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Best Practices in Clinical Supervision: Another Step in Delineating Effective Supervision Practice Borders, L DiAnne

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ABSTRACT   Across the helping professions, we have arrived at a point where it is possible to create statements of best practices in supervision that are based on available empirical research; credentialing, ethical, and legal guidelines; and consensus opinion. Best practices are different from, but certainly complementary to, statements of supervision competencies. In this paper, I highlight the differences between competencies and best practices, and then describe the development and content of one comprehensive statement, the Best Practices in Clinical Supervision created for the field of counseling and counselor education. I then illustrate the applicability of the Best Practices across disciplines and countries through a comparison and contrast with several other existing documents. I conclude with a brief look at the development of supervisor expertise, which requires not only declarative knowledge (competencies) and procedural knowledge (statements of best practices), but also reflective knowledge. The latter is composed of insights built over years of supervision education, experience, and self-reflection regarding necessary adaptions and improvisations that inform an individualized approach to supervision practice. FULL TEXT   Headnote Across the helping professions, we have arrived at a point where it is possible to create statements of best practices in supervision that are based on available empirical research; credentialing, ethical, and legal guidelines; and consensus opinion. Best practices are different from, but certainly complementary to, statements of supervision competencies. In this paper, I highlight the differences between competencies and best practices, and then describe the development and content of one comprehensive statement, the Best Practices in Clinical Supervision created for the field of counseling and counselor education. I then illustrate the applicability of the Best Practices across disciplines and countries through a comparison and contrast with several other existing documents. I conclude with a brief look at the development of supervisor expertise, which requires not only declarative knowledge (competencies) and procedural knowledge (statements of best practices), but also reflective knowledge. The latter is composed of insights built over years of supervision education, experience, and self-reflection regarding necessary adaptions and improvisations that inform an individualized approach to supervision practice. KEYWORDS: supervision; clinical supervision; evidence-based practice; best practices INTRODUCTION Attention to clinical supervision processes and supervisor training has exploded globally in recent years. As a result, a large body of research now provides greater specification about effective supervision practice and effective education of supervisors, although all supervision-related questions clearly have not been answered. Efforts to harness the expanse of supervision knowledge have taken two formats (Watkins, 2012): explication of supervisor competencies and statements of evidence-based or best practices. Both formats provide important guidelines for

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supervision practice and supervisor education. They are different but certainly complementary. Statements of both competencies and best practices enhance one’s ability to practice supervision in an accountable and ethical manner, both are based in conceptual and empirical literature, and both evolve as new knowledge becomes available. Their differences highlight their complementary nature. Stated in the most basic terms: Competencies outline required declarative knowledge, or what a competent supervisor needs to know; best practices provide the basis for procedural knowledge, describe when and how declarative knowledge is applied, or what a supervisor does during supervision. Best practices provide evidence-based guidelines for implementing or applying competencies (as well as ethical codes). For example, the supervision competency “ability to provide effective formative and summative feedback” (Falender et al., 2004, p. 778) is a critical supervision skill. However, when stated as a competency only, it does not suggest the recommended frequency or content of each feedback nor the basis for evaluation (e.g., direct observation of counseling sessions). Competencies and best practices are not always clearly delineated. For example, Roth and Pilling’s (2008) elaborations of their supervision competence framework describe applications of competencies that read as best practices. For example, elaborations under the competency “An ability to structure sessions” include moving the group from supervision in a group to supervision with a group to, finally, supervision by the group [see Specific Supervision Competences section at CORE Supervision Framework Website]). In short, consideration of supervision competencies and best practices should not take an either/or perspective, as both offer critical guidelines necessary to developing effective supervision as a core professional activity. With that caveat, my focus in this article is to describe the Best Practices for Clinical Supervision created by a task force of the Association for Counselor Education and Supervision (ACES). PROFESSIONAL CONTEXT OF THE BEST PRACTICES IN CLINICAL SUPERVISION The best practices statement is built on several decades of work within the counseling profession to articulate clinical supervision as a professional specialty, and began with the Standards for Counseling Supervisors (Dye &Borders, 1990). The Standards were then translated into a set of learning outcomes in the Curriculum Guide for Training Counseling Supervisors (Borders, Bernard, Dye, Fong, Henderson, &Nance, 1991) and further transformed