Ethical and Effective Clinical Supervision:
Unique Considerations for a Vital Role in Psychological Training

Darcy Gist Zornes, MEd, MA; Heather Sheafer, PhD; and the OPA Ethics Committee

Supervision serves as a cornerstone of psychology training, and providing ethical and effective mental health care to patients is directly linked to ethical and effective supervisory practices. Clinical supervisors play a vital role in shaping the ethical and professional behavior of their supervisees as well as ensuring the protection of those their supervisees serve. The nature of the supervisory position is unique, as the supervisor is not only a teacher and mentor with responsibility to their trainee, but also a provider who is ultimately responsible for the wellbeing of the patient.

In 2015, the American Psychological Association (APA) published their Guidelines for Clinical Supervision in Health Service Psychology (inclusive of the specialties of clinical, counseling, and school psychology), which describes seven suggested domains of competence (Board of Educational Affairs Task Force on Supervision Guidelines, 2015). These domains are situated within a competency-based metatheoretical framework 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” (p. 2).

● Domain A: Supervisor Competence. Supervisors strive to be competent in (1) services provided to patients by their supervisees, (2) the practice of supervision, (3) working with diverse populations and across diverse settings, and (4) the use of technology, and they endeavor to coordinate with other professionals responsible for the supervisee’s education and training.

● Domain B: Diversity. Supervisors strive to develop and maintain self-awareness regarding their diversity competence (i.e., attitudes, knowledge, and skills) and to be familiar with scholarly literature and promising practices for navigating conflicts among personal and professional values. They pursue ongoing training in diversity competence, are knowledgeable about the effects of bias, prejudice, and stereotyping, and model promoting changes in organizations and communities that best serve patients.

● Domain C: Supervisory Relationship. Supervisors strive to maintain a collaborative relationship to promote supervisees’ competence, specify the responsibilities and expectations of both parties, formulate individual learning goals, and regularly review both the supervisees’ progress and the supervisory relationship.

● Domain D: Professionalism. Supervisors strive to model and teach knowledge, skills, and attitudes associated with professionalism (i.e., “behavior and comportment that reflect values and attitudes of psychology” p. 14) and provide feedback to the supervisee about their progress toward meeting expectations in this area.

● Domain E: Assessment / Evaluation / Feedback. Supervisors strive to provide feedback that is direct, clear, timely, behaviorally anchored, responsive, and mindful of the impact on the supervisory relationship and includes the use of live observation or review of recorded sessions. They further strive to incorporate supervisee self-assessment into the evaluation process and to seek and incorporate feedback from the supervisee to improve supervisory competence.

● Domain F: Professional Competence Problems. Supervisors strive to adhere to the supervisory contract and relevant policies and procedures (e.g., program, institutional, legal) and to address performance problems directly and promptly. They are mindful of their roles as gatekeepers and are competent in taking action to remediate performance problems.

● Domain G: Ethics, Legal, and Regulatory Considerations. Supervisors model ethical practice and decision making (e.g., APA ethical guidelines, organizational guidelines, jurisdictional laws and regulations); provide clear expectations and parameters preferably in the form of a written contract; maintain documentation of supervisee performance related to competency and professional development; serve as gatekeepers in assessing supervisee’s suitability; and “uphold their primary ethical and legal obligation to protect the welfare of the patient” (p. 19).

Group Supervision: A Distinct Competency

While the APA guidelines provide general guidance around supervisory practices, research has shown that group supervision is a distinct competency and thus merits particular consideration (Grassby & Gonsalvez, 2022). Riva and Smith (2024) broadened the APA guidelines to include group supervision, adding specific knowledge, skills, and attitudes relevant to each domain. For example, in the domain of competency, supervisors need to be competent in facilitating and managing group dynamics to create a safe and effective community where feedback is shared among supervisees. As part of this process, supervisors should delineate roles and responsibilities at the beginning and discuss what group supervision is and is not. Related to diversity, “regressive supervision” (i.e., when trainees have a more advanced understanding of diversity than their supervisors) can lead to rupture and leave trainees feeling anxious or frustrated. One study found that, in a sample of 112 group supervisees, more than half of the microaggressions that took place in group supervision were attributed to the group supervisor (Kaufman & Riva, 2021). Given the range of identities within a group process, group supervision is inherently a multicultural experience and thus supervisors need specific competence to nurture respectful dialogue in that setting. Finally, related to ethics, group experiences have the power “to deepen ethical self-examination and to create space for the struggles and uncertainties that arise through the acculturation process” (Riva & Smith, 2024, p. 168). Group supervision offers a unique context in which trainees grapple with ethical issues together––a learning experience that relies on the supervisor’s ability to guide those discussions while also modeling ethical values and behavior.

