Moderation Effects of Supervisee Levels on the Relationship Between Supervisory Styles and the Supervisory Working Alliance

Dan Li

Supervisee development is integral to counselor training. Despite the general acknowledgement that supervisors adopt different styles when supervising counselor trainees at varying levels, there is a paucity of studies that (a) measure supervisee levels using reliable and valid psychometric instruments, other than a broad categorization of supervisees based on their training progression (e.g., master’s level vs. doctoral level, practicum vs. internship, counselor trainee vs. postgraduate); and (b) empirically document how the matching of supervisory styles and supervisee levels relates to supervision processes and/or outcomes. The supervisory working alliance is key to the supervision process and outcome. To test the hypothesized moderation effects of supervisee levels on the relationship between supervisory styles and the supervisory working alliance, the author performed a series (n = 16) of moderation analyses with a sample (N = 113) of master’s- and doctoral-level counseling trainees and practitioners. Results suggested that supervisee levels and their three indicators (self and other awareness, motivation, and autonomy) were statistically significant moderators under different contexts. These findings (a) revealed extra intricacies of the relationships among the study variables, (b) shed light on future research directions concerning supervisee development, and (c) encouraged supervisors to adopt a composite of styles to varying degrees to better foster supervisee growth.

Keywords: supervisee development, supervisory styles, supervisory working alliance, supervisee levels, moderation analyses

Clinical supervision is integral to promoting counseling supervisees’ learning (Goodyear, 2014), safeguarding the quality of professional services offered to supervisees’ clients, and gatekeeping the counseling profession (Bernard & Goodyear, 2019). Because supervisors and supervisees are two parties of the tripartite entity of supervision, literature has extensively documented supervisor characteristics (e.g., supervisory styles, self-disclosure, cultural humility), supervisee characteristics (e.g., professional development levels), and the relationship between the two (e.g., supervisory working alliance) as related to supervision processes and outcomes (King et al., 2020; Ladany, Walker, & Melincoff, 2001; Stoltenberg & McNeill, 2010).

Of these relationships, research has consistently revealed a positive correlation between supervisory styles and the supervisory working alliance (Efstation et al., 1990; Heppner & Handley, 1981; Ladany & Lehrman-Waterman, 1999; Ladany, Walker, & Melincoff, 2001). Although such direct positive correlation is theoretically appealing and statistically compelling, there is limited research that further investigates the intricacy of this association, if at all (e.g., whether the direction or strength of this relationship may alter in different contexts). Particularly, abundant supervision literature (Friedlander & Ward, 1984; Li et al., 2018; Li et al., 2019; Li, Duys, & Granello, 2020; Li, Duys, & Vispoel, 2020; Stoltenberg & McNeill, 2010) suggested the adoption of different supervision approaches when working with supervisees at various levels of professional development. Therefore, supervisee levels present as a potential context to examine how supervisory styles relate to the supervisory working alliance.

However, supervisee levels are frequently conceptualized based on supervisees’ training progression (e.g., master’s level vs. doctoral level, practicum vs. internship, counselor trainee vs. postgraduate), which may not accurately approximate where supervisees are. As such, I adopted the Supervisee Levels Questionnaire-Revised (SLQ-R; McNeill et al., 1992), a reliable and valid psychometric instrument, to measure supervisee levels (collectively as an overall assessment and separately with their three indicators) in this study.

Supervisory Styles
     Supervisory styles embody a constellation of behavior patterns that supervisors exhibit in establishing a working relationship with supervisees (Hunt, 1971) and are related to the interactional pattern that is fostered by supervisors in a direct or indirect manner (Munson, 1993). Specifically, supervisory styles encompass supervisors’ consistent focus in supervision, the manner in articulating their theoretical orientation, as well as the philosophy of practice and supervision and how it is communicated to supervisees (Munson, 1993). Friedlander and Ward (1984) identified three distinctive factors that correspond to three supervisory styles—attractive, interpersonally sensitive, and task-oriented—as measured by the Supervisory Styles Inventory (SSI) used in the present study. Attractive style supervisors appear to be warm, supportive, friendly, open, and flexible, denoting the collegial dimension of supervision; the interpersonally sensitive style is a relationship-oriented approach, and supervisors of this style tend to be invested, committed, therapeutic, and perceptive; and task-oriented supervisors are content-focused, goal-oriented, thorough, focused, practical, and structured (Friedlander & Ward, 1984). These styles resonate with the consultant, counselor, and teacher roles of the supervisor, respectively, in Bernard’s (1997) discrimination model.

