counseling approaches have often neglected the cul-
tural group issues, the risk now is that in some cases this area may be overem-
phasized, especially for therapists who have a group identification similar to
that of the client. In addition, as Stewart and McDermott (2004) warn, indi-
viduals have multiple overlapping identities associated with diversity charac-
teristics (ethnicity, age, gender, SES, religion, etc.) that become more or less
salient depending upon the context. Being aware of these multiple identities
is important so that specific, perhaps more obvious, ones are not inappropri-
ately highlighted for a given individual for a particular context.
Leong (1996) presented a model of multicultural counseling that iden-
tifies three levels of client functioning and concerns: universal, cultural-
group-centered, and individual. Most recently, Allen (2007) provides a
comprehensive model for multicultural assessment within the supervisory
process that balances these factors, including the respective cultural identi-
ties of the supervisor and trainee, supervision process variables, and develop-
ment of skills leading to cultural competence in assessment practice. The
point we made earlier is again emphasized: all practitioners have an ethical
mandate to increase their competencies in working with diverse populations.
Supervisors are no exception, and learning from supervisees can be a valu-
able opportunity. At the same time, the role and experience of the supervisor
must be acknowledged. We strongly advise consultation for the supervi-
sor (and perhaps the supervisee as well) in such situations. Handled well, the
result can be improved communication between supervisor and supervisee
and effective services for clients.
Humberto, a Level 2 Latino practicum student, was convinced that
his female white supervisor could not understand the concerns of the
trainee’s Latino client. The client, a highly acculturated medical student,
was dealing with the death of his mother. The supervisee, somewhat less
acculturated and high in ethnic identity, insisted on focusing on the cli-
ent’s grief solely within the context of Latino culture. When the supervi-
sor pointed out the more universal aspects of the grief process, Humberto
listened to her words passively but then ignored them when working with
the client. When asked about his response in the next supervision session,
Humberto accused his supervisor of not comprehending the cultural
context. The supervisor, after some initial defensiveness, consulted with a
colleague, who was able to help her separate her admitted need for further
224 IDM Supervision: An Integrative Developmental Model
understanding of some cultural variables from her supervisee’s inability
to grasp the entire picture of his client’s distress. Although Humberto
remained somewhat resistant, he made sufficient progress to provide the
client with effective help in working through his grief process.
Competence to Supervise
New supervisors clearly need to attend to statements of ethics, professional
standards, and guidelines such as those articulated in this and the previ-
ous chapter. While the APA ethics code mandates that psychologists pro-
vide services in areas only within the boundaries of their competence, again,
only the Association for Counselor Education and Supervision in its Ethical
Guidelines for Counseling Supervisors addresses the need for both conceptual
knowledge and skill in supervision. Chapter 9 addresses the crucial impor-
tance of and increased need for competence in supervision, discussing recent
work in defining supervisor competencies and presenting guidelines for
supervisor development.
There are a number of general legal theories of liability under which medi-
cal and mental health professionals have been held liable. Each of these deals
specifically with supervisor competence. According to Saccuzzo (2002), neg-
ligent supervision is a matter of direct liability, and three theories—respon-
dent superior, the borrowed servant rule, and enterprise liability—cover cases
of vicarious liability.
In order to establish direct liability for negligent supervision, the plaintiff
must demonstrate a direct link between his or her injuries and the actions of
the supervisor. Although cases involving mental health supervisors have been
relatively few thus far, there are a number of relevant cases in medical settings
from which analogies can be drawn. Regulatory agencies are also aware of
and utilize tenets of direct liability. As one example, in Masterson v. Board
of Examiners of Psychologists (1995), a psychologist’s license was revoked for
failure to “monitor and control” a supervisee. In Steckler v. Ohio State Board
of Psychologists (1992), a supervising psychologist’s license was suspended for
failure to exercise “full direction, control, and responsibility” for client wel-
fare. The often cited case of Tarasoff v. Regents of the University of California
(1974), in which a therapist and the police were cited for “failure to warn”
a person that a threat had been made against her life, includes comments
regarding supervisor negligence as well.
The respondent superior theory holds those in positions of authority
legally liable for damages caused by their subordinates. Thus, supervisors
Ethical and Legal Issues 225
may be held liable either as the “master” or as an employer. Under this doc-
trine, Saccuzzo (2002) notes, there is little doubt that where actions of an
unlicensed supervisee negligently result in damages to a client or patient,
the supervisor may be liable. Further, in the case of sexual misconduct, the
supervisor may be liable even where the misconduct occurs outside the ther-
apy office or after therapy has been terminated. As a result, supervisors need
to “carefully monitor the therapy process, and above all, maintain control of
the case” (Saccuzzo, 2002, p. 5).
The borrowed servant rule arises in the context of training programs that
place students in mental health facilities outside the educational program.
A critical factor in determining liability is who had control of the supervi-
see at the time of the negligent act. The educational program (or university
supervisor) would be considered the general employer and the placement
facility (or on-site supervisor) would be known as the special employer. In
evaluating whether the general or special employer agreed to assume liability,
courts will turn to any affiliation agreements between the program and the
site (Saccuzzo, 2002). Consequently, professional training programs are well
advised to arrange careful, specific affiliation agreements with external or
field training sites and to assure themselves that the quality and quantity of
supervision at such sites are appropriate.
Enterprise liability theory views damages as part of the cost of doing busi-
ness, for example, by billing for the patient contact hours of supervisees.
Consequently, any profit the supervisor accrues from this common type of
supervision arrangement results in the supervisor bearing the risk of damages
to patients or clients (Saccuzzo, 2003).
Since there currently exists neither a consensus nor an explicit statement
of the standard of care in psychotherapy supervision by relevant professional
groups, it is essential that supervisors consult relevant ethical guidelines and
related statements noted earlier. The Kitchener principles, also previously
cited, provide helpful standards as well. Models that advocate an amount
and type of supervision based on a careful assessment of the therapist’s level
may be especially useful to the supervisor or agency in determining supervi-
sion practices.
Additional Ethical and Legal Concerns
Chief among the other ethical and legal matters that must be addressed by
supervisors as part of the mandate of competence are the following.
226 IDM Supervision: An Integrative Developmental Model
Confidentiality and Informed Consent Supervisors and supervisees need to
discuss in advance, and then inform clients of, the process by which super-
vision will be monitored, and who holds primary responsibility for client
care. We suggest that client agreement with this process be in written form,
as part of the discussion regarding limits of confidentiality. The supervisee
also needs to understand the supervisor’s expectations and the supervisory
process the supervisor will employ (Saccuzzo, 2002; Recupero & Rainey,
2007; Hall et al., 2007). Useful examples of written contracts covering vari-
ous components of informed consent in supervision have been presented by
Saccuzzo (2002) and Thomas (2007).
Multiple Relationships It is not difficult to understand the power differential
between supervisors and supervisees, especially in situations in which the
supervisee is a student. The APA Code speaks, as do others, to the necessity
of avoiding conduct that is demeaning to supervisees, not engaging in sexual
relationships with supervisees, and respecting the rights of others to hold
values, attitudes, and opinions that are different from the supervisor’s own.
Supervisors must also be alert to possible inappropriate relationships between
supervisees and their patients or clients (Saccuzzo, 2002).
Supervisees may not be in a position to select their own supervisors,
but every care must be taken to avoid multiple relationships in supervisory
assignments as well as other areas, or, minimally, to clarify these and track
their impact. For example, one should be careful when supervising an aca-
demic advisee, as this situation concentrates additional power in one per-
son. Biaggio, Paget, and Chenoweth (1997) and Gottlieb, Robinson, and
Younggren (2007) provide helpful guidelines for sorting out the variety of
multiple relationships that occur in academic settings. Similar considerations
would apply in an employer–employee situation.
Evaluation of Supervisees Evaluation of all supervisees is crucial, both for
supervisee development and for ensuring the quality of professional services.
It is essential that such processes be clear to all concerned and based on
actual performance and established standards of practice. Possible impair-
ment in the supervisee demands careful evaluation, feedback, and a clear
plan of remediation (Kaslow et al., 2007).
Evaluation of the Client The supervisor must make initial and ongoing
assessments of the client in order to assess an appropriate match with the
Ethical and Legal Issues 227
supervisee. Especially with inexperienced trainees, this evaluation will surely
include video recording and possibly face-to-face interaction with the client.
Representation of Credentials Supervisors practicing in jurisdictions in
which practice is controlled by licensure or credentialing must be clear on the
titles used by their supervisees. In some states, the relationship of a licensed
supervisor to an unlicensed supervisee could be constructed as “lending the
license” unless such a relationship is made explicit. Such a practice would
provide grounds for disciplinary action for the supervisor/licensee.
Reimbursement for Supervisee Insurance fraud may be charged if a supervi-
sor signs as the provider for services actually provided by the supervisee. It is
essential for the supervisor to understand and follow the billing practices of
each entity with which a contractual agreement is negotiated. Principle 6.06
of the APA Code also specifically speaks to these issues.
Competence, then, becomes the heart and soul of the supervisory role. A
competent and ethical professional who assumes the role of supervisor needs
to realize that areas of competence in professional techniques and methods,
ethics, and legal and regulatory areas must be expanded and sharpened. In
addition, the supervisor assumes responsibilities for that third and often most
ambiguous area of the Lamb et al. (1991) model, personal functioning.
Personal Functioning
Professional development in training, while inclusive of multiple performance
competencies, also includes interpersonal functioning (Elman, Illfelder-Kaye,
& Robiner, 2005). Consequently, supervisors have a responsibility to moni-
tor and assess the personal strengths and limitations and general well-being
of their supervisees, for the benefit of the supervisees themselves and to pro-
tect client welfare. As we have noted previously in this book, while supervi-
sion can, at times, share similar processes with therapy, the supervisor must
not become the supervisee’s therapist. Knowing when to appropriately refer a
supervisee to therapy to address personal difficulties and limitations serving
as roadblocks to the supervisee’s development as a therapist is a challenging
task. In addition, the limitations of therapy as an approach for dealing with
problems of professional competence and the lack of data to support its util-
ity need to be considered (Kaslow et al., 2007).
228 IDM Supervision: An Integrative Developmental Model
Supervisees are individuals who, like others, will sometimes be in the midst
of personal problems that have the potential for interfering with their clinical
work. Most of these problems are ones that can be dealt with by supervisor
and supervisee. However, some difficulties require additional attention. Lamb
et al. (1991) offer a model for response to psychology intern “impairment” that
can easily be adapted to fit other situations with other supervisees. Their model
consists of a four-step process: (1) identification of the problem, (2) explicit
discussion and planning with training staff, (3) implementation and review of
actions, and (4) addressing organizational reaction to the decisions and process.
In addition, Forrest, Elman, Gizara, and Vacha-Haase (1999) provide a thor-
ough review of related issues, including identification, remediation, dismissal,
and legalities, and McAdams, Foster, and Ward (2007) describe and examine a
program’s decision to dismiss a difficult student, which involved negotiating a
maze of protocols, lawsuits, and trial in federal court. Also, Falender and Collins
(2004) note that the use of the term “impairment” in regard to problematic stu-
dents is fraught with legal risk in the context of the Americans with Disabilities
Act; these authors recommend identifying trainees whose behavior is problem-
atic or who do not meet performance standards as “difficult students.”
Dealing with problematic supervisee behavior is perhaps the most com-
plex and demanding activity required of supervisors. The dual commitment
to supervisee and client can be deeply tested. This is one of those times when
the knowledge, commitment, and moral strength of the supervisor are on the
line. Supervisors are strongly advised to seek support and consultation from
relevant colleagues in such situations.
Surprisingly, at least to us, some supervisees are able to handle the early
years of training, where they are typically working in a clinical setting only
a few hours a week, without demonstrating problematic behaviors. In the
intensive, full-time arena of internship, residency, or the first professional
position, hiding difficulties that interfere with effective client treatment is
far more difficult. Then, too, being away from familiar support systems and
assuming many new responsibilities at one time is stressful to most people,
and some advanced supervisees and newer professionals are unable to handle
this stress productively.
Implications for Specific Levels
Each level of supervisee functioning in the IDM frames relevant issues.
Level 1 supervisees are generally eager to learn and use appropriate ethical
Ethical and Legal Issues 229
and regulatory codes. In their studies, however, they often encounter only
client situations in which ethical and legal guidelines are clear and unequiv
ocal. Supervisors in such cases can stretch supervisees’ thinking a bit by
introducing models of ethical and moral development and suggesting rel-
evant reading on ethical issues in clinical practice. When complex issues arise
for supervisees at this level, an extraordinary level of supervisor support is
necessary. The supervisor will also usually need to help the supervisee move
through the ethical decision making in careful detail.
Generally, supervisees at Level 2 are very aware of and committed to the
ethical demands of client welfare. They can on occasion avoid dealing with
other ethical or legal issues that may conflict with their ideas regarding what
is best for their client. This is the prime time for the use of models of ethical
development. The developing need for autonomy on the part of the supervi-
see is well matched by models that require careful consideration of options
and may pose conflicting interests. A real challenge for the supervisor is to
encourage this autonomy while still monitoring ethical and legal basics. In
other words, ethical decision making is a prime area in which the conflicts
of Level 2 are acted out.
One of us worked with a trainee who, typical of Level 2, became almost
totally encapsulated in his client’s view of herself as an abused woman and
chose to overlook the clearly abusive manner in which she was handling situ-
ations with her children. Only the supervisor’s strong confrontation forced
him to acknowledge the legal mandate to report the abuse, as well as deal
with the very important clinical issues involved.
The broader personal and professional integration characteristic of Level 3
therapists presents opportunities for the supervisee to develop a personalized
professional code of ethics. This person is now able to see guidelines and
codes as part of a broader perspective on the rights of individuals and the
responsibility of the profession. While the integration of professional identity
with salient issues of personal identity is possible at all levels, the relative calm
and maturity of Level 3 provides an optimal opportunity for this process. As
Vasquez and McKinley (1982) assert, “…if we are to promote maximum
growth in minority supervisees, we must attend to and stimulate their efforts
to incorporate ethnic identity with professional identity” (p. 60). Supervisors
need to be aware of the possible multiple sources of differences in supervisee
development discussed throughout this book, and Level 3 provides a time to
explore and integrate these more fully.
Each supervisee develops into his or her own professional person, bound
to others by common competencies and ethics, but differing in style, beliefs,
230 IDM Supervision: An Integrative Developmental Model
and areas of greatest expertise. The supervisor guides and facilitates, but
Level 3 supervisees are ready and able to march to the beat of their own
drummer. That is truly the reward of the ethical, competent, and committed
supervisors who walked with supervisees on the journey.
11
A Qualitative Examination
of the IDM
•
Rachel Ashby, Cal Stoltenberg, Paul Kleine
It is the purpose of this chapter to provide a specific empirical examina-
tion of the theoretical formulations of the authors’ IDM framework and let
trainees describe in their own words how they experience their own profes-
sional development. While throughout the book we have reviewed the extant
literature that both supports and critiques our IDM framework, we would
like to discuss a qualitative study that was carried out at the University of
Oklahoma to explicitly examine the degree of support, or lack of support, for
each of the three levels stipulated in the framework (Ashby, 1999).
To accomplish this task, an intensive qualitative study was undertaken
that followed four counseling psychology Ph.D. students through a year of
their training. By comparing students who were in year one and year two
of their doctoral training (after having had master’s-level practica), the devel-
opmental aspects of the IDM could be explored. Also, by observing and inter-
viewing over an entire year of experience, the rich data source should yield
insights into the levels of development and some of the domains discussed in
the IDM, at least as they pertain to the perspectives provided by the train-
ees. One of the challenges in exploring a model like the IDM is the lack of
adequate measures to tap the changes in the structures across developmental
levels and domains of practice. Although we think the somewhat complex
nature of this process maps rather well onto the extant research in clinical
supervision, and fits with other literatures such as those on learning, motiva-
tion, cognition, and emotion, there is no simple way to fully test the model.
231
232 IDM Supervision: An Integrative Developmental Model
This is particularly true with the nonlinear way the structures manifest them-
selves in Level 2. Also, we think that using trainees’ own words to describe
their experiences adds some richness to the articulation of the model.
Empirical Evidence of Counselor Development
We won’t attempt to review the bulk of the research we have cited in prior
chapters concerning the IDM, but to remind readers of the empirical status of
the model, a short summary is in order. Early work on developmental models
of supervision was reviewed by Worthington (1987), and later by Stoltenberg,
McNeill, and Crethar (1994), who reached similar conclusions. They sum-
marized the research literature as showing “support for general developmen-
tal models”; “perceptions of supervisors and supervisees are consistent with
developmental theories, the behavior of supervisors changes as counselors
gain experience, and the supervision relationship changes as counselors gain
experience” (p. 419). Other reviews of the supervision literature (Ellis &
Ladany, 1997; Ellis, Ladany, Krengel, & Schult, 1996) have concluded that
problems exist with the methodology of the studies and that the IDM has
not yet been adequately investigated. On the other hand, Stoltenberg (2005)
maintains that the IDM is the most investigated model of supervision with
the most support to date.
In an examination of actual in-session behavior, Bear and Kivlighan
(1994) used Stoltenberg and Delworth’s (1987) IDM for the basis of a single-
subject study examining the process of individual supervision. An experi-
enced supervisor worked with both a beginning trainee and an advanced
trainee. The researchers taped and transcribed 12 supervision sessions for
each dyad. The session transcripts were then rated for supervisor and supervi-
see interpersonal behaviors and for supervisee depth of information process-
ing. Consistent with the IDM, the results revealed that the supervisor was
more structured and directive with the beginning supervisee, who made more
dependent responses. On the other hand, the supervisor was more collegial
and collaborative with the advanced supervisee, who made more autonomous
responses. The directive and structured supervisor interventions produced
more deep-elaborative information processing by the beginner, whereas this
preferred type of processing was stimulated by the collegial or consultative
supervisor interventions for the advance trainee.
In Chapter 6 we discussed a phenomenological investigation of “good”
supervision events conducted by Worthen and McNeill (1996). They
A Qualitative Examination of the IDM 233
interviewed eight trainees from three APA-approved counseling psychology
doctoral programs. As you will recall, their results indicated that intermedi-
ate trainees (advanced practicum) experienced a fragile and fluctuating level
of confidence and a generalized state of disillusionment and demoralization
with the efficacy of providing therapeutic interventions. In addition, they
were anxious and sensitive to supervisor evaluation. Trainees felt that their
anxiety level decreased when supervisors helped to normalize their struggles
as part of their ongoing development. They also characterized the supervi-
sory relationship as empathic, nonjudgmental, and validating, with encour-
agement to explore and experiment. These conditions appeared to set the
stage for a nondefensive analysis as the trainees’ confidence was strength-
ened. Participants also reported an increased perception of therapeutic com-
plexity, an expanded ability for therapeutic conceptualizing and intervening,
a positive anticipation to reengage in previous difficulties and issues they
had struggled with, and a strengthening of the supervisory alliance. Finally,
Worthen and McNeill found that intern-level trainees exhibited a basic sense
of confidence and autonomy and that inadequacies were identified as domain
specific. As a result of increased levels of insight and self-awareness, these
trainees not only display openness but also prefer to further acknowledge
and confront issues of transference-countertransference, therapy-supervision
overlap, and parallel processes in supervisory and client relationships. Inter
estingly, they also reported previous unrewarding supervision experience,
perhaps resulting in an aversion to overt evaluation and a strong desire for
more rewarding supervision. In common with less experienced trainees, the
interns also viewed good supervision as characterized by an empathic, non-
judgmental relationship with encouragement to experiment and explore, and
they were pleased when their struggles were normalized. As a result, positive
outcomes of good supervision events were similar to those of their less expe-
rienced peers. In addition, their confidence was affirmed and they reported
an increased impetus for refining a professional identity.