into ethical principles in the Ethical Guidelines for Counseling Supervisors (Hart, Borders, Nance, &Paradise, 1995; which is now subsumed by the American Counseling Association [ACA] 2005 Code of Ethics). These documents also informed supervisor credentialing efforts: requirements for supervision instruction in doctoral programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2009); requirements for the Approved Counseling Supervisor (ACS) credential, created by The National Board for Certified Counselors (NBCC, 1997); criteria stated in the Approved Supervisor Model, endorsed by the American Association of State Counselor Boards (AASCB, 2007); and regulations for training for supervisors of counselor licensure applicants in 26 states (ACA, 2010). The Best Practices in Clinical Supervision task force was created in response to ACES members’ request for more specific guidance that incorporated ethical and legal principles, credentialing and licensure requirements, and research evidence for their supervisory practice. Accordingly, task force members reviewed relevant legal precedents and ethical codes, studied accreditation and credentialing documents, read supervision competency and practice statements from other professions, and conducted a comprehensive review of conceptual and empirical supervision literature across several helping disciplines. In writing the best practice statements, they followed a systematic process, a “best available evidence” approach (Petticrew &Roberts, 2006), integrating research evidence with commonly espoused beliefs about supervision. Task force members sought to create aethoretical guidelines that would be relevant and applicable across a range of counseling settings and client populations, for preservice

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and postgraduate supervision practice. Endorsed by the ACES Executive Council on April 22, 2011, the full task force report and best practice guidelines (ACES, 2011) are available online at http:// www.acesonline.net/wp- content/uploads/2011/10/ACES-Best-Practicesin- clinical-supervision-document-FINAL.pdf (see also Borders et al., in press). CONTENT OF THE BEST PRACTICES IN CLINICAL SUPERVISION The Best Practices in Clinical Supervision document is made up of 12 sections covering the phases and processes in conducting supervision as well as supervisor training, characteristics, and competent behaviors. The first section, “Initiating Supervision,” outlines sound informed consent practices, including a supervisor professional disclosure statement and components of the supervision contract that should be shared with the supervisee, including limits of confidentiality. Supervisors lead a discussion of expectations (e.g., preparation for supervision) and responsibilities (e.g., documentation) of both supervisor and supervisee. During these discussions, supervisors also facilitate the development of a working alliance, including taking the lead in addressing topics such as diversity and the supervisee’s preferred learning style(s). “Goal-Setting” includes both the development of goals and attention to goals throughout the supervisory relationship. To the extent possible, supervisors work with the supervisee to construct goals that are realistic, measurable, and attainable; address all areas of counselor competence; support delivery of effective services; benefit the therapeutic alliance; match the supervisee’s developmental level and prioritized learning needs; and are within the supervisor’s areas of competence. Supervisors then intentionally address one or more of these goals in each supervision session, review the supervisee’s progress toward the goals on a regular basis, and use the goals as one piece of evaluations. At the same time, supervisors are conducting their own ongoing assessments of supervisees’ skills and learning needs that, along with supervisees’ goals, are prioritized for attention. Best practices for “Giving Feedback” provide guidelines offering constructive feedback without overwhelming the supervisee. Such feedback is characterized as regular, ongoing, manageable, timely, concrete, descriptive, directive as needed, appropriate to the supervisee’s developmental level and counseling setting, that achieve a balance of challenge and support. Feedback is based, at least in part, on direct observation (e.g., live observation, review of digital recordings) of the supervisee’s work. Supervisors also help supervisees pay attention to feedback from clients and peers, and are aware that their in-session behavior is a form of non-verbal feedback. “Conducting Supervision” includes best practices for individual, group, and triadic supervision modalities. Across all modalities, supervisors adhere to professional standards (e.g., frequency of supervision); meet face-to-face with supervisees or use technology that approximates face-toface synchronous contact; and create plans that are structured as needed, purposeful, attend to supervisee goals, and can be modified as needed based on supervisee needs and client welfare. Supervisors intentionally employ a variety of supervisory interventions that address a range of supervision foci (e.g., skills, case conceptualization, self-awareness). Supervisors choose and plan group and triadic (meeting with two supervisees simultaneously) modalities for educational reasons, not primarily for time efficiency. Supervisors use effective group leadership skills, facilitate peer feedback and processing of feedback, and encourage increasing supervisee autonomy and responsibility for the conduct of the group or triad. Supervisors use technology in ways that enhance learning and adhere to ethical and legal guidelines. Within all modalities, supervisors actively evaluate the effectiveness of supervision and the experience of the supervisee (e.g., whether an intern’s site supervisor provides appropriate oversight and learning opportunities for the supervisee). Perhaps the most empirically supported best practice is the role of “The Supervisory Relationship.” Supervisors give deliberate attention to fostering a safe and mutually trusting supervisory environment. They view supervisee anxiety