Of the three styles, the interpersonally sensitive and task-oriented styles appear to be empirically distinct from one another and distinct from the attractive style (Shaffer & Friedlander, 2017). For instance, Li, Duys, and Vispoel (2020) studied 34 supervisory dyads and found the interpersonally sensitive style was the only discriminant variable, based on which supervisory dyads exhibited statistically different state-transitional patterns (i.e., movement patterns across six common supervision states). Earlier, Fernando and Hulse-Killacky (2005) also found this same style was the only predictor that uniquely and significantly explained supervisees’ satisfaction with supervision, but the task-oriented style was the only significant predictor in explaining supervisees’ perceived self-efficacy.

Supervisory Working Alliance
     Park et al.’s (2019) meta-analysis indicated that the supervisory working alliance was positively related to supervision outcome variables. Bordin (1983) first coined the concept of the supervisory working alliance as a parallel concept to the therapeutic working alliance and introduced the three aspects of the therapeutic working alliance to the alliance in supervision—mutual agreements on the goals, tasks, and bond—which laid the foundation for the adapted Working Alliance Inventory (WAI; Bahrick, 1989) for both supervisors and supervisees. Efstation et al. (1990) instead used three supervisor factors (client focus, rapport, and identification) and two supervisee factors (rapport and client focus) to conceptualize the supervisory working alliance in their Supervisory Working Alliance Inventory (SWAI). In view of the collinearity issue for the goal and task dimensions in the WAI (Hatcher et al., 2020), I adopted the SWAI in the present study.

The working alliance is one of the most robust predictors of outcome in psychotherapy (Norcross, 2011). Although such robust prediction cannot be directly replicated in supervision between the supervisory working alliance and supervision outcome (Goodyear, 2014), scholars (DePue et al., 2016; DePue et al., 2022) have found the supervisory working alliance to be related to the therapeutic working alliance. Specifically, supervisees’ perception of the supervisory working alliance was positively related to their perception of the therapeutic alliance (DePue et al., 2016). However, supervisees’ perception of the supervisory working alliance did not significantly contribute to clients’ perception of the therapeutic working alliance (DePue et al., 2016).

Supervisory Styles and the Supervisory Working Alliance
     Extensive research has documented a close relationship between supervisory styles and the supervisory working alliance (Efstation et al., 1990; Heppner & Handley, 1981; Ladany, Walker, & Melincoff, 2001; Shaffer & Friedlander, 2017). Broadly, as supervisees perceived a greater mixture of supervisory styles in their supervisors (i.e., higher ratings on all three styles; Ladany, Marotta, & Muse-Burke, 2001), supervisees were more likely to report a stronger supervisory working alliance (Li et al., 2021). Despite this global positive correlation, when scholars examined each style independently in relation to each dimension of the supervisory working alliance, such statistical significance was not consistent (Ladany, Walker, & Melincoff, 2001). For instance, in Ladany, Walker, and Melincoff’s (2001) study, participants’ perceptions of an attractive style uniquely and significantly accounted for their perceptions of the bond dimension in alliance, whereas both the interpersonally sensitive and task-oriented styles had this unique and significant association with the task dimension in alliance.

The Moderating Role of Supervisee Levels
     It is not uncommon for a counselor supervisor to start supervision with an expectation of a supervisory style to use (Hart & Nance, 2003). But supervisors have to decide what to address with the supervisee and adopt the most functional style (Bernard, 1997), which could be subject to a myriad of factors, such as contextual factors (Holloway, 1995), cultural considerations (Li et al., 2018), and supervisees’ developmental levels and needs (Friedlander & Ward, 1984; Stoltenberg & McNeill, 2010), among others. Particularly, in Friedlander and Ward’s (1984) study, supervisory styles were differentially related to supervisees’ experience levels. For example, supervisors reported that they were more task-oriented with practicum students but more attractive and interpersonally sensitive with internship students. This interaction effect was also echoed by practicum students’ higher ratings on the task-oriented style but lower ratings on the interpersonally sensitive style, compared to their internship counterparts (Friedlander & Ward, 1984). Similarly, in the study conducted by Li, Duys, and Granello (2020), supervisory dyads with less experienced supervisees tended to be more preoccupied with foundational competencies (e.g., counseling skills and theories, maintenance of standards of service) than dyads with more experienced supervisees. Consistently, more experienced supervisees in Li et al.’s (2019) study were more likely to display positive social emotional behaviors (e.g., self-disclosure, empathy, reflection of feelings, expanding on supervisors’ ideas, praise) in response to supervisors’ opinions, which in turn were more likely to elicit supervisors’ opinions that helped facilitate supervisees’ growth.

