Examining Clinical Supervision and Putting It to the Acid Test

Supervision is aimed to guide the future. But the question to ask is: if supervisors use the techniques they learned from their supervisors, who learned them from theirs, is this always recursive progression?

The esteemed succession model, following the revered canons of their respective disciplines, came into question by C. Edward Watkins, Jr., Professor of Psychology, Department of Psychology, University of North Texas, Denton. His primary professional interests focus on psychotherapy supervision and psychoanalytic theory, practice, and research.

We know very little

A central practice in clinical work regardless of the clinical profession is supervision, a time-honored tradition with its universal acceptance and built-in respect and expectation.

Clinical supervision is defined as a formal process of professional support, reflection and learning. The goal is to contribute to individual development.
Watkins asked the question, "what do we know empirically about the contribution of psychotherapy supervision to clinical outcomes?"

According to Watkins, who surveyed 30 years of supervision research prior to 2011, “we know very little.” 
With my further review of the literature from 2011 to the present, I found the same shortage of studies examining the relationship between supervision and outcomes.

Can I, as a long time supervisor, and you be confident that popular supervisory techniques such as isomorphism (parallel process) and the exploration of the person-of-the-therapist (Aponte and Kissil, 2016; Watkins, 2016) alleviate suffering?  
As in highlighting other cherished components of supervision, such as self-awareness and reflectivity (Senediak, 2014), multicultural engagement (Gutierrez, 2018), and critical consciousness (Garcia, Kosutic, McDowell and Anderson, 2009) it will require assurances that they too make a difference. 
Indeed, tracking the effectiveness of supervisors' interventions against outcomes, is the Acid Test. This paucity of vetted supervision presents a conundrum and as Watkins has noted, “If we cannot show that supervision positively affects patient outcomes, can we continue to justify supervision?" (Watkins, 2011, p. 238)

What should we do as field?

To address uncertainty, a scientific approach is required. An outcome tracking system will provide an opportunity for the clinician and supervisor to measure, record and audit outcomes to establish the effectiveness of interventions.
In my book, Performance-Based Family Therapy: A Therapist’s Guide to Measurable Change, I advocate that our field adopt Results Based Accountability (RBA), a straightforward, systemic, grounded framework that has transformed government services world-wide over the last twenty years. It can do the same for ours.
In my work with severely troubled adolescents, I developed a hybridized RBA-Intensive Structural Therapy supervisory model that can inform the supervisorial team if their joint outcomes are positive.
J.W. Lichtenberg, in 2007, had a call to action: “the reason for providing supervision and the ethical justification for requiring it is that it should make a difference with respect to client outcomes.”

With a paucity of outcome data, the supervisory team is forced to transform. By doing it yourself using this methodology the dyad establishes themselves as Local Clinical Scientists, tracking their own outcomes (Stricker, 2006). Is anybody better off?

Stricker’s belief is that we must build a bridge between science and practice with clinicians; sharing their experiences and insights, and their local observations and solutions, is the way forward.

The dyad, faithful to a historic process, has had no opportunity to gather their data and share it with others. The best evidence movement and peer reviewed research has often been a barrier.

Stricker suggests that closing this worldwide gap could help clinicians become researchers, an alternative to traditional research. In this way, the psychotherapy field expands its jurisdiction of the definition of what is acceptable data.


Aponte, H.J., & Nelson, G. (2018). I matter, too. Journal of Family Psychotherapy, 29(1), 31-42. https://doi.org/10.1080/08975353.1018.1416111

Fishman, H.C. (2022). Performance-Based Family Therapy: A Therapist’s Guide to Measurable Change (1st ed.). Routledge. https://doi.org/10.4324/9781003161257

Garcia, M., Kosutic, I., McDowell, T. & Anderson, S.A. (2009). Raising Critical Consciousness in Family Therapy Supervision, Journal of Feminist Family Therapy, 21(1), 18-38, https://doi.org/10.1080/08952830802683673

Gutierrez, D. (2018). The Role of Intersectionality in Marriage and Family Therapy Multicultural Supervision, The American Journal of Family Therapy, 46(1), 14-26, https://doi.org/10.1080/01926187.2018.1437573

Senediak, C. (2014). Integrating Reflective Practice in Family Therapy Supervision. Australian & New Zealand Journal of Family Therapy, 35(4), 338-351. https://doi.org/10.1002/anzf.1035

Stricker G. (2006) The local clinical scientist, evidence-based practice, and personality assessment. J Pers Assess. 2006 Feb;86(1):4-9. https://doi.org/10.1207/s15327752jpa8601_02

Watkins, Jr, C.E. (2011). Does Psychotherapy Supervision Contribute to Patient Outcomes? Considering Thirty Years of Research, The Clinical Supervisor, 30(2), 235-256. https://doi.org/10.1080/07325223.2011.619417