APA Guidelines for Clinical Supervision in Health Service Psychology

GUIDELINES FOR CLINICAL SUPERVISION IN HEALTH SERVICE PSYCHOLOGYA

APA GUIDELINES

for Clinical Supervision in

Health Service Psychology

BOARD OF EDUCATIONAL AFFAIRS TASK FORCE ON SUPERVISION GUIDELINES

APPROVED BY APA COUNCIL OF REPRESENTATIVES

2014

B AMERICAN PSYCHOLOGICAL ASSOCIATION

acknowledgment is given to the American Psychological Association. This material may not be reprinted, translated, or distributed electronically without

prior permission in writing from the publisher. For permission, contact APA, Rights and Permissions, 750 First Street, NE, Washington, DC 20002-4242.

This document was approved by the APA Council of Representatives over the course of its meeting on August 6, 2014 and is set to expire in approximately

10 years. It is available online at: www.apa.org/about/policy/guidelines-supervision.pdf

Suggested bibliographic reference

American Psychological Association. (2014). Guidelines for Clinical Supervision in Health Service Psychology. Retrieved from

http://apa.org/about/policy/guidelines-supervision.pdf

APA Guidelines for Clinical Supervision

in Health Service Psychology

BOARD OF EDUCATIONAL AFFAIRS TASK FORCE ON SUPERVISION GUIDELINES

Members

Carol Falender, PhD (Chair)

Clinical Professor, Department of Psychology

University of California, Los Angeles

Beth Doll, PhD

Associate Dean for Academic Affairs

College of Education and Human Sciences

University of Nebraska Lincoln

Michael Ellis, PhD

Director, Division of Counseling Psychology

Department of Educational and Counseling Psychology

University at Albany

Rodney K. Goodyear, PhD

Professor, School of Education

University of Redlands

Stephen McCutcheon, PhD

Director, Psychology Training Programs

VA Puget Sound Healthcare System, Seattle Division

Marie Miville, PhD

Associate Professor of Psychology and Education

Teachers College, Columbia University

Celiane Rey-Casserly, PhD (liaison from BEA)

Director, Neuropsychology Program

Boston Children’s Hospital

Nadine Kaslow, PhD (liaison from the APA Board of Directors)

Professor, Department of Psychiatry and Behavioral Sciences

and Chief Psychologist, Grady Health System

Emory University School of Medicine

APA Staff

Catherine Grus, PhD

Deputy Executive Director, Education Directorate

Jan-Sheri Morris

Program Officer, Education Directorate

II AMERICAN PSYCHOLOGICAL ASSOCIATION

PREFACE

1

A competency-based approach is meta-theoretical and refers to working within any theoretical or practice modality, systematically consid-

ering the growth of specific competencies in the development of competence.

This document outlines guidelines for supervision of students in health service psychology edu-

cation and training programs. The goal was to capture optimal performance expectations for

psychologists who supervise. It is based on the premises that supervisors a) strive to achieve

competence in the provision of supervision and b) employ a competency-based, meta-theoret-

ical approach

to the supervision process.

The Guidelines on Supervision were developed as a resource to inform education and training

regarding the implementation of competency-based supervision. The Guidelines on Supervision

build on the robust literatures on competency-based education and clinical supervision.

They are organized around seven domains: supervisor competence; diversity; relationships;

professionalism; assessment/evaluation/feedback; problems of professional competence,

and ethical, legal, and regulatory considerations. The Guidelines on Supervision represent the

collective effort of a task force convened by the APA Board of Educational Affairs (BEA).

GUIDELINES FOR CLINICAL SUPERVISION IN HEALTH SERVICE PSYCHOLOGYIII

CONTENTS

Preface II

Executive Summary 

Introduction 

Statement of Need and Context for the Guidelines on Supervision 

Scope of Applicability 

Assumptions of the Guidelines on Supervision 

Use of the Term Guidelines 

Process of Developing the Guidelines on Supervision 

Purpose of the Guidelines on Supervision 

Implementation Steps 

Feedback 

Guidelines for Clinical Supervision in Health Service Psychology 

Domain A Supervision Competence 

Domain B Diversity 

Domain C Supervisory Relationship 

Domain D Professionalism 

Domain E AssessmentEvaluationFeedback 

Domain F Professional Competence Problems 

Domain G Ethical Legal and Regulatory Considerations 

Conclusion 

References 

Appendix Definitions 

GUIDELINES FOR CLINICAL SUPERVISION IN HEALTH SERVICE PSYCHOLOGY1

EXECUTIVE SUMMARY

The purpose of the Guidelines for Clinical Supervision in Health Service Psychology (hereafter

referred to as Guidelines on Supervision) is to delineate essential practices in the provision of

clinical supervision. The overarching goal of these Guidelines on Supervision is to promote the

provision of quality supervision in health service psychology using a competency framework

to enhance the development of supervisee competence ensuring the protection of clients/

patients and the public. These Guidelines on Supervision are intended to be aspirational in

nature to guide psychologists proactively towards enhancing supervision practice. The term

Guidelines on Supervision, as used in this document, is consistent with the provisions of the

American Psychological Association (APA) policy on Developing and Evaluating Standards and

Guidelines Related to Education and Training in Psychology (Section I C[1]) (APA, 2004), as

passed by the APA Council of Representatives.

An assumption underlying all supervision is that the supervisor is competent—both as a

professional psychologist and as a clinical supervisor (Fouad et al., 2009). Supervision is for

assessment, treatment, and other activities of the health service psychologist; and it occurs

across varied settings. Ironically, however, minimal attention has been given to defining, assess-

ing, or evaluating supervisor competence (Bernard & Goodyear, 2014; Falender & Shafranske,

2013) or to determining requisite training for clinical supervision. The supervisor is responsible

for ensuring the protection of the public, and this duty cannot be achieved without supervisor

competence. This requires developing the knowledge, skills, and attitudes in the provision

of supervision, and receiving training specific to clinical supervision (Falender, Burnes, & Ellis;

2013; Falender, Ellis, & Burnes, 2013; Reiser & Milne, 2012). Further, education and training in

health service psychology increasingly employs a competency-based approach to the definition,

assessment, and evaluation of student learning outcomes. Both the competence of supervisors

and the application of competency-based approach to supervision can be enhanced by develop-

ing guidelines that assist supervisors in the provision of high quality supervision.

The Guidelines on Supervision are the product of a task force convened by the APA Board of

Educational Affairs. Members of the task force were selected for their expertise in the area of

supervision. The majority of their work was conducted through conference calls and electronic

mail with one face-to-face meeting; and the task force adhered to a tight timeline in recognition

of the considerable need for such a document.

2 AMERICAN PSYCHOLOGICAL ASSOCIATION

The Guidelines on Supervision are predicated on a number of

common assumptions and agreed upon definitions. Although an

extensive list of definitions appears in Appendix A to this docu-

ment, three key definitions are provided below:

HEALTH SERVICE PSYCHOLOGIST. “Psychologists are

recognized as Health Service Providers if they are duly trained

and experienced in the delivery of preventive, assessment,

diagnostic and therapeutic intervention services relative to

the psychological and physical health of consumers based

on: 1) having completed scientific and professional training

resulting in a doctoral degree in psychology; 2) having

completed an internship and supervised experience in health

care settings; and 3) having been licensed as psychologists at

the independent practice level” (APA, 1996).

The Guidelines on Supervision focus on supervision for health

service psychologists. A health service psychologist was defined

by APA policy in 1996 and reaffirmed in the 2011 revision of the

APA Model Act for State Licensure of Psychologists (APA, 2011c).

Members of the task force agreed that a clear and delimited

scope for the Guidelines on Supervision was important to promote

understanding and use of this document. The term health service

psychology (HSP) is preferred as it is narrower than professional

psychology, a designation that includes the specialty of indus-

trial-organizational psychology, which was not addressed by the

task force. Health service psychology is inclusive of the specialties

of clinical, counseling, and school psychology.

SUPERVISION is a distinct professional practice employing

a collaborative relationship that has both facilitative and

evaluative components, that extends over time, which has

the goals of enhancing the professional competence and

science-informed practice of the supervisee, monitoring

the quality of services provided, protecting the public, and

providing a gatekeeping function for entry into the profession.

Henceforth, supervision refers to clinical supervision and

subsumes supervision conducted by all health service

psychologists across the specialties of clinical, counseling,

and school psychology.

COMPETENCY-BASED SUPERVISION is a metatheoretical

approach that explicitly identifies the knowledge, skills

and attitudes that comprise clinical competencies, informs

learning strategies and evaluation procedures, and meets

criterion-referenced competence standards consistent

with evidence-based practices (regulations), and the local/

cultural clinical setting (adapted from Falender & Shafranske,

2007). Competency-based supervision is one approach to

supervision; it is metatheoretical and does not preclude other

models of supervision.

