Psychotherapy Supervision: An Invitational, Clarifying, Educational, Empowering, and Transparent (ICEE-T) Written Agreement.

The authors make the case for using a written instead of a spoken supervision agreement at supervision's outset in order to provide clarity and education about supervision, supply an accessible document that supervisees can readily reference, sidestep memory issues that negatively affect the supervision process, and enable dyadic collaboration that sets an immediate positive tone for supervision. The invitational, clarifying, educational, empowering, and transparent (ICEE-T) supervision agreement approach is described, with emphasis on the essential elements to put in place at the outset of supervision. A written agreement, which is valuable at any supervisee developmental stage, can be invaluable when working with novice supervisees (e.g., because of the anxieties and self-doubt of first-time supervisees) and is explored with that group foremost in mind.

Cultural humility and racial microaggressions in cross-racial clinical supervision: A moderated mediation model.

Cultural humility is important in supervision; however, studies have primarily sampled White supervisees. Racially and ethnically minoritized trainees experience microaggressions during their training, yet cross-racial supervision is less often studied. We examined a moderated mediation model to test whether the supervisory working alliance mediated the relationship between frequency of racial microaggressions and satisfaction with supervision, and whether the impact of racial microaggressions on the supervisee and supervisor cultural humility moderated the relationship between racial microaggression frequency and the supervisory working alliance. In a sample of supervisees of color (N = 102; majority cisgender women, 86.2%, and heterosexual, 59.8%; 35.3% Black/African American, 28.4% Asian/Pacific Islander, 18.6% Hispanic/Latine) receiving clinical supervision from White supervisors, we found that racial microaggression frequency was negatively associated with satisfaction with supervision, and this relationship was fully accounted for by the supervisory working alliance. Racial microaggressions in supervision were found to be detrimental to the supervisory working alliance, which was then related to lower satisfaction with supervision. Further, racial microaggression impact and cultural humility moderated the relationship between racial microaggression frequency and the supervisory working alliance; this relationship was strongest when racial microaggression impact was high and cultural humility was average or high. The social bond hypothesis suggests we are more likely to allow ourselves to be vulnerable when we assess cultural humility to be high. We posit that the observed moderation effect may be due to supervisees experiencing greater shock when experiencing racial microaggressions from supervisors whom they perceived to be culturally humble. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Multicultural Streaming in Group Psychotherapy Supervision: Orientation to and Preparation for Culturally Humble Practice.

How do psychotherapy supervisors most effectively integrate issues and concerns about multiculturalism and social justice (MSJ) into the supervisory experience? Concrete examples of how to best address this integration are needed, and this article provides one such example. The authors propose multicultural streaming as one approach to orient supervisees about, and prepare them for, incorporation of MSJ matters into group supervision and to foster their evolving sense of culturally humble practice. This article defines multicultural streaming, presents a plan for its implementation at the group's outset, and identifies implementation guideposts for consideration. A set of cultural humility guidelines adapted for group supervision is also proposed for group facilitation. This perspective is presented with the hope of generating further discussion about integrating MSJ issues into the group supervisory experience.

Eating disorder diagnosis and the female athlete: A longitudinal analysis from college sport to retirement.

OBJECTIVES: Female athletes experience eating disorders (EDs) at clinical, and subclinical, levels; most studies have determined point-prevalence rates through cross-sectional methodologies. To date, few studies have examined the long-term stability of EDs in female athletes; none extend into retirement. DESIGN: A longitudinal investigation of ED classification (i.e., Clinical ED, Subclinical ED, Healthy) and weight control behaviors (e.g., vomiting, laxative use) from when athletes actively competed (T1) into their retirement (T2). METHODS: Participants included U.S. female athletes (N=193) who were collegiate competitors (T1) and eventually were retired from their collegiate sports six years later (T2). RESULTS: At T2, athletes were classified as Healthy (69.9%), Subclinical ED (26.9%), and Clinical ED (3.1%). Overall percentage of Subclinical EDs increased from 18.7% (T1) to 26.9% (T2); 52.8% of T1 Subclinical ED athletes continued to meet criteria for either Subclinical or Clinical ED at T2. Of the 13 Clinical ED athletes at T1, six (46.2%) continued to meet criteria for either a subclinical or clinical ED at T2. Though exercising (2+ hours/day; n=8, 4.1%) and dieting/fasting (4+ times/year; n=14, 7.3%) were the most frequently used weight control behaviors at T2, rates were substantially lower than at T1. CONCLUSIONS: Retirement does not result in immediate remittance of eating concerns among female athletes; many continue or develop Subclinical and Clinical ED symptoms. Thus, addressing healthy body image and nutrition when athletes are competing is imperative to assist prevention and intervention efforts that may alleviate ED symptoms as athletes transition from sport.