The Intent of the Study
We wanted to add to these studies by extending an investigation over a full
year and getting trainee perspectives multiple times across this experience.
We explored trainee responses to their training by considering not only the
supervision received but also the influences of the trainees’ current and previ-
ous counseling experiences and the academic program itself. We anticipated
234 IDM Supervision: An Integrative Developmental Model
that this would allow us to look at multiple influences on trainees over an
extended period of time, tapping the ongoing perceptions of trainees in a way
that would not be possible using a single-shot collection of data from objec-
tive (and, therefore, limited) questionnaires.
Although there is considerable empirical support for general models of
counselor development, and specifically the IDM, the field still lacks clear
evidence of the existence of some of the characteristics of Level 2 trainees,
as we have hypothesized in our earlier work (Stoltenberg & Delworth, 1987;
Stoltenberg, McNeill, & Delworth, 1998) and in the present book. The fluc-
tuation in motivation, the vacillation between autonomy and dependency, the
client-centered focus of the trainee, and a reduced interest in labeling clients
with a diagnosis are noteworthy examples of hypothesized differences between
Level 2 trainees and others that we hoped we could delineate in this study.
As noted, prior research has helped clarify trainees’ supervisory needs
as they gain experience, the consistency of trainee and supervisor per-
ceptions with developmental theories, the changes in supervisor behavior as
trainees gain experience, and the change in supervision relationship as coun-
selors gain experience (Stoltenberg, McNeill, & Crethar, 1994). We intended
to add depth to this body of work by examining trainees’ perceptions of their
levels, needs, experience, and supervision as well as their interactions with
their supervisors as they progressed through a year in their doctoral program
in counseling psychology.
Of course, all studies have limitations, and this is certainly no exception.
Given the small number of participants (four supervisees, two supervisors), the
very specific setting (a particular academic training program with a training
clinic), and all the limitations of self-report data, we certainly cannot claim
to explain, define, or delineate all the variables involved in the complexity of
counselor development and supervision. What we tried to accomplish was to
accurately portray the growth and development of two doctoral students in
their first year of doctoral practicum and two students in their second year
of doctoral practicum at the program training clinic within the context of an
APA-accredited counseling doctoral program.
Our Method
This study considered individuals and their development as counselors
within a training program context with a focus on highly individualized
responses by the trainees. Critical Incident Questionnaires (CIQs; Heppner
A Qualitative Examination of the IDM 235
& Roehlke, 1984) and interviews were used to allow participants to give
their perceptions of the supervision experience in individual ways without
limitations imposed by objective-test items. In other words, by focusing on
the experiences revealed through the CIQs and using semistructured inter-
views, the trainees were encouraged to openly share their perspectives and
highlight what they saw as important in their supervision and training.
Four men (two first-year and two second-year students) of European
American ethnicity were recruited from the counseling psychology doc-
toral program at the University of Oklahoma, a program accredited by the
American Psychological Association, and were in program-required practica
in our Counseling Psychology Clinic. Trainees ranged in age from 23 to
27 years, were in their second to fourth year of graduate education, and had
completed two to six semesters of practicum training under direct supervi-
sion. It was expected that this range of experience should capture at least some
evidence of Level 1 and Level 2 processes across some domains as described
by the IDM. The trainees’ supervisors were two men, a 34-year-old who was
at the start of his supervisory experience and a 43-year-old with 16 years of
supervisory experience. We decided to include only men so as to avoid gen-
der interaction within the supervision dyad. Further, the four trainees were
chosen to most closely match (within levels) on education and on counsel-
ing and supervision experience. Participants all agreed to complete the CIQs
and participate in tape-recorded interviews. Participants were volunteers and
were not paid for any part of their involvement in the research. All trainees
and supervisors who were invited to participate accepted the invitation.
The number of participants is small, so the trainees’ and supervisors’ char-
acteristics, of course, do not represent all trainees or supervisors in this spe-
cific program and certainly not programs in general. As with all studies of
this type, results should not be generalized to a larger population of counsel-
ing psychology trainees as a whole. The small sample size allowed us to focus
intently on the experience of a few trainees without creating unworkable
demands on time or resources.
We selected the Critical Incident Questionnaire (CIQ; Heppner &
Roehlke, 1984) because of its ease of administration and for its priming
effect to elicit reflection immediately after supervision sessions. The CIQ
asked trainees to describe events related to critical incidents, or major turn-
ing points, within the supervision process that resulted in change(s) in the
trainee’s effectiveness as a counselor. For this instrument, a critical incident
was defined as an occurrence that resulted in a significant change: that is,
an interaction between supervisor and trainee that is recognizable as a kind
236 IDM Supervision: An Integrative Developmental Model
of turning point, resulting in change(s) in the trainee’s effectiveness as a
counselor/psychotherapist. This definition was followed by three questions
that asked for information related to the occurrence of any such critical inci-
dent in supervision:
1. Please describe any such incident in your supervision this session.
2. What made this a critical incident for you?
3. What did you want to gain from this supervision session? Did you
receive it?
Interviews were conducted with each trainee and supervisor across the aca-
demic year. According to Bogdan and Biklen (1992), qualitative interviews
are used predominantly in two ways: as the primary source of data, or in
conjunction with other data-gathering techniques such as observation or writ-
ten questionnaires. This second use is most appropriate for our intentions,
as we expected the interviews to provide insight in analyzing participants’
CIQs and, we hoped, lead to a better understanding of how the supervision
process and the trainees’ specific experiences influence counselor training/
development for their trainees.
The CIQs were completed independently by both trainee and supervisor
following each weekly one-hour supervision session from September through
May. In addition, audiotaped personal interviews, lasting approximately
thirty minutes to one hour each, to follow up on responses to the ques-
tionnaires were conducted six times for each participant across the fall and
spring semesters on the following dates: October 4–11; November 15–22;
December 16–18; February 18–25; April 5–11; and May 5–9. The interviews
were conducted by a doctoral student in the program who was familiar with
the supervisees and supervisors in the study. Detailed qualitative studies can
be lengthy. As we are mostly interested here in illuminating the supervisees’
perceptions of their experiences, we will only examine their CIQs and inter-
view data.
What We Found
It is important to note that initially the interviews were “trainee centered,”
guided by trainees’ CIQs and remembered experiences across time. However,
toward the latter part of the year, the interviewer actively directed the train-
ees to speak to all eight domains of the IDM. Though obviously limited by
A Qualitative Examination of the IDM 237
the single program studied and the small sample size, the results suggest that
some of the IDM domains were more effective than others in predicting
change in these counselor trainees. Results clearly indicate that the interven-
tion skills competence, interpersonal assessment, and theoretical orientation
domains were most effective in predicting development across the structures.
The domains of assessment skills, professional ethics, and client conceptu-
alization were moderately effective domains. Finally, minimally effective
domains included treatment plans and goals as well as individual differences.
For the sake of brevity, the data for the moderately supported domains are
not reported here, but are available in Ashby 1999. We feel that greater clar-
ity is achieved by contrasting those domains that received high support with
those receiving minimal support. To assist the reader, the number 1 is placed
behind the names (pseudonyms) of the first-year trainees and the number 2 is
placed behind the names of the second-year trainees. Table 11.1 summarizes
trainee comments across interviews for each domain and can be found at the
end of the chapter.
Support for the Model
Intervention Skills Competence
Within the intervention skills competence domain, the trainees clearly fol-
lowed the IDM progression from therapists who were highly motivated to
acquire skills, were dependent on the supervisor for step-by-step direction,
and had limited self-awareness with a strong focus on self to therapists whose
motivation fluctuated, who dealt with the dependency–autonomy conflict,
and who began to focus more on the client. Throughout the first semester,
Alan’s counseling experience with individual adults and Dirk’s experience
with couples characterized the Level 1 therapist across all three structures
through high motivation, dependence on the supervisor, a primary focus on
self, and anxiety due to lack of skills and knowledge.
Alan (1): I don’t feel like I know the counseling process well enough. I feel
like I ask questions, and I deal with things with clients and we
talk about things, but I don’t feel like I am directed … I want to
be told exactly how do I use this and how do I do this specifically.
I wish there was an instruction book that tells you how to imple-
ment these things.
238 IDM Supervision: An Integrative Developmental Model
Dirk (1): My supervisor sat down and kind of wrote down a plan for a first
session with them and we haven’t gotten through it yet … My
supervisor also gave me a big ol’ chapter on integrated behav-
ioral couples therapy. It’s been really helpful, ’cause I’ve been very
much up in the air about that. It’s been helpful. I haven’t gotten
through all of it … it’s been good.
Into the spring semester both first-year trainees appeared to progress
through the IDM Level 1 across the structures. The trainees reported that as
their level of experience and efforts to seek out literature relevant to clients
increased, their anxiety decreased, and as a result, both appeared to desire
more autonomy than was warranted. Also, by the end of the year they had
begun to switch their focus more to the client and away from their own
thoughts or performance in session. While Alan experienced this growth
(assimilation) in his work with individual adults, Dirk’s development
occurred in his work with couples.
Alan (1): Counseling is a lot more productive now, and it’s a lot more enjoy-
able than it was at any point last semester. Part of it is I finally
had more clients and did the reading and the preparation. I don’t
feel that pressure to need to solve things like I did last semester.
And some of that letting go of that frustration stuff made it more
fun for me to do the reading and research what’s going on and it
just made counseling in general more fun. I feel like I now have
control over what’s going on.
Dirk (1): And now most of the stuff, just I’ve gotten comfortable with and
it’s not a problem. And I can get into their world a little better
than I used to. And I feel more confident about things, so it’s been
real good. I really think more than anything else it’s just been
experience, more clients, that has contributed to the confidence.
According to the IDM, the next steps in development should be fluctu-
ating motivation, dependency–autonomy conflict, and more focus on the
client (ideally, empathy and perspective taking). This reflects the limitations
of assimilation and the need for accommodation. This fluctuation, or in this
case drop, of motivation was captured in the last interview with Dirk as he
was discussing his comfort and confidence in his intervention skills.
A Qualitative Examination of the IDM 239
Dirk (1): Occasionally I’ll find myself leaning way back and … looking out
the window. I’ve done that a lot, ’cause one of my clients is blind,
so he doesn’t know. So I’m looking out the window the whole
time I’m talking to him. I’ve got to stop doing that.
This transition issue of motivation fluctuation in Dirk was expanded to
include the Level 2 reactance within the dependency–autonomy conflict and
more focus on the client by David in his first semester of his second year of
doctoral work.
David (2): I’m kind of in that ambivalent stage where you’ve got the basic
skills down and you feel pretty good about those, but yet you
know there’s so many areas in which you have to grow and so
you’re kind of regressing. I mean, it’s so … I guess it’s where you
actually regress a little bit in your microskills and your basic
skills, because you’re going to look, “Where the hell am I going
with this client, because I’m conceptualizing it like this?” And
so, when you’re trying to do that, you actually regress as far as
your empathy and all that, the basic perfection of those kind of
things. Well, I mean, just the kind of the common theme that
I’ve been thinking about is just this idea that you reach a certain
point in your growth and you’re like, “Leave me alone, I’m doing
fine. I’ll grow on my own from now on, just I don’t need any
more supervision, thanks. You don’t need to supervise my work
anymore, ’cause I’m taking care of it on my own.” But then as
you’re forced to take more supervision, you realize that’s not the
case, that while you are growing on your own, you have some
responsibility as far as receiving new information, new skills, that
it really does help to have someone that’s been through that to
kind of be monitoring your work, thoughts about it and saying,
“Well, you’re doing good, but have you thought about this? Or
maybe you should consider this or this.”
Congruent with the IDM, at this stage the primary conflict for the trainee
is a vacillation between autonomy and dependency. On one hand, trainees
are developing their own ideas and gaining knowledge through experi-
ence, individual and group supervision, and course work regarding effective
interventions with clients. Thus, they have the tendency to move away from
240 IDM Supervision: An Integrative Developmental Model
imitating the supervisor. Trainees become more confident, and sometimes
reactive, in asserting their independence in intervening with clients. At the
same time, however, they remain dependent on their supervisor for advice and
direction in various cases where they lack experience or confidence, or both.
According to the IDM, this dependency–autonomy struggle also affects
the motivation of Level 2 therapists. They desire to function independently,
but when they are exposed to more difficult client types, client problems, and
methods of intervention they may not be effective with some clients. They
may start questioning their skills, and the experience may shake their level of
confidence and sense of therapeutic efficacy. For some therapists, this confu-
sion manifests itself in high levels of motivation to seek additional guidance
and support. Others wallow in frustration, which can reduce motivation to
learn and engage in difficult clinical activities. Phil, in his second year, dis-
played a reduction of motivation in dealing with the confusion and frustra-
tion. He was comfortable and confident in his work with low-maintenance
clients and he reported an intent to turn to his supervisor given a new clinical
situation. However, he appeared to have a reduced motivation and avoided
difficult clinical activities.
Phil (2): Right now I feel really comfortable with where I’m at with my cli-
ents, ’cause I’ve seen them for a while. But if I am assigned a new
client, I would hope to get some guidance and I’ll probably have
a lot of questions about where to go and what to work on … But
when it comes to that one couple that’s blah, I … don’t get excited
… if they cancel, they cancel, they skip till next week. ’Cause
they think they’re just here to jump through hoops, they’re not
really willing to work on the issue at hand, they want to without
having any homework or anything else. I think that’s how they
see it. That’s just my motivation to why should I put all this freak-
ing energy into this, when they are not doing anything on their
part to get anything else out of it.
Interpersonal Assessment
Within the interpersonal assessment domain the trainees, again, closely fol-
lowed the IDM progression from highly motivated, self-conscious therapists
who rely on their supervisor for step-by-step direction to therapists with
fluctuating motivation, who deal with dependency–autonomy conflicts, and
A Qualitative Examination of the IDM 241
who focus more on the client, understand client worldviews, and empathize
with affect.
The IDM’s clearest prediction for Level 1 therapists is a self-focus that
limits their ability to take the perspective of the client and their ability to
accurately monitor their own reactions. The motivation to learn to assess
clients is high, but the supervisor plays a crucial role in serving to redirect,
interpret information, or offer alternative conceptualizations for the trainee.
Throughout most of the academic year, the two first-year trainees’ self-focus
appeared to limit their ability to take the perspective of the client as well as
their ability to accurately monitor their own reactions. It was not until the
last two interviews of the year that the trainees identified an awareness of
client worldviews and emotions in the session. Consistent with the IDM self-
and other-awareness structure, at this point both trainees possessed a high
level of self-awareness in this new area of learning. Alan reported a belief
that he had begun to work to convey his understanding of the client’s emo-
tional experience. Dirk also reported a new focus on the client’s affect and a
hope to effectively express his own emotional responses. Dirk’s comment also
reflected his previous Level 1 tendency in this domain to ignore, or not even
notice, the client’s worldview and emotions that were occurring in therapy.
Alan (1): Emotions and affective stuff, that’s what I wasn’t doing before,
and my supervisor and I really tried to get me to focus on emo-
tions and conveying to the client that I understand the emotions
they’re talking about.
Dirk (1): I think I’m doing better at paying attention to their affect in ses-
sion, ’cause I’ve always assumed how they must feel, but I think
I’m doing better about really finding out even though it’s uncom-
fortable for me to do that. I think I’m doing better at finding out
what’s really there. Just being more connected, more emotionally
available, that kind of thing. That’s something I really have a lot
of room to grow.
In accordance with the IDM, this increased attention to client reactions
indicated movement or transition to Level 2 in this domain. However, the
beginning of empathetic understanding and the depth of emotional contact
with the clients expected more at Level 2 are still not present. Nonetheless,
according to the IDM, the Level 2 therapist may overaccommodate to the cli-
ent’s worldview. Thus, the therapist may find it difficult to separate responses
242 IDM Supervision: An Integrative Developmental Model
to clients based on accurate perceptions of the client’s interpersonal interac-
tions from countertransference reactions outside of immediate awareness. It
is not unusual that increased awareness in this domain is met with confusion
by trainees. At the end of the academic year, the first-year trainees demon-
strated their initial awareness and concern of, or confusion regarding how to
handle (or, in Dirk’s case, to “protect” himself from), client affect.
Alan (1): I was much more comfortable dealing with the thoughts and
cognitions and stuff and not so comfortable talking about the
emotions.
Dirk (1): But maintain emotional boundaries so that you’re very much
there and interacting with the person, but yet protecting yourself,
because you have to. You know, I’m starting to really see that.
You really have to. I mean, you must! Not sitting around thinking
about stuff … About the most I do anymore in terms of personal-
izing is just saying, “I’m glad I’m not that guy!” or whatever. And
I try not to do that too much, ’cause I think that belittles their
problems. I don’t intend for it to, but I think maybe it does. But
mainly, I’m just saying, not allowing things to bug me, ’cause
I think—maybe I just rationalize it to myself—but I think I’m
developing a coping mechanism that is really going to be essential
to this field. Not just essential for my own sanity, but … essential
for my effectiveness and longevity. I will not make it if I let myself
get drawn into every person’s life that comes along ‘cause it’s just
too much. But yet not getting callous to it, that’s the trick.
Consistent with the IDM Level 1 therapist in transition to Level 2, in
this study, both second-year trainees began the year with an awareness of
client affect but reported having their eyes opened or an increased awareness
of their own emotional reactions to clients. As suggested by the IDM, ini-
tially the respective supervisors assisted trainees in developing an awareness
of their own reactions to clients.
Phil (2): One week ago, I talked with my supervisor about how frustrated
I was with this particular couple. My supervisor said that it is
important that I let them know about my frustrations and tell
them. It kind of opened my eyes to how my frustration was inter-
acting with my therapy.
A Qualitative Examination of the IDM 243
David (2): Those kind of things and some in‑session dynamics, like being
aware of how I am feeling about something the client is telling me
and using that affect in myself to direct me in intervention.
As the year progressed it was interesting to note how the two second-year
trainees appeared to develop differently. Consistent with the IDM’s predic-
tion of Level 2 development, David experienced a fluctuation of motivation
and confidence while gaining experience with more complexity. He also
increased in awareness of his own emotional reactions within any given ses-
sion, and he began to report a greater appreciation for what the client actually
felt and experienced. Throughout this process, he vacillated between inde-
pendent functioning and less assertive, dependent situations.