Multicultural Orientation in Supervision

Watkins and colleagues (2019) argued that “if psychotherapists in training are to learn about multiculturalism and make it matter practically, then psychotherapy supervision appears to be a, if not the, prime modality through which that desideratum can be rendered a reality” (p. 29). They applied a multicultural orientation (MCO) model to the practice of supervision and described three pillars of this framework. First, cultural humility involves supervisors having openness and willingness to reflect on themselves as cultural beings and to hear about and understand the cultural background and identity of both their supervisees and the supervisees’ patients. Second, cultural comfort includes feelings of “being at ease, open and non-defensive, and calm and relaxed” during culturally relevant conversations with the supervisee (p. 42). Third, cultural opportunities refers to moments when supervisors either take the initiative to bring up issues relevant to culture in conversations with the supervisee or miss those chances. In an empirical investigation of the MCO framework in the context of supervision, Wilcox et al. (2022) found that, in a sample of 123 therapist trainees, satisfaction with their supervisory experience had a significant positive relationship with their supervisors demonstrating cultural humility and attending to cultural opportunities. Interestingly, this effect was only seen in the context of the relationship between supervisor and supervisee (i.e., supervisor’s attention and humility regarding core aspects of the supervisee’s cultural background) and was not related to the supervisors’ multicultural orientation as it related to the trainees’ patients (i.e., supervisor’s attention and humility regarding the supervisee’s patient’s cultural background). Thus, the importance of multicultural orientation in supervisory practice may be primarily driven by enhancing the working alliance between supervisor and supervisee.

In line with a multicultural orientation approach, Sandeen and colleagues (2018) proposed a pragmatic framework that promotes cultural competence in psychology. They argued that “[w]hether a psychologist will be able to effectively practice in a culturally competent way in any specific locale will largely depend upon whether the person has acquired a method of reflective practice around culture during formal training” (p. 144). Thus, reflective local practice (RLP) encourages engagement in a variety of techniques and activities to promote self-awareness and develop skills related to culturally effective practice, including asking provocative questions to explore aspects of one’s own background and learning about local history through cultural events and literature. In acknowledgement that vocabulary and risk of rupture are barriers to effective communication, supervisors can utilize novel terms to aid discussion of self-awareness of cultural factors in a non-blaming way: hot spots (topics and actions that arouse strong emotions due to personal past experience of powerlessness, oppression, or harm), soft spots (overidentification or sympathy stemming from unexamined assumptions that lowers expectations for patient behavior), and blind spots (lack of awareness of relevant cultural information, typically in dimensions of experience where one holds relative power). Implementing RLP in the supervisory relationship, particularly in a group setting, may be an impactful and meaningful way to support improved cultural competence in both supervisors and trainees.

Intersection of Supervision and APA Ethics Codes

Within the APA’s code of conduct, a number of ethical standards are relevant to supervisory roles and relationships (American Psychological Association, 2017). Boundaries of competence and maintaining competence (standards 2.01 and 2.03, respectively) apply not only to the supervisor’s own work with patients but also to their trainee’s patients. In some settings, the gap between the supervisor’s competence and the populations the trainee serves may introduce ethical concerns. Delegation of work to others (standard 2.05) places responsibility on the supervisor to ensure that the supervisee is assigned an appropriate caseload and is competent to perform those services. Supervisors must be cognizant about avoiding exploitation of their supervisees, inadvertently or otherwise. This is particularly salient given the power differential and hierarchical nature of the supervisory relationship. Regarding assessment, supervisors have an ethical duty to establish a process for evaluation of assessment skills and provide feedback to support the trainee’s overall professional development. This should include regular review of the trainees’ clinical performance, either in the form of live observation or review of recordings. Finally, and perhaps most importantly, supervisors inherently occupy a multitude of roles (e.g., program instructor, dissertation committee member, and supervisor), which necessitates managing multiple relationships mindfully, using clear communication around boundaries and expectations.

References

American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). https://www.apa.org/ethics/code

Board of Educational Affairs Task Force on Supervision Guidelines. (2015). Guidelines for clinical supervision in health service psychology. American Psychological Association. https://www.apa.org/about/policy/guidelines-supervision.pdf

Grassby, S., & Gonsalvez, C. (2022). Group supervision is a distinct supervisor competency: Empirical evidence and a brief scale for supervisory practice. Australian Psychologist, 57(6), 352–358. https://doi.org/10.1080/00050067.2022.210789 

Kaufman, G., & Riva, M. T. (2021, August). Exploring the types of microaggressions that occur in group supervision: Reports from supervisees [Poster presentation]. American Psychological Association Conference, San Diego, CA, United States.

Riva, M. T., & Smith, R. D. (2024). Beyond the dyad: Broadening the APA supervision guidelines to include group supervision. Psychotherapy, 61(2), 161–172. https://doi.org/10.1037/pst0000525

Sandeen, E., Moore, K. M., & Swanda, R. M. (2018). Reflective local practice: A pragmatic framework for improving culturally competent practice in psychology. Professional Psychology, Research and Practice, 49(2), 142–150. https://doi.org/10.1037/pro0000183

Watkins, C. E., Hook, J. N., Owen, J., DeBlaere, C., Davis, D. E., & Van Tongeren, D. R. (2019). Multicultural orientation in psychotherapy supervision: Cultural humility, cultural comfort, and cultural opportunities. American Journal of Psychotherapy, 72(2), 38–46. https://doi.org/10.1176/appi.psychotherapy.20180040