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as well as supervisee resistance as normal responses to challenge and change, and thus manage these dynamics in ways that allow ongoing growth and development. They anticipate some level of conflict in the supervisory relationship and deal with it productively. They also address parallel process issues, transference, and countertransference in developmentally appropriate ways. Supervisors address diversity issues and the power differential in the supervisory relationship, and avoid or manage dual relationships. Supervisors are on the alert to recognize their own unproductive or harmful influences, such as transference, countertransference, values and beliefs, in the supervisory relationship, and how these may be contributing to supervisee anxiety, resistance, and relationship conflict. Supervisors give diligent attention to “Diversity and Advocacy Considerations” within the supervisory and counseling relationships. Supervisors initiate conversations about power and privilege, require attention to a full range of diversity and cultural factors during case conceptualization, facilitate multicultural knowledge and competence in supervisees, use culturally sensitive interventions in supervision, promote advocacy with and for clients as appropriate, and engage in self-assessment of their own cultural competence. “Ethical Considerations” are highlighted separately and infused throughout the best practices statement. Supervisors adhere to professional ethical codes and other relevant guidelines for the conduct of supervision, particularly around informed consent, limits of confidentiality, and parameters of evaluation. They monitor their own competence, only supervise within their areas of clinical competence, limit the number of supervisees to maintain effectiveness, regularly seek peer consultation or supervision, engage in various forms of continuing education, and model self- care. Supervisors understand that protecting client welfare is their first and highest responsibility and oversee supervisees’ work to achieve this (e.g., assign clients appropriate to supervisee developmental level, review supervisee professional disclosure statement). Supervisors work to avoid multiple relationships (e.g., supervisor and personal friend) and potentially harmful relationships with supervisees, and act within appropriate parameters (e.g., avoid acting as counselor with the supervisee) in addressing supervisees’ personal issues. Supervisors expect the same high ethical standards of their supervisees in their clinical work, guide critical thinking and decision-making when supervisees are faced with an ethical dilemma, and report ethical breaches when necessary. Supervisors are aware that ongoing assessment and evaluation are needed; they explain the evaluation process and reporting upfront, base evaluations on methods of direct observation, and provide fair evaluations that address supervisee strengths and limitations. These ethical considerations apply to counseling supervisees as well as supervisors-in- training. “Documentation” provides supervisors with one measure of accountability. Supervisors’ documentation includes the supervision contract (signed by all parties involved), supervision session case notes, and supervisee evaluations. Supervisors maintain documentation that is sensitive to clients and supervisees, protects client welfare, and protects the privacy and confidentiality of clients and supervisees. The “Evaluation” section repeats some best practices from other sections (e.g., “Ethical Considerations”), highlighting again the importance of ongoing formative evaluations and regular summative evaluations, based on direct observation of a representative sample of the supervisee’s work and including review of complete counseling sessions. Supervisors clearly communicate the evaluation plan to supervisees at the beginning of supervision, encourage supervisee self-evaluation and self-reflection, and attend to the range of counseling skills as well as the supervisee’s own learning goals. If a remediation plan is necessary, the supervisor immediately notifies the supervisee and presents a written remediation plan with clear objectives and timeline. Supervisors invite and encourage supervisee feedback, including opportunities for anonymous feedback when possible. Supervisors choose a “Supervision Format” in line with professional guidelines, supervisee needs, and client welfare

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rather than supervisor convenience. When possible, the supervisor makes intentional pairings (e.g., by developmental level) for triadic and group supervision. “The Supervisor” section outlines supervisor competences and characteristics, including training and experience as a counseling practitioner and as a supervisor. Some best practices are emphasized again in this section, such as competency in multicultural and diversity considerations, awareness of the power differential, acceptance of the evaluation role, commitment to protecting client welfare, and managing relationship dynamics. Of note here are statements about supervisors’ knowledge of the educational processes underlying supervision, such as practices that promote supervisee self-efficacy and competence at various developmental levels, ability to individualize supervision based on supervisee needs, and articulation of their supervisory style(s), roles, and approaches. Self- reflection is emphasized, especially on issues of culture, power, privilege, and openness to supervisee feedback. Supervisors regularly engage in professional development activities (e.g., reading supervision research), and base their supervision practice on current knowledge of best practices in supervision. Supervisor characteristics include being open to