David (2): I have more of an appreciation for what the client’s experiencing
and what they’re going through, the emotional side and the soft
stuff. Not their right parietal lobe has a lesion and it’s causing
them to do this or not being able to do that. That they’re doing
that and experiencing that, but it’s also impacting their life in this
way and they’re [experiencing] depression. Uh, you know, and
my supervisor made the point you can’t fake empathy, and I agree
with that and I don’t have an absence of empathy. I just don’t
express it to my clients, and that’s what I’m working on, being
able to get in there with them and really talk about one specific
thing and have a feeling about it.
As a result, David reported a greater investment in and understanding
of the client’s world as he continued to work for a level of comfort with the
application of affect and use of self in his therapeutic work.
David (2): I don’t think awareness of my reactions has restricted my ability
to focus very much. I mean, I am thinking about it during ses-
sion, but I’m still able to focus on the client. I don’t know that it
gets that restrictive. In some sense it might have encouraged me
to focus more on what they’re going through. I’m getting better,
but not where I want to be. I feel like I’ve made progress in that
area, but I catch myself falling back into old habits. For a while
my supervisor would just kind of talk about it and we would dis-
cuss it kind of abstractly, but I’ve taken the lead with asking for
244 IDM Supervision: An Integrative Developmental Model
more examples and have him display for me what that would look
like in session, and so he sort of started kind of modeling what I
could do, and that’s been very helpful.
David’s previous comment, made during the last interview of the year, is
indicative of the beginning of the transition from Level 2 to Level 3 in this
domain, as proposed by the IDM. His stated ability to focus on the client
and the ability to reflect on personal reaction to the client enabled him to use
the interpersonal nature of therapy to generate an in-depth understanding
of the client’s interpersonal world. However, despite the fact that he had the
awareness and developed these interpersonal skills, David still struggled with
confusion in application of these skills. Also, there was no solid evidence that
David’s empathic and understanding skills had developed to the point of
being able to fully appreciate, let alone utilize, this perspective.
On the other hand, Phil appeared to avoid difficult and unsuccessful cases
that might cause him to question his effectiveness as a therapist. His motiva-
tion and effort in developing his interpersonal assessment skills seemed to
be quite low, as reflected by his reported “relief” and desire to escape from
therapy situations, such as this, that caused confusion or frustration.
Phil (2): If they show up, if they don’t show up, it doesn’t matter to me …
When they stopped coming in, it relieved my emotions because I
didn’t like working with them in the first place.
Theoretical Orientation
The theoretical orientation domain development was also accurately pre-
dicted by the IDM. Highly motivated in his search for the “best” ori-
entation for himself, Dirk displayed his dependence on his supervisors
when he reported in the initial interview, “Well, I guess I probably best
identify with the cognitive-behavioral because that seems to be the theory
of choice of many of my supervisors.” This focus on a single approach did
serve to reduce anxiety, as predicted by the IDM, and began to provide
some cognitive structure for understanding the process. Also consistent
with the IDM, as the trainees experienced some success with clients and
increased in a sense of autonomy (advanced Level 1), they appeared to
experience a temporary period of lowered motivation to expand knowl-
edge in this domain.
A Qualitative Examination of the IDM 245
Dirk (1): Applying theory on the one hand is getting easier, and on the other
hand, I’m kind of thinking, “Well, my understanding of efficacy
studies and that really doesn’t matter, so, as far as what theory you
use, as long as you use it well.” Overall, since Christmas break
I’m just kind of cruising along on autopilot. I haven’t really been
doing a whole lot of thinking. I do whatever I’m told. I’m just
floating through to spring break … I’m motivated to keep up, but
I’m not threatened about things like I probably should be.
Alan (1): I’m feeling a lot more comfortable with not being completely sure
what to do. I don’t feel as much pressure now to have to tie myself
to a theoretical orientation. But I’m also able now where I can
take a client’s problem and think about it from different perspec-
tives, where I couldn’t before. But I’ve given up the idea that I
need to use a manual in session.
According to the IDM, as Level 1 trainees grow in confidence, motivation
to learn new orientations may drop as they try to avoid reentering a phase of
confusion. Nonetheless, by the end of the year, the trainees reported a high
level of motivation to move away from their strict allegiance to one specific
theoretical orientation to more experimentation with a wider variety of tech-
niques and strategies.
Dirk (1): I’m trying, very actively trying, to formulate an eclectic approach,
because I just don’t see the rationale in picking one thing and
sticking to it because you are told to or whatever. But in the sense
of trying to learn two or three different orientations well and
within their parameters and pick and choose.
Alan (1): But the difference is this semester I’m okay not knowing what my
theoretical orientation is. I feel like I do a good job with my cli-
ents and that I’m still learning about theory. And I’m learning to
use different ones, but I guess before I felt like I had to know what
my theoretical orientation was to be confident in counseling.
According to the IDM, after this movement away from a strict allegiance
to a specific theoretical orientation identified with the program, faculty
member, or supervisor, one would expect the next step to be more experi-
mentation with a wider variety of techniques and strategies. This study
appeared to join the second-year trainees defining and building upon a
246 IDM Supervision: An Integrative Developmental Model
personal approach. However, as the year progressed, the two trainees devel-
oped the Level 2 therapist’s stronger focus on the client’s responses, and
they began to value and enjoy exposure to other orientations, which they
evaluated the general advantages and disadvantages of for their given cli-
ent against a growing understanding of their chosen therapeutic orienta-
tion. Finally, without abandoning this preferred orientation, the trainees
chose to add theoretical constructs from empirical research to their working
knowledge of therapy. David’s comment specifically demonstrated the IDM
Level 2 therapist’s reactance, which is a common result of the dependency–
autonomy conflict.
David (2): Actually, looking back at it, the interpersonal intervention even-
tually opened up the way for the client to make some insights.
But being encouraged to adopt an affective, almost feminist-
based therapy, it’s almost been implied that I don’t use the CBT
as much. I don’t know if my supervisor intended that or not, but
in some ways I reacted against that, because I’m not willing to
give up CBT. But I’m willing to incorporate more affective stuff
into it, because I believe CBT is effective, but you do have prob-
lems sometimes with it with some clients.
Phil (2): Well, at this point I’m definitely more humanistic, but then I did
research with the OC client and cognitive-behavioral came out
on top with techniques to use, and the other two I had to use
cognitive-behavioral approach since that was what was the focus
of the study. So I consider usefulness in a combination of both of
the two. I think [my approach is] humanistic, but with cognitive-
behavioral tendencies.
Limited Support for the Model
Only limited support for the concept of the IDM Level 2 therapist in the self-
and other-awareness structure within the individual differences and treat-
ment plans and goals domains was found.
Treatment Plans and Goals
The IDM predicts that the Level 1 trainee’s initial focus is often more on
keeping the clients coming than of expecting or planning facilitative change.
A Qualitative Examination of the IDM 247
In addition, it suggests that sometimes the trainees have techniques in mind
to use but do not necessarily tie these into goals, or they have some goals in
mind but no idea how to reach them. Finally, the trainee’s approaches are
sometimes random or based on a predetermined sequence of interventions as
part of a structured program.
Although the data within this domain were very limited, the first-year
trainees’ reports in this study support some of the model’s predictions for
a Level 1 therapist. For example, Dirk reported an initial focus on keeping
clients coming in addition to working with a couple from his supervisor’s
outline. In addition, he reported an anxiety that his supervisor assumed that
he knew more about treatment planning than he actually knew.
Dirk (1): My supervisor sat down and kind of wrote down a plan for a first
session with them and we haven’t gotten through it yet … I think
my supervisor takes for granted or something that I don’t need
help to actually plan cases. And, well, I’ve had that, what I’m
beginning to see is a pretty common feeling that, gosh, I must
be the worst counselor because they come once and I never see
them again.
Phil’s dependence on his supervisor as well as his anxiety with the dif-
ficulty of understanding and providing effective treatment for couples is
another solid indicator of the Level 1 therapist’s self-focus and dependence
on the supervisor for this client type in this domain.
Phil (2): I just got annoyed with it and my supervisor told me to confront
them and say, “You’re like a mother, and you’re like an adolescent,
like a teenager, if not younger. You’re 30-something, but you’re
actually only 12.”
Setting basic treatment goals and plans seems functional and concrete
for the Level 1 trainee and serves to reduce anxiety. However, the IDM
self- and other-awareness structure suggests that the overaccommodation
demonstrated by the Level 2 therapist may result in anxiety concerning the
difficulty of providing effective treatment or discouragement when initial
treatment plans fail. Further, in the act of overaccommodating to the cli-
ent’s perspective, treatment goals may simply reflect the client’s initial reasons
for seeking counseling, ignoring the relevance of therapist assessment and
248 IDM Supervision: An Integrative Developmental Model
conceptualization in the goal-setting process. These trainees did not clearly
manifest these characteristics throughout this study. In fact, little evidence to
support this Level 2 prediction was provided by trainee interviews or writ-
ten reports.
Individual Differences
The IDM suggests that although it is increasingly likely that Level 1 trainees
are being exposed to these issues early in their training experiences, they still
often rely too heavily on their own idiosyncratic experiences and percep-
tions of the world in their attempt to understand their clients. This self-focus
seemed to be captured by Dirk’s unreported acknowledgment of the cultural
differences between himself and a male client who was blind and living in a
very low SES. The only mention Dirk gave of this client was in the context
of telling about his comfortable and relaxed attitude in working with clients
in session.
Dirk (1): I think I know how to appear interested to somebody, everybody
does it all the time in conversation, so I think it’s silly to put too
much emphasis on that. So I don’t worry about that kind of stuff
so much. Occasionally I’ll find myself leaning way back and look-
ing out the window. I’ve done that a lot, ‘cause one of my clients
is blind, so he doesn’t know. So I’m looking out the window the
whole time I’m talking to him. I’ve got to stop doing that.
Consistent with the IDM, the scarcity of data in this domain seems to
suggest that the first-year, Level 1 trainees were unaware of and did not
acknowledge the importance of differences in background, culture, gender,
or physical or mental abilities.
The IDM prediction for progress to Level 2 across the structures in this
domain is an ability to acknowledge the influence of sociocultural and envi-
ronmental variables on behavior and the limitations of conventional counsel-
ing modalities for working with diverse clientele. However, according to the
IDM, they may still vacillate between general culture-specific characteristics
they believe apply to all individual members of various groups and the idea
that every client is so unique that defining cultural values, attitudes, and
behaviors may be ignored. Although the therapist may be confused or vacil-
lating, he or she simultaneously has greater openness and interest in learning
about other groups and exhibits a genuine attempt to understand the varieties
A Qualitative Examination of the IDM 249
of human experience and the effects on the counseling process. This vacilla-
tion in awareness and motivation was seen in the two second-year trainees.
For example, David demonstrated cultural awareness and high motivation as
he sought out more information on women with depression.
David (2): Two of my clients are women with major depression. I have been
focusing more on doing more affect-based counseling and reading
or learning more about feminist therapy or interpersonal therapy
to work with these women.
On the other hand, Phil’s experience with a female client who would not
leave an abusive relationship was indicative of limited other-awareness and
low motivation to thoroughly understand or appreciate her predicament.
Phil (2): I wanted to just tell her then, “Why are you doing this? I can’t do
anything for you if you’re still going to stay in this relationship!”
No additional evidence to support the IDM predictions for this domain
was found.
Discussion
The results we obtained in this study strongly supported the IDM inter-
vention skills competence, interpersonal assessment, and theoretical
orientation domains as effective in predicting development across the
structures. More limited evidence was found to support the IDM’s predic-
tions regarding the individual differences domain and the treatment plans
and goals domains. Unexamined here was the moderate support noted
earlier for the assessment skills, professional ethics, and client conceptu-
alization domains.
When examining the shortcomings of the IDM, we are faced with two
issues. Some of the issues within the domains were not specifically addressed
by direct questioning. We relied primarily on the trainees’ recognition that
issues were salient enough for them to be raised in the interviews. Thus, we
cannot know if the lack of data supporting aspects of the IDM is an indi-
cation of the limited utility of parts of the model or a function of areas of
experience of the trainees that weren’t tapped or primed by the present meth-
odology. Another possibility, as we have previously noted in this book, is that
250 IDM Supervision: An Integrative Developmental Model
development tends to occur in salient domains. Perhaps the demands of the
context (supervision, courses, etc.) weren’t sufficient to highlight these areas
for the trainees and to stimulate professional development (or for them to
recognize it). We hope that future research will attempt to more completely
examine the utility of certain domains, particularly the individual differences
domain and the treatment plans and goals domain, across training contexts.
The data were less complete in addressing issues related to Level 2 devel-
opment than what was observed for Level 1. Did these more experienced
trainees simply not exhibit all of the characteristics expected by the IDM?
Were the omissions due to methodology problems noted above, or to a lack
of saliency of the issues for the trainees? Alternatively, were the trainees not
functioning at Level 2 across the domains and, consequently, did not dem-
onstrate the expected Level 2 characteristics? We have consistently warned
in prior chapters that therapists are unlikely to function at the same develop-
mental level across all domains and that developmental level can not be tied
to specific years of experience or practicum level. Perhaps none of the trainees
was functioning consistently at Level 2 within certain domains.
Other limitations of the study include the use of volunteer participants
whose particular characteristics restricted the subject pool and possibly shaped
the data (Rosenthal & Rosnow, 1975). Because of the limited number of par-
ticipants, the study was exploratory rather than conclusive. Repeated samples
of different training models need to be used in any subsequent research.
Clearly, more replications of studies examining the impact of supervi-
sion over time and across levels are necessary to allow for the accumulation
of sufficient data/experiences to more adequately test the utility of aspects of
the IDM. It is apparent from the data in the present study that repetition
of counseling experiences is necessary for trainees to assimilate information
into existing schemata as well as stimulate accommodation and refinement
of these schemata. Similarly, more replications of studies examining super-
visee development are necessary to understand the supervision process. It is
often easier to describe, in general, how trainees develop over time (as we
have in previous chapters) than it is to capture specific comments by them
that clearly reflect this development. Nonetheless, we hope that the specific
examples of trainees’ perceptions of their clinical and supervisory experiences
have provided the reader with a sense of how professional development can
be experienced by supervisees.
