Studies involving the analysis of online supervision competencies and/or cross-cultural competencies

Two studies focused on analyzing the competencies of clinical supervisors in the online modality (^{Miljkovic, 2023}; ^{Yang et al., 2018}). Miljkovic (2023) highlights the lack of adequately validated clinical models for electronic supervision and presents a model called the Supportive Model of Electronic Supervision (SMeS), based on the following structure: (a) warm-up conversation; (b) task review; (c) 60-minute supervision sessions; (d) an active, directive, and dynamic supervisory stance; (e) compassionate and fair formulation of feedback; (f) case conceptualization; (g) reducing hierarchical distance during electronic supervision while maintaining professional boundaries; and (h) effective use of verbal feedback. The study by ^{Yang et al. (2018}) provides evidence on the benefits and challenges of online cross-cultural supervision and the feasibility of this training modality. The core competencies involved in the cross-cultural supervision model (or culturally sensitive supervision) include awareness of cultural and linguistic differences in the clients served, discussion of culture-related topics, and consideration of the potential influence of cultural differences on the supervision process and outcomes. The supervisor’s approach consisted of: (a) creating a warm and supportive environment; (b) providing intellectual and emotional support; (c) respecting the supervisee’s opinions and ideas; (d) expressing curiosity about culturally shaped behaviors; (e) adopting a strengths-focused and nonjudgmental stance; (f) mutual respect; (g) professional guidance from the supervisor; and (h) flexibility in the supervision style.

Four studies discuss essentially cross-cultural aspects within the supervised process (^{Barletta et al., 2021}; ^{Milne, 2018}; ^{Newman, 2013}; ^{Reiser & Milne, 2013}). Barletta et al. (2021) investigate the perceptions of female supervisors who received training in CBT clinical supervision. In Brazil, supervisors begin their training at the master’s degree level. After graduation, a psychologist in Brazil may work as both a therapist and a supervisor, provided they are registered with the professional council. This difference should be considered in clinical supervision training programs, particularly regarding the amount of prior experience.

^{Milne (2018}) points out that, in the context of supervision, culturally sensitive supervisory practice requires self-awareness and sensitivity toward the supervisee. The author highlights the seemingly frequent occurrence of situations in which the supervisee’s cultural background is disregarded, which may result in distancing within the supervisory relationship, diminished supervisee engagement, and conceptualization errors on the part of the supervisor. A culturally informed education also helps reduce stereotypes and harmful judgments within supervision. ^{Newman (2013}) describes that awareness of and attention to cultural differences between the supervisor and their supervisees is also a skill. An example would be the supervisor taking the initiative in discussions related to cultural diversity. ^{Reiser and Milne (2013}) discuss the dilemma faced by novice supervisors in deciding whether to adhere strictly to validated CBT treatment programs or to individualize and adapt treatments to better meet patients’ individual needs and/or cultural differences, noting the scarcity of scientific studies validating the implementation procedures for such specific adaptations.

Studies involving the analysis of group supervision competencies

Two studies focused on investigating the competencies of the group supervisor (^{Barletta et al., 2012}; ^{Riva & Smith, 2024}). Barletta et al. (2012) identify as essential the maintenance of a supportive and cohesive supervision group, in which mistakes are accepted without punishment, as one of the main objectives of the supervisor. The ability to conduct supervision in a group format is considered part of the essential competency domains for CBT supervisors. The authors emphasize the importance of providing feedback throughout the meeting, not only at the end of the process, as this is also essential for supervisee engagement and meaningful learning. ^{Riva and Smith (2024}) provide important insights regarding clinical supervisor competencies related to group supervision. The authors highlight four key group supervisor competencies: (a) the group supervisor facilitated engagement and enhanced the contributions of all members; (b) learning activities were well planned and coordinated; (c) the supervisor demonstrated insight into the client-professional relationship and the group; (d) the supervisor ensured a safe space for appropriate disclosure and professional growth; and (e) facilitation of mutual engagement among all group members, awareness of group processes or factors that may be present, and creation of a safe environment for supervisees to ask questions.

Competency analysis in individual supervision

Most of the studies (twenty-one) emphasized the analysis of clinical supervisor competencies in individual supervision modalities (^{Alfonsson et al., 2020}; ^{Axelsson et al., 2024}; ^{Barletta et al., 2021}; ^{Bearman et al., 2020}; ^{Cummings e al., 2015}; ^{Gonsalvez et al., 2023}; ^{Guindon et al., 2022}; ^{Harris et al., 2022}; ^{Kelly & Hassett, 2021}; ^{Lewis et al., 2014}; ^{Meza et al., 2023}; ^{Milne, 2018}; ^{Milne et al., 2013}; ^{Murr et al., 2020}; ^{Nakamura et al., 2014}; ^{Newman, 2013}; ^{Pearl et al., 2013}; ^{Reiser & Milne, 2013}; ^{Velasquez, 2017}; ^{Watkins et al., 2021}; ^{Weck et al., 2016}).

In ^{Alfonsson et al. (2020}) supervision focused on CBT-specific competencies and employed experiential learning methods, such as role-playing. ^{Axelsson et al. (2024}) identified two main themes in competence-based supervision-learning and development-and five associated subthemes: structure and purpose, prerequisites, experience-based learning, therapeutic skills, and personal development. ^{Barletta et al. (2021}) highlighted that supervision training is fundamental for developing supervisory competencies. Supervisors training future supervisors should be prepared to implement activities focused on both clinical and teaching competencies. The transition from therapist to supervisor appears to be underestimated in the literature on female supervisors. ^{Bearman et al. (2020}) also focused on investigating the importance of prior and formal supervision training (meta-supervision), which helped develop a well-trained workforce of supervisors capable of better supporting the use of evidence-based therapies, such as CBT.