The Guidelines on Supervision are organized around seven domains:

Domain A: Supervisor Competence

Domain B: Diversity

Domain C: Supervisory Relationship

Domain D: Professionalism

Domain E: Assessment/ Evaluation/ Feedback

Domain F: Problems of Professional Competence

Domain G: Ethical, Legal, and Regulatory Considerations

Within each of these seven domains, guidelines for supervision

are articulated with a supporting rationale informed by the empir-

ical and theoretical literature. Although this framework is useful to

present the Guidelines on Supervision, there is considerable concep-

tual and practical overlap among these domains. Consideration

was given to the utility and implementation of the Guidelines on

Supervision as well as to minimizing redundancy when making

decisions about the best domain for a specific guideline.

GUIDELINES FOR CLINICAL SUPERVISION IN HEALTH SERVICE PSYCHOLOGY3

INTRODUCTION

Statement of Need and Context for the Guidelines on Supervision

A primary goal of education and training programs in health service psychology is to prepare

psychologists who are competent to engage in provision of psychological services and profes-

sional practice. Supervision is thus a cornerstone in the preparation of health service psychol-

ogists (Falender et al., 2004). There is a tremendous amount of conceptual, theoretical, and

research literature pertaining to supervision, but prior to the development of these Guidelines

on Supervision, there has been no set of consensually agreed upon guidelines adopted as asso-

ciation policy to inform the practice of high quality supervision for health service psychology.

Although supervisor competency is assumed, little attention has been focused on the

definition, assessment, or evaluation of supervisor competence (Bernard & Goodyear, 2014;

Falender & Shafranske, 2013). This has diminished the perceived necessity for training in

supervision. As Kitchener (2000) concluded, it has been much easier to identify the absence

of competence than to define it. Articulating practices consistent with competent supervision

ultimately facilitates the provision of quality services by supervisees and minimizes potential

harm to supervisees and clients (Ellis et al., 2014).

Competence entails performing one’s professional role within the standards of practice

and includes the ability to identify when one is not performing adequately. An essential aspect

of competence is metacompetence, or the ability to know what one does not know and to

self-monitor reflectively one’s ongoing performance (Falender & Shafranske, 2007; Hatcher &

Lassiter, 2007; APA, 2010, 2.01). Professional negligence is the failure of competence and is

legally actionable: a failure of competence is practicing below a reasonable standard of care for

supervision (Falender & Shafranske, 2014; Saccuzzo, 2002).

While clinical supervision has been recognized as a distinct activity in the literature, its rec-

ognition as a core competency domain for psychologists has been a long time coming (Bernard

& Goodyear, 1992; Hess, 2011). Since the profession’s adoption of supervision as a distinct pro-

fessional competence (Fouad et al., 2009; Kaslow et al., 2004), a definition of supervision has

emerged and encompasses the knowledge, skills, and values/attitudes specific to the practice

of supervision (Falender et al., 2004; Falender & Shafranske, 2004, 2007; Fouad et al., 2009).

This recognition of supervision as a distinct competency has evolved in the context of an over-

all focus on competency-based education and training in health service psychology that has

gained momentum over the past decade (Fouad & Grus, 2014). The movement is consistent

with the national dialogue about the responsibility of education and training programs to be

accountable for ensuring quality education and training that leads to expected student learning

outcomes (New Leadership Alliance for Student Learning and Accountability, 2012).

Supervisory competency includes valuing supervision as a distinct professional com-

petency and valuing specific training in clinical supervision (Falender, Burnes, & Ellis; 2013;

Falender, Ellis, & Burnes, 2013; Reiser & Milne, 2012). However, the recognition that training

in supervision is necessary has also been slow to occur (Rings, Genuchi, Hall, Angelo, &

Cornish, 2009). A preliminary framework for supervisor competence was produced by the

2002 Competencies Conference (Falender et al., 2004), received confirmatory support from

doctoral internship directors (Rings et al., 2009), and serves as a basis for this framework.

To be a competent supervisor, an individual possesses and maintains knowledge, skills, and

values/attitudes that comprise the distinct professional competency of clinical supervision as

well as general competence in the areas of clinical practice supervised and in consideration of

the cultural contexts.

4 AMERICAN PSYCHOLOGICAL ASSOCIATION

Supervision that applies a competency-based approach

entails the creation of an explicit framework and method to initi-

ate, develop, implement, and evaluate the process and outcomes

of supervision. A competency-based approach is predicated on

supervisors having the knowledge, skills, and attitudes regarding

the provision of quality supervision and professional psychol-

ogy models, theories, practices. In addition, supervisors have

knowledge, skills and values with respect to multiculturalism and

diversity, legal and ethical parameters; and management of super-

visees who do not meet criteria for performance. Supervisors also

attain knowledge and skills in theories and processes for group,

individual, and distance supervision. Implicit in the concept of

competence is an awareness of and attention to one’s interper-

sonal functioning and professionalism and valuing individual and

cultural diversity (Kaslow et al., 2007). The competency-based

approach is being adopted in multiple specialties (e.g., Stucky,

Bush, & Donders, 2010), psychotherapy theoretical approaches

(e.g., Farber, 2010; Farber & Kaslow, 2010; Sarnat, 2010), and

internationally (e.g., Psychology Board of Australia, 2013).

A logical next step to build upon the identified elements of

competence in supervision is to develop and approve guidelines

that promote the provision of competent supervision. Other

organizations have published guidelines on supervision that have

informed the development of these Guidelines on Supervision.

Specifically, the following regulatory boards and psychological

associations have promulgated guidelines related to supervision.

• The Association for Counselor Education and Supervision

(ACES), a division of the American Counseling Association

developed supervision guidelines for counselor education

(Borders et al., 2011). The ACES guidelines on supervision

are organized around 12 domains.

• The American Association of Marriage and Family

Therapy developed a formal approval process for super-

visors with nine learning objectives that candidates must

demonstrate (American Association of Marriage and

Family Therapy, 2007).

• The National Association for School Psychologists

addresses supervision as part of a more comprehensive

document on the provision of integrated and comprehen-

sive school psychological services (National Association

for School Psychologists, 2010).

• The Psychology Board of Australia’s Guidelines for super-

visors and supervisor training providers consists of a doc-

ument that focuses on competency-based supervision

(Psychology Board of Australia, 2013).

• The Australian Psychological Society Guidelines on

Supervision specifically addresses the supervision contract,

2

ACES categories are: initiating supervision, goal setting, giving feedback, conducting supervision, the supervisory relationship, diversity and advocacy considerations, ethical considerations, documentation,

evaluation, supervision format, the supervisor, and supervisor preparation.

3

AAMFT categories include: knowledge of supervision models, ability to delineate one’s own model of supervision, ability to foster relationships with the supervisee and the client, assess relationship

problems, conduct supervision using various modalities, able to act on considerations within the supervisory relationship, attentive to issues of diversity, knowledge of ethical and legal issues related to

supervision, and AAMFT supervisor procedural knowledge.

ethical issues, and supervision contexts (Australian

Psychological Society, 2003).

• The New Zealand Psychologists Board’s Best-practices

guidelines for supervision provides recommendations about

a variety of aspects of supervision including the process

and functions of supervision, supervisor competencies,

the supervision relationship, and cultural issues (New

Zealand Psychologists Board, 2007).

• The British Psychological Society, Committee on Training

in Clinical Psychology has guidelines for clinical super-

vision within their criteria for the accreditation of post-

graduate training programs in clinical psychology (British

Psychological Society, Committee on Training in Clinical

Psychology, 2008).

• The Association of State and Provincial Psychology Boards

(ASPPB) is currently revising their supervisions guidelines

(Steve DeMers, personal communication, 2013a).

• The California Board of Psychology has published a doc-

ument on supervision best practices (California Board of

Psychology, 2010).

• The College of Psychologists of Ontario, Canada has

a Supervision Resource Manual (2

edition) (College of

Psychologists of Ontario, Canada, 2009).

• The Canadian Psychological Association developed

the Ethical guidelines for supervision in psychology:

Teaching, research, practice, and administration (Canadian

Psychological Association, 2009) and a Resource guide for

psychologists: Ethical supervision in teaching, research, prac-

tice, and administration (Pettifor et al., 2010). Four princi-

ples frame the guidelines(from the CPA Code of Ethics,

2000): respect for the dignity of persons, responsible car-

ing, integrity in relationships, and responsibility to society.

• The Association of Social Work Boards has developed

guidelines on supervision for both educators and reg-

ulators using a competency framework identifying six

domains of competence (Association of Social Work

Boards, 2009).

• The National Association of Social Workers and the

Association of Social Work Boards recently released a

document on best practices for supervision (National

Association of Social Workers and the Association of

Social Work Boards,2013), articulating five standards:

context in supervision, conduct of supervision, legal and

regulatory issues, ethical issues, and technology.