However, supervisees’ developmental levels were not always significantly associated with supervision processes or outcomes. For instance, in Bucky et al.’s (2010) study, doctoral-level supervisees did not rate their supervisor characteristics as related to the supervisory working alliance differently based on their developmental levels. Nevertheless, researchers in that study (Bucky et al., 2010) gauged supervisees’ developmental levels based on supervisees’ training progression (i.e., the current level or year level) as commonly practiced (e.g., practicum vs. internship), which may not accurately capture the actual developmental levels of supervisees. Or supervisee levels may not be strikingly distinct in doctoral programs, at least in that sample. In this study, supervisee levels were conceptualized not only as an overall assessment of where supervisees are but with three dimensions (self and other awareness, motivation, and autonomy) aligned with Stoltenberg and McNeill’s (2010) integrative developmental model (IDM) using the Supervisee Levels Questionnaire-Revised (SLQ-R; McNeill et al., 1992).

Statement of Purpose
     Although literature evidenced the overall positive correlation between supervisory styles and the supervisory working alliance, the direction and strength of such a relationship in different contexts warrants additional attention. Particularly, supervisees’ developmental progression entails a flexible mixture of different supervisory styles as suggested theoretically and empirically, but whether and how the relationship between supervisory styles and the supervisory working alliance may vary across different supervisee levels calls for further investigation. To this end, the purpose of the current study was to test the potential moderation effects of supervisee levels on the relationship between supervisory styles and the supervisory working alliance.

Given that supervisees at earlier stages of professional development may need more guidance and support from supervisors, which necessitates a variety of supervision styles that are critical to their perception of the working alliance with their supervisors, I hypothesized that the positive relationship between supervisory styles and the supervisory working alliance would be more sensitive for supervisees at earlier stages of development, compared to their more experienced counterparts. In other words, the positive relationship would be stronger for supervisees at lower levels of professional development and weaker for supervisees at higher levels of professional development.

Method

Participants
     The data set of this study is part of a larger national quantitative study with a cross-sectional sample (Li et al., 2021). Yet, researchers have not examined supervisee levels that are crucial to measuring supervisee development using a robust psychometric instrument. The current sample comprised 113 participants (see Table 1), with the majority as master’s-level (n = 54, 47.79%) or doctoral-level students (n = 46, 40.71%). Approximately 17% of participants (n = 19) identified themselves as post-master’s or post-doctoral practitioners or other. Some participants reported both their training and practicing levels (e.g., both as a doctoral student and a post-master’s practitioner), which caused the sample size to be larger than 113 if simply adding the frequencies across the three categories together. Most participants reported their specialty areas in clinical mental health counseling (n = 53, 46.90%), school counseling (n = 43, 38.05%), and counselor education and supervision (n = 27, 23.89%). Because some participants indicated more than one specialty area, the total percentage did not add up to 100.

In this sample, approximately 80% were female (n = 90) and 23 were male (20.35%). At the time of filling out the questionnaire, most of them fell in the 21–30 age range (n = 72, 63.72%), with 19 in the 31–40 range (16.81%), 13 in the 41–50 range (11.50%), and nine beyond 50 years old (7.96%). Participants in this sample predominantly identified themselves as White (n = 97; 85.84%), with eight as Asian (7.08%), five as Black or African American (4.42%), one as American Indian and Alaska Native (0.88%), one as biracial or multiracial (0.88%), and one indicating other (0.88%). Most participants reported their counseling experience as 1 year or less (n = 44, 38.94%) or longer than 3 years (n = 37; 32.74%), with the rest reporting in between (n = 32, 28.31%). See Table 1 for more detailed demographic information.

Procedure
     Upon receiving IRB approval, I started collecting data online through Qualtrics in 2017–2018. The recruitment criteria included (a) one is at least 18 years of age by the time of filling out the survey; and (b) one is a student or a practitioner who had supervision experience in the counseling field. I disseminated the recruitment post through several professional networks, including the Counselor Education and Supervision Network-Listserv (CESNET-L) and American Counseling Association (ACA) Connect. In addition to this convenience sampling, I also used snowball sampling because participants were encouraged to share the recruitment post with anyone who they thought might be eligible to participate in the study. The recruitment post contained a survey link that directed potential participants to the informed consent webpage and then a compiled questionnaire webpage.

