Current Limitations of Traditional Supervision Methods
While this vignette took place twenty years ago, it remains a fresh
example of the current limitations of our field’s “traditional
supervision” (TS) method. Broadly speaking, TS suffers from training
therapists to get good at talking about therapy in supervision
and not necessarily as good at actually doing therapy in session
(Vaz & Rousmaniere, 2024, 2022; Miller et al., 2020). This can be
illustrated through the approach TS takes to teaching and learning and
what it does and does not include as part of its structure:
- By privileging conceptual teaching, TS often misses key
opportunities to practice specific clinical skills. Conceptual
learning is learning that takes place through reflection, such as
understanding theories, reading papers or attending lectures. My early
supervisor placing the emphasis on my client’s borderline tendencies
is an example of an attempt to use conceptual learning as a way to
become a better therapist. There is nothing wrong with conceptual
learning, since it is important that therapists build conceptual
knowledge. The problem lies in its overemphasis and the expectation
that a therapist will reliably translate the conceptual understanding
into clinical skill when they sit down again with their client
(Bennett-Levy, 2019; Axelsson et al., 2023; Boswell, Constantino, &
Goldfried, 2020).
- By not utilizing recording technologies, TS often works with a
“low resolution picture” of what transpired in the therapy session. TS frequently relies on therapists self-reporting what took place in
the session with the client and then uses this reporting as the basis
for the supervisor creating a learning goal. (For example, my bringing
in my process notes and my supervisor using this account to figure out
how to best intervene.) While it is important that we ask therapists
to organize their thoughts into a coherent self-report, TS is
challenged by using this “low resolution picture” as the central
source for building an understanding of what actually took place in
the session.
- In not making routine outcome measures a built-in part of the
structure of supervision, TS misses opportunities to address client
deterioration and the supervisee’ most pertinent clinical challenges. TS relies on the often unspoken assumption that therapists will bring
in clients who are at the greatest risk of deterioration and
supervisors will track these clients over the course of the
supervision relationship. However, extensive research has demonstrated
that therapists are often unable to recognize clients in deterioration
and thus in need of supervisory consultation (Hatfield et al., 2010;
Lambert, 2010; Hartmann et al., 2015).
Taken together – an over-reliance on conceptual learning and not
utilizing recording technologies and routine outcome-measures –, the
traditional supervisory process ends up spending too much time and
energy on abstractions and not enough on acquiring specific therapy
skills to aid in the supervisee’s concrete clinical challenges (Axelsson
et al., 2023; Boswell, Constantino, & Goldfried, 2020; Vaz &
Rousmaniere, 2022, 2024). Any form of supervision has a great deal to
accomplish in a limited window of time. Refining the field’s supervisory
learning methods and structure are promising contributions that
deliberate practice (DP) can offer to traditional supervision.