GUIDELINES FOR CLINICAL SUPERVISION IN HEALTH SERVICE PSYCHOLOGY5

Scope of Applicability

These Guidelines on Supervision are meant to inform the practice

of clinical supervision with supervisees in areas of health service

psychology and training. They apply to the full range of supervised

service delivery including assessment, intervention, and consul-

tation and across all aspects of professional functioning. The

Guidelines on Supervision are predicated on a number of pre-exist-

ing policies, fundamental assumptions, and definitions:

Supervision can occur in a variety of contexts: supervision

of service delivery by supervisees, administrative supervision,

supervision of research activities conducted by supervisees, and

supervision of individuals mandated by regulatory entities related

to disciplinary actions. This document addresses supervision of

clinical services provided by individuals in health service psychol-

ogy education and training programs and applies to supervision

of practicum experiences, internships, and postdoctoral training.

Interprofessional education is a valuable training activity and

supervisees should have opportunities to learn from and with

professionals other than a psychologist. Recent guidelines for

Interprofessional Collaborative Practice (2011) were endorsed by

APA (Interprofessional Education Collaborative, 2011). However,

this supervision guidelines document refers exclusively to super-

vision provided by psychologists to supervisees in health service

psychology.

Supervisors are committed to upholding the APA Ethical

Principles of Psychologists and Code of Conduct (2010) and adher-

ing to state and federal statues regulating psychologist and

psychological practice. Supervisors strive to adhere to relevant

APA general practice guidelines including but not limited to the

Guidelines for Psychological Practice with Lesbian, Gay and Bisexual

Clients, Guidelines for Assessment of and Intervention with Persons

with Disabilities, Guidelines for Psychological Practice with Girls and

Women, Guidelines for Psychological Practice with Older Adults, and

the Guidelines on Multicultural Education, Training, Research, Practice,

and Organizational Change for Psychologists (APA, 2011a, 2011b,

2007a, 2004a, 2003).

Supervisors are expected to comply with relevant education

and training standards such as those promulgated through the

APA Commission on Accreditation (APA, 2009) as well as other

relevant guidelines, e.g., American Psychological Association

Guidelines for the Practice of Telepsychology (APA, 2013a), Guidelines

for Psychological Practice in Health Care Delivery Systems (APA,

2013b), and Record Keeping Guidelines (APA, 2007b).

4

Supervision is distinguished from these other professional activities by 1) professional responsibility and liability, 2) the purpose of the activity, 3) the relative power of the parties involved, and 4) the

presence or absence of evaluation. In consultation, the consultant does not evaluate the referring provider, does not bear case responsibility, and the consultee is not required to implement the input of

consultation. Supervision is distinguished from personal psychotherapy of the supervisee by maintaining the focus of inquiry on the client/patient, supervisee reactions to the client/patient, and/or the

supervision process related to the client/patient (Bernard & Goodyear, 2014; Falender & Shafranske, 2004). Mentoring is distinguished from supervision by an absence of evaluation or power differential,

and by the mentor’s advocacy for the protege’s professional development and welfare (Johnson & Huwe, 2002; Kaslow & Mascaro, 2007).

Assumptions of the Guidelines on Supervision

The development of these Guidelines on Supervision is predicated

on a number of assumptions. These assumptions were agreed

upon by the members of the task force as foundational to the

provision of clinical supervision and are reflected in the guidelines

delineated in this document. Specifically, supervision:

• is a distinct professional competency that requires formal

education and training

• prioritizes the care of the client/patient and the protec-

tion of the public

• focuses on the acquisition of competence by and the pro-

fessional development of the supervisee

• requires supervisor competence in the foundational and

functional competency domains being supervised

• is anchored in the current evidence base related to super-

vision and the competencies being supervised

• occurs within a respectful and collaborative supervisory

relationship, that includes facilitative and evaluative

components and which is established, maintained, and

repaired as necessary

• entails responsibilities on the part of the supervisor and

supervisee

• intentionally infuses and integrates the dimensions of

diversity in all aspects of professional practice

• is influenced by both professional and personal factors

including values, attitudes, beliefs, and interpersonal

biases

• is conducted in adherence to ethical and legal standards

• uses a developmental and strength-based approach

• requires reflective practice and self-assessment by the

supervisor and supervisee

• incorporates bi-directional feedback between the super-

visor and supervisee

• includes evaluation of the acquisition of expected compe-

tencies by the supervisee

• serves a gatekeeping function for the profession

• is distinct from consultation, personal psychotherapy, and

mentoring

6 AMERICAN PSYCHOLOGICAL ASSOCIATION

Use of the Term Guidelines

The term guidelines generally refers to pronouncements, state-

ments, or declarations that recommend or suggest specific pro-

fessional behaviors, endeavors, or conduct for psychologists. In

this spirit, they are aspirational in intent. They are not intended to

be mandatory or exhaustive and may not be applicable to every

situation, nor are they intended to take precedence over the judg-

ment of supervisors or others who are responsible for education

and training programs.

Education and training guidelines may be written as an advi-

sory set of procedures related to curriculum development, peda-

gogy, or assessment; as interpretive commentary or instruction on

education policy or standards; as a set of guiding principles about

teaching and learning or program development; or as suggested

goals and objectives of learning. These Guidelines on Supervision

are intended as suggestions or recommendations for psycholo-

gists providing supervision of students in education and training

programs in health service psychology. As used in this document,

the term guidelines is consistent with the provisions of the APA

policy on Developing and Evaluating Standards and Guidelines

Related to Education and Training in Psychology (Section I C[1])

(APA, 2004b), as passed by the APA Council of Representatives.

Process of Developing the Guidelines

on Supervision

The Guidelines on Supervision were prepared by a task force con-

vened by the APA Board of Educational Affairs in March of 2012.

The task force was charged to:

“develop education and training guidelines for promising

practices in (1) supervision encompassing the range of

requisite supervisor {supervision} competencies; (2) adoption

of a competency-based approach to supervision mindful of the

developmental trajectory of the supervisee {of the process}.”

The task force met via conference call approximately once

a month from late summer 2012 to early spring 2013. One face-

to-face meeting of the task force occurred May 31-June 2, 2013 at

which previously prepared drafts of the Guidelines on Supervision

were discussed and revised. Following the meeting, the task force

continued to refine the Guidelines on Supervision via electronic mail.

Purpose of these Guidelines on Supervision

The Guidelines on Supervision have the potential for broad impact

on the profession by delineating practices relevant to quality

supervision. Specifically, the Guidelines on Supervision are intended

to have the following impacts:

• For supervisors, the Guidelines on Supervision provide a

framework to inform the development of supervisors and

to guide self-assessment regarding professional develop-

ment needs.

• For supervisees, the Guidelines on Supervision promote the

delivery of competency-based supervision with the goal

of supervisee competency development.

• A goal of the Guidelines on Supervision is to provide assur-

ance to regulators that supervision of students in educa-

tion and training programs in health service psychology is

provided with and places value on quality.

Implementation Steps

BEA will serve as the APA entity responsible for oversight of the

implementation process. Implementation and dissemination of

the Guidelines on Supervision will occur through:

• Distribution to and possible endorsement by the member

organizations represented on the Council of Chairs of

Training Councils, including the doctoral training coun-

cils and the Association of Psychology Postdoctoral and

Internship Centers

• Presentations at the annual meetings of the APA and

training council meetings.

• Submission to a peer-reviewed psychology journal for

publication of a manuscript describing the Guidelines on

Supervision.

• Submission to the APA Commission on Accreditation for

consideration as a resource document in program reviews

for accreditation.

• Development of continuing education programs targeted

to health service psychologists who may not have had

formal training in supervision.

GUIDELINES FOR CLINICAL SUPERVISION IN HEALTH SERVICE PSYCHOLOGY7

Feedback

The Guidelines on Supervision is a “living document.” Accordingly,

APA has established a systematic plan for periodically reviewing

and revising such documents to reflect developments in the disci-

pline and the education and training process. Formal reviews will

occur every ten years, which is consistent with APA Association

Rule 30-8.3 requiring cyclical review of approved standards and

guidelines within periods not to exceed 10 years. Comments and

suggestions are welcomed at any time.

Feedback on the Guidelines on Supervision may be sent to:

[email protected].

8 AMERICAN PSYCHOLOGICAL ASSOCIATION

Content of the Guidelines

Guidelines for

Clinical Supervision

in Health Service

Psychology

The Guidelines on Supervision are organized around seven domains:

Domain A: Supervisor Competence

Domain B: Diversity

Domain C: Supervisory Relationship

Domain D: Professionalism

Domain E: Assessment/ Evaluation/ Feedback

Domain F: Problems of Professional Competence

Domain G: Ethical, Legal, and Regulatory Considerations

These domains are drawn from a review of the literature on supervision as well as com-

petency-based education and training. The domains and their associated Guidelines are

interdependent and while some overlap exists among them it is important that they are

considered in their entirety.