Table 11.1
Trainees’ Comments
Trainees’ Comments: Theoretical Orientation
1 Alan (1) 2 Rely on CBT, 3 Want to be more 4 Feel less 5 Last semester 6 Confused—been
Uncomfortable but likes therapy driven pressure to tie said CBT, but I saying CBT, but
without theoretical biopsychosocial myself to a wasn’t—I am more client centered/I
orientation/don’t theoretical orienta- CBT now am okay not
feel grounded/don’t tion/don’t really knowing my
understand theory know my theoreti- theoretical
application cal orientation/ orientation,
Maria’s study because I feel like I
helped me to see a do a good job with
certain therapy my clients and I’m
applied/goal = use still learning about
A Qualitative Examination of the IDM
therapy better theories
(continued on next page)
251
252
Table 11.1 (continued)
Trainees’ Comments
1 Dirk (1) CBT— 2 More comfortable 3 No change 4 Applying theory 5 Cognitive, but 6 IDK—Eclectic/
supervisor/more with cognitive type easier/use what broadening— don’t see the
comfortable/sink therapy/see need makes it easier to experimental rationale of picking
my teeth into/don’t for other theoretical conceptualize— systems or client just one/trying to
feel I’ve picked up orientations/but what makes sense/ centered learn two or three
theories very well need to pick one doesn’t matter what well and pick and
and stick to it theory you use as choose within their
long as you use it parameters
well (efficacy
studies)
1 David (2) 2 3 Goal = integrate 4 Supervisor 5 6 My focus has
CBT—trained with approaches, encouraging other shifted from a naïve
Maria’s study augmenting to my modes of therapy/ loyalty to CBT to
approach want a deeper trying to learn more
understanding of about it, because
Beck’s approach they’re not always
(CBT) and better as effective as I
appreciation of as would have
many approaches thought/not willing
IDM Supervision: An Integrative Developmental Model
as I can to give up CBT, but
will to incorporate
affective
1 Phil (2) 2 Figuring out the 3 Remain client 4 Humanistic—use 5 Rogerian with 6 Humanistic and
style that I enjoy centered research to choose individuals/ CBT/research
working with/client intervention hodgepodge or backed CBT with
centered, CBT with couples OCD client
strengths—rapport,
empathy,
genuineness/
confident with my
style and approach
Trainees’ Comments: Assessment Techniques
1 Alan (1) 2 3 4 5 Assessment 6 Assessment
clinic has been clinic good/I feel
great for me more confident in
assessment
1 Dirk (1) 2 Gaining 3 4 Assessment 5 Two clients in 6 Assessed 6
Assessment clinic experience through clinic going good assessment clinic/ males (9–21 y.o.)/I
assessment clinic as specialty prac Spanish believe
in Pauls Valley (IQ, assessment assessment is one
behavior)/learning (interpret of my strengths/
A Qualitative Examination of the IDM
some about testing qualitatively) makes sense to
special populations me/more objective/
(MR) better interview
than used to be/
would like more
Spanish testing
(continued on next page)
253
254
Table 11.1 (continued)
Trainees’ Comments
1 David (2) 2 Focus on clients’ 3 4 Appreciation for 5 More aware of 6
Neuropsych testing symptomatology to suicide history taking and
get full clinical assessment client symptoms
picture
1 Phil (2) 2 3 4 5 6 Confident—
assessment clinic
for two years/TA for
intelligence,
personality and
projective/
experience assists
my conceptualiza-
tion skills
Trainees’ Comments: Client Conceptualization
1 Alan (1) 2 Case 3 Believe case 4 Feel I can 5 6
presentation presentation helped conceptualize but
helped—I can me the most with find it difficult to
conceptualize/want conceptualizing apply it in session
supervisor to allow and looking at
IDM Supervision: An Integrative Developmental Model
me to conceptualize research
and tell me if it’s
accurate
1 Dirk (1) Feel 2 I need help 3 Goal this 4 Conceptualizing 5 6
shaky conceptualizing semester was to getting easier/use
work on what makes it
conceptualization easier for me to
conceptualize
(efficacy studies)/
still need help
sometimes, I ask
for it
1 David (2) 2 3 4 5 6 Helping my
Conceptualization trainees
has grown conceptualize their
cases has helped
me think through a
lot of things
1 Phil (2) 2 Have 3 Battered woman 4 I feel more 5 I feel more 6
conceptualized approach/I have a confident because I confident because I
(looked at) my better idea where to know where to go know where to go
clients and my go and what needs with my clients/use with my clients/use
cases from other to be done and research literature research literature
A Qualitative Examination of the IDM
approaches but where things need to help to help
continue practicing to be, what things conceptualize conceptualize
Rogerian treatment need to be
addressed
(continued on next page)
255
256
Table 11.1 (continued)
Trainees’ Comments
Trainees’ Comments: Professional Ethics
1 Alan (1) 2 3 4 5 6 Colleague—
ethical violation
1 Dirk (1) 2 3 4 5 6 Career-
threatening ethical
dilemma regarding
a colleague/prac
class as a whole
dealt with “what is
our liability?”/intake
with a class of
2012 student
1 David (2) 2 3 4 5 6
1 Phil (2) 2 3 4 Aware of 5 Responsibility to 6 Terminating and
IDM Supervision: An Integrative Developmental Model
termination coming transfer clients as transferring clients
in May—evaluating he leaves the clinic
client needs
Trainees’ Comments: Interpersonal Assessment
1 Alan (1) 2 3 4 5 I defend against 6 In session—focus
talking about on affect/convey
emotions, to my understanding
protect myself clients’ emotion
1 Dirk (1) 2 Empathy for 3 4 5 Overwhelmed by 6 Focus on client
Assessment clinic psychotic patient/ every single thing affect/express my
personal values screwed up in emotions effectively
affecting his depressed client’s and dealing with
treatment life—difficult to pick others’ emotions/
out a situation to maintain boundary
work on emotionally/
developing coping
mechanisms/not
personalizing/
empathize with
clients better
(continued on next page)
A Qualitative Examination of the IDM
257
258
Table 11.1 (continued)
Trainees’ Comments
1 David (2) 2 Awareness of my 3 More of an 4 Need more 5 Affect—getting 6 Animation and tie
feelings about what appreciation for growth in affect- better at focusing it in with affect
client is saying and what the client based strategies and using but still
using that affect in feels and not where I want to
me to direct my experiences/goal = be/supervisor
interventions/focus become more models focus on
on therapeutic rounded—affect self and client
relationship/ counseling, greater affect
empathy is focus on affect
there—need to
express it
1 Phil (2) 2 Confrontation 3 On evaluation got 4 Personalize 5 Empathy for 6 I don’t focus on
Supervision kind of difficulties 4 out of 5 experience with physically abused my affect/last fall
opened my eyes to confrontation and couple women, turned out focus on affect, this
how my frustration expressing feelings she was physically semester
was interacting with toward clients/my abusive to her cognitions/need to
my treatment confrontation style husband/ express my anger
is not hard core awareness of own and frustration, but
values and morals, comfortable with
but not always use own style/focus
IDM Supervision: An Integrative Developmental Model
it or express it/let more on client
clients express affect than own
emotions
Trainees’ Comments: Intervention Skills Competence
1 Alan (1) Need 2 Pattern of firing 3 Feeling 4 More clients, I do 5 Let go of need to 6 Focus on client
more direction questions/only one ineffective/ readings and have step-by-step emotions/feel I am
looking for info: no client— supervisor still not preparation / more approach, it is a doing better at
knowledge of counseling’s providing readings/ confident, control/ process— counseling overall/
family treatment. I boring, view counseling get away from experience helpful: have more
want to be counseling as a frustrating/disagree question after just get to know clients—allow me
competent now! “I puzzle/wish there with supervisor on question/no client and listen/still the chance to try
don’t know what was an instruction history/no manual pressure to solve hit hurdles, but less out techniques/
I’m doing,” want book to tell me how to do (clicked)/I’m frustrating/my more comfortable
instruction it and not enough managing the client reading—give as a counselor
cookbook clients/still asking understanding
questions
1 Dirk (1) 2 Professional 3 New area— 4 I enjoy 5 Totally paying 6 Focus on what
Getting back into readings/ couples/supervisor counseling more attention to the client is really
the swing of things counseling as an provides a detailed now/a little more of client/I feel useful saying/affect/don’t
(1½ years gone)/ art, religion, session for couples a sense of and productive/get think about
supervisor helping intuitive nature/ and readings, very competence with into clients’ world everyday stuff
and encouraging view tapes—notice helpful/more individual adults/ better/more anymore/more
me to look at microskills, looking readings would be don’t need detailed confident, clients—got used
A Qualitative Examination of the IDM
literature/okay with for specific helpful plan/still a little experience with to it
adjustment issue direction with overwhelmed with clients/see
couples couples progress
(continued on next page)
259
260
Table 11.1 (continued)
Trainees’ Comments
1 David (2) 2 My work with 3 Not questioning 4 5 Using literature to 6 Trying to be more
Comfortable clients better— my abilities/don’t guide interventions animated in session
working with allow myself to be feel as effective, but with clients
couples and more flexible and know I am learning
depressed women/ slow down and becoming
compare self to proficient
pros
1 Phil (2) 2 Confident in 3 Comfortable with 4 Last semester, 5 Concrete 6 More focus on
Comfortable with abilities/frustration divorce counseling/ confront couple. intervention with cognitions/growth—
adults/novice with with couple, worry physical and This semester, OCD client— couples treatment
couples work/focus about confronting, emotional abuse/ confront individual/ motivated/more (Maria’s study)
on permission to fearful about trying to empower successful experience with
confront and be confronting her, I have a better experiences with couples, increase
tough individuals with focus when I go clients builds comfort with skills/
severe pathology into session/ confidence, use interesting clients—
comfortable with research to choose more exciting and
clients now intervention more motivated,
IDM Supervision: An Integrative Developmental Model
but not motivated
to work with clients
not willing to work
Trainees’ Comments: Individual Differences
1 Alan (1) 2 3 4 5 6
1 Dirk (1) 2 3 4 5 6
1 David (2) 2 3 Feminist therapy 4 5 6
Depressed women
1 Phil (2) 2 3 Seeking out info 4 5 6
on feminist therapy
Trainees’ Comments: Treatment Goals and Plans
1 Alan (1) 2 3 4 5 6
1 Dirk (1) Want 2 How do I get a 3 Goal this 4 5 6
more help in client to have semester to work
supervision/I think insight? How do on treatment
it’s taken for you manage their planning
granted that I know stress level?
how to develop a
treatment plan
1 David (2) 2 3 4 5 6
A Qualitative Examination of the IDM
1 Phil (2) 2 3 4 5 6
261
Epilogue
•
The role of clinical supervisor is broadly viewed as one of the more important
training functions in the field of mental health. Unfortunately, empirical
support for the impact of supervision on client outcomes is still in its infancy.
Although models continue to proliferate, many of them appear to be reitera-
tions of constructs and principles already articulated in prior models. We
have devoted much of our careers to the exploration of clinical supervision
issues of practice, model building, and research, a field that has for too long
languished in the shadow of clinical practice and, at times, has been identi-
fied as merely a subset of psychotherapy in general. We hope that our discus-
sion of the IDM and related research has served to highlight the importance
of clinical supervision as a unique enterprise, crucial to developing psycho-
therapy and other professional skills yet a separate process.
We have discussed some of the challenges that have emerged from the
health care reform movement and how they affect mental health profession-
als who engage in clinical supervision. We examined some of the potentially
deleterious impacts of the economics of managed care on psychotherapist
training and supervision. Other threats to progress in understanding and
implementing effective clinical supervision involve apathy, lack of time,
clinical naïveté, and professional burnout. Without a strong commitment to
research and practice in clinical supervision by all of us who engage in it, we
will do a disservice to our supervisees, our clients, and the profession.
We are confident that interest and investment in clinical supervision are
continuing to grow. As we attend professional conferences, correspond with
colleagues, read the literature, and present workshops, we are impressed with
the commitment of mental health professionals to developing skills in and
understanding the process of clinical supervision. The push toward establish-
ing and promoting competency in supervision is a welcome and important
development. By articulating what benchmarks are to be expected of trainees
at each stage of training, we can move toward systematizing the process for
our profession and solidify our commitment to the integration of science and
practice. This not only will benefit trainees but also will enhance the profes-
sion and enable the best services to be provided to the public. We hope that
263
264 IDM Supervision: An Integrative Developmental Model
the present delineation of the IDM provides a contribution to the field in
terms of articulating important processes of training that need to be attended
to in assisting trainees to develop competencies and reach their professional
potential. We also hope it proves useful to everyone who sees the role of
supervisor as an important part of his or her professional identity.
Over the course of this book, we have addressed a number of issues rel-
evant to the effective and ethical practice of clinical supervision. Although
we believe this book to be the most comprehensive explication of a model
of clinical supervision to date, we realize that we have probably overlooked
some areas and have failed to fully develop others. Nevertheless, we hope that
we have been sufficiently detailed in our discussion to enable you to under-
stand the tenets of the IDM and how it is implemented. For those of you who
engage, or plan to engage, in clinical or supervisory research, we hope that
the level of detail we provided will allow you to empirically investigate the
model and add to the growing body of research. By attempting to integrate
research and theory from related areas such as learning, cognition, emotion,
and development, we have tried to imbed the IDM within the larger frame-
work of psychology as well as other traditional frameworks of psychotherapy.
Although supervision is a separate discipline with its own set of skills and
competencies, we still rely on many processes similar to other areas of inquiry
and practice. We think it is important to avoid reinventing the wheel; rather,
we should learn and benefit from the work of our colleagues in related areas.
As we have discussed throughout the book, evidence-based practice utilizes
the best research, not just from the areas of counseling, psychotherapy, or
even clinical supervision, but across disciplines.
In addition to our focus on theory and research and their impact on how
we understand the learning and supervision process, we have spent consider-
able time focusing on how one actually conducts clinical supervision. As we
have seen, there is no “cookbook” for this process. Rather, we need to under-
stand the processes and knowledge related to the various domains of profes-
sional practice, understand how professionals-in-training learn and develop
over time, and be aware of and intentionally regard our influence as super-
visors. This requires constant effort and diligence on our part to meet the
training needs of the individuals who are our supervisees. Although there is
consistency in processes, we must approach each supervisee as an individual
and realize that his or her professional development is impacted by personal
development, life history, and cultural environment, among other influences.
One size does not fit all.
Epilogue 265
Another important focus of ours has been on encouraging, teaching, and
practicing ethical behavior. As we have noted, the professions of counseling
and psychology (and others) have developed detailed ethical guidelines and
standards to protect the public and guide our work. The supervision process
presents specific challenges in balancing the needs of clients, supervisees, and
supervisors as well as the demands of the environments in which we func-
tion. We must be constantly attentive to these issues so that we don’t do harm
while trying to help.
Throughout this book, we have used scenarios, supervisee and super-
visor perceptions, and an occasional metaphor to exemplify supervisory
issues. As we consider the import ance of the role of clinical supervisor
and the rewards associated with this process, another analogy comes to
mind. Both of us have spent time at the University of Iowa in Iowa City.
One of the more famous citizens there is Dan Gable, the university’s
former wrestling coach whose succ ess as an NCAA and Olympic wres-
tler preceded his success as a coach. A quotation that has been described
as one of Coach Gable’s favorites captures some of what we feel about
working with superv isees in the clinical supervision process: “To coach
someone to be the best is a much higher honor than being the best.”
Similarly, to assist psychotherapists to become as good as they can be,
and be of assistance to the multitude of clients who will seek serv ices
from them, is for some of us an even higher calling than our own work
as psychotherapists.
We look forward to an ongoing dialogue on this issue as the recogni-
tion of the importance of the practice of clinical supervision grows and is
informed by research, and the research on clinical supervision continues to
be informed by practice.
Appe nd i x A
Case Conceptualization Format*
•
This format is intended to help the therapist collect and integrate informa-
tion relevant to case conceptualization, diagnosis, and treatment. It is not
intended to serve as a concise summary of client attributes and treatment
data, but rather to organize a breadth of information and stimulate under-
standing and decision making.
1. Clinic Data:
a. Therapist name
b. Status (first practicum, intern, staff, etc.)
c. Agency/clinic site
d. Number of sessions with client
e. Type of sessions (individual, group, marital, family)
2. Client Demographic Data:
a. Name (initials or altered name for confidentiality)
b. Date of birth/age
c. Sex
d. Ethnicity
e. Marital status
f. Children (in and out of home, ages, sex)
g. Living situation
1) House, apartment …
2) People living in the home and relationship to client
* Cal D. Stoltenberg and Terry M. Pace, University of Oklahoma
267
268 Case Conceptualization Format
3. SES Data:
a. Occupational status
1) Client
2) Family members
b. Average family monthly income
c. Transportation status (drives own car, public transport)
d. Other economic resources (own house, savings, family support …)
e. Economic stressors (debts, child support …)
4. Presenting Problem(s): This section should include a description of the
problem areas (listed separately) from the client’s perspective, particu-
larly noting the client’s view of their order of importance. Suggested
items to focus on include
a. Were there precipitating factors?
b. How long have problems persisted?
c. Have problems previously occurred? What were the circumstances?
d. In what way, if any, do the problems relate to each other?
5. Relevant History: This section will vary in comprehensiveness accord-
ing to depth and length of treatment, and will vary in focus accord-
ing to theoretical orientation and the specific nature of the problems.
Suggested foci include
a. Family and relationship history
1) Family of origin/developmental issues
2) Past marriages/significant relationships (duration, sexual func-
tioning, dissolution factors, sexual preference …)
3) Children (from current and prior relationships and current
status)
4) Current family status and structure
b. Cultural history and identity
1) Issues of ethnicity and race
2) Identification/acculturation
c. Educational history
1) Childhood/developmental
2) Adulthood/current status
d. Vocational history (types, stability, satisfaction …)
e. Medical history (acute/chronic illness, hospitalizations, surgeries,
major patterns of illness in family, accidents, injuries, with whom/
where/how often receive medical care …)
Case Conceptualization Format 269
f. Health practices (sleeping, eating patterns, tobacco use, exercise …)
g. Mental health history (prior problems, symptoms, diagnoses, eval-
uations, therapy experiences, past prescribed medications, current
and family or origin mental health histories)
h. Current medications (doses, purposes, physician, compliance, effects,
side effects …)
i. Legal history (arrests, DUIs, jail/prison, lawsuits, any pending legal
actions)
j. Use/abuse of alcohol or drugs (prescription or illegal); family (cur-
rent and origin) alcohol/drug history
6. Interpersonal Factors: This section should include a description of the
client’s orientation toward others in his or her environment, including
a. Manner of dress
b. Physical appearance
c. General self-presentation
d. Nature of typical relationships (dependent, submissive, aggressive,
dominant, withdrawing …)
e. Behavior toward therapist (therapeutic alliance …)
7. Environmental Factors:
a. Elements in the environment, not mentioned, that function as
stressors to the client—those centrally related to the presenting
problems and more peripheral
b. Elements in the environment, not previously mentioned, that
function as support for the client (friends, family, recreational
activities …)
8. Personality Dynamics:
a. Cognitive factors: This section will include any data relevant to
thinking and mental processes, such as
1) Intelligence
2) Mental alertness
3) Persistence of negative cognitions
4) Positive cognitions
5) Nature and content of fantasy life
6) Level of insight (awareness of changes in feelings, behavior,
reactions of others, understanding of the interplay …)
7) Capacity for judgment (ability to make decisions and carry out
practical affairs of daily living)
270 Case Conceptualization Format
b. Emotional factors:
1) Typical or most common emotional states
2) predominant mood during interviews
3) Appropriateness of affect
4) Range of emotions client can display
5) Cyclical aspects of client’s emotional life
c. Behavioral factors:
1) Psychosomatic symptoms
2) Existence of problematic habits or mannerisms
9. Testing: Present both past and recent testing.
a. Methods or instruments
b. Evaluator, location, dates, reasons for testing
c. Results
10. Life Transition/Adaptation Skills:
a. Coping skills: Concrete efforts to deal with distressing situations (e.g.,
anticipation, preparation, response)
b. Social resources: Summary of supportive social networks
c. Psychological resources: Adaptive personality characteristics (e.g.,
self-efficacy, hardiness, optimism)
11. Formal Diagnosis: DSM-IV diagnosis (all applicable axes), checklist of
symptoms/criteria showing how client meets diagnostic criteria.
12. Therapist’s Conceptualization of the Case: This section will include
a summary of the therapist’s view of the problems and their effects
on the client. Include only the most central and core dynamics of the
client’s personality, relationships, and environmental influences. Note
the interrelationships among the major factors. What are the common
themes? What ties it all together? This is a synthesis of all the relevant
data and the essence of the therapist’s understanding of the client.
13. Treatment Plan: Based on the above information, describe the treat-
ment plan you will follow to address the presenting and emerging
problems. Make it consistent with the theoretical orientation utilized and
available empirical evidence. Estimate the number and types of sessions
needed to address the issues.
14. Quesions/Issues: Note the questions you have regarding this case and
any issues you would like to address during the case conference.
Appe nd i x B
Practicum Competencies Outline
Overview*
A. Baseline Competencies
1. Personality characteristics, intellectual and personal skills students
bring to the graduate training experience:
a) Interpersonal skills: Encompass both verbal and nonverbal forms
of communication, the ability to listen and be empathic and
respectful of others, and the ability to be open to feedback.
b) Cognitive skills: Includes an attitude of intellectual curiosity
and flexibility, and abilities in problem-solving, critical think-
ing, and organized reasoning.
c) Affective skills: The ability to tolerate affect, to tolerate and
understand interpersonal conflict, and to tolerate ambiguity
and uncertainty.
d) Personality/attitudes: The desire to help others, openness to new
ideas, honesty and integrity and the valuing of ethical behavior,
and personal courage.
e) Expressive skills: The ability to communicate accurately one’s
ideas, feelings, and information in verbal, nonverbal, and writ-
ten forms.
f) Reflective skills: The ability to examine and consider one’s own
motives, attitudes and behaviors and one’s effect on others.
g) Personal skills: Personal organization, hygiene, and appropriate
dress.
2. Knowledge from graduate classroom experience prior to or concur-
rent with practicum:
a) Assessment and clinical interviewing
* Copyright © 2007 by the American Psychological Association. Reproduced with permisison.
The official citation that should be used in referencing this material is: Hatcher, R. L. & Lassiter, K. D.
(2007). Initial training in professional psychology: The practicum competencies outline. Training and
Education in Professional Psychology, 1, 49–63. The use of APA information does not imply endorsement
by APA.
271
272 Practicum Competencies Outline
b) Intervention
c) Ethical and legal standards
d) Individual and cultural differences
B. Skills Developed During Practicum
1. Relationship/interpersonal skills
2. Application of research
3. Psychological assessment
4. Intervention
5. Consultation/interprofessional collaboration
6. Diversity: Individual and cultural differences
7. Ethics
8. Leadership
9. Supervisory skills
10. Professional Development: Building a foundation for life-long
learning
a) Practical skills to maintain effective clinical practice
b) Professional development competencies
11. Metaknowledge/metacompetencies:
Note: For a downloadable copy of the complete Practicum Competencies
Outline, please visit the Association of Directors of Psychology Training
Clinics Web site at http://www.adptc.org or the Council of Chairs of Train
ing Councils Web site at http://www.psychtrainingcouncils.org.
Practicum Competencies Outline: Excerpt
B. Description of Skills Leading to Competencies That Are Developed During the Practicum Experience
Competence Level expected by the completion of practicum is indicated in the column on the right. Completed
N = Novice; I = Intermediate; A = Advanced. See introduction for definition of these levels. Practicum
These competencies are built upon fundamental personality charactistics, intellectual and personal skills (see Section A1).