The Psychotherapy Supervisor as an Agent of Transformation: To Anchor and Educate, Facilitate and Emancipate.

OBJECTIVE: The objective of this review was to answer the question, What do supervisors actually do in promoting transformative change in the beginning therapist supervisee? New therapist trainees, lacking treatment skills and a sense of "therapist identity," are prone to experience self-doubt, feel anxious and demoralized, and think of themselves as impostors. Psychotherapy supervision can be helpful and encouraging to beginning therapists in their process of development. METHODS: Using Mälkki and Green's concepts of liminality, edge emotions, and boundary confusion as framework, the author examines the pivotal role of the supervisor in striving to create a transformative supervision space. RESULTS: The author identifies and elaborates on three transformative streams of supervisory action-to anchor and ground, to educate and facilitate, and to liberate and emancipate. The constituents of each action stream are also identified. CONCLUSIONS: Psychotherapy supervisors serve foremost as agents of transformation, their chief objective being to actuate and actualize a transformative process of therapist development. The crucial processes by which supervisors achieve that transformative objective reside in the three streams of supervisory action. Accordingly, psychotherapy supervision is best conceptualized as a transformative learning pedagogy.

Creating and Elaborating the Cultural Third: A Doers-Doing with Perspective on Psychoanalytic Supervision.

Although recognized as highly crucial to supervision practice (e.g., Tummala-Narra, 2004), culture has been addressed minimally in the psychoanalytic supervision literature. Calls to remedy that limitation have been made and making culture matter has been identified as a most pressing need for psychoanalytic supervision. But how then do we as supervisors go about doing that? How might we better position culture in, and make culture central to, our psychoanalytic supervisory conceptualization and conduct? We subsequently take up those questions, expanding upon our earlier proposals about cultural humility and the Cultural Third (Watkins and Hook, 2016) by (a) proposing a tripartite multicultural perspective (i.e., cultural humility-cultural comfort-cultural opportunities) as supervision sine qua non; (b) using recognition theory as a way to better understand that very process of Third creation and elaboration; and (c) providing a rupture/repair case example that shows efforts to create and build the Cultural Third in supervision. The Cultural Third is conceptualized as a product of doers-doing with so as to culturally learn together through "not knowing".

Multicultural Orientation in Psychotherapy Supervision: Cultural Humility, Cultural Comfort, and Cultural Opportunities.

As a complement to multicultural competence, the multicultural orientation (MCO) perspective has been proposed as a pragmatic way to enhance cultural understandings about psychotherapeutic dynamics, processes, and outcomes. Consisting of three core components-cultural humility, cultural comfort, and cultural opportunities-the MCO is considered relevant for both individual and group treatment. However, the MCO perspective has yet to be specifically applied to psychotherapy supervision. Because supervision often provides multicultural oversight for individual and group psychotherapy services, considering the ramifications of MCO for psychotherapy supervision (MCO-S) is important. In this article, the implications of MCO-S are reviewed, with attention given to the impacts of cultural humility, cultural comfort, and cultural opportunities on the supervisor-supervisee relationship. Case examples are provided to illustrate the ways in which MCO can affect the psychotherapy supervision process and outcome. Supervision research possibilities are also proposed.