GUIDELINES FOR CLINICAL SUPERVISION IN HEALTH SERVICE PSYCHOLOGY9

DOMAIN A

SUPERVISOR COMPETENCE

Supervision is a distinct professional practice with knowledge, skills, and attitudes, that super-

visors require specific training to attain (Falender, Burnes, & Ellis; 2013; Falender, Ellis, & Burnes,

2013; Bernard & Goodyear, 2014; Reiser & Milne, 2012). The supervisor serves as role model

for the supervisee, fulfills the highest duty of protecting the public, and is a gatekeeper for the

profession ensuring that supervisees meet competence standards in order to advance to the

next level or to licensure.

1. Supervisors strive to be competent in the psychological services provided to clients/

patients by supervisees under their supervision and when supervising in areas in which

they are less familiar they take reasonable steps to ensure the competence of their

work and to protect others from harm.

Supervisors possess up-to-date knowledge and skills regarding the areas being super-

vised (e.g., psychotherapy, research, assessment), psychological theories, diversity

dimensions (e.g., age, gender, gender identity, race, ethnicity, culture, national origin,

religion, sexual orientation, disability, language, and socio-economic status), and indi-

vidual differences and intersections of these with diversity dimensions. Supervisors also

have knowledge of the clinical specialty areas in which supervision is being provided

and of requirements and procedures to be taken when supervising in an area in which

expertise has not been established (Barnett et al., 2007; Goodyear & Rodolfa, 2012; APA,

2010, 2.01, 2.03).

Supervisors are knowledgeable of the context of supervision including its imme-

diate system and expectations, and the sociopolitical context. Supervisors are knowl-

edgeable too about emergent events in the setting or context that impact the client(s)/

patient(s) (Falender et al., 2004).

10 AMERICAN PSYCHOLOGICAL ASSOCIATION

2. Supervisors seek to attain and maintain competence in the

practice of supervision through formal education and

training.

Competence entails demonstrated evidence-based practice

as well as in the various modalities (e.g., family, group and

individual), theories, and general knowledge, skills, and atti-

tudes and research support of competency-based supervi-

sion. Supervisors obtain requisite training in knowledge,

skills, and attitudes of clinical supervision (Newman, 2013;

Watkins, 2012). Supervisors are skilled and knowledgeable

in competency-based models, in developing and managing

the supervisory relationship/alliance (Bernard & Goodyear,

2014; Falender & Shafranske, 2004; Ladany, Mori, & Mehr,

2013), and in enhancing the supervisee’s clinical skills

(Milne, 2009). The formal education and training should

include instruction in didactic seminars, continuing educa-

tion, or supervised supervision. At a minimum, education

and training in supervision should include: models and

theories of supervision; modalities; relationship formation,

maintenance, rupture and repair; diversity and multicultur-

alism; feedback, evaluation; management of supervisee’s

emotional reactivity and interpersonal behavior; reflective

practice; application of ethical and legal standards; decision

making regarding gatekeeping; and considerations of devel-

opmental level of the trainee (Bernard & Goodyear, 2014;

Falender & Shafranske, 2012; Newman, 2013). The super-

vision reflects practices informed by competency- and evi-

dence-based practice to enhance accountability (Milne &

Reiser, 2012; Reese et al., 2009; Stoltenberg & Pace, 2008;

Watkins, 2011; Watkins, 2012; Worthen & Lambert, 2007).

Assessment entails use of outcome measures and ratings

from multiple supervisors (e.g., Reese et al., 2009, Watkins,

2011; Worthen & Lambert, 2007). Assessment strategies

include both formative and summative evaluation and pro-

cedures for competence assessment.

3. Supervisors endeavor to coordinate with other profession-

als responsible for the supervisee’s education and training

to ensure communication and coordination of goals and

expectations.

Coordination can assist supervisees in managing these

multiple roles and responsibilities as well as supervisory

expectations. Coordination is especially important to seek

when a supervisee is exhibiting performance problems,

when the supervisory relationship is under stress, or when

the supervisor seeks another perspective (Thomas, 2010).

4. Supervisors strive for diversity competence across

populations and settings (as defined in APA,2003).

Diversity competence is an inseparable and essential com-

ponent of supervision competence that involves relevant

knowledge, skills, and values/attitudes (for more informa-

tion, see Domain B: Diversity).

5. Supervisors using technology in supervision (including

distance supervision), or when supervising care that

incorporates technology, strive to be competent regarding

its use.

Supervisors ensure that policies and procedures are in

place for ethical practice of telepsychology, social media,

and digital communications between any combination of

client/patient, supervisee, and supervisor (APA, 2013b;

Fitzgerald, Hunter, Hadjistavropoulos, & Koocher, 2010).

Considerations should include services appropriate for dis-

tance supervision, confidentiality, and security. Supervisors

are knowledgeable about relevant laws specific to technol-

ogy and supervision, and technology and practice.

Supervisors model ethical practice, ethical deci-

sion-making, and professionalism, and engage in thoughtful

dialogues with supervisees regarding use of social network-

ing and internet searches of clients/patients and supervis-

ees (Clinton, Silverman, & Brendel, 2010; Myers, Endres,

Ruddy, & Zelikovsky, 2012).

GUIDELINES FOR CLINICAL SUPERVISION IN HEALTH SERVICE PSYCHOLOGY11

DOMAIN B

DIVERSITY

Diversity competence is an inseparable and essential component of supervision competence.

It refers to developing competencies for working with diversity issues and diverse individuals,

including those from one’s own background. More commonly, these competencies refer to

working with others from backgrounds different than one’s own but includes the complexity

of understanding and factoring in the multiple identities of each individual: client(s), super-

visee, supervisor and differing worldviews. Competent supervision attends to a broad range of

diversity dimensions (e.g., age, gender, gender identity, race, ethnicity, culture, national origin,

religion, sexual orientation, disability, language, and socio-economic status), and includes sen-

sitivity to diversity of supervisees, clients/patients, and the supervisor (APA, 2003, 2004a,

2007a, 2010 (2.03); 2011a, 2011b). Supervisors are encouraged to infuse diversity into all

aspects of clinical practice and supervision, including attention to oppression and privilege and

the impact of those on the supervisory power differential, relationship, and on client/patient

and supervisee interactions and supervision interactions.

1. Supervisors strive to develop and maintain self-awareness regarding their diversity

competence, which includes attitudes, knowledge, and skills.

Supervisors understand that they serve as important role models regarding openness to

self- exploration, understanding of one’s own biases, and willingness to pursue educa-

tion or consultation when indicated. Supervisors also are important role models regard-

ing their diversity knowledge, skills and, attitudes. Supervisors’ ability to self-reflect,

revise and update knowledge and advance their skills in diversity serve as important

lessons for supervisees. Modeling these competencies helps to establish a safe environ-

ment in which to address diversity dimensions within supervision as well as in the larger

professional setting.

2. Supervisors planfully strive to enhance their diversity competence to establish a

respectful supervisory relationship and to facilitate the diversity competence of their

supervisees.

Supervisors consider infusion of diversity competence in supervision as an ethical

imperative and respect the human dignity of their supervisees and the clients/patients

with whom the supervisee works (APA, 2010; Bernard & Goodyear, 2014; Falender,

Shafranske, & Falicov, 2014). Supervisors play a significant role in developing the diver-

sity competencies of their supervisees. Research finds that diversity competence among

supervisors can lag behind that of their supervisees (Miville, Rosa, & Constantine,

2005). Fortunately, diversity competence can be directly and constructively addressed

by supervisors, who in turn can facilitate the diversity competence of their supervisees.

Moreover, all supervision can be viewed as multicultural in the same manner that all

therapy is multicultural (Pederson, 1990). Adopting such a framework strengthens the

supervisory relationship, enhances supervisor competence, and promotes the diversity

competencies of both supervisors and supervisees (Andrews, Kuemmel, Williams,

Pilarski, Dunn, & Lund, 2013; Dressel, Consoli, Kim,on, 2007; Snowman, McCown, &

Biehler, 2012). Viewing diversity as normative, rather than as an exception, aids supervi-

sors in being sensitive to important similarities and differences between themselves and

their supervisees that may affect the supervisory relationship.

12 AMERICAN PSYCHOLOGICAL ASSOCIATION

3. Supervisors recognize the value of and pursue ongoing

training in diversity competence as part of their

professional development and life-long learning.

In order to ensure diversity competence sufficient to

provide culturally sensitive supervision, supervisors seek

to continue to develop their own knowledge, skills, and

attitudes, particularly in diversity domains that are most

commonly relevant to their clinical supervision. At a min-

imum, supervisors should have attained formal training

in diversity through their own doctoral training program

or continuing professional development workshops, pro-

grams, and independent study, should be familiar with APA

guidelines addressing diversity (APA, 2003, 2004a, 2007a,

2011a, 2011b), and should pursue continuing education

to maintain current competence and build knowledge in

emerging areas (APA, 2010, 2.03).