1. Relationship/Interpersonal Skills
The ability to form and maintain productive relationships with others is a cornerstone of professional psychology.
Productive relationships are respectful, supportive, professional, and ethical. Professional psychologists should possess
these basic competencies when they first begin their clinical training. Although the ability to form such relationships is
grounded in basic skills that most students will have developed over the course of their lives to date, helping the student
hone and refine these abilities into professional compentencies in the clinical setting is a key aim of the practicum.
In particular, the practicum seeks to enhance students’ skills in forming relationships:
a) With patients/clients/families:
i) Ability to take a respectful, helpful professional approach to patients/clients/families. A
ii) Ability to form a working alliance. I
iii) Ability to deal with conflict, negotiate differences. I
iv) Ability to understand and maintain appropriate professional boundaries. I
b) With colleagues:
i) Ability to work collegially with fellow professionals. A
ii) Ability to support others and their work and to gain support for one’s own work. I
iii) Ability to provide helpful feedback to peers and receive such feedback nondefensively from peers. I
(continued on next page)
274
Practicum Competencies Outline: Excerpt
Completed
c) With supervisors, the ability to make effective use of supervision, including:
Practicum
i) Ability to work collaboratively with the supervisor. A
Collaboration means understanding, sharing, and working by a set of common goals for supervision. Many of these
goals will change as the student gains professional competence, although a core goal, of working cooperatively to
enhance the student’s skills as a clinician, will remain constant. It is this aspect of collaboration that is expected to
be at the “A” level by the end of practicum training. Competencies ii & iii below may be considered aspects of
collaboration with the supervisor.
ii) Ability to prepare for supervision. A
iii) Ability/willingness to accept supervsiory input, including direction; ability to follow through on recommendations; A
ability to negotiate needs for autonomy from and dependency on supervisors.
iv) Ability to self-reflect and self-evaluate regarding clinical skills and use of supervision, including using good I
judgment as to when supervisory input is necessary.
d) With support staff:
i) Ability to be respectful of support staff roles and persons. A
e) With teams at clinic:
i) Ability to participate fully in team’s work. A
ii) Ability to understand and observe team’s operating procedures. I
f ) With community professionals:
i) Ability to communicate professionally and work collaboratively with community professionals. I
g) For the practicum site itself:
i) Ability to understand and observe agency’s operating procedures. A
ii) Ability to participate in furthering the work and mission of the practicum site. A
iii) Ability to contribute in ways that will enrich the site as a practicum experience for future students. A
Competency Review Student: _ ________________________________
Year in Program: 1 2 3 4 5 + Quarter and Date: ________________________________
The purpose of the Competency Review is to assess the student’s current level of skill in each of the areas described. This evaluation is part of the
ongoing graduate training process and is designed to pinpoint areas of strength and needed development, and to set and refine practicum goals.
There are four columns to the right of each competency. In the first column, Year Expected, the program designates the year at which that skill
is expected to emerge. Alternatively, if the program does not train in that skill, the box may be marked with an X. The remaining columns, U,
NI, and S, represent student status relative to that competency or skill. Because it is expected that students will continue to evolve their
professional skills, attitudes, and behaviors as they progress through their training, what is considered competent for a first year student will be
different than what is expected of a fourth year student who has completed all program requirements. Therefore, it is possible that a student
would meet requirements in one year but fall short in another.
The rating is based on a standard comparison of other students at the same developmental level. Data to be considered in arriving at an
assessment of the student’s current skill level are the students’ individual Competency Reviews (completed for each year of the program),
performance in practicum, completion of coursework in identified areas, performance of graduate assistant (GA), research assistant (RA) and/or
teaching duties, performance in research labs, defense of master’s thesis, performance on comprehensive doctoral examinations, proposal and
defense of the dissertation, and any other relevant activities engaged in by the student (i.e., participation and/or leadership in organizations).
Student progress is described by the rating scale below. The evaluator will circle the appropriate letter beside each competency.
Student status is described as:
U = Unsatisfactory NI = Needs Improvement S = Successful
Unsatisfactory (U): the student is deficient in the competency or skill and there needs to be significant further training and a special effort made
in order to bring it up to the Successful level. Needs Improvement (NI): the student has shown some evidence of the competency or skill, but
performance is inconsistent or there may be examples of poor motivation or minor irresponsibility. It is anticipated that the rating will improve
with some further training, supervision, and student effort. Successful (S): the student has shown basic mastery of the competency or skill.
Programs are encouraged to pay particular attention to the assessment of Baseline Competencies in section A, as the breadth and depth of these
skills, attitudes and values establish the parameters from which professional skills are shaped and refined.
Appe nd i x C
Supervisee Information Form
•
This form can be used to collect relevant background information from
supervisees for decision making in practicum, internship, and postdegree
supervision. This information helps the supervisor to make an initial assess-
ment of the developmental level of the supervisee.
Date:_ _____________________________________________________
Name:_ ____________________________________________________
Educational status (for example, year in program, years past degree, and so on):
__________________________________________________________
Highest degree earned:_________________________________________
Hours of individual counseling or psychotherapy experience:_ __________
Over how many years?_________________________________________
Hours of group counseling or psychotherapy experience:_______________
What types of groups?_________________________________________
Hours of marital and family counseling or psychotherapy experience:
__________________________________________________________
Over how many years?_________________________________________
Percentage of all counseling or psychotherapy experience that was supervised:
__________________________________________________________
277
278 Supervisee Information Form
Breadth of client populations (age, racial/ethnic/cultural, gender) including
diagnostic classifications (please describe):
__________________________________________________________
__________________________________________________________
__________________________________________________________
Professional environments in which you have worked (agencies, hospitals,
private practice). Please describe how long you were there and what your
duties included.
__________________________________________________________
__________________________________________________________
__________________________________________________________
Hours of direct supervision received (total):
One-to-one: __________
Group or peer: __________
Theoretical orientations to which you have been exposed:
__________________________________________________________
__________________________________________________________
__________________________________________________________
Preferred orientation:
__________________________________________________________
__________________________________________________________
What assessment techniques or instruments have you used (administered,
scored, and interpreted)? Please estimate how many of each.
__________________________________________________________
__________________________________________________________
__________________________________________________________
How many intake assessments?_ _________________________________
How many written assessment reports?_ ___________________________
Supervisee Information Form 279
For whom have these reports been written (courts, physicians, schools)?
__________________________________________________________
Describe any special experiences not already covered.
__________________________________________________________
__________________________________________________________
__________________________________________________________
What do you perceive as your professional strengths?
__________________________________________________________
__________________________________________________________
__________________________________________________________
What do you perceive as your professional weaknesses?
__________________________________________________________
__________________________________________________________
__________________________________________________________
References
•
Aarons, G. A., Sommerfeld, D. H., Hecht, D. B., Silovsky, J. F., & Chaffin, M. J.
(2009). The impact of evidence-based practice implementation and fidelity
monitoring on staff turnover: Evidence for a protective effect. Journal of
Consulting and Clinical Psychology, 77, 270–280.
Addis, M. E., & Cardemil, E. V. (2006). Psychotherapy manuals can improve
outcomes. In J. C. Norcross, L. E. Beutler, & R. F. Levant (Eds.), Evidence-
based practices in mental health (pp. 131–140). Washington, DC: American
Psychological Association.
Allen, J. (2007). A multicultural assessment supervision model to guide research and
practice. Professional Psychology: Research and Practice, 38, 248–258.
Allen, G. J., Szollos, S. J., & Williams, B. E. (1986). Doctoral students’ comparative
evaluations of best and worst psychotherapy supervision. Professional Psychol
ogy: Research and Practice, 17, 91–99.
American Psychological Association. (2000). Guidelines for psychotherapy with les-
bian, gay, and bisexual clients. American Psychologist, 55, 1440–1451.
American Psychological Association. (2002a). Book 1: Guidelines and principles for
accreditation of programs in professional psychology. Washington, DC: Office of
Program Consultation and Accreditation.
American Psychological Association. (2002b). Ethical principles of psychologists and
code of conduct. American Psychologist, 57, 1060–1073.
American Psychological Association. (2002c). Guidelines on multicultural educa-
tion, training, research, practice, and organizational change for psychologists.
Washington, DC: Author.
American Psychological Association. (2003). Guidelines on multicultural educa-
tion, training, research, practice, and organizational change for psychologists.
American Psychologist, 58, 377–402.
American Psychological Association. (2006). Evidence-based practice in psychology.
American Psychologist, 61, 271–285.
Anderson, J. R. (1996). ACT: A simple theory of complex cognition. American
Psychologist, 51, 355–365.
Anderson, J. R. (2005). Cognitive psychology and its implications (6th ed.). New
York: Worth.
Anonymous. (1995). Hidden benefits of managed care. Professional Psychology:
Research and Practice, 26, 235–237.
Arredondo, P., Toporek, R., Brown, S. P., Jones, J., Locke, D. C., Sanchez, J.,
et al. (1996). Operationalization of the multicultural counseling competencies.
Journal of Multicultural Counseling and Development, 24, 42–78.
Ashby, R. H. (1999). Counselor development and supervision: An exploratory study of
the integrated developmental model. Unpublished doctoral dissertation, Univer
sity of Oklahoma.
281
282 IDM Supervision: An Integrative Developmental Model
Association for Counselor Education and Supervision. (1993). Ethical guidelines for
counseling supervisors. Alexandria, VA: Author. Retrieved October 15, 2008,
from http://www.acesonline.net/ethical_guidelines.asp
Association of State and Provincial Psychology Boards. (2003). Supervision guidelines.
Montgomery, AL: Author
Association of State and Provincial Psychology Boards. (2008). Guidelines on practi-
cum experience for licensure. Montgomery, AL: Author.
Bahrick, A. S. (1990). Role induction for counselor trainees: Effects on the super-
visory working alliance. Dissertation Abstracts International, 51(3–b) (Abstract
#1991–51645).
Baltes, P. B., Reese, H. W., & Nesselroade, J. R. (1977). Life-span developmental psy-
chology: Introduction to research methods. Monterey; CA: Brooks/Cole.
Barker, R. G., and associates. (1978). Habitats, environments, and human behavior: Studies
in ecological psychology and eco-behavioral science. San Francisco: Jossey-Bass.
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 and Practice, 38, 268–275.
Bear, T. M., & Kivlighan, D. M., Jr. (1994). Single-subject examination of the process
of supervision of beginning and advanced supervisees. Professional Psychology:
Research and Practice, 25, 450–457.
Behling, J. C., Curtis, C., & Foster, S. A. (1982). Impact of sex-role combinations on
student performance in field instruction. Journal of Education for Social Work,
18, 93–97.
Bernard, J. M. (1979). Supervisor training: A discrimination model. Counselor Edu
cation and Supervision, 19, 60–68.
Bernard, J. M. (1992). The challenge of psychotherapy-based supervision: Making
the pieces fit. Counselor Education and Supervision, 31, 232–237.
Bernard, J. M., & Goodyear, R. K. (2004). Fundamentals of clinical supervision
(3rd ed.). Boston: Allyn & Bacon.
Bernard, J. M., & Goodyear, R. K. (2009). Fundamentals of clinical supervision
(4th ed.). Needham Heights, MA: Allyn & Bacon.
Beutler, L. E., & Clarkin, J. (1990). Systematic treatment selection: Toward targeted
therapeutic interventions. New York: Brunner/Mazel.
Beutler, L. E., & Johannsen, B. E. (2006). Principles of change. In J. C. Norcross,
L. E. Beutler, & R. F. Levant (Eds.), Evidence-based practices in mental health
(pp. 226–234). Washington, DC: American Psychological Association.
Biaggio, M., Paget, T. L., & Chenoweth, M. S. (1997). A model for ethical manage-
ment of faculty-student dual relationships. Professional Psychology: Research and
Practice, 28, 184–189.
Black, B. (1988). Components of effective and ineffective psychotherapy supervision
as perceived by supervisees with different levels of clinical experience (Doctoral
dissertation, Columbia University, 1987). Dissertation Abstracts International,
48, 3105B.
Bogdan, R. C., & Biklen, S. K. (1992). Qualitative research for education: An intro-
duction to theory and methods. Boston: Allyn & Bacon.
Bohart, A. C. (2006). The active client. In J. C. Norcross, L. E. Beutler, & R. F. Levant
(Eds.), Evidence-based practices in mental health (pp. 218–226). Washington,
DC: American Psychological Association.
References 283
Borders, L. D., Bernard, J. M., Dye, H. A., Fong, M. L., Henderson, P., & Nance,
D. W. (1991). Curriculum guide for training counseling supervisors: Rationale,
development, and implementation. Counselor Education and Supervision, 31,
58–80.
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the work-
ing alliance. Psychotherapy: Theory, research, and practice, 16, 252–260.
Bordin, E. S. (1983). A working alliance model of supervision. The Counseling
Psychologist, 11, 35–42.
Boylan, J. C., & Scott, J. (2009). Practicum and internship: Textbook and resource
guide for counseling and psychotherapy (4th ed.). New York: Routledge.
Bradley, L. J., & Ladany, N. (2001). Counselor supervision: Principles, process, and
practice (3rd ed.). Philadelphia: Brunner-Routledge.
Bradley, L. J., & Richardson, B. K. (1987). Trends in practicum and internship
requirements: A national study. The Clinical Supervisor, 5, 97–105.
Burhke, R. A. (1989). Lesbian-related issues in counseling supervision. Women and
Therapy, 8, 195–206.
Burkard, A. W., Johnson, A. J., Madson, M. B., Pruitt, N. T., Contreras-Tadych,
D. A., Kozlowski, J. M., et al. (2006). Supervisor cultural responsiveness and
unresponsiveness in cross-cultural supervision. Journal of Counseling Psychology,
53, 288–301.
Burke, W., Goodyear, R. K., & Guzzardo, C. (1998). Weakenings and repairs in
supervisory alliances: A multiple-case study. American Journal of Psychotherapy,
52, 450–462.
Cacioppo, J. T. (2002). Social neuroscience: Understanding the pieces fosters under-
standing the whole and vice versa. American Psychologist, 57, 819–830.
Cacioppo, J. T., & Berntson, G. G. (1992). Social psychological contributions to the
decade of the brain: Doctrine of multilevel analysis. American Psychologist, 47,
1019–1028.
Cacioppo, J. T., & Petty, R. E. (1980). Sex differences in influenceability: Toward
specifying the underlying processes. Personality and Social Psychology Bulletin,
6, 651–656.
Cantor, D. W. (1997). Open letter to managed care. APA Monitor, 28, 2.
Carroll, M. (1996). Counseling supervision: Theory, skills, and practice. London: Cassell.
Cashdan, S. (1988). Object relations therapy. New York: Norton.
Center for Credentialing and Education. (2001). Approved clinical supervisor.
Greensboro, NC: Author.
Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S.,
Daiuto, A., et al. (1998). Update on empirically validated therapies II. The
Clinical Psychologist, 51, 3–16.
Chambless, D. L., & Crits-Christoph, P. (2006). The treatment method. In J. C.
Norcross, L. E. Beutler, & R. F. Levant (Eds.), Evidence-based practices in mental
health (pp. 191–200). Washington, DC: American Psychological Association.
Chambless, D. L., Sanderson, W. C., Shoham, V., Bennett-Johnson, S., Pope, K. S.,
Crits-Christoph, P., et al. (1996). An update on empirically validated therapies.
The Clinical Psychologist, 49, 5–18.
Chung, Y. B., Marshall, J. A., & Gordon, L. L. (2001). Racial and gender biases in
supervisory evaluation and feedback [Special issue]. The Clinical Supervisor, 20,
99–111.
284 IDM Supervision: An Integrative Developmental Model
Comas-Díaz, L. (2006). Cultural variation in the therapeutic relationship. In C. D.
Goodheart, A. E. Kazdin, & R. J. Sternberg (Eds.), Evidence-based psychother-
apy: Where practice and research meet (pp. 81–105). Washington, DC: American
Psychological Association.
Constantine, M. G. (1997). Facilitating multicultural competency in counseling
supervision: Operationalizing a practical framework. In D. B. Pope-Davis &
H. L. K. Coleman (Eds.), Multicultural counseling competencies: Assessment,
education and training, and supervision (pp. 310–324). Thousand Oaks, CA:
Sage Publications.
Constantine, M. G., Miville, M. L., & Kindaichi, M. M. (2008). Multicultural com-
petence in counseling psychology practice and training. In S. D. Brown and
R. W. Lent (Eds.). Handbook of Counseling Psychology (4th Ed., pp. 141–158).
Constantine, M. G., & Sue, D. W. (2007). Perceptions of racial microaggressions
among black supervisees in cross-racial dyads. Journal of Counseling Psychology,
54, 142–153.
Cook, D. A., & Helms, J. E. (1988). Visible racial/ethnic group supervisees’ satisfac-
tion with cross-cultural supervision as predicted by relationship characteristics.
Journal of Counseling Psychology, 35, 268–274.
Cormier, L. S., Hackney, H., & Segrist, A. (1974). Three counselor training models:
A comparative study. Counselor Education and Supervision, 14, 95–104.
Cummings, N. A. (1995). Impact of managed care on employment and training: A
primer for survival. Professional Psychology: Research and Practice, 26, 10–15.
Dixon, D. N., & Claiborn, C. D. (1987). A social influence approach to coun-
selor supervision. In J. E. Maddux, C. D. Stoltenberg, & R. Rosenwein (Eds.),
Social processes in clinical and counseling psychology (pp. 83–93). New York:
Springer-Verlag.
Duan, C., & Hill, C. E. (1996). Theoretical confusions in the construct of empathy:
A review of the literature. Journal of Counseling Psychology, 43, 261–274.
Duan, C., & Roehlke, H. (2001). A descriptive “snapshot” of cross-racial supervi-
sion in university counseling center internships [Special issue]. Journal of Multi
cultural Counseling and Development, 29, 131–146.
Duncan, B. L., & Miller, S. D. (2006). Treatment manuals do not improve outcomes. In
J. C. Norcross, L. E. Beutler, & R. F. Levant (Eds.), Evidence-based practices in men-
tal health (pp. 140–149). Washington, DC: American Psychological Association.
Duval, S., & Wicklund, R. A. (1972). A theory of objective self-awareness. Orlando,
FL: Academic Press.
Eells, T. D. (2007). Handbook of psychotherapy case formulation (2nd ed.). New
York: Guilford.
Efstation, J. F., Patton, M. J., & Kardash, C. M. (1990). Measuring the working alli-
ance in counselor supervision. Journal of Counseling Psychology, 37, 322–329.
Eichenfield, G., & Stoltenberg, C. D. (1996). The sub-level 1 trainee: Some devel-
opmental difficulties encountered with counselor training. Clinical Supervisor,
14, 25–37.
Ekstein R., & Wallerstein, R. S. (1972). The teaching and learning of psychotherapy
(2nd ed.). New York: International Universities Press.