The Supervision Pyramid: A Commonalities-Based Synthesis of Intervention, Relationship, and Person/Personhood.

Adapting the therapeutic pyramid to the supervision of psychotherapy, the author presents and describes the supervision pyramid-a simple meta-model of the broad conceptual organizers of the supervisor's contribution to the experience and outcomes of supervision. The supervision pyramid consists of three commonalities: supervisor skills and interventions, the supervisory relationship, and the supervisor's person and personhood. Those three commonalities converge to stimulate supervisee learning and relearning and client improvement and symptom reduction. The implications of this meta-model for supervision conceptualization and conduct and for supervisor training are briefly described.

Listening to and Sharing of Self in Psychoanalytic Supervision: The Supervisor's Self-Perspective.

Just as the analyst's self-perspective is critical to effective analytic process, the supervisor's self-perspective is accordingly critical to effective supervision process. But the supervisor's self-perspective has received virtually no attention as a listening/experiencing perspective in the psychoanalytic supervision literature. In this paper, the author defines the supervisor's self-perspective and considers five ways by which it contributes to an effective supervisory process: (1) sharing one's own impressions of/reactions to patients; (2) sharing personal disclosures about the supervisee-patient relationship; (3) sharing personal disclosures about the supervisee as a developing analytic therapist; (4) sharing personal disclosures about the supervisor-supervisee relationship; and (5) using one's own self-reflection as a check and balance for supervisory action. The supervisor's self-perspective provides the missing supervisory voice in the triadic complement of subject-other-self, has the potential to be eminently educative across the treatment/supervision dyads, and serves as a prototype for the supervisee's own development and use of analytic (or analyst) self-perspective.

Cultural Humility in Psychotherapy Supervision.

As a core component of multicultural orientation, cultural humility can be considered an important attitude for clinical supervisees to adopt and practically implement. How can cultural humility be most meaningfully incorporated in supervision? In what ways can supervisors stimulate the development of a culturally humble attitude in our supervisees? We consider those questions in this paper and present a model for addressing cultural humility in clinical supervision. The primary focus is given to two areas: (a) modeling and teaching of cultural humility through interpersonal interactions in supervision, and (b) teaching cultural humility through outside activities and experiences. Two case studies illustrating the model are presented, and a research agenda for work in this area is outlined.

Supervisor Allegiance as a Critical Construct: A Brief Communication.

Allegiance, long regarded as a significant variable in psychotherapy and psychotherapy research, has been ignored in the psychotherapy supervision literature. It is our contention that allegiance is similarly significant for psychotherapy supervision. In this brief communication, we define supervisor allegiance, consider its impact on supervision outcome, and highlight its role in the contextual supervision relationship model (a trans-theoretical model of the supervisory relationship).

Cultural humility: The cornerstone of positive contact with culturally different individuals and groups?

Comments on the original article by Christopher et al. (see record 2014-20055-001) regarding cultural and folk psychologies. As noted by Christopher, Wendt, Marecek, and Goodman (2014), "U.S. psychology remains not only overwhelmingly U.S.- centric but also largely unaware of how its cultural roots shape theory and research.

The alliance in reflective supervision: a commentary on Tomlin, Weatherston, and Pavkov's critical components of reflective supervision.

What are the critical components of reflective supervision? In this commentary, I offer a complementary perspective on A.M. Tomlin, D.J. Weatherston, and T. Pavkov's (2014) seminal study about that very question. I consider their findings within the context of what we now know about the supervisory alliance-a highly robust, heuristic, and eminently practical construct that appears to capture the spirit of reflection, collaboration, and regularity at its best. Matters of alliance theory, practice, and research are briefly addressed, and effort is made to consider the implications of the supervisory alliance as fundamental, foundational, and quintessentially organizational for reflective supervision practice.

Psychotherapy supervision developments and innovations for the new millennium: contributions from the cutting edge.