4. Supervisors aim to be knowledgeable about the effects of

bias, prejudice, and stereotyping. When possible,

supervisors model client/patient advocacy and model

promoting change in organizations and communities in

the best interest of their clients/patients.

Supervision occurs within the context of diversity and

social and political systems. Of special importance is the

impact of bias, prejudice and stereotyping, both positive

and negative, on therapeutic and supervisory relationships

within these systems. Supervisors promote the supervis-

ee’s competence by modeling advocacy for human rights

and intervention with institutions and systems (Burnes &

Singh, 2010).

5. Supervisors aspire to be familiar with the scholarly

literature concerning diversity competence in supervision

and training. Supervisors strive to be familiar with

promising practices for navigating conflicts among

personal and professional values in the interest of

protecting the public.

Considerable scholarship has been published on supervi-

sion and diversity (e.g., Bernard & Goodyear, 2014; Falender,

Burns, & Ellis, 2013; Miville et al., 2009). Resources include

competency-based training models for integrating diversity

dispositions of supervisors and supervisees (Miville et al.,

2009), and the duty of supervisors to assist supervisees in

navigating inevitable tensions between personal and pro-

fessional values in providing competent client/patient care

(e.g., Behnke, 2012; Bienske & Mintz, 2012; Forrest, 2012;

Mintz, Jackson, Neville, Illfelder-Kaye, Winterowd, & Loewy,

2009; Winterowd, Adams, Miville, & Mintz, 2009).

GUIDELINES FOR CLINICAL SUPERVISION IN HEALTH SERVICE PSYCHOLOGY13

DOMAIN C

SUPERVISORY RELATIONSHIP

The quality of the supervisory relationship is essential to effective clinical supervision (e.g.,

Bernard & Goodyear, 2014; Falender & Shafranske, 2004; Holloway, 1995; O’Donovan, Halford,

& Walters, 2011). Quality of the supervision relationship is associated with more effective

evaluation (Lehrman-Waterman & Ladany, 2001), satisfaction with supervision (Ladany, Ellis,

& Friedlander, 1999), and supervisee self-disclosure of personal and professional reactions

including reactivity and counter transference (Falender & Shafranske, 2004; Ladany , Lehrman-

Waterman, Molinaro, & Wolgast, 1999). The power differential is a central factor in the super-

visory relationship and the supervisor bears responsibility for managing, collaborating, and

discussing power within the relationship (Porter & Vasquez, 1997).

1. Supervisors value and seek to create and maintain a collaborative relationship that

promotes the supervisees’ competence.

Supervisors initiate collaborative discussion of the expectations, goals, and tasks of

supervision. By initiating this discussion, they establish a working relationship that

values the dignity of others, responsible caring, honesty, transparency, engagement,

attentiveness, and responsiveness, as well as humility, flexibility, and professionalism

(Ellis, Ring, Hanus, & Berger, 2013). In discussing the supervisory relationship, the super-

visor should: (1) initiate discussions about differences, including diversity, values, beliefs,

biases, and characteristic interpersonal styles that may affect the supervisory relation-

ship and process; (2) discuss inherent power differences and supervisor responsibility

to manage such differences wisely; and (3) take responsibility to establish relationship

conditions that promote trust, reliability, predictability, competence, perceived expertise,

and developmentally-appropriate challenge.

2. Supervisors seek to specify the responsibilities and expectations of both parties in the

supervisory relationship. Supervisors identify expected program competencies and

performance standards, and assist the supervisee to formulate individual learning goals.

The supervisor is encouraged to explicitly discuss with the supervisee aspects of the

supervision process such as: program goals, individual learning goals, roles and respon-

sibilities, description of structure of supervision, supervision activities, performance

review and evaluation, and limits of supervision confidentiality. The supervisor also pro-

vides clarity about duties including that the primary duty of supervisor is to the client/

patient, and secondarily to competence development of the supervisee. (The supervi-

sion contract is discussed further in the Legal and Ethical Section.)

3. Supervisors aspire to review regularly the progress of the supervisee and the

effectiveness of the supervisory relationship and address issues that arise.

As the supervisory relationship and the supervisee’s learning needs evolve over time,

the supervisor should work collaboratively with the supervisee to revise the supervision

goals and tasks. When disruptions occur in the supervisory relationship, supervisors

seek to address and resolve the impasses and disruptions openly, honestly, and in

the best interests of client/patient welfare and the supervisee’s development (Safran,

Muran, Stevens, & Rothman, 2008).

14 AMERICAN PSYCHOLOGICAL ASSOCIATION

DOMAIN D

PROFESSIONALISM

Professionalism goes hand in hand with a profession’s social responsibility (see Hodges et al., 2011;

Vasquez & Bingham, 2012). The “professionalism covenant” puts the needs and welfare of the

people they serve at the forefront (Grus & Kaslow, 2014). Grus and Kaslow (2014) summarized

these as: “behavior and comportment that reflect the values and attitudes of psychology (Fouad

et al., 2009; Hatcher et al., 2013). The essential components include: (1) integrity – honesty,

personal responsibility and adherence to professional values; (2) deportment; (3) accountability;

(4) concern for the welfare of others; and (5) professional identity.”

1. Supervisors strive to model professionalism in their own comportment and

interactions with others, and teach knowledge, skills, and attitudes associated with

professionalism.

Supervisory modeling of professionalism occurs across professional settings.

Supervisees’ understanding of what is professional or ethical is still developing (Gottlieb,

Robinson, & Younggren, 2007). Modeling is a powerful means to teach attitudes and

behaviors ( e.g., Tarvydas, 1995), including professionalism (Cruess, Cruess, & Steinert,

2009).) Supervisors, in vivo, can exemplify virtue, humanism, and honest communica-

tion (Grus & Kaslow, 2014, modified from Hatcher et al., 2013).

One important aspect of supervision is to socialize supervisees into a particular

profession (e.g., Ekstein & Wallerstein, 1972); to help them learn to “think like” those in

that profession.

In interprofessional settings, supervisors model professionalism in cooperative,

collaborative, and respectful interaction with team members.

2. Supervisors are encouraged to provide ongoing formative and summative evaluation

of supervisees’ progress toward meeting expectations for professionalism appropriate

for each level of education and training.

Modeling alone is insufficient to teach professionalism; it should be embedded in a

larger training curriculum incorporating developmentally expected behaviors (Grus &

Kaslow, 2014). Supervisees need clear criteria to judge the extent to which they are

demonstrating developmentally appropriate professionalism (Fouad et al., 2009;

Kaslow et al., 2009) as well as feedback about the extent to which they are meeting

those criteria. The knowledge, skills, and attitudes associated with professionalism have

been addressed within and across disciplines with much congruence. These include,

“altruism, accountability, benevolence, caring and compassion, courage, ethical practice,

excellence, honesty, honor, humanism, integrity, reflection/self-awareness, respect for

others, responsibility and duty, service, social responsibility, team work, trustworthiness,

and truthfulness” (Grus and Kaslow, 2014).

GUIDELINES FOR CLINICAL SUPERVISION IN HEALTH SERVICE PSYCHOLOGY15

DOMAIN E

ASSESSMENT/EVALUATION/

FEEDBACK

Assessment, evaluation, and feedback are essential components of ethical supervision (Carroll,

2010; Falender et al., 2004). However, supervisors have been found to provide it relatively

infrequently (e.g., Ellis et al., 2014; Friedlander, Siegel, & Brenock, 1989; Hoffman, Hill, Holmes,

& Freitas, 2005), which leads to failures in gatekeeping and failures of supervisors in informing

supervisees about their competency development (Thomas, 2010), and creates potential for

ethical complaints (Falvey & Cohen, 2004; Ladany et al., 1999). To be effective, assessment,

evaluation, and feedback need to be directly linked to specific competencies, to observed

behaviors, and be timely (APA, 2010, 7.06; Hattie & Timperley, 2007).

1. Ideally, assessment, evaluation, and feedback occur within a collaborative supervisory

relationship. Supervisors promote openness and transparency in feedback and

assessment, by anchoring such in the competency development of the supervisee.

Establishment and maintenance of the supervisory relationship provide the basis for

assessment, evaluation, and feedback. Supervisee disclosure of client data is enhanced by

a strong relationship (See Domain C in this document on the Supervisory Relationship.)

2. A major supervisory responsibility is monitoring and providing feedback on supervisee

performance. Live observation or review of recorded sessions is the preferred procedure.