In ^{Cummings et al. (2015}) the authors shared practices they regularly use in their supervision: (1) setting a supervision agenda for each meeting; (2) encouraging supervisees to solve problems before receiving specific supervision input; and (3) providing regular formative feedback. ^{Gonsalvez et al. (2023}) found that, compared with their supervisors’ ratings, trainees underestimated their competence during the early stages of training, with this discrepancy decreasing over the course of training and supervision. Compared with their own overall competence ratings, trainees ranked the domains of Relationship and Communication, Reflective Practice, and Professionalism as relative strengths. Another point highlighted by the article concerns the importance of metacompetence-namely, realistic self-assessment and reflective practice (self-observation, self-analysis, self-evaluation)-which appears to be self-monitored and self-directed, suggesting that training programs should systematically monitor self-assessments.

^{Guindon et al. (2022}) identify several core competencies for supervisory work from the supervisee’s perspective, including: didactic teaching, prior planning of instructional activities, clarification on case formulation, the use of experiential training/experimentation activities, and evaluation of the supervisee’s work. ^{Harris et al. (2022}) point to three main themes related to the management of competencies in supervising cases of psychosis: (a) questions about knowledge/content and about procedures/processes; (b) questions about course requirements/assessment methods (training). The study indicates that supervision should prioritize knowledge, process learning, and active experimentation in training therapists to deliver high-quality CBT for individuals with psychosis.

^{Kelly & Hassett (2021}) identified six categories denoting important characteristics of CBT supervision: (A) the nature of the supervision process/relationship; (B) ethical and legal factors; (C) the generic supervision process; (D) mirroring the CBT approach; (E) the supervisor’s skills/knowledge; and (F) challenge, difference, and disagreement/improvement of practice. ^{Lewis et al. (2014}) specify clinical domains relevant to supervision outcomes, namely: knowledge, skills, attitudes, values, supervision relationship, general competencies, and patient outcomes. The authors note a potential relationship between training in these domains and improved patient engagement and positive outcomes. ^{Meza et al. (2023}) identified two supervision approaches: (a) directive support and (b) nondirective support, with both having a positive impact on supervision processes. ^{Milne (2018}) identifies the following competencies: (1) needs assessment; (2) goal setting; (3) empowering the supervisee; (4) facilitating learning; and (5) monitoring. The supervisor’s stance as a “sports coach” is also discussed, aiming to foster continuous development throughout the professional trajectory. Milne et al. (2013) compare traditional supervision (case reporting only) with evidence-based clinical supervision (competency analysis).

According to ^{Murr et al. (2020}), supervisees reported that recordings of sessions with patients were vital for understanding what they needed to change in their practice and how to implement those changes. By observing actual behavior rather than just case reports, it was possible to discuss specific management points in greater detail, as well as allowing supervisors to access behaviors and remarks from supervisees that they themselves had not noticed. ^{Nakamura et al. (2014}) found that both supervisors and therapists improved competencies related to teaching and implementing therapy techniques, as well as in supervision based on competency analysis. A limitation noted by the authors was that supervisors were given free rein regarding how to conduct supervision. ^{Newman (2013}) identified the following as important tools for clinical supervision: (1) an overview of the main responsibilities and competencies of being a clinical supervisor; (2) the supervision relationship; (3) familiarity with and sensitivity to ethical and cross-cultural issues in supervision; (4) maximizing the supervisee’s CBT competence, using the Cognitive Therapy Scale in supervision; (5) documentation, feedback provision, and the evaluative role of the supervisor; and (6) providing supervision in high-risk clinical situations.

^{Pearl et al. (2013}) note that a supervisor needs to conceptualize the skill levels of supervisees. Difficulties in essential CBT skills should be measured so they can be included in the supervision goals and personalized training plan. This plan can be guided by questions such as: (1) Does the supervisee possess the basic and universal skills of psychotherapy (empathy, genuineness, nonjudgmental attitude)? (2) How well does the supervisee understand the basic theoretical principles underlying CBT?

Reiser and ^{Milne (2013}) discuss integrating adult learning educational principles into training and supervision processes. Competencies such as metacognition and reflection on one’s own practice appear essential. When space for such reflection is provided, a corrective feedback loop is created, helping supervisors identify areas needing attention and giving supervisees a mechanism for self-correction.

^{Velasquez (2017}) pointed to a lack of standardization in the supervision structure offered in more than half of postgraduate courses in Brazil. The use of recorded sessions does not appear to be a common practice in supervision in the country. It is also common for clinical supervisors to be hired based on their clinical experience and academic background, with specific training in supervision and meta-supervision being an uncommon requirement. Similarly, ^{Watkins et al. (2021}) aimed to analyze some of the obstacles that have apparently prevented supervision research from advancing more effectively in Brazil, noting that such recommendations and/or guidelines are not put into practice. Finally, ^{Weck et al. (2016}) found that the therapeutic relationship and clinical competencies were greater among therapists supervised using BITE (in which the supervisor provides written instructions through a visual display simultaneously during the supervisee’s session) than in DVB (video-based supervision).