Ellis, M. V., & Dell, D. M. (1986). Dimensionality of supervisor roles: Supervisors’
perceptions of supervision. Journal of Counseling Psychology, 33, 282–291.
References 285
Ellis, M. V., & Ladany, M. (1997). Inferences concerning supervisees and clients in
clinical supervision: An integrative review. In C. E. Watkins, Jr. (Ed.), Handbook
of psychotherapy supervision (pp. 447–507). New York: Wiley.
Ellis, M. V., Ladany, N., Krengel, M., & Schult, D. (1996). Clinical supervision
research from 1981 to 1993: A methodological critique. Journal of Counseling
Psychology, 43, 35–50.
Ellis, M. V., Siembor, J., Swords, B. A., Morere, L., & Blanco, S. (2008). Prevalence
and characteristics of harmful and inadequate clinical supervision. Paper pre-
sented at the 4th annual International Interdisciplinary Clinical Supervision
Conference, Buffalo, NY.
Elman, N. S., & Forrest, L. (2004). Psychotherapy in the remediation of psychology
trainees: Exploratory interviews with training directors. Professional Psychology:
Research and Practice, 35, 123–130.
Elman, N. S., Illfelder-Kaye, J., & Robiner, W. N. (2005). Professional development:
Training for professionalism as a foundation for competent practice in psychol-
ogy. Professional Psychology: Research and Practice, 36, 367–375.
Falender, C. A., & Collins, C. J. (2004). Use of the term “impairment” in psychol-
ogy supervision. APPIC Newsletter Online. Retrieved October 28, 2008, from
http://www.appic.org/NewsOnLine/Articles/SuperImpairment12-8-04.html.
Falender, C. A., Cornish, J. A. E., Goodyear, R., Hatcher, R., Kaslow, N. J., Leventhal,
G., et al. (2004). Defining competencies in psychology supervision: A consen-
sus statement. Journal of Clinical Psychology, 60, 771–785.
Falender, C. A., & Shafranske, E. P. (2004). Clinical supervision: A competency-based
approach. Washington, DC: American Psychological Association.
Falvey, J. E. (1987). Handbook of administrative supervision. Alexandria, VA:
Association for Counselor Education and Supervision.
Fassinger, R. E. (1991). The hidden minority: Issues and challenges in working with
lesbian women and gay men. The Counseling Psychologist, 19, 157–176.
Finkelstein, H., & Tuckman, A. (1997). Supervision of psychological assessment: A
developmental model. Professional Psychology: Research and Practice, 28, 92–95.
Forrest, L., Elman, N., Gizara, S., & Vacha-Haase, T. (1999). Trainee impairment: A
review of identification, remediation, dismissal, and legal issues. The Counseling
Psychologist, 27, 627–686.
Fouad, N. A., Grus, C. L., Hatcher, R. L., Kaslow, N. J., Hutchings, P. S., Madson,
M., Collins, F. L., Jr., & Grossman, R. Competency benchmarks: A model for
the understanding and measuring of competence in professional psychology
across training levels. Training and Education in Professional Psychology.
Gagne, E. D., Yekovich, C. W., & Yekovich, F. R. (1993). The cognitive psychology of
school learning (2nd ed.). New York: HarperCollins.
Galante, M. (1988). Trainees’ and supervisors’ perceptions of effective and ineffec-
tive supervisory relationships (Doctoral dissertation, Memphis State University,
1987). Dissertation Abstracts International, 49, 933B.
Gatmon, D., Jackson, D., Koshkarian, L., Martos-Perry, N., Moline, A., Patel,
N., et al.. (2001). Exploring ethnic, gender, and sexual orientation variables
in supervision: Do they really matter? Journal of Multicultural Counseling and
Development, 29, 102–113.
286 IDM Supervision: An Integrative Developmental Model
Geddes, J. L. (2004). Good supervision as experienced by advanced American
Indian doctoral students: A phenomenological study (Doctoral dissertation,
Washington State University, 2004). Dissertation Abstracts International, DAI-B
65/09, p. 4829 (UMI No. 3147849).
Gilligan, C. (1982). In a different voice: Psychological theory and women’s development.
Cambridge, MA: Harvard University Press.
Goldfried, M. R. (1980). Toward the delineation of therapeutic change principles.
American Psychologist, 35, 991–999.
Goleman, D. (1995). Emotional intelligence. New York: Bantam.
Goleman, D. (2006). Social intelligence: The new science of human relationships. New
York: Bantam.
Gomez, S. P. (2003). Racial/ethnic minority and White students’ perceptions of their
supervision environment experiences (Doctoral dissertation, Washington State
University, 2003). Dissertation Abstracts International, DAI-B 64/07, p. 3509.
Goodyear, R. (Producer). (1982). Psychotherapy supervision by major theorists [Videotape
series]. Manhattan: Instructional Media Center, Kansas State University.
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.
Granello, D. H. (2003). Influence strategies in the supervisory dyad: An investiga-
tion into the effects of gender and age. Counselor Education and Supervision,
42, 189–202.
Granello, D. H., Beamish, P. M., & Davis, T. E. (1997). Supervisee empowerment:
Does gender make a difference? Counselor Education and Supervision, 36, 305–317.
Gray, L. A., Ladany, N., Walker, J. A., & Ancis, J. R. (2001). Psychotherapy trainees’
experience of counterproductive events in supervision. Journal of Counseling
Psychology, 48, 371–383.
Greenberg, L. S. (2002). Integrating an emotion-focused approach to treatment into
psychotherapy integration. Journal of Psychotherapy Integration, 12, 154–189.
Greenberg, L. S., & Paivio, S. C. (1997). Working with emotions in psychotherapy.
New York: The Guilford Press.
Guest, P. D., & Beutler, L. E. (1988). Impact of psychotherapy supervision on thera-
pist orientation and values. Journal of Consulting and Clinical Psychology, 56,
653–658.
Gutierrez, F. J. (1982). Working with minority counselor education students.
Counselor Education and Supervision, 21, 218–226.
Hale, K., & Stoltenberg, C. D. (1988). The effects of self-awareness and evaluation
apprehension on counselor trainee anxiety. Clinical Supervisor, 6, 49–69.
Hall, J. A., & Bernieri, F. J. (2001). Interpersonal sensitivity: Theory and measurement.
Mahwah, NJ: Erlbaum.
Hall, R. C. W., Macvaugh, III, G. S., Merideth, P., & Montgomery, J. (2007).
Commentary: Delving further into liability for psychotherapy supervision. The
Journal of the American Academy of Psychiatry and the Law, 35, 196–199.
Hansen, N. D., & Goldberg, S. G. (1999). Navigating the nuances: A matrix of
considerations for ethical-legal dilemmas. Professional Psychology: Research and
Practice, 30, 495–503.
Harrar, W. R., VandeCreek, L., & Knapp, S. (1990). Ethical and legal aspects of
clinical supervision. Professional Psychology: Research and Practice, 21, 37–41.
References 287
Harris, D. B. (1957). The concept of development. Minneapolis: University of
Minnesota Press.
Hatcher, R. L., & Lassiter, K. D. (2007). Initial training in professional psychology:
The practicum competencies outline. Training and Education in Professional
Psychology, 1, 49–63.
Haviland, E. B. (2001). The role of supervisee gender within the supervisory relation-
ship (Doctoral dissertation, Washington State University, 2001). Dissertation
Abstracts International, DAI-A 63/04, p. 1265.
Heppner, P. P., & Roehlke, H. J. (1984). Differences among supervisees at differ-
ent levels of training: Implications for a developmental model of supervision,
Journal of Counseling Psychology, 31, 76–90.
Heppner, P. P., Wampold, B. E., & Kivlighan, D. M., Jr. (2008). Research design in
counseling (3rd ed.). Belmont, CA: Thompson Brooks/Cole.
Hersch, L. (1995). Adapting to health care reform and managed care: Three strategies
for survival and growth. Professional Psychology: Research and Practice, 26, 16–26.
Hess, A. K. (1980). Training models and the nature of psychotherapy supervision.
In A. K. Hess (Ed.). Psychotherapy supervision: Theory, research and practice
(pp. 15–28). New York: John Wiley and Sons.
Hill, C. E. (2004). Helping skills: Facilitating exploration, insight, and action (2nd ed.).
Washington, DC: American Psychological Association.
Hillerbrand, E., & Claiborn, C. D. (1990). Examining reasoning skill differences
between expert and novice counselors. Journal of Counseling and Development,
68, 684–691.
Holloway, E. L. (1992). Supervision: A way of teaching and learning. In S. D.
Brown and R. W. Lent (Eds.), Handbook of counseling psychology (2nd ed.,
pp. 177–214). New York: Wiley.
Holloway, E. L. (1995). Clinical supervision: A systems approach. Thousand Oaks,
CA: Sage.
Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the
working alliance inventory. Journal of Counseling Psychology, 36, 223–233.
Horvath, A. O., & Symonds, D. B. (1991). Relationship between working alli-
ance and outcome in psychotherapy: A meta-analysis. Journal of Counseling
Psychology, 38, 139–149.
Hubble, M. A., Duncan, B. L., & Miller, S. D. (1999). The heart and soul of change.
What works in therapy. Washington, DC: American Psychological Association.
Huhra, R. L., Yamokoski-Maynhart, C. A., & Prieto, L. R. (2008). Reviewing
videotape in supervision: A developmental approach. Journal of Counseling &
Development, 86, 412–418.
Hunt, P. (1987). Black clients: Implications for supervision of trainees. Psychotherapy:
Theory, Research, and Practice, 24, 114–119.
Hutt, C. H., Scott, J., & King, M. (1983). A phenomenological study of supervisees’
positive and negative experiences in supervision. Psychotherapy: Theory, Research,
and Practice, 20, 118–123.
Hyde, J. S. (2005). The gender similarities hypothesis. American Psychologist, 60,
581–592.
Ivey, A. E. (1971). Microcounseling: Innovations in interviewing training. Springfield,
IL: Thomas.
Jacobson, N. S. (1991). Toward enhancing the efficacy of marital therapy and marital
therapy research. Journal of Family Psychology, 4, 373–393.
288 IDM Supervision: An Integrative Developmental Model
Jacobson, N. S., & Christensen, A. (1996). Integrative couple therapy: Promoting
acceptance and change. New York: Norton.
Jacobson, N. S., Roberts, L. J., Berns, S. B., & McGlinchey, J. B. (1999). Methods
for defining and determining the clinical significance of treatment effects:
Description, application, and alternatives. Journal of Consulting and Clinical
Psychology, 67, 300–307.
Jaffee, S., & Hyde, J. S. (2000). Gender differences in moral orientation: A meta-
analysis. Psychological Bulletin, 126, 703–726.
Jennings, L., & Skovholt, T. M. (1999). The cognitive, emotional, and relational
characteristics of master therapists. Journal of Counseling Psychology, 46, 3–11.
Kagan, N. (1975). Influencing human interaction-Eleven years with IPR. Canadian
Counselor, 9, 74–97.
Kaslow, N. J. (2004). Competencies in professional psychology. American Psychologist,
59, 774–781.
Kaslow, N. J., Borden, K. A., Collins, F. L., Forrest, L., Illfelder-Kaye, J., Nelson,
P. D., et al. (2004). Competencies conference: Future directions in education
and credentialing in professional psychology. Journal of Clinical Psychology, 60,
699–712.
Kaslow, N. J., Rubin, N. J., Forrest, L., Elman, N. S., Van Horne, B. A., Jacobs,
S. C., et al. (2007). Recognizing, assessing, and intervening with problems
of professional competence. Professional Psychology: Research and Practice,
38, 479–492.
Kennard, B. D., Stewart, S. M., & Gluck, M. R. (1987). The supervision relation-
ship: Variables contributing to positive versus negative experiences. Professional
Psychology: Research and Practice, 18, 172–175.
Kitchener, K. S. (1992). Psychologist as teacher and mentor: Affirming ethical values
throughout the curriculum. Professional Psychology: Research and Practice, 23,
190–195.
Kohlberg, L. (1969). Stage and sequence: The cognitive-developmental approach to
socialization. In D. Goslin (Ed.), Handbook of socialization theory and research
(pp. 347–480). Chicago: Rand McNally.
Korzybski, A. (1948). Science and sanity: An introduction to non-Aristotelian systems and
general semantics (3rd ed.). Lakeville, CT: International Non-Aristotelian Library.
Kowalski, R. M., & Leary, M. R. (Eds.). (1999). The social psychology of emotional and
behavioral problems: Interfaces of social and clinical psychology. Washington, DC:
American Psychological Association.
Krause, A. A., & Allen, G. J. (1988). Perceptions of counselor supervision: An exam
ination of Stoltenberg’s model from the perspectives of supervisor and supervi-
see. Journal of Counseling Psychology, 35, 77–80.
Ladany, N., Friedlander, M. L., & Nelson, M. L. (2005). Critical events in psycho-
therapy 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, 10–24.
Ladany, N., Lehrman-Waterman, D., Molinaro, M., & Wolgast, B. (1999).
Psychotherapy supervisor ethical practices: Adherence to guidelines, the super-
visory working alliance, and supervisee satisfaction. The Counseling Psychologist,
27, 443–475.
References 289
LaFromboise, T. D., & Foster, S. L. (1992). Cross-cultural training: Scientist-
practitioner model and methods. The Counseling Psychologist, 20, 472–489.
Lamb, D. H., Cochran, D. J., & Jackson, V. R. (1991). Training and organiza
tional issues associated with identifying and responding to intern impairment.
Professional Psychology: Research and Practice, 22, 291–296.
Lambert, M. J., & Hawkins, E. J. (2004). Measuring outcome in professional practice:
Considerations in selecting and using brief outcome instruments. Professional
Psychology: Research and Practice, 35, 492–499.
Leach, M. M., Stoltenberg, C. D., McNeill, B. W., & Eichenfield, G. (1997). Self-
efficacy and counselor development: Testing the Integrated Developmental
Model. Counselor Education and Supervision, 37, 115–124.
Lefley, H. P. (1985a). Impact of cross-cultural training on black and white mental health
professionals. International Journal of Intercultural Relations, 9, 305–318.
Lefley, H. P. (1985b). Mental-health training across cultures. In P. B. Pedersen (Ed.),
Handbook of cross-cultural counseling and therapy (pp. 259–273). Westport, CT:
Greenwood Press.
Lefley, H. P., & Bestman, E. W. (1991). Public-academic linkages for culturally sensitive
community mental health. Community Mental Health Journal, 27, 473–488.
Leong, F. T. L. (1996). Toward an integrative model for cross-cultural counseling and
psychotherapy. Applied and Preventive Psychology, 5, 189–209.
Lerner, R. M. (1986). Concepts and theories of human development (2nd ed.). New
York: Random House.
Loevinger, J. (1976). Ego development: Conceptions and theories. San Francisco:
Jossey-Bass.
Loganbill, C., & Hardy, E. (1983). Developing training programs for clinical super-
visors. Clinical Supervisor, 1, 15–21.
Loganbill, C., Hardy, E., & Delworth, U. (1982). Supervision: A conceptual model.
The Counseling Psychologist, 10(1), 3–42.
Lopez, S. R., Gover, K. P., Holland, D., Johnson, M. J., Kain, C. D., Kanel, K.,
et al. (1989). Development of culturally sensitive psychotherapists. Professional
Psychology: Research and Practice, 20, 369–376.
Maddux, J. E., Stoltenberg, C. D., & Rosenwein, R. (Eds.). (1987). Social processes in
clinical and counseling psychology. New York: Springer-Verlag.
Mahon, B. R., & Altmann, H. A. (1977). Skill training: Cautions and recommenda-
tions. Counselor Education and Supervision, 17, 42–50.
Maslach, C. (1978). Job burnout: How people cope. Public Welfare, 36, 56–58.
Masterson v. Board of Examiners of Psychologists, No. 95A-03-011, 1995 LEXIS 589
(Del. Super. CT. 1995).
McAdams, C. R., III, Foster, V. A., & Ward, T. J. (2007). Remediation and dismissal
policies in counselor education: Lessons learned from a challenge in federal
court. Counselor Education and Supervision, 46, 212–229.
McCarthy, P. R., Danish, S. J., & D’Augelli, A. R. (1977). A follow-up evaluation of
helping skills training. Counselor Education and Supervision, 17, 29–35.
McNeill, B. W., Horn, K. L., & Perez, J. A. (1995). The training and supervisory
needs of social/ethnic minority students. Journal of Multicultural Counseling
and Development, 23, 246–258.
McNeill, B. W., & Stoltenberg, C. D. (1989). Reconceptualizing social influence in
counseling: The elaboration likelihood model. Journal of Counseling Psychology,
36, 24–33.
290 IDM Supervision: An Integrative Developmental Model
McNeill, B. W., Stoltenberg, C. D., & Pierce, R. A. (1985). Supervisees’ perceptions
of their development: A test of the counselor complexity model. Journal of
Counseling Psychology, 32, 630–633.
McNeill, B. W., Stoltenberg, C. D., & Romans, J. S. (1992). The integrated devel-
opmental model of supervision: Scale development and validation procedures.
Professional Psychology: Research and Practice, 23, 504–508.
McNeill, B. W., & Worthen, V. (1989). The parallel process in psychotherapy super-
vision. Professional Psychotherapy: Research and Practice, 20, 329–333.
McVee, M. B., Dunsmore, K., & Gavelek, J. R. (2005). Schema theory revisited.
Review of Educational Research, 75, 531–566.
Merta, R. J., Stringham, E. M., & Ponterotto, J. G. (1988). Simulating culture shock
in counselor trainees: An experiential exercise for cross-cultural training. Journal
of Counseling and Development, 66, 242–245.
Messinger, L. (2004). Out in the field: Gay and lesbian social work students’ experi-
ences in field placement. Journal of Social Work Education, 40, 187–204.
Messinger, L. (2007). Supervision of lesbian, gay, and bisexual social work students
by heterosexual field instructors: A qualitative dyad analysis. The Clinical
Supervisor, 26, 195–222.
Mio, J. S. (1989). Experiential involvement as an adjunct to teaching cultural sensi-
tivity. Journal of Multicultural Counseling and Development, 17, 38–46.
Minuchin, S., & Fishman, H. C. (1981). Family therapy techniques. Cambridge, MA:
Harvard University Press.
Mueller, W. J., & Kell, B. L. (1972). Coping with the conflict: Supervising counselors
and psychotherapists. Englewood Cliffs, NJ: Prentice Hall.
Nelson, G. H. (1978). Psychotherapy supervision from the trainee’s point of view: A
survey of preferences. Professional Psychology, 9, 539–550.
Nelson, M. L., Barnes, K. L., Evans, A. L., & Triggiano, P. J. (2008). Working
with conflict in clinical supervision: Wise supervisors’ perspectives. Journal of
Counseling Psychology, 55, 172–184.
Nelson, M. L., & Friedlander, M. L. (2001). A close look at conflictual supervisory
relationships: The trainee’s perspective. Journal of Counseling Psychology, 48,
384–395.