ambiguity, modesty, courage to take risks, and ability to learn from one’s mistakes. “Supervisor Preparation: Supervision Training and Supervision of Supervision” outlines a sequence of didactic instruction and experiential training in clinical supervision (i.e., supervision of supervision) based in best practices and teaching best practices (i.e., pedagogy). Supervisor training emphasizes, among other things, the role modeling supervisors provide whenever interacting with supervisees, the supervisory relationship as the primary vehicle for learning in supervision, the delicate balance of challenge and support of the supervisee, relevant learning theories and principles, and development of a personal philosophy of supervision. UNDERLYING THEMES IN THE BEST PRACTICES IN CLINICAL SUPERVISION Beyond the specifics included in the Best Practices statement are central themes that supported their creation. First, supervision is a proactive, planned, purposeful, goal-oriented, and intentional activity (Borders &Brown, 2005). Supervisors following best practices spend a good bit of time planning for supervision sessions. For example, they review recordings of a supervisee’s counseling sessions; reflect on the supervisee’s learning goals, strengths, developmental needs, personality, cognitive complexity and cognitive/learning style, cultural characteristics, motivation, self-presentation and responsiveness in previous supervision sessions; evaluate effectiveness of supervision interventions to date; and consider the client’s needs and progress. These and other relevant factors (e.g., stage of supervisory relationship, knowledge of any external influences such as a recent death in the supervisee’s family) inform the supervisor’s plan for the upcoming supervision session, particularly the appropriate, manageable “mismatch” needed in the learning environment that both challenges the supervisee’s growth while supporting him or her. This planning is confounded when more than one supervisee will be in the session, such as in triadic and group supervision. Second, supervision is developmental, and so the appropriate learning environment necessarily will need to vary in the amount of structure, direction, support, challenge, and collaboration to “match” the supervisee. The appropriate learning environment not only will differ by supervisee, but also change over time with the same supervisee (although development and experience are not necessarily synonymous); it may differ even within a session with the same supervisee. As a result, this leads to a third theme-supervisors must be flexible and able to employ a range of roles and approaches and effectively focus on various counseling competencies (e.g., skills, case conceptualization, cultural competence, self-awareness and self-reflection). These themes point to a fourth: supervision is an educational process which should be informed by knowledge and research from relevant fields such as learning theory, teacher education, and cognitive science (Borders, 2001, 2010; Goodyear, 2013; Watkins, 2012). Thus, supervisors should be trained in principles and practices that support their development of an identity as an educator within the supervision context that compliments their identity as a clinician. Fifth, attention to diversity and cultural competence of supervisee and supervisor are embedded throughout the Best Practices.

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Similarly, in the sixth theme, supervisors teach supervisees reflection skills, encourage self-reflection during counseling sessions, and model and practice selfreflection on an on-going basis. In line with the “best practices” nomenclature, supervisors act in ways that are accountable, a seventh theme, including adherence to ethical, legal and credentialing guidelines as well as evaluation of their own supervision practice. Being accountable also means basing supervision in direct observation of supervisees’ counseling practice, an eighth theme. Finally, the best practices and their underlying themes are reflected in the education and supervision of supervisors, a sequence of didactic and experiential (supervised supervision) educational activities. TRANSDISCIPLINARY RELEVANCE OF THE BEST PRACTICES IN CLINICAL SUPERVISION Falender et al. (2004) pointed to similarities across supervision standards published at that time as evidence of external validity of their supervisor competencies. Similarities among the Best Practices and other evidence-based supervision statements across disciplines and countries support their transdisciplinary relevance for supervision practice. Indeed, such similarities are evident. For example, even though the Best Practices are aethoretical, they reflect similar content and emphases found in the four evidence-based guidelines for cognitive behavioral therapy (CBT) supervision developed in Britain (Milne &Dunkerley, 2010, p. 48): “Developing the Supervision Contract (including collaborative agendasetting), Methods of Facilitating Learning (including making supervision an active process with experiential methods, such as reviewing tapes), Evaluation in Supervision (e.g., reviewing one’s competence), and The Supervisory Alliance (the relational context).” More recently, the National Association of Social Workers and the Association of Social Work Boards (2013) published a statement of Best Practice Standards in Social Work Supervision. Their best practices are organized into five standards: * context in supervision (e.g., understanding scope of practice, cultural awareness and cross-cultural supervision, dual supervision and conflict resolution); * conduct of supervision (e.g., confidentiality, contracting, competency, self-care); * legal and regulatory issues (e.g., liability, regulations, documentation); * ethical issues (e.g., ethical decision-making, boundaries, self-disclosure, attending to safety, alternative practice); and * technology (e.g., distance supervision, risk management). (pp. 10-24) Other sections