Supervisee self-report is the most frequently used source of data on supervisee perfor-

mance and client/patient progress (e.g., Goodyear & Nelson, 1997; Noelle, 2002; Scott,

Pachana, & Sofranoff, 2011). The accuracy of those reports, however, is constrained by

human memory and information processing as well as by supervisees’ self-protective

distortion and biases, (Haggerty & Hilsenroth, 2011; Ladany, Hill, Corbett, & Nutt, 1996;

Pope, Sonne, & Green, 2006; Yourman & Farber, 1996) that result in their not disclosing

errors, resulting in the loss of potentially important clinical data.

The more direct the access a supervisor has to a supervisee’s professional work,

the more accurate and helpful their feedback will likely be. Supervisors should use live

observation or audio or video review techniques whenever possible, as these are asso-

ciated with enhanced supervisee and client/patient outcomes (Haggerty & Hilsenroth,

2011; Huhra, Yamokoski-Maynhart, & Prieto, 2008). Supervisors should not limit work

samples only to those identified by the supervisee; some work samples should be

selected by supervisors. Review of work samples should be planful and focus on specific

competency development and defined supervision goals (Breunlin, Karrer, McGuire, &

Cimmarusti, 1988; Hatcher, Fouad, Grus, Campbell, McCutcheon, & Leahy, 2013). In

addition, the developmental level of the supervisee should be considered when identify-

ing methods to monitor and provide feedback to the trainee. An organization can reduce

legal risk through direct observation of the supervisee’s work (e.g., using live or video

observation of sessions) thus satisfying the monitoring standard of care in supervision.

16 AMERICAN PSYCHOLOGICAL ASSOCIATION

3. Supervisors aspire to provide feedback that is direct, clear,

and timely, behaviorally anchored, responsive to

supervisees’ reactions, and mindful of the impact on the

supervisory relationship.

In delivering feedback, supervisors are sensitive to: (a) the

power differential as a function of the supervisory evalua-

tive and gatekeeping roles; (b) culture, diversity dimensions

(e.g., gender, race, sexual orientation, socio-economic sta-

tus) and other sources of privilege and oppression (Ancis

& Ladany, 2001; Ryde, 2000; Shen-Miller, Forrest, & Burt,

2012); (c) supervisee developmental level (Stoltenberg

& McNeill, 2010); (d) the possibilities of the supervisee

experiencing demoralization (Watkins, 1996) or shame

(Bilodeau, Savard, & Lecomte, 2012) in response to the

feedback; and (e) timing and the amount of feedback that a

supervisee can assimilate at any given moment (Westberg

& Jason, 1993).

Feedback should occur at frequent intervals, with

some positive and corrective feedback in each supervision

session so that evaluation is not a surprise (Bennett et al.,

2006). In instances when a supervisee exhibits problems

in professional competence, supervisors are expected to

be courageous and provide this difficult feedback, doing so

in a direct and supportive manner. Indirect delivery of dif-

ficult feedback to supervisees is not associated with good

training outcomes (Hoffman et al., 2005). The difficulty

of delivering difficult feedback is especially challenging in

multicultural supervision (Burkard, Knox, Clarke, Phelps, &

Inman, in press; Shen-Miller et al., 2012). Collaborative con-

versations among supervisors regarding diversity, consulta-

tion, and examination of biases were described as helpful in

contextual understanding of individual supervisee develop-

ment (Shen-Miller et al., 2012).

4. Supervisors recognize the value of and support supervisee

skill in self-assessment of competence and incorporate

supervisee self-assessment into the evaluation process.

Incorporating the use of supervisee self-assessment into

the evaluation of supervisees can enhance skill develop-

ment, provide useful reflection on the delivery of services,

and inculcate attitudes of self-assessment as a lifelong

learning tool (Wise, Sturm, Nutt, Rodolfa, Schaffer, &

Webb, 2010). Research has shown that there are lim-

itations to the accuracy of self-assessments (Dunning,

Heath, & Suls, 2004; Gruppen, White, Fitzgerald, Grum,

& Woolliscroft, 2000) indicating that the provision of

significant feedback to supervisees should be used to

enhance supervisee assessment of self-efficacy (Eva &

Regehr, 2011).

5. Supervisors seek feedback from their supervisees and

others about the quality of the supervision they offer, and

incorporate that feedback to improve their supervisory

competence.

It is important that supervisors obtain regular feedback

about their work. Supervisors may not obtain regular feed-

back once they are licensed and as a result may tend to

overestimate their competence (e.g., Walfish, McAlister,

O’Donnell, & Lambert, 2012) and tend to grow in confidence

about their abilities, even though that is not necessarily

matched by corresponding increases in ability (see Dawes,

1994). Although studies on supervisee nondisclosures (e.g.,

Ladany et al, 1996; Mehr, Ladany & Caskie, 2010; Yourman

& Farber, 1996) suggest difficulty in obtaining candid infor-

mation from supervisees, it is important that supervisors

routinely seek—and utilize—feedback about their own

supervision (see e.g., Williams, 1994).

GUIDELINES FOR CLINICAL SUPERVISION IN HEALTH SERVICE PSYCHOLOGY17

DOMAIN F

PROFESSIONAL COMPETENCE

PROBLEMS

Only a small proportion of supervisees in health service psychology programs demonstrate

significant problems in professional competence, but most academic and internship programs

report at least one supervisee with competence problems in the previous five years (Forrest

et al., 1999). When this occurs it can be helpful to consider the multiple contexts in which

problem behavior is embedded (e.g., cultural beliefs, licensure and accreditation, peers, faculty,

supervisors) (Forrest et al., 2008). Supervisors must be prepared to protect the well-being

of clients/patients and the general public, while simultaneously supporting the professional

development of the supervisee. They also must be mindful of the effects on the training pro-

gram itself, as peers typically are aware of trainees with problems of professional competence

and often have concerns that those problems are not being addressed (Rosenberg, Getzelman,

Arcinue, & Oren, 2005; Shen-Miller et al., 2011; Veilleux et al., 2012).

Supervisors give precedence to protecting the well-being of clients/patients above the

training of the supervisee. When supervisees display problems of professional competence

decisions made and actions taken by supervisors in response to supervisees’ competence

problems should be completed in a timely manner (Kaslow, Rubin, Forrest, & et al., 2007).

They also are guided by the training program’s intentional and well-prepared plans for address-

ing such problems (Forrest et al., 2013).

1. Supervisors understand and adhere both to the supervisory contract and to program,

institutional, and legal policies and procedures related to performance evaluations.

Supervisors strive to address performance problems directly.

Effective management of professional competence problems begins with the supervi-

sion contract (elements of that contract are presented in the Ethics section of these

Guidelines on Supervision) (Goodyear & Rodolfa, 2012; Thomas, 2007). The contract

provides prior written notice of the competencies required for satisfactory performance

in the supervised experience (Gilfoyle, 2008) as well as the process of evaluation, the

procedures that will be followed if the supervisee does not meet the criteria, and proce-

dures available to the supervisee to clarify or contest the evaluation. This contract shall

occur in the context of the program communicating clearly the Due Process Guidelines

to the supervisees as required by the Commission on Accreditations Guidelines and

Principles (Domains A and G). In the event a supervisee is exhibiting performance prob-

lems, supervisors seek consultation to ensure understanding of program, institutional,

and legal policies and procedures related to performance evaluations.

2. Supervisors strive to identify potential performance problems promptly, communicate

these to the supervisee, and take steps to address these in a timely manner allowing

for opportunities to effect change.

Supervisors evaluate on an ongoing basis the supervisee’s functioning with respect

to abroad range of foundational and functional competencies, including professional

attitudes and behaviors that are relevant to professional practice. Their determinations

about areas in which the supervisee does not meet competence expectations must (a)

take into consideration distinctions between normative developmental challenges and

significant competence problems (Fouad et al., 2009; Hatcher et al., 2013; Kaslow et al.,

2004; Rodolfa et al., 2005) and (b) be attuned to the intersections between diversity

issues and competence (Constantine & Sue, 2007; Kaslow, Rubin, Forrest, & et al., 2007;

Shen-Miller et al., 2009). Supervisors also seek consultation from and work in concert

18 AMERICAN PSYCHOLOGICAL ASSOCIATION

with relevant program and institutional participants when

addressing potential performance issues.

Especially when potential performance problems

are suspected, supervisors directly observe and monitor

supervisees’ work, and seek input about the supervis-

ee’s performance from multiple sources and from more

than one supervisor. Supervisee’s professional behaviors

and attitudes should be carefully documented in writing

with dates and specific behaviors included in the record.

Documentation is essential throughout the training tra-

jectory in establishing clarity regarding the performance

expectations and the supervisee’s attaining the requisite

competencies and is important in remediation or in adver-

sarial actions.

Once supervisors have identified that a supervisee has

professional competence problems, they have an ethical

responsibility to discuss these with the supervisee and to

develop a plan to remediate those problems (APA, 2010;

7.06). Supervisors do so in a manner that is clear, direct, and

mindful of the barriers to assuring that such conversations

are effective and likely to maintain the supervisory relation-

ship (Hoffman et al., 2005; Jacobs et al., 2011).