Instruments
Demographic Questionnaire
     The purpose of including this self-constructed Demographic Questionnaire was to report the basic demographic information of participants. Specifically, the questionnaire included the gender, age, race/ethnicity, length of counseling-related work experience, training/practicing level, and training or specialty area of participants.

Supervisory Styles Inventory
     The SSI (Friedlander & Ward, 1984) is a 33-item instrument used to measure the degree to which one endorses descriptors representative of each of the three dimensions of supervisory style: Attractive (7 items), Interpersonally Sensitive (8 items), and Task-Oriented (10 items), with the remainder as the filler items (8 items). Participants rate each item along a 7-point Likert scale from 1 (not very) to 7 (very). Higher scores in each dimension mean that one endorses descriptors of a certain supervisory style to a larger extent. Sample items for the Attractive, Interpersonally Sensitive, and Task-Oriented subscales are “supportive,” “perceptive,” and “didactic,” respectively.

Friedlander and Ward (1984) reported the Cronbach’s alphas of the three subscales separately and combined ranged from .76 to .93 (Ns ranging from 105 to 202). Additionally, the item–scale correlations ranged from .70 to .88 for the Attractive subscale, from .51 to .82 for the Interpersonally Sensitive style, and from .38 to .76 for the Task-Oriented scale (N1 = 202, N2 = 183; Friedlander & Ward, 1984). The test-retest reliability (N = 32) for the combined scale was .92; they were .94, .91, and .78 for the Attractive, Interpersonally Sensitive, and Task-Oriented subscales, respectively (Friedlander & Ward, 1984). They also reported the convergent validity based on moderate to high positive relationships (ps < .001) between the SSI and Stenack and Dye’s (1982) measure of supervisor roles (i.e., consultant, counselor, and teacher; N = 90). In the present study, the Cronbach’s alpha was .96 for the Attractive style, .94 for the Interpersonally Sensitive style, .92 for the Task-Oriented style, and .96 for the entire measure.

Supervisory Working Alliance Inventory
     The SWAI (Efstation et al., 1990) is used to measure the relationship in counselor supervision. It has both the supervisor and supervisee forms. The supervisee form applied to the current study includes two scales: Rapport (12 items) and Client Focus (7 items). Supervisees indicate the extent to which the behavior described in each item seems characteristic of their work with their supervisors on a 7-point Likert scale, with 1 being almost never and 7 being almost always. Higher scores in the Rapport scale indicate a stronger perceived rapport with their supervisor, and higher scores in the Client Focus scale suggest more attention to issues related to the client in supervision. A sample item for the Rapport scale is “I feel free to mention to my supervisor any troublesome feelings I might have about him/her.” A sample item for the Client Focus scale is “I work with my supervisor on specific goals in the supervisory session.”

Efstation et al. (1990) reported that the alpha coefficient was .90 for Rapport and .77 for Client Focus (N = 178) for the supervisee form. Moreover, the item–scale correlations ranged from .44 to .77 for Rapport, and from .37 to .53 for Client Focus. They used the SSI to obtain initial estimates of convergent and divergent validity for the SWAI (Efstation et al., 1990). As expected, the Client Focus dimension of the SWAI showed moderate correlation (r = .52) with the Task-Oriented style in the SSI supervisee’s form, but low correlation (r = .04) with the Attractive style and low correlation (r = .21) with the Interpersonally Sensitive style. The Rapport dimension from the SWAI had low correlation (r < .00) with the Task-Oriented style of the SSI. In the present study, the Cronbach’s alpha was .95 for Rapport, .90 for Client Focus, and .96 for the entire scale.

Supervisee Levels Questionnaire-Revised
     The Supervisee Levels Questionnaire-Revised (SLQ-R; McNeill et al., 1992) is used to measure supervisees’ developmental levels (Stoltenberg & Delworth, 1987). It has 30 items developed around three dimensions: Self and Other Awareness (12 items), Motivation (8 items), and Dependency-Autonomy (10 items). Supervisees can indicate their current behavior along a 7-point Likert scale, with 1 representing never, 2 rarely, 3 sometimes, 4 half the time, 5 often, 6 most of the time, and 7 always. Higher scores (after reverse-scoring for some of the items) in these dimensions reflect higher levels of supervisee development in Self and Other Awareness, Motivation, and Autonomy, respectively. A sample item for the Self and Other Awareness dimension is “I feel genuinely relaxed and comfortable in my counseling/therapy sessions”; a sample item (reverse-scoring) for the Motivation dimension is “The overall quality of my work fluctuates; on some days I do well, on other days, I do poorly”; and a sample item for the Dependency-Autonomy dimension is “I am able to critique counseling tapes and gain insights with minimum help from my supervisor.”