What are some of the most recent, cutting-edge developments and innovations in psychotherapy supervision? And what is their particular significance for supervision now and into its future? In this special supervision issue of the American Journal of Psychotherapy, those questions are considered, and some compelling answers are provided. In what follows, I introduce this special journal issue: (a) define supervision and indicate its purposes; (b) summarize the contents of each innovative paper; and (c) accentuate the significance of each presented development/innovation. The papers contained in this issue boldly speak to supervision's future and provide exciting--and highly profitable--directions to pursue in forever making psychotherapy supervision a far more anchored, accountable, and educational experience.

Clinical supervision in the 21st century: revisiting pressing needs and impressing possibilities.

What are some of the most pressing needs currently confronting clinical supervision? In this paper, I give attention to that question. Drawing on two 1990 reviews for comparative purposes, I examine where supervision is now relative to four areas: (a) supervision training and practice; (b) measurement; (c) difference and diversity; and (d) research. Lines of advance, pressing needs, and potential remedies are considered across each area. Effort is made to accentuate the "robustly international" nature of clinical supervision and its increasing globalization.

The supervisory alliance: a half century of theory, practice, and research in critical perspective.

Over the course of psychotherapy supervision history, the supervisor-supervisee alliance has increasingly emerged as a variable of preeminent importance in the conceptualization and conduct of the supervision experience: It has come to be embraced as the very heart and soul of supervision. But after a half century, what evidence do we actually have to justify that highly favorable outlook afforded to the alliance? What do we really know about the supervisory alliance? What do we need to know about it? As we mark the first 50 years of supervisory alliance and look toward its future, I thought it might be useful to examine those questions and provide a current status report about the construct itself In what follows, I (a) describe the two supervisory alliance visions that have been (and remain) dominant in the supervision literature and (b) provide a review of 20 plus years of supervision alliance research. While the supervisory alliance has accumulated solid clinical support, its empirical support appears to be more tentative and less robust. I consider why that is so, identify some missing elements in the alliance research conducted thus far and propose possible remedies to move inquiry in this area forward.

On psychoanalytic supervision as signature pedagogy.

What is signature pedagogy in psychoanalytic education? This paper examines that question, considering why psychoanalytic supervision best deserves that designation. In focusing on supervision as signature pedagogy, I accentuate its role in building psychoanalytic habits of mind, habits of hand, and habits of heart, and transforming theory and self-knowledge into practical product. Other facets of supervision as signature pedagogy addressed in this paper include its features of engagement, uncertainty, formation, and pervasiveness, as well as levels of surface, deep, and implicit structure. Epistemological, ontological, and axiological in nature, psychoanalytic supervision engages trainees in learning to do, think, and value what psychoanalytic practitioners in the field do, think, and value: It is, most fundamentally, professional preparation for competent, "good work." In this paper, effort is made to shine a light on and celebrate the pivotal role of supervision in "making" or developing budding psychoanalysts and psychoanalytic psychotherapists. Now over a century old, psychoanalytic supervision remains unparalleled in (1) connecting and integrating conceptualization and practice, (2) transforming psychoanalytic theory and self-knowledge into an informed analyzing instrument, and (3) teaching, transmitting, and perpetuating the traditions, practice, and culture of psychoanalytic treatment.

The beginnings of psychoanalytic supervision: the crucial role of Max Eitingon.

Psychoanalytic supervision is moving well into its 2nd century of theory, practice, and (to a limited extent) research. In this paper, I take a look at the pioneering first efforts to define psychoanalytic supervision and its importance to the psychoanalytic education process. Max Eitingon, the "almost forgotten man" of psychoanalysis, looms large in any such consideration. His writings or organizational reports were seemingly the first psychoanalytic published material to address the following supervision issues: rationale, screening, notes, responsibility, supervisee learning/personality issues, and the extent and length of supervision itself. Although Eitingon never wrote formally on supervision, his pioneering work in the area has continued to echo across the decades and can still be seen reflected in contemporary supervision practice. I also recognize the role of Karen Horney-one of the founders of the Berlin Institute and Poliklinik, friend of Eitingon, and active, vital participant in Eitingon's efforts-in contributing to and shaping the beginnings of psychoanalytic education.