Nelson, M. L., & Holloway, E. L. (1990). Relation of gender to power and involve-
ment in supervision. Journal of Counseling Psychology, 37, 473–481.
Norcross, J. C., Beutler, L. E., & Levant, R. F. (2006). Evidence-based practices in
mental health. Washington, DC: American Psychological Association.
Norcross, J. C., & Lambert, M. J. (2006). The therapy relationship. In J. C. Norcross,
L. E. Beutler, & R. F. Levant (Eds.), Evidence-based practices in mental health
(pp. 208– 218). Washington, DC: American Psychological Association.
Ochsner, K., & Lieberman, M. (2001). The emergence of social cognitive neurosci-
ence. American Psychologist, 56, 717–734.
Olk, M. E., & Friedlander, M. L. (1992). Trainees’ experiences of role conflict and
role ambiguity in supervisory relationships. Journal of Counseling Psychology,
39, 389–397.
Ollendick, T. H., & King, N. J. (2006). Empirically supported treatments typically
produce outcomes superior to non-empirically supported treatment therapies.
In J. C. Norcross, L. E. Beutler, & R. F. Levant (Eds.), Evidence-based prac-
tices in mental health (pp. 308–317). Washington, DC: American Psychological
Association.
References 291
Pearson, Q. M. (2006). Psychotherapy-drive supervision: Integrating counseling
theories into role-based supervision. Journal of Mental Health Counseling, 28,
241–252.
Pedersen, P. B. (Ed.). (1998). Multiculturalism as a fourth force. Philadelphia: Brunner-
Mazel.
Pedersen, P. B., Draguns, J. G., Lonner, W. J., & Trimble, J. E. (2008). Counseling
across cultures (6th ed.). Thousand Oaks, CA: Sage.
Petty, R. E., & Cacioppo, J. T. (1986). Communication and persuasion: Central and
peripheral routes to attitude change. New York: Springer-Verlag.
Petty, R. E., & Wegener, D. T. (1999). The Elaboration Likelihood Model: Current
status and controversies. In S. Chaiken & T. Trope (Eds.), Dual process theories
in social psychology (pp. 41–72). New York: Guilford Press.
Pfohl, A. H. (2004). The intersection of personal and professional identity: The
heterosexual supervisor’s role in fostering the development of sexual minority
supervisees. The Clinical Supervisor, 23, 139–164.
Pilkington, N. W., & Cantor, J. M. (1996). Perceptions of heterosexual bias in
professional psychology programs: A survey of graduate students. Professional
Psychology: Research and Practice, 27, 604–612.
Prieto, L. R. (1996). Group supervision: Still widely practiced but poorly under-
stood. Counselor Education and Supervision, 35, 295–307.
Putney, M. W., Worthington, E. L., Jr., & McCullough, M. E. (1992). Effects of
supervisor and supervisee theoretical orientation and supervisor-supervisee
matching on interns’ perceptions of supervision. Journal of Counseling Psychology,
39, 258–265.
Rabinowitz, F, E., Heppner, P. P., & Roehlke, H. J. (1986). Descriptive study of
process and outcome variables of supervision over time. Journal of Counseling
Psychology, 33, 292–300.
Ramos-Sanchez, L., Esnil, E., Goodwin, A., Riggs, S., Touster, L. O., Wright, L. K.,
et al. (2002). Negative supervisory events: Effects on supervision and supervi-
sory alliance. Professional Psychology: Research and Practice, 33, 197–202.
Recupero, P. R., & Rainey, S. E. (2007). Liability and risk management in outpatient
psychotherapy supervision. Journal of the American Academy of Psychiatry and
the Law, 35, 188–195.
Reed, G. M., Kihlstrom, J. F., & Messer, S. B. (2006). Dialogue: Convergence and
Contention. In J. C. Norcross, L. E. Beutler, & R. F. Levant (Eds.), Evidence-
based practices in mental health (pp. 40–55). Washington, DC: American
Psychological Association.
Rest, J. R. (1984). Research on moral development: Implications for training coun-
seling psychologists. The Counseling Psychologist, 12, 19–29.
Ridley, C., & Lingle, D. W. (1996). Cultural empathy in multicultural counseling:
A multidimensional process model. In P. B. Pedersen, J. G. Draguns, W. J.
Lonner, & J. E. Trimble (Eds.), Counseling across cultures (4th ed., pp. 21–46).
Thousand Oaks, CA: Sage.
Ridley, C. R., Mendoza, D. W., Kanitz, B. E., Angermeier, L., & Zenk, R. (1994).
Cultural sensitivity in multicultural counseling: A perceptual schema model.
Journal of Counseling Psychology, 41, 125–136.
Rodolfa, E. R., Bent, R. J., Eisman, E., Nelson, P. D., Rehm, L., & Ritchie, P. (2005).
A cube model for competency development: Implications for psychology educa-
tors and regulators. Professional Psychology: Research and Practice, 36, 347–354.
292 IDM Supervision: An Integrative Developmental Model
Romans, J. S. C., Boswell, D. L., Carlozzi, A. F., & Ferguson, D. B. (1995). Training
and supervision practices in clinical, counseling, and school psychology pro-
grams. Professional Psychology: Research and Practice, 26, 407–412.
Rosenberg, E., Medini, G., & Lomranz, J. (1982). Factorial dimensions of supervisor-
student evaluation. Journal of Social Psychology, 18, 105–111.
Rosenthal, R., & Rosnow, R. L. (1975). The volunteer subject. New York: John Wiley
& Sons.
Russell, R. K., Crimmings, A. M., & Lent, R. W. (1984). Counselor training
and supervision: Theory and research. In S. D. Brown & R. W. Lent (Eds.),
Handbook of counseling psychology (pp. 625–681). New York: Wiley.
Russell, R. K., & Petrie, T. (1994). Issues in training effective supervisors. Applied and
Preventive Psychology, 3, 27–42.
Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of
intrinsic motivation, social development, and well-being. American Psychologist,
55, 68–78.
Saccuzzo, D. (2002). Liability for failure to supervise adequately: Let the master
beware. The National Register of Health Service Providers in Psychology: The
Psychologist’s Legal Update, 13, 1–14.
Saccuzzo, D. (2003). Liability for failure to supervise adequately: Let the master
beware. Part 2: Ethical basis for standard of care in supervision. The National
Register of Health Service Providers in Psychology: The Psychologist’s Legal Update,
13, 1–20.
Sarason, S. B. (1972). The creation of settings and the future societies. San Francisco:
Jossey-Bass.
Savickas, M. L., Marquart, C., & Supinski, C. (1986). Effective supervision in groups.
Counselor Education and Supervision, 26, 17–25.
Schneider, S. F. (1990). Psychology at a crossroads. American Psychologist, 45,
521–529.
Schön, D. A. (1987). Educating the reflective practitioner. San Francisco, CA: Jossey-Bass.
Sells, J. N., Goodyear, R. K., Lichtenberg, J. W., & Polkinghorne, D. E. (1997).
Relationship of supervisor and trainee gender to in-session verbal behavior and
ratings of trainee skills. Journal of Counseling Psychology, 44, 406–412.
Shanfield, S. B., Hetherly, V. V., & Matthews, K. L. (2001). Excellent supervision:
The residents’ perspective. Journal of Psychotherapy Practice and Research, 10,
23–27.
Shanfield, S. B., Mohl, P. C., Matthews, K. L., & Hetherly, V. (1992). Quantitative
assessment of the behavior of psychotherapy supervisors. American Journal of
Psychiatry, 149, 352–357.
Sherry, P. (1991). Ethical issues in the conduct of supervision. The Counseling
Psychologist, 19, 566–584.
Smolak, L. (1993). Adult development. Englewood Cliffs, NJ: Prentice Hall.
Snyder, C. R., & Forsyth, D. R. (1991). Handbook of social and clinical psychology:
The health perspective. New York: Pergamon Press.
Spooner, S. E., & Stone, S. C. (1977). Maintenance of specific counseling skills over
time. Journal of Counseling Psychology, 24, 66–71.
Steckler v. Ohio State Bd. of Psychologists, 613 N. E. 2d 1070 (Ohio Ct. App. 1992).
Stein, D. M., & Lambert, M. J. (1995). Graduate training in psychotherapy: Are therapy
outcomes enhanced? Journal of Consulting and Clinical Psychology, 63, 182–196.
References 293
Stewart, A. J., & McDermott, C. (2004). Gender in psychology. Annual Review of
Psychology, 55, 519–544.
Stoltenberg, C. D. (1981). Approaching supervision from a developmental perspec-
tive: The counselor complexity model. Journal of Counseling Psychology, 28,
59–65.
Stoltenberg, C. D. (2005). Enhancing professional competence through develop-
mental approaches to supervision. American Psychologist, 60, 855–864.
Stoltenberg, C. D. (2008a). Supervision. In E. Altmaier & B. D. Johnson (Series Eds.)
& F. T. L. Leong (Vol. Ed.), Encyclopedia of counseling: Volume One: Changes
and challenges for counseling in the 21st century. Thousand Oaks, CA: Sage.
Stoltenberg, C. D. (2008b). Developmental approaches to supervision: A case exam-
ple. In C. A. Falender & E. P. Shafranske (Eds.), Casebook for clinical supervi-
sion: A competency-based approach (pp. 39–56). Washington, DC: American
Psychological Association.
Stoltenberg, C. D., & Delworth, U. (1987). Supervising counselors and therapists. San
Francisco: Jossey-Bass.
Stoltenberg, C. D., Kaslow, N. J., Cornish, J., Falender, C., Bjorkman, A., Goodyear,
R. K., et al. (August, 2003). Future directions in education and credential-
ing in clinical supervision. Annual meeting of the American Psychological
Association, Toronto, Canada.
Stoltenberg, C. D., McNeill, B. W., & Crethar, H. C. (1994). Changes in supervision
as counselors and therapists gain experience: A review. Professional Psychology:
Research and Practice, 25, 416–449.
Stoltenberg, C. D., McNeill, B. W., & Crethar, H. C. (1995). Persuasion and devel-
opment in counselor supervision. The Counseling Psychologist, 23, 633–648.
Stoltenberg, C. D., McNeill, B. W., & Delworth, U. (1998). IDM supervision: An
integrated developmental model for supervising counselors and therapists. San
Francisco, CA: Jossey-Bass.
Stoltenberg, C. D., & Pace, T. M. (2007). The scientist-practitioner model: Now
more than ever. Journal of Contemporary Psychotherapy, 37, 195–203.
Stoltenberg, C. D., & Pace, T. M. (2008). Science and practice in supervision: An
evidence-based practice in psychology approach. In B. W. Walsh (Ed.), Biennial
review of counseling psychology (pp. 71–95). New York: Routledge.
Stoltenberg, C. D., Pierce, R. A., & McNeill, B. W. (1987). Effects of experience on
counselor trainees’ needs. The Clinical Supervisor, 5, 23–32.
Stricker, G. (2006). A poor fit between empirically supported treatments and psy-
chotherapy integration. In J. C. Norcross, L. E. Beutler, & R. F. Levant (Eds.),
Evidence-based practices in mental health (pp. 275–282). Washington, DC:
American Psychological Association.
Strong, S. R. (1968). Counseling: An interpersonal influence process. Journal of
Counseling Psychology, 15, 215–224.
Strong, S. R., & Matross, R. P. (1973). Change processes in counseling and psycho-
therapy. Journal of Counseling Psychology, 20, 25–37.
Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse (5th ed.). Hoboken,
NJ: John Wiley & Sons.
Sullivan, M. J. (1995). Medicaid’s quiet revolution: Merging the public and private
sectors of care. Professional Psychology: Research and Practice, 26, 229–234.
Tarasoff v. Regents of the University of California. 118 Cal. Rptr. 129 P 2d 533 (1974).
294 IDM Supervision: An Integrative Developmental Model
Teyber, E. (2006). Interpersonal process in therapy: An integrative model (5th ed.).
Belmont, CA: Brooks/Cole.
Thomas, J. T. (2007). Informed consent through contracting for supervision:
Minimizing risks, enhancing benefits. Professional Psychology: Research and
Practice, 38, 221–231.
Thyer, B. A., Sowers-Hoag, K., & Love, J. P. (1988). The influence of field instructor-
student gender combinations on student perceptions of field instruction qual-
ity. The Clinical Supervisor, 6, 169–179.
Tomes, H. (1997). Concerns continue on managed care. APA Monitor, 28, 41.
Tracey, T. J., Ellickson, J. L., & Sherry, P. (1989). Reactance in relation to different
supervisory environments and counselor development. Journal of Counseling
Psychology, 36, 336–344.
Vansteenkiste, M., Lens, W., & Deci, E. L. (2006). Intrinsic versus extrinsic goal
contents in self-determination theory: Another look at the quality of academic
motivation. Educational Psychologist, 41, 19–31.
Vasquez, M. J. T. (1992). Psychologist as clinical supervisor: Promoting ethical prac-
tice. Professional Psychology: Research and Practice, 23, 196–202.
Vasquez, M. J. T. (2007). Cultural difference and the therapeutic alliance: An
evidence-based analysis. American Psychologist, 62, 875–885.
Vasquez, M. J., & McKinley, D. (1982). A conceptual model—Reactions and an
extension. The Counseling Psychologist, 10, 59–63.
Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings.
Mahwah, NJ: Lawrence Erlbaum Associates.
Wampold, B. E. (2006). Not a scintilla of evidence to support empirically sup-
ported treatments as more effective than other treatments. In J. C. Norcross,
L. E. Beutler, & R. F. Levant (Eds.), Evidence-based practices in mental health
(pp. 299–308). Washington, DC: American Psychological Association.
Watkins, C. E., Jr. (1996, August). Developmental approaches to psychotherapy
supervision: Translating theory into practice. Paper presented at the annual
meeting of the American Psychological Association, Toronto, Canada.
Welfel, E. R. (1992). Psychologist as ethics educator: Successes, failures, and unan-
swered questions. Professional Psychology: Research and Practice, 23, 182–189.
Werner, H., & Kaplan, B. (1956). The developmental approach to cognition: Its rele-
vance to the psychological interpretation of anthropological and ethnolinguistic
data. American Anthropologist, 58, 866–880.
Westen, D., & Weinberger, J. (2004). When clinical description becomes statistical
prediction. American Psychologist, 59, 593–613.
Wicker, A. W. (1979). An introduction to ecological psychology. Monterey, CA:
Brooks/Cole.
Wilbur, M., Roberts-Wilbur, J., Morris, J., Betz, R., & Hart, G. (1991). Structured
group supervision: Theory and practice. Journal for Specialists in Group Work,
16, 91–100.
Wiley, M. O., & Ray, P. B. (1986). Counseling supervision by developmental level.
Journal of Counseling Psychology, 33, 439–445.
Williams, A. (1995). Visual and active supervision: Roles, focus, technique. New
York: Norton.
Winter, M., & Holloway, E. L. (1991). Relation of trainee experience, conceptual
level, and supervisor approach to selection of audiotaped counseling passages.
The Clinical Supervisor, 9, 87–103.
References 295
Worthen, V., & McNeill, B. W. (1996). A phenomenological investigation of “good”
supervision events. Journal of Counseling Psychology, 43, 25–34.
Worthington, E. L., Jr. (1987). Changes in supervision as counselors and supervi-
sors gain experience: A review. Professional Psychology: Research and Practice, 18,
189–208.
Worthington, E. L., Jr., & Roehlke, H. J. (1979). Effective supervision as perceived by
beginning counselors-in-training. Journal of Counseling Psychology, 26, 64–73.
Worthington, E. L., & Stern, A. (1985). Effects of supervisor and supervisee degree
level and gender on the supervisory relationship. Journal of Counseling Psychology,
32, 252–262.
Worthington, R. L., Tan, J. A., & Poulin, K. (2002). Ethically questionable behav-
iors among supervisees: An exploratory investigation. Ethics and Behavior, 12,
323–351.
Wrenn, C. G. (1962). The culturally-encapsulated counselor. Harvard Educational
Review, 32, 444–449.
Zuniga, M. E. (1987). Mexican-American clinical training: A pilot project. Journal of
Social Work Education, 23, 11–20.
