New study explores impacts of clinical supervisory relationships on supervisees and supervisors

Click here to read more about Dr. Rubio’s background.
Click here to read about Dr. Rubio's work with Expressive Arts.

The San Francisco Department of Public Health - Behavioral Health Services is undergoing external review by the State. As part of this review, Dr. Ritchie Rubio, Full-Time Faculty member in the Counseling Psychology program, will be presenting on his ongoing study of clinical supervisors of the city.

Dr. Rubio describes the study and its findings: "In summary, I looked at the relationship of clinical supervisor skills and behaviors as it relates to the relationship with their supervisees, development of their supervisees, satisfaction with the supervisory role, burnout, and supervisory practices. The highlight of my study, from the first round of data-gathering is: A collaborative, open, and secure relationship between a clinical supervisor and a supervisee is strongly related to better supervisory skills, lesser burnout, and greater satisfaction. This is parallel to the greater research on Common Therapeutic Factors that what ultimately accounts for better outcomes in therapy clients is the therapeutic alliance between the therapist and their client. So similarly, a more collaborative and secure relationship between supervisor and supervisee is strongly related to clinical supervision competence, which ultimately promotes greater development of a supervisee."

Students in the daytime format of the Counseling Psychology program at the Wright Institute will have the benefit of learning directly from Dr. Rubio in the Research Based Practice course. Dr. Rubio also teaches several other courses, including Common Therapeutic Factors, Crisis, Disaster, & Trauma Counseling, Psychopharmacology & the Biological Bases of Behavior, and MFT Professional Development Seminar.

The presentation summary is included below:

Title of Presentation: Reflective, relational, and skillful clinical supervision in a public behavioral health system

Presenters: Ritchie J. Rubio, PhD., Farahnaz K. Farahmand, Ph.D., and Jonathan Maddox, MFT

​Summary: ​Supervision practices within the public behavioral health sector have declined significantly as the job of providers and supervisors have become more challenging (Hoge et al., 2011). While clinical supervision is the principal method to ensure quality of care, majority of supervision time is spent on administrative functions (Accurso, Taylor, & Garland, 2011). Reflective supervision is a third type, which explores the relationship between the practitioner and supervisor, the practitioner and client; and attends to the emotional content of the work where a supervisor listens and waits, allowing the supervisee to discover solutions. Reflective supervision reduces secondary traumatization (Turner, 2009); promotes job satisfaction; and model intervention fidelity (Finello et al., 2011).

The present study aims to contribute to the literature on the practice of supervision within public behavioral health systems and to describe demographic and clinical factors that predict and promote improvements in reflective supervision; supervisory relationships; competencies/skills; burnout; and satisfaction.

A survey was administered to all clinical supervisors and the clinicians they supervise within the San Francisco Department of Public Health, Behavioral Health Services. Of this sample, 60 clinical supervisors are enrolled in a 10-month Clinical Supervision Training & Learning Collaborative (TLC) which includes a 2-day foundational training by Yale’s Program on Clinical Supervision, three 1-day specialty trainings (Reflective Supervision; Building a Trusting Supervisory Relationship; Supervising to Effective Clinical Care), and four 2-hour reflective learning communities that convened in the months after each training.

Longitudinal and dyadic data analyses will be conducted across three time periods: pre- (a month before the training institute in August 2017); mid- (5 months into the training on January 2018); and post-assessment (a month after the training on June 2018). The following measures were and will be completed by supervisors and supervisees:
Supervisory Relationship Questionnaire (SRQ)
Competent Clinical Supervision (CCS) Scale: a 30-item scale of supervision skills and behaviors constructed for this study (Cronbach’s alpha = .90)
Supervisee Levels Questionnaire (SLQ)
Counselor Burnout Inventory (CBI)
Supervision Satisfaction and Practices (from the Yale Supervision Development Initiative)

Exploratory correlational analyses and Canonical Correlation Analysis (CCA) highlighted the following results from the pre-assessment data with 50 supervisors and 74 supervisees:
Being collaborative and a safe base is strongly related to supervision skills around strengths-based practice, reflective supervision, and vicarious trauma processing.
Feelings of exhaustion is moderately related in the negative direction to skills involving role plays, reflective supervision, and supporting supervisees when treatment fails.
Reflective supervision strongly relates to being satisfied as a clinical supervisor.

Being collaborative and open is a strong predictor of feeling less exhausted and, to a lesser extent, being impacted by a negative work environment.
Reflective Supervision is associated with more years providing supervision, and less time spent in administrative supervision.
The implications of our findings will be discussed in terms of specific clinical supervision practice innovations to: (1) improve reflective and relational supervision, (2) mitigate burnout, and (3) augment satisfaction. In addition, the challenges and successes to strengthening clinical supervision within the context of a large public behavioral health system will be discussed.

Click here to learn more about the Wright Institute’s Doctor of Clinical Psychology (Psy.D.) program.
Click here to learn more about the Wright Institute’s Master of Counseling Psychology program.