Conversations addressing competence problems shall

occur with sensitivity to issues of individual and cultural dif-

ferences (Constantine & Sue, 2007; Shen-Miller et al., 2012).

3. Supervisors are competent in developing and implementing

plans to remediate performance problems.

In conjunction with the supervisee and relevant training

colleagues, the supervisor develops written documentation

of areas in which the supervisee has competence deficits,

performance expectations, steps to be taken to address

deficits, responsibilities for each party, performance mon-

itoring processes, and the timelines that will be followed

(Kaslow, Rubin, Forrest, & et al., 2007). The supervisor will

follow the steps outlined in this plan, including the develop-

ment of timely written evaluations that are anchored in the

stipulated performance criteria (Kaslow, Rubin, Forrest, &

et al., 2007). Supervisors evaluate their role in the super-

visory relationship and adjust their role as needed, provid-

ing more direction and oversight and assuring that client/

patient welfare is not threatened and appropriate care is

provided. These responsibilities need to be balanced with

both training and gatekeeping responsibilities.

4. Supervisors are mindful of their role as gatekeeper and

take appropriate and ethical action in response to

supervisee performance problems.

In most situations, supervisees are ethically and legally

entitled to a fair opportunity to remediate the compe-

tence problems and continue in their program of study

(McAdams & Foster, 2007). Supervisors strive to closely

monitor and document the progress of supervisees who are

taking steps to address problems of competence. Should

the supervisee not meet the stipulated performance lev-

els after completing the agreed-upon remediation steps,

attending to supervisee due process, supervisors must con-

sider dismissal from the training program. Supervisors must

have a clear understanding of competence problems that

reflect unethical and/or illegal behavior that is sufficiently

serious to warrant immediate dismissal from the training

program (Bodner et al., 2012). Such considerations occur in

the context of the training program’s organization’s explicit

plans for addressing such problems

GUIDELINES FOR CLINICAL SUPERVISION IN HEALTH SERVICE PSYCHOLOGY19

DOMAIN G

ETHICS, LEGAL, AND REGULATORY

CONSIDERATIONS

Valuing and modelling ethical behavior and adherence to relevant legal and regulatory param-

eters in supervision is essential to upholding the highest duty of the supervisor, protecting the

public. Improper or inadequate supervision is the seventh most reported reason for disciplinary

actions by licensing boards (ASPPB, 2013c). Supervisees may perceive their supervisors to

engage in unethical behavior (Ladany, et al., 1999), sometimes due to misunderstanding the

structure of the supervisory relationship and/or a supervisor’s failure to secure informed con-

sent. Generally, though, there is some evidence that supervisors and supervisees agree on

what comprises ethical behavior (Worthington, Tan, & Poulin, 2002).

1. Supervisors model ethical practice and decision making and conduct themselves in

accord with the APA ethical guidelines, guidelines of any other applicable professional

organizations, and relevant federal, state, provincial, and other jurisdictional laws and

regulations.

Supervisors support the acculturation of the supervisee into the ethics of the profes-

sion, their professionalism, and the integration of ethics into their professional behavior

(Handelsman, Gottlieb, & Knapp, 2005; Knapp, Handelsman, Gottlieb, & VandeCreek,

2013). Supervisors ensure that supervisees develop the knowledge, skills, and attitudes

necessary for ethical and legal adherence. The supervisor is a role model for ethical and

legal responsibility.

Supervisors discuss values that bear on professional practice, applications of ethi-

cal guidelines to specific cases, and the use of ethical decision-making models (Koocher

& Keith-Spiegel, 2008; Pope & Vasquez, 2011).

The supervisor is responsible for understanding the jurisdictional laws and regula-

tions and their application to the clinical setting for the supervisee (e.g., duty to warn

and protect; Werth, Welfel, & Benjamin, 2009).

Supervisors are knowledgeable of legal standards and their applicability to both

clinical practice and to supervision.

2. Supervisors uphold their primary ethical and legal obligation to protect the welfare of

the client/patient.

The highest duty of the supervisor is protection of the client/patient (Bernard & Goodyear,

2014). Supervisors balance protection of the client/patient with the secondary respon-

sibility of increasing supervisee competence and professional development. Supervisors

ensure that supervisees understand the multiple aspects of this responsibility with

respect to their clinical performance (Falender & Shafranske, 2012). Supervisors under-

stand that they are ultimately responsible for the supervisee’s clinical work (Bernard &

Goodyear, 2014).

20 AMERICAN PSYCHOLOGICAL ASSOCIATION

3. Supervisors serve as gatekeepers to the profession.

Gatekeeping entails assessing supervisees’ suitability to

enter and remain in the field.

Supervisors help supervisees advance to successive stages

of training upon attainment of expected competencies

(Bodner, 2012; Fouad et al., 2009). Alternatively, if com-

petencies are not being attained, in collaboration with the

supervisee’s academic program, supervisors devise action

plans with supervisees, with the understanding that if the

stated competencies are not achieved, supervisees who

are determined to lack sufficient foundational or functional

competencies for entry to the profession may be terminated

to protect potential recipients of the supervisee’s practice

(Forrest et al., 2013). Descriptions of such processes are in

the training program’s or organization’s explicit plans for

addressing competency problems or the unsuitability of the

supervisee for the profession.

4. Supervisors provide clear information about the

expectations for and parameters of supervision to

supervisees preferably in the form of a written supervisory

contract.

A supervision contract serves as the foundation for estab-

lishing the supervisory relationship by specifying the roles,

tasks, responsibilities of supervisee and supervisor and

performance expectations of the supervisee (Bernard &

Goodyear, 2014; Osborn & Davis, 2009; Thomas, 2007,

2010). Supervisors convey the value of the points in the

supervision contract through conversations with supervis-

ees and may modify the understanding over time as war-

ranted as the goals for supervision change. The contract

includes a delineation of the following elements:

a. Content, method, and context of supervision—

logistics, roles, and processes

b. Highest duties of the supervisor: protection of the

client(s) and gatekeeping for the profession

c. Roles and expectations of the supervisee and the

supervisor, and supervisee goals and tasks

d. Criteria for successful completion and processes

of evaluation with sample evaluation instruments

and competency documents (APA, 2010, 2.06)

e. Processes and procedures when the supervisee

does not meet performance criteria or reference

to such if they exist in other documents

f. Expectations for supervisee preparation for

supervision sessions (e.g., video review, case

notes, agenda preparation) and informing super-

visor of clinical work and risk situations

g. Limits of confidentiality of supervisee disclosures,

behavior necessary to meet ethical and legal

requirements for client/patient protection, and

methods of communicating with training pro-

grams regarding supervisee performance

h. Expectations for supervisee disclosures including

personal factors and emotional reactivity (pre-

viously described, and worldviews (APA, 2010,

7.04)

i. Legal and ethical parameters and compliance,

such as informed consent, multiple relationships,

limits of confidentiality, duty to protect and warn,

and emergent situation procedures

j. Processes for ethical problem-solving in the case

of ethical dilemmas (e.g., boundaries, multiple

relationships)

5. Supervisors maintain accurate and timely documentation

of supervisee performance related to expectations for

competency and professional development.

Keeping supervision records is an important means of

documenting the conduct of supervision and supervisee

progress (e.g., APA, 2007b; Falvey & Cohen, 2004; Luepker,

2012; Thomas, 2010).

GUIDELINES FOR CLINICAL SUPERVISION IN HEALTH SERVICE PSYCHOLOGY21

CONCLUSION

The Guidelines on Supervision address seven domains of supervision and offer specific sugges-

tions in each of these domains that delineate essential practices in the provision of compe-

tency-based clinical supervision. The overarching goal of the Guidelines on Supervision is to

promote the provision of quality supervision in health service psychology using a competency

framework to enhance the development of supervisee competence while upholding the high-

est duties of supervision, ensuring the protection of patients, the public, and the profession.

The Guidelines on Supervision are intended to be aspirational in nature and are responsive to

current trends in education and training in health service psychology. They are considered a

living document. Accordingly, they should be reviewed periodically and informed by develop-

ments, including the evidence-base regarding clinical supervision.

22 AMERICAN PSYCHOLOGICAL ASSOCIATION

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28 AMERICAN PSYCHOLOGICAL ASSOCIATION

APPENDIX

DEFINITIONS

Assessment refers to the processes supervisors use to gather, interpret,

and synthesize data about clients/patients, supervisees, and supervision

(Ellis et al., 2008). We define assessment to include observations of

supervisees’ psychological practice, clinical assessment, as well as formal

measures, scales, rating protocols, and evaluation performance ratings.

Assessment entails gathering data to make inferences, for example about

evaluation performance of the supervisee, the supervisor, and the supervi-

sory relationship. Assessment pertains to assessing and measuring attri-

butes of supervisees (characteristics, traits, values, behaviors, competence,

and so forth).