Index
•
A questions/issues, 286
relevant history, 284–285
Addicted trainee, 77 SES data, 283
Advanced supervisees, 47–48 testing, 286
Affective, level 2 therapist development, 34–35 therapist conceptualization of case, 286
Affective reactions to client, supervisor, 110 treatment plan, 286
Alliance building, 208 Challenges, managed care, 196–198
Alternative views, introduction of, 110 Challenging, support, balance between, 208
Ambiguity, conflict, balance between, 73 Client assignment, 66–67, 101–102, 131
Anxiety Client conceptualization, 26, 58, 95–96,
manageable levels of, 73 124–125
performance, 40 trainee comments, 254–255
Assessment techniques, 25, 55, 94–95, 122–123 Clinical, training needs, balance between, 208
trainee comments, 253–254 Codes, 217–218
Autonomy, 24–25, 51–52, 90–91, 110, 120–121 Cognition, 86, 115–117
level 1 therapist development, 31–32 Cognitive development, 29, 33–34
level 2 therapist development, 36 Cognitive models, 4–12
level 3 therapist development, 38 cognitive processing, 6–7
level 3i therapist development, 40 refinement of schema, 7–10
Autonomy-dependency conflict, 40 schema development, 7–10
Awareness of others, 28, 48–50, 87–89, 117–119 skill development, 10–12
Comments by trainees
assessment techniques, 253–254
B client conceptualization, 254–255
individual differences, 261
Balance between, clinical, training needs, 208 interpersonal assessment, 257–258
Balancing of multiple roles, 208 intervention skills competence, 259–260
Behavior, 219–221 professional ethics, 256
Blocks, response to, 134 theoretical orientation, 251–253
Boundaries, 208 treatment goals, plans, 261
Building alliances, 208 Competence, 221–227
informed consent, 226
intervention skills, 25
C Competencies framework, supervision, 208–209
Compliant personality, 40
Career decisions, 134 Conceptual training, 209–212
Case conceptualization format, 283–286 Conditional dependency, 40
client demographic data, 283 Confidentiality, 226
clinic data, 283 Conflict, ambiguity, balance between, 73
environmental factors, 285 Confrontation, ability to handle, 110
formal diagnosis, 286 Confrontational approach, 134
interpersonal factors, 285 Constraints on supervision, 114–117
life transition/adaptation skills, 286 Consultation, 208
personality dynamics, 285–286 Countertransference, 110
presenting problems, 284 Credentials, representation of, 227
297
298 Index
D teaching skills, 208
theories, knowledge of, 208
Denying trainee, 76 verification of previous supervision, 209
Dependency, conditional, 40 videotape observation, 209
Dependency-autonomy conflict, 40 Didactic skills, 208
Development, therapist, 199–215 Didactic training, 209–212
alliance building, 208 Distrustful trainee, 76–77
boundaries, 208 Diverse therapists, supervisory relationships,
clinical, training needs, balance between, 150–156
208 Diversity, 208
competencies framework, supervision, documentation, 209
sensitivity to, 208
208–209
Documentation, 160–161
conceptual training, 209–212
Documented supervisee feedback, 209
didactic training, 209–212
Domains
diversity, 208
assessment techniques, 25
documentation, 209
client conceptualization, 26
sensitivity to, 208
goals, 26
documented supervisee feedback, 209
individual differences, 26
empowering others, commitment to, 208
interpersonal assessment, 25–26
ethical issues, 208
intervention skills competence, 25
ethical principles, valuing of, 208
level 1 therapist, 41–42
ethics, knowledge of, 208
level 2 therapist, 42–43
evaluative feedback from trainee, use of, 208
level 3 therapist, 43–44
experiential training, 212–213
level 3i therapist, 44
feedback, 208
professional ethics, 27
flexibility, 208 structure, interaction, 40–44
formative feedback, 208 structures, interaction of, 93–99
growth in trainee, promotion of, 208 structures across, 52–63
learning, commitment to, 208 theoretical orientation, 26
level of supervisee assessment, 208 treatment plans, 26
levels of supervisor development, 200–207
level 1, 201–203
level 2, 203–205 E
level 3, 205–206
level 3i, 206–207 Elements of acceptable activity, 158–160
limitations, commitment to knowing, 208 Empirical evidence, counselor development,
observation, 209 232–233
process outcome knowledge, 208 Empowering others, commitment to, 208
professional development, knowledge of, 208 Encouragement, 73, 208
psychotherapy, knowledge of, 208 Entry-level trainee, 45–47
respectfulness, 208 cognition, 46
responsibility for client, supervisee, learning, 46
acceptance of, 208 motivations for entering field, 46–47
scientific thinking, 208 Ethical issues
self-assessment, 209 behavior, 219–221
self-assessment process, 208 codes, 217–218
sensitivity to multiple roles, 208 competence, 221–227
sociopolitical context, awareness of, 208 competence to supervise, 224–225
supervisee learning needs, assessment of, 208 confidentiality, 226
supervision in field settings, 214–215 ethical knowledge, 219–221
supervisor assessment, 213–214 evaluation of client, 226–227
support, challenging, balance between, 208 evaluation of supervisees, 226
Index 299
guidelines, 217–218 I
knowledge of, 208
multiple relationships, 226 Ideological trainee, 77
personal functioning, 227–228 Individual differences, 26, 59–60, 96–97,
professional, 27 125–126, 248–249
professional competencies, 221–224 trainee comments, 261
reimbursement for supervisee, 227 Information form for supervisees, 293–295
representation of credentials, 227 Initial session preparation, 173–174
Ethical knowledge, 219–221 Integration, striving for, 134
Ethical principles, valuing of, 208 Intelligence, social, 14–16
Evaluation of client, 226–227
Intent of study, 233–234
Evaluation of supervisees, 226
Interaction of domain, structure, 40–44
Evaluative feedback from trainee, use of, 208
level 1 therapist, 41–42
Excerpt from practicum competencies outline,
level 2 therapist, 42–43
289–290
level 3 therapist, 43–44
Experiential training, 212–213
level 3i therapist, 44
Expert, novice, distinguished, 12–14
Interpersonal assessment, 25–26, 55–58, 95,
123–124, 240–244
F trainee comments, 257–258
Interpersonal influence, 14–16
Interpretation of dynamics, 110
Feedback
documented, 209 Intervention skills competence, 25, 52–55, 94,
summarizing, 208 121–122, 237–240
for therapist, 182–184 trainee comments, 259–260
from trainee, use of, 208 Interventions, 67–70
Flexibility, 208
Focus on personal, professional integration, 134
K
Formative feedback, 208
Formats, 160–161
Foundations of theory Knowledge of diversity, 208
cognitive models, 4–12
cognitive processing, 6–7
L
refinement of schema, 7–10
schema development, 7–10
skill development, 10–12 Learning, 86, 115–117
expert versus novice, 12–14 commitment to, 208
interpersonal influence, 14–16 Legal issues
models of human development, 18–20 behavior, 219–221
motivation, 16–18 codes, 217–218
social intelligence, 14–16 competence, 221–227
competence to supervise, 224–225
confidentiality, 226
G ethical knowledge, 219–221
evaluation of client, 226–227
Group supervision, 73, 110, 134, 184–185 evaluation of supervisees, 226
Growth in trainee, promotion of, 208 guidelines, 217–218
Guidelines, 217–218 knowledge of, 208
multiple relationships, 226
personal functioning, 227–228
H professional competencies, 221–224
reimbursement for supervisee, 227
Human development models, 18–20 representation of credentials, 227
300 Index
Level 1 therapist professional ethics, 98–99
addicted or nonpracticing addicted trainee, self-awareness, 33, 87–89
77 supervising, 99–108
advanced supervisees, 47–48 client assignment, 101–102
affective development, 29–30 normalizing level 2 experience, 108
assessment techniques, 55 supervisor interventions, 102–108
autonomy, 31–32, 51–52 therapeutic adolescence, 100–101
awareness of others, 28 supervisory mechanisms, 108–110
client conceptualization, 58 theoretical orientation, 97–98
cognitive development, 29 transitional issues, 111–112
development, 27–33 treatment plans, goals, 98
domains, structures across, 52–63 Level 3 therapist
entry-level trainee, 45–47 assessment techniques, 122–123
cognition, 46 autonomy, 38, 120–121
learning, 46 client conceptualization, 124–125
motivations for entering field, 46–47 cognition, 115–117
ideological trainee, 77 constraints on supervision, 114–117
individual differences, 59–60 development, 37–39
interpersonal assessment, 55–58 group supervision, 134
intervention skills competence, 52–55 individual differences, 125–126
metaphor, 32–33 interpersonal assessment, 123–124
motivation, 30–31, 50–51
intervention skills competence, 121–122
professional ethics, 62–63
learning, 115–117
reincarnated trainee, 75
level 3 structures, 117–121
savior trainee, 75–76
metaphor, 39
self-awareness, 28, 48–50
motivation, 38, 119–120
structures, 48–52
professional ethics, 127
sublevel 1 trainees, 74–78
self-awareness, 37–38, 117–119
supervising, 63–74
structures across domains, 121–127
client assignment, 66–67
supervising, 127–134
final considerations, 73–74
client assignment, 131
interventions, 67–70
general considerations, 128–130
supervisory mechanisms, 70–73
suspicious, distrustful trainee, 76–77 interventions, 131–132
theoretical orientation, 60–61 supervisory mechanisms, 132–134
transition issues, 80–81 theoretical orientation, 126
treatment plans, goals, 61–62 treatment plans, goals, 127
unfinished client/denying trainee, 76 Level 3i therapist
Level 2 therapist autonomy, 40
affective development, 34–35 development, 39–40
assessment techniques, 94–95 metaphor, 40
autonomy, 36, 90–91 motivation, 39
client conceptualization, 95–96 self-awareness, 39
cognition, 86 Levels of supervisor development
cognitive development, 33–34 level 1, 201–203
development, 33–37 level 2, 203–205
domains, structures, interaction of, 93–99 level 3, 205–206
individual differences, 96–97 level 3i, 206–207
interpersonal assessment, 95 Levels of therapist development
intervention skills competence, 94 level 1, 27–33
learning, 86 affective, 29–30
level 2 structures, 87–93 autonomy, 31–32
metaphor, 37 awareness of others, 28
motivation, 35–36, 92–93 cognitive, 29
Index 301
metaphor, 32–33 level 3
motivation, 30–31 autonomy, 38
self-awareness, 28 metaphor, 39
level 2, 33–37 motivation, 38
affective, 34–35 self-awareness, 37–38
autonomy, 36 level 3i
awareness of others, 33 autonomy, 40
cognitive, 33–34 metaphor, 40
metaphor, 37 motivation, 39
motivation, 35–36 self-awareness, 39
self-awareness, 33 levels of therapist development, 27–40
level 3, 37–39 level 1, 27–33
autonomy, 38 level 2, 33–37
awareness of others, 37–38 level 3, 37–39
metaphor, 39 level 3i, 39–40
motivation, 38 overriding structures, 23–25
self-awareness, 37–38 autonomy, 24–25
level 3i, 39–40 motivation, 24
autonomy, 40 self-awareness, 23–24
awareness of others, 39 specific domains, 25–27
assessment techniques, 25
metaphor, 40
client conceptualization, 26
motivation, 39
goals, 26
self-awareness, 39
individual differences, 26
Limitations, commitment to knowing, 208
interpersonal assessment, 25–26
Limited support for model, 246
intervention skills competence, 25
professional ethics, 27
M theoretical orientation, 26
treatment plans, 26
Models of human development, 18–20
Managed care challenges, 196–198
Motivated, dependent development level, 40
Methods of assessment, 179
Motivation, 16–18, 24, 50–51, 92–93, 119–120
Modalities, knowledge of, 208
level 1 therapist development, 30–31
Model overview, 21–44
level 2 therapist development, 35–36
domain, structure, interaction, 40–44 level 3 therapist development, 38
level 1 therapist, 41–42 level 3i therapist development, 39
level 2 therapist, 42–43 Multiple relationships, 226
level 3 therapist, 43–44 Multiple roles, balancing of, 208
level 3i therapist, 44
level 1
affective, 29–30 N
autonomy, 31–32
awareness of others, 28 Need for consultation, awareness of, 209
cognitive, 29 Need for structure, 40
metaphor, 32–33 Nonpracticing addicted trainee, 77
motivation, 30–31 Normalizing level 2 experience, 108
self-awareness, 28 Novice, expert, distinguished, 12–14
level 2
affective, 34–35
autonomy, 36 O
cognitive, 33–34
metaphor, 37 Observation, 73, 110, 209
motivation, 35–36 Overidentification, 40
self-awareness, 33 Overriding structures, 23–25
302 Index
autonomy, 24–25 P
awareness of others, 23–24
motivation, 24 Parallel processing, 110
self-awareness, 23–24 Peer supervision, 134
Overview of model, 21–44 Performance anxiety, 40
domain, structure, interaction, 40–44 Personal functioning, 227–228
level 1 therapist, 41–42 Personality disorders, 110
level 2 therapist, 42–43 Practicum competencies outline
level 3 therapist, 43–44 excerpt, 289–290
level 3i therapist, 44 overview, 287–291
level 1
baseline competencies, 287–288
affective, 29–30
skills developed during practicum, 288
autonomy, 31–32
Process outcome knowledge, 208
awareness of others, 28
Processing, cognitive, 6–7
cognitive, 29
Professional competencies, 221–224
metaphor, 32–33
Professional development, 208
motivation, 30–31
knowledge of, 208
self-awareness, 28
Professional ethics, 27, 62–63, 98–99, 127
level 2
trainee comments, 256
affective, 34–35
Professional growth, commitment to, 208
autonomy, 36
Psychotherapy, knowledge of, 208
cognitive, 33–34
metaphor, 37
motivation, 35–36 Q
self-awareness, 33
level 3
Qualitative assessment, 177–182
autonomy, 38
methods of assessment, 179
metaphor, 39
motivation, 38 supervise perception, 180–181
self-awareness, 37–38 supervisor perceptions, 181–182
level 3i work samples, 179–180
autonomy, 40 Qualitative model examination, 231–261
metaphor, 40 assessment techniques, trainee comments,
motivation, 39 253–254
self-awareness, 39 client conceptualization, trainee comments,
levels of therapist development, 27–40 254–255
level 1, 27–33 empirical evidence, counselor development,
level 2, 33–37 232–233
level 3, 37–39 individual differences, 248–249
level 3i, 39–40 trainee comments, 261
overriding structures, 23–25 intent of study, 233–234
autonomy, 24–25 interpersonal assessment, 240–244
motivation, 24 trainee comments, 257–258
self-awareness, 23–24 intervention skills competence, 237–240
specific domains, 25–27 trainee comments, 259–260
assessment techniques, 25 limited support for model, 246
client conceptualization, 26 professional ethics, trainee comments, 256
goals, 26 support for model, 237–249
individual differences, 26 theoretical orientation, 244–246
interpersonal assessment, 25–26 trainee comments, 251–253
intervention skills competence, 25 trainee comments, 251–261
professional ethics, 27 treatment goals, plans, trainee comments,
theoretical orientation, 26 261
treatment plans, 26 treatment plans, goals, 246–248
Index 303
R intervention skills competence, 25
professional ethics, 27
Regression or stress, autonomy during, 110 theoretical orientation, 26
Reimbursement for supervisee, 227 treatment plans, 26
Reincarnated trainee, 75 Stable developmental level, 40
Relationships, supervisory, 137–156 Stagnation, response to, 134
across levels, 144–149 Standards, 157–168
level 1, 144–145 Strengths, addressing, 73
level 2, 145–148 Stress, autonomy during, 110
level 3, 148–149 Structures
across domains, 121–127
with diverse therapists, 150–156
autonomy, 24–25
theory, 138–144
domain, interaction, 40–44
Representation of credentials, 227
level 1 therapist, 41–42
Research, 138–144
level 2 therapist, 42–43
knowledge of, 208
level 3 therapist, 43–44
Respectfulness, 208
level 3i therapist, 44
Responsibilities of supervisor, 161–163
motivation, 24
Responsibility for client, supervisee, acceptance
need for, 40
of, 208
provided by trainee, 134
Role playing, 73, 110
self-awareness, 23–24
Sublevel 1 trainees, 74–78
S Summarizing feedback, 208
Supervisees. See also Supervision
assessment, evaluation, 174–175
Savior trainee, 75–76
information form, 293–295
Schema development, 7–10
learning needs, assessment of, 208
cognitive models, 7–10 responsibility for, 208
Schema refinement, cognitive models, 7–10 Supervision
Scientific thinking, 208 across settings, 187–198
Scientist-practitioner supervision methods, adolescence, therapeutic, 100–101
168–173 advanced, 47–48
evaluation, 172 assessment, 213–214
supervise qualities, 170–171 client assignment, 66–67, 101–102, 131
supervision plan, 171–172 competence, 224–225
Self-assessment, 208–209 competence to supervise, 224–225
process, 208 competencies framework, 208–209
trainee, 208 constraints on, 114–117
Self-awareness, 23–24, 28, 33, 37–39, 48–50, development, 199–215
87–89, 117–119 development levels, 200–207
Sensitivity diverse therapists, 150–156
to diversity, 208 documentation, 160–161
to multiple roles, 208 effectiveness, therapeutic, 175–177
Settings, 193–196 elements of acceptable activity, 158–160
Skill development, 10–12, 163–168 environments, 73, 110, 134
Skills training, 73 evaluation, 172, 226
Social intelligence, 14–16 feedback for therapist, 182–184
Sociopolitical context, awareness of, 208 in field settings, 214–215
Specific domains, 25–27 formats, 160–161
assessment techniques, 25 group, 73, 110, 134, 184–185
client conceptualization, 26 group supervision, 184–185
goals, 26 in-context model, 187–189
individual differences, 26 components, 189
interpersonal assessment, 25–26 initial session preparation, 173–174
304 Index
interventions, 67–70, 102–108, 131–132 cognitive models, 4–12
mechanisms, 132–134 cognitive processing, 6–7
modalities, 208 refinement of schema, 7–10
normalizing, 108 schema development, 7–10
peer supervision, 134 skill development, 10–12
perception, 180–181 expert versus novice, 12–14
perceptions, 181–182 interpersonal influence, 14–16
plan, 171–172 models of human development, 18–20
qualitative assessment, 177–182 motivation, 16–18
methods of assessment, 179 social intelligence, 14–16
supervise perception, 180–181 Theoretical orientation, 26, 60–61, 97–98, 126,
supervisor perceptions, 181–182 244–246
work samples, 179–180 trainee comments, 251–253
qualities, 170–171 Theories, knowledge of, 208
reimbursement, 227 Therapeutic adolescence, 100–101
relationships, 137–156 Therapeutic effectiveness, 175–177
diverse therapists, 150–156 Therapist development levels
theory, 138–144 level 1, 27–33
responsibilities, 161–163 affective, 29–30
responsibilities of supervisor, 161–163 autonomy, 31–32
scientist-practitioner, 168–173 awareness of others, 28
scientist-practitioner supervision methods, cognitive, 29
168–173 metaphor, 32–33
evaluation, 172 motivation, 30–31
supervise qualities, 170–171 self-awareness, 28
supervision plan, 171–172 level 2, 33–37
skill development, 163–168 affective, 34–35
standards, 157–168 autonomy, 36
supervisee assessment, 174–175 cognitive, 33–34
evaluation, 174–175 metaphor, 37
supervisee information form, 293–295 motivation, 35–36
supervisory mechanisms, 70–73 self-awareness, 33
theory, 138–144 level 3, 37–39
therapeutic effectiveness, 175–177 autonomy, 38
training, 207–213 metaphor, 39
Supervisor assessment, 213–214 motivation, 38
Supervisor interventions, 102–108 self-awareness, 37–38
Supervisor perceptions, 181–182 level 3i, 39–40
Supervisory relationships, 137–156 autonomy, 40
across levels, 144–149 metaphor, 40
level 1, 144–145 motivation, 39
level 2, 145–148 self-awareness, 39
level 3, 148–149 Trainee comments, 251–261
with diverse therapists, 150–156 Training
theory, 138–144 alliance building, 208
Support, challenging, balance between, 208 boundaries, 208
Support for model, 237–249 clinical, training needs, balance between, 208
Suspicious, distrustful trainee, 76–77 competencies framework, supervision,
208–209
conceptual training, 209–212
T didactic training, 209–212
diversity, 208
Teaching skills, 208 documentation, 209
Theoretical foundations, 1–20 sensitivity to, 208
Index 305
documented supervisee feedback, 209 supervisee learning needs, assessment of, 208
empowering others, commitment to, 208 supervision in field settings, 214–215
ethical issues, 208 supervisor assessment, 213–214
ethical principles, valuing of, 208 support, challenging, balance between, 208
ethics, knowledge of, 208 teaching skills, 208
evaluative feedback from trainee, use of, 208 theories, knowledge of, 208
experiential training, 212–213 verification of previous supervision, 209
feedback, 208 videotape observation, 209
flexibility, 208 Transitional issues, 80–81, 111–112
formative feedback, 208 Translation of scientific findings, 208
growth in trainee, promotion of, 208 Treatment plans, 26, 61–62, 98, 127, 246–248
learning, commitment to, 208 trainee comments, 261
levels of supervisor development, 200–207
level 1, 201–203
level 2, 203–205 U
level 3, 205–206
level 3i, 206–207 Unfinished client/denying trainee, 76
limitations, commitment to knowing, 208
observation, 209
process outcome knowledge, 208 V
professional development, knowledge of, 208
psychotherapy, knowledge of, 208 Verification of previous supervision, 209
respectfulness, 208 Video observation, 73, 110, 209
responsibility for client, supervisee,
acceptance of, 208
scientific thinking, 208 W
self-assessment, 208–209
sensitivity to multiple roles, 208 Weaknesses, addressing, 73
sociopolitical context, awareness of, 208 Work samples, 179–180