McNeill et al. (1992) reported that the Cronbach alpha coefficients of the SLQ-R (N = 105) were .83, .74, and .64 for the three subscales, respectively, and .88 for the total scores. To assess the construct validity of the SLQ-R, they examined the differences in subscale and total scores across the beginning, intermediate, and advanced groups. Hotelling’s test of significance indicated that the three groups differed significantly both on the total SLQ-R scores, F(2, 102) = 7.37, p < .001, and on a linear combination of SLQ-R subscale scores, F(6, 198) = 2.45, p < .026. In the present study, the Cronbach’s alpha was .89 for Self and Other Awareness, .85 for Motivation, .57 for Autonomy, and .91 for the entire measure.

Data Analysis
     To thoroughly test the potential moderation effects of supervisee levels on the relationship between supervisory styles and the supervisory working alliance, I carried out three rounds of moderation analysis in which the supervisory working alliance was always the outcome variable. In the first round (n = 1), supervisory styles as a whole were the predictor, and supervisee levels as a whole were the moderator. The second round (n = 6) involved two series of analyses. In the first series (n = 3), each supervisory style was the predictor, and supervisee levels as a whole were the moderator. In the second series (n = 3), supervisory styles as a whole were the predictor, and each indicator of supervisee levels was the moderator. In the third round (n = 9), each supervisory style was the predictor, and each indicator of supervisee levels was the moderator. Figure 1 presents path diagrams of three rounds of tests and Table 2 lists all tested models (n = 16).

I followed up each significant moderation effect (n = 5) with a simple slopes analysis (Aiken & West, 1991) to interpret the nature of the interaction effect. The PROCESS v4.0 tool in SPSS was employed to perform all these analyses. A total of 166 potential participants accessed the survey, but only 113 of them completed all the study instruments (SSI, SWAI, and SLQ-R) in the present study. To alleviate the impact of significantly incomplete responses, I removed the 53 respondents who left at least one instrument unanswered. The a priori power analysis via G*Power 3.1.9.7 indicated that the minimum sample size would be 55 to detect an interaction effect with a medium effect size (f 2 = .15), given the desired statistical power level of .80 and type I error rate of .05. As such, the ultimate sample size of 113 meets this requirement.

I made the linearity and homoscedasticity assumptions using the zpred vs. zresid plot, which did not show a systematic relationship between the predicted values and the errors in the model (Field, 2017). Provided that participants independently filled out the study survey, I held the assumption of independence that the errors in the model were not dependent on each other. Further screening detected 12 missing values scattered across the three scales, which accounted for 0.13% of the entire 9,266 possible values. To determine the nature of these missing values, I performed the Little’s test (1988), and the results signified that these values were missing completely at random (MCAR; χ2 = 884.185, df = 890, p = .549). Because multiple imputation (MI; Schafer, 1999) can provide unbiased and valid estimates of associations based on information from the available data and can handle MCAR (Pedersen et al., 2017), I adopted MI to replace the missing values before performing further analyses in this study.

Results

Results of this study in part supported my broad hypothesis that the positive relationship between supervisory styles and the supervisory working alliance would be more sensitive for supervisees at earlier stages of development, compared to their more experienced counterparts. Examining each supervisory style and each indicator of supervisee levels independently revealed the intricacy of the relationship between the two constructs.

There were two groups of major findings. First, supervisee levels as a whole were a significant moderator between the interpersonally sensitive style and the supervisory working alliance according to supervisees’ perceptions, ΔR2 = .0272, F(1, 109) = 7.8551, p = .006, with a small to medium effect size
(f 2 = .07; Lorah & Wong, 2018). Specifically, the strength of the relationship between the interpersonally sensitive style and the supervisory working alliance differed based on supervisee levels (see Table 3).