of the document describe qualifications for supervisors in social work, evaluation and outcomes, and termination of the supervisory relationship. Again, the similarities in terminology and content are obvious, although a cursory review of the social work best practice standards revealed some discipline-based differences. For example, the social work standards reflect an agency-based orientation, such as helping supervisees learn “how to respond to workplace conflict, respond to threats and harassment, protect property, and deal with assaults and their emotional aftermath” (p. 22). Perhaps the agency-based orientation also accounts for reliance on “case studies, progress notes, conversations, the successful implementation of treatment plans, and client outcomes” (p. 22) as the criteria for measuring goal attainment; these criteria do not include the repeated emphasis in the Best Practices in Clinical Supervision that direct observation of supervisees’ work be used as the basis for evaluation. In addition, counselor education accreditation standards allow triadic supervision, a modality receiving increasing attention from researchers exploring the most appropriate structure, procedures, and learning objectives for this modality (e.g.,

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Borders et al., 2012); triadic supervision does not appear in the social work best practice standards. An agency-based orientation similar to that in the social work document is evident in a preliminary list of recommended best practice guidelines for mental health nurses in Northern Ireland (Rice et al., 2007). Stakeholders in that effort found it impossible to separate clinical supervision from managerial supervision and performance evaluations. Thus, Rice et al. provided recommendations that emphasize organizational policies that allow supervision to occur during the workday. Their few recommendations specific to supervisors are similar to the Best Practices (e.g., be available, supportive, and able to help supervisees reflect on and evaluate their work, have received training), although stated much more broadly. Somewhat similarly, Roth and Pilling’s (2008) supervision competence framework is focused on the workplace in the UK (e.g., “ability to take into account the organizational context for supervision,” p. 10) yet also cover many competencies evident in the Best Practices. Examples include “ability to employ educational principles which enhance learning,” “ability to structure supervision sessions,” “ability to use a range of methods to give accurate and constructive feedback,” “ability to gauge supervisee’s level of competence,” “ability for supervisor to reflect (and act on) limitations in own knowledge and experience,” “ability to help the supervisee practice specific clinical skills,” and “ability to incorporate direct observation into supervision” (p. 10). Thus, it might be expected that future statements of supervision best practices, such as those currently being written for psychologists in the United States, will include many of the same topics as found in the ACES document, with variations and emphases that are based in the traditions, culture, structure, and terminology of the discipline in a particular country (for example, see the emphasis on cultural supervision with Maori in the Guidelines on Supervision, New Zealand Psychologists Board, 2010). In the meantime, the Best Practices in Clinical Supervision provide a useful statement of applicable guidelines for effective, ethical, competent, and accountable supervision practice in a number of contexts. CONCLUSION Supervision competencies and best practices have provided much needed declarative and procedural knowledge regarding supervision practice and supervisor education. The development of supervisor expertise, however, also requires reflective knowledge (cf. Schön, 1983, 1987; Watkins, 2012), and the insights one gains over time about how and when to adapt (even improvise). One’s supervision approach is based on the context, supervisee, and client through recognizing the complexity, ambiguity, and ill-defined problems endemic to supervision. Others, including Falender and Shafranske (2007) and Roth and Pilling (2008), have referred to a similar construct: “meta- competence.” Falendar and Shafranske (2007) defined meta-competence as “the ability to assess what one knows and what one doesn’t know” (p. 232), while Roth and Pilling (2008) focused on “the need to make appropriate adaptations in order to maximize the supervisee’s ability to learn” and the ability to “apply professional judgment to complex issues” (p. 14). Reflective knowledge is built during years of practice and is dependent on continual self- awareness, selfassessment, self-monitoring, and self-reflection, which are predominant characteristics of expert supervisors as reported in a recent study (Kemer, Borders, &Willse, 2014). “Professional artistry” (Schön, 1987, p. 22) based in supervisor’s reflective knowledge requires both reflection-inaction, supervisors’ thinking about what they are doing while they are doing it, as well as reflection on reflection-in-action (Schön). Any statement of best practices is somewhat outdated at its moment of publication. The ACES task force members suggested revisiting the Best Practices document at least every decade. Hopefully, future revisions will achieve even more specification and explication based in results of supervision research in the counseling field and other disciplines, in the United States and globally.

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References REFERENCES American Association of State Counseling Boards. (2007). Approved supervisor model. Retrieved January 21, 2009, from http://www.aascb.org/associations/7905/files/AASCB_Supervision_ Model-0607.pdf. American Counseling Association. (2005). Code of ethics. Alexandria, VA: Author. American Counseling Association. (2010). Licensure requirements for professional counselors: A state-by-state report. Alexa