Benchmarks are standards for measuring performance that can be used for

comparison and to identify where a need for improvement exists. They con-

note task or performance indicators (Kaslow, Rubin, Bebeau, & et al., 2007).

Boundaries are “a limit, rule, guideline or protective space that helps

define the relationship or is defined by the relationship” (Sommers-

Flanagan, 2012, p. 246).

Clients/patients refers to the child, adolescent, adult, older adult, couple,

family, group, organization, community, or other population receiving psy-

chological services.

Competence “in professional psychology is the ability to demonstrate con-

text-relevant knowledge, skills and professional attitudes (as expressed in

behavior) and their integration.” Competence is judged in relation to a

standard or a set of performance criteria” (adapted from ASPPB, 2013b).

Competencies are the integration of psychologically relevant knowledge,

skills, values, and attitudes that are judiciously applied in context to the

required standard for a desired outcome (ASPPB, 2013b). They are a con-

stellation of demonstrable elements: knowledge, skills and attitudes, and

their integration.

Diversity refers to self-awareness, competence, and respect for the mul-

ticultural identities (e.g., cultural, individual, and role differences, includ-

ing those based on age, gender, gender identity, race, ethnicity, culture,

national origin, religion, sexual orientation, disability, language, and socio-

economic status), and the resultant multiple worldviews of the client(s)/

patient(s), supervisee/therapist, and supervisor(s).

Diversity competency refers to self-awareness and knowledge, skills,

and attitudes regarding the multiple identities of the client(s)/patient(s),

supervisee/therapist, and supervisor(s) to work within the context of indi-

vidual and cultural diversity-awareness, and the infusion of these into pro-

fessional practice and clinical supervision. Diversity competency includes

the use of reflective practice and the sensitivity and skills to work with

diverse individuals, groups, and communities who represent various cul-

tural and personal background as well as characteristics defined broadly

and consistent with APA policy (Fouad et al.,2009).

Evaluation involves determining the extent to which expected per-

formance is congruent with actual performance (Ellis et al., 2008) and

establishing a timely and specific process for providing information to

supervisees regarding their performance. Evaluation also includes pro-

viding information regarding the evaluation process to the student at the

beginning of supervision (APA, 2010, 7.06).

Evidence-based practice integrates “the best available research with clin-

ical expertise in the context of client/patient characteristics, culture, and

preferences” (APA Presidential Task Force on Evidence-based Practice,

2006, p. 271).

Feedback refers to the “timely and specific” (APA, 2010, 7.06) process

of explicitly communicating information about performance. Feedback

can be verbal, written, or both. Effective feedback provides a balance of

positive (that which meets or exceeds performance expectations) and

constructive feedback (that which needs improvement) to the supervisee

about (a) the supervisee’s progress towards supervision goals, compe-

tency attainment, and professional development; and perceptions of (b)

the process and content of supervision, the nature of the supervisory rela-

tionship, and effectiveness of supervision.

Formative evaluation refers to ongoing assessment and monitoring of the

supervisee’s performance in comparison to the expected, criterion-refer-

enced goals for the supervisee’s development of competence (knowledge,

skills, and attitudes). The purpose of formative evaluation is fostering the

supervisee’s growth and professional development. Formative evaluation

is the set of inferences and conclusions supervisors make about the super-

visee’s ongoing performance.

Foundational competencies refer to the knowledge, skills, and attitudes

that serve as the foundation for the functions a psychologist is expected

to carry out. Foundational competencies are interdependent with each

other and with the functional competencies (Rodolfa et al., 2005).

Foundational competencies are further described in the Competency

Benchmarks (Fouad et al., 2009); and the 2011 (APA, 2011) revisions to

the competency benchmarks model that include Professionalism, Ethics/

Legal Standards, Individual and Cultural Diversity, Reflective Practice/Self-

assessment/Self-care, Relationships, Scientific Knowledge and Methods,

and Research/Evaluation

Functional competencies encompass the major functions that a psychol-

ogist is expected to carry out (Rodolfa et al., 2005). Functional compe-

tencies include Assessment, Intervention, Consultation, Evidence Based

Practice, Supervision, Teaching, Interdisciplinary Systems, Management/

Administration, and Advocacy (Fouad et al., 2009).

Gatekeeping is the ethical obligation not to graduate, promote, or allow

to proceed “those who because of their incompetence or lack of ethical

sensitivity would inflict harm on the consumers they have agreed to help”

GUIDELINES FOR CLINICAL SUPERVISION IN HEALTH SERVICE PSYCHOLOGY29

(Kitchener, 1992, p. 190) to ensure maintenance of the integrity of the

profession (modified from Brear & Dorrian, 2010, Behnke, 2005). A most

important gate supervisees must pass through (or not) is licensure per-

mitting independent practice (Goodyear & Rodolfa, 2012).

Inferences refer to tentative conclusions based on information that has

been gathered (e.g., from observations, measures, or other data; Ellis et

al., 2008).

Informed consent is a legal and ethical obligation and respectful process

to provide information to supervisees about the nature of the supervision

relationship, logistics, expectations, and the requirements and competen-

cies that must be met for satisfactory completion (adapted from Thomas,

2010).

Observation refers to information that is secured by immediate sensory

experience (visual, auditory, kinesthetic; Pepinsky & Pepinsky, 1954). In the

case of supervision, observations may be conducted via video or live.

Problems of professional competence is the preferred terminology to

refer to supervisees whose performance or behavior does not meet pro-

fessional and/or ethical standards for professional practice. The use of the

phrase, problems of professional competence, conveys three essential

points: there is a performance problem or deficiency; there is a profes-

sional competency standard that the trainee is not attaining; the perfor-

mance problem(s) is defined in a competency/behavioral framework..

Professionalism is a multidimensional construct that includes interper-

sonal, intrapersonal, and public elements (Van de camp, Vernooij-Dassen,

Grol, & Bottema, 2004) including behavior and comportment that reflects

the values and ethics of psychology, integrity, and responsibility as a psy-

chologist (Fouad et al., 2009). Professionalism is defined as “the conduct,

aims, or qualities that characterize or mark a professional or a professional

person” (Merriam-Webster Online Dictionary, 2013).

Reflective practice is a process of self-regulated learning that occurs

in the context of identification of an unforeseen situation that is in turn

examined and results in new understanding (Shön, 1987). It creates an

environment of inquiry marked by curiosity, attentiveness, and openness

(Carroll, 2010). Reflection is ‘‘Purposeful focusing on thoughts, feelings,

sensations and behaviour in order to make meaning from those fragments

of experience” (Voller, 2009, cited by Carroll, 2010).

Remediation plan is a plan outlining the developmentally expected bench-

marks for foundational and functional competencies that the supervisee

has not met. The plan describes the problem in each competency domain

identified, articulates specific expectations, supervisee responsibilities and

actions, supervisor responsibilities and actions, timeframe, assessment, and

consequences of successful and unsuccessful remediation (Competency

Remediation Plan, APA; Kaslow, Rubin, Forrest, & et al., 2007).

Self-assessment refers to a supervisee “learning and responding to feed-

back for the purpose of fostering development, identifying and addressing

competence challenges and preventing competence problems” (modified

from Kaslow, Rubin, Forrest, & et al., 2007).

Summative evaluation refers to the supervisor’s summary conclusions

regarding the supervisee’s status and progress towards competence

standards, developmentally appropriate expectations, and program

requirements. Summative evaluation necessarily includes formal written

feedback to the supervisee. They typically occur at a minimum of twice

during a supervisory experience: at mid-point and at the conclusion.

Social justice refers to “the fair and equitable distribution of rights, oppor-

tunities, and resources between individuals and between groups of indi-

viduals within a given society and the establishment of relations within

the society, such that all individuals are treated with an equal degree of

respect and dignity” (Lewis, 2010, p. 146).

Supervisee is a person who functions under the extended authority of

the psychologist to provide, or while in training to provide, psychological

services (ASPPB, 2005).

(Limits of) Supervision confidentiality refers to a statement describing

the limits of confidentiality of supervisee disclosures to the supervisor.

These limits relate to supervisors’ responsibility to disclose supervisee

statements/behavior/evaluation as necessary to uphold ethical and legal

standards for client/patient protection, to prevent entry into practice of

supervisees who are unsuitable for practice (i.e., gatekeeping responsibil-

ities), and to communicate with training programs regarding supervisee

development and performance.

Supervision contract is an informed consent document, describing the

expectations, goals, requirements, and parameters of supervision; roles

and responsibilities of supervisee and supervisor(s); specific limits of

confidentiality in supervision (e.g., normative reporting/disclosures to

graduate programs, licensing boards, training teams); and liability, direct

and vicarious, of the supervisor(s), by virtue of their relationship with the

supervisee.

30 AMERICAN PSYCHOLOGICAL ASSOCIATION