In view of this significant moderation effect, I conducted a simple slopes analysis as a follow-up, which indicated that the simple slopes for 1 standard deviation (SD) below the mean, at the mean, and 1 SD above the mean of supervisee levels were 1.6185, 1.4019, and 1.1853, respectively (see Figure 2). In other words, the interpersonally sensitive style and the supervisory working alliance were positively associated (B = 1.4019, p < .001), but the strength of this correlation decreased as supervisees reported higher levels of professional development. It is worth noting that supervisees at higher developmental levels tended to report a stronger supervisory working alliance in general, compared to those at lower levels. The linear model of the interpersonally sensitive style, supervisee levels, and the product of the two (interpersonally sensitive style × supervisee levels) explained 62.31% (p < .001) of the variance in the supervisory working alliance. A further look into the moderation effect of supervisee levels indicated that statistical significance consistently persisted as each indicator of supervisee levels (self and other awareness, motivation, and autonomy) was independently tested as a moderator between the interpersonally sensitive style and the supervisory working alliance (see Round 3 in Table 2).

Figure 2
Moderation Effect of Supervisee Levels With the Interpersonally Sensitive Style on the Supervisory Working Alliance

Note. N = 113. Predictor = Interpersonally Sensitive Style; Moderator = Supervisee Levels; Outcome = Supervisory Working Alliance. The three lines of color represent three regressions with the interpersonally sensitive style as predictor and the supervisory working alliance as outcome at different supervisee levels. The blue regression line denotes the group in which supervisee levels were one standard deviation (SD) below the mean, the green denotes the group in which supervisee levels were at the mean, and the pink denotes the group in which supervisee levels were one SD above the mean.

The second major finding was about the task-oriented supervisory style. When the three indicators of supervisee levels were independently examined as moderators, it was found that self and other awareness moderated the relationship between the task-oriented style and the supervisory working alliance, ΔR2 = .0311, F(1, 109) = 5.0639, p = .0264, with a small to medium effect size (f 2 = .05; Lorah & Wong, 2018). Similar to the first group of findings, the strength of the relationship between the task-oriented style and the supervisory working alliance varied based on the level of supervisee self and other awareness (one indicator of supervisee levels; see Table 4). A simple slopes analysis signified a consistent pattern—the task-oriented style and the supervisory working alliance were positively correlated, but the strength of this relationship decreased as supervisees rated higher on self and other awareness (see Figure 3). Specifically, the simple slopes for one SD below the mean, at the mean, and one SD above the mean of supervisee self and other awareness were 1.2620, 0.9540, and 0.6460, respectively. The area below the moderator (self and other awareness) value of 13.3857 constituted a region of significance in which the relationship between the task-oriented style and the supervisory working alliance was significant (p < .05; Johnson & Neyman, 1936). The linear model of the task-oriented style, supervisee self and other awareness, and the product of the two (task-oriented style × self and other awareness) accounted for 33.13% (p < .001) of the variance in the supervisory working alliance.

Discussion

Findings of the present study corroborated the positive correlation between supervisory styles and the supervisory working alliance that has been consistently identified in the existing literature (Efstation et al., 1990; Heppner & Handley, 1981; Ladany & Lehrman-Waterman, 1999; Ladany, Walker, & Melincoff, 2001). The intricacy of this relationship was further explored, and the current study confirmed that the strength of such correlation varied across different contexts. Supervisee levels and their three indicators turned out to be significant moderators in five models out of the 16 tested. Explicitly, the positive correlation between the interpersonally sensitive style and the supervisory working alliance was stronger for supervisees at lower levels of professional development but weaker for supervisees at higher levels. Furthermore, this significant moderation effect existed not only when supervisee levels were viewed as an overarching construct but when each indicator of supervisee levels was independently examined. Moreover, this moderation pattern was echoed by the positive association between the task-oriented style and the supervisory working alliance, wherein the correlation was stronger for supervisees at lower levels of self and other awareness (one indicator of supervisee levels) but weaker for those at higher levels of self and other awareness. Notably, supervisees at higher developmental levels (including indicators of supervisee levels) in all models with significant moderation effects reported a stronger supervisory working alliance than did their counterparts at lower levels.

According to developmental theories of supervision, supervisees broadly progress through a series of qualitatively different levels in the process of becoming effective counselors, despite myriad individual idiosyncrasies (Chagnon & Russell, 1995; Stoltenberg & McNeill, 2010). Entry-level supervisees typically focus on their own anxiety, their lack of skills and knowledge, and the likelihood that they are being regularly evaluated (Stoltenberg & McNeill, 2010). Accordingly, beginning supervisees identified supervisor care and concern as one of the most important supervisor variables to allow supervisees to take risks and grow (Jordan, 2007). As such, interpersonally sensitive supervisors who are invested, committed, therapeutic, and perceptive (Friedlander & Ward, 1984