Exploring the relationship between clinical supervision and client outcomes

Section A

This review sought to investigate the evidence for the impact of clinical supervision on client outcomes in psychological therapies. Professional guidelines and clinical practice reflected a broad assumption that supervision served the interests of the client with a relative lack of research examining this claim. Previous reviews in the area were also deemed to be dated or contained important limitations. Searches in online databases PsychInfo, CINAHL, and ASSIA yielded 12 studies that met eligibility criteria, which were assessed using appraisal criteria. The current review found little evidence that supervision contributes substantially to client welfare, and limited progress appears to have been made since the last review of this kind. Though studies in the area are low in number and evidently contain issues with design and clarity of reporting, the review also reinforced the real challenge in trying to comprehend the links between supervision and therapeutic outcomes. Researchers are encouraged to explore relationships between more proximal variables than those studies included in this review attempted, with the intention of gradually clearing the path between supervision and client wellbeing. Clinicians are encouraged to continue their engagement with the process of supervision, but with a critical eye on assumptions and possibilities in the absence of convincing data for guidance.

Section B

This study used reflexive thematic analysis to qualitatively explore the relationship between supervision and the therapeutic alliance from the perspective of trainee clinical psychologists. Based on nine participants’ accounts, it appears that supervision offers a model of relating that can be translated to the therapeutic relationship, and a crucible within which change happens, to the benefit or detriment of the alliance. Supervisors and trainees who engaged together with emotional and relational material were perceived as contributing more positively to the trainee-client relationship, whereas supervision which entailed a more detached and inflexible approach to what was brought by trainees was perceived as limiting or mitigating trainee and client security and development.

The findings of this study suggest support for attachment and supervisory relationship models of supervision, which see the supervisor as a ‘base’ from which the supervisee can access security, support, and guidance. The psychodynamic model of supervision suggests a transfer of this relationship to the therapeutic alliance and vice versa, a concept which is seemingly supported by the data in this study.

Limitations, and research and clinical implications are discussed. Recommendations for future research include mixed methods longitudinal investigations of trainee experience over time, and concurrent efforts to better understand client and supervisor experinces. In terms of clinical practice, testimony provided by participants in this study illuminates the promise and pitfalls of supervision- its potential to contain so trainees may offer containment to their clients, and its potential to neglect in a way that is felt to be at best limiting and at worst distressing for trainees and, potentially, for clients. Qualified and trainee staff, as well as professional and training institutions, are encouraged to actively engage with the understanding and practice of supervision to avoid harm and to increase safety and effectiveness for the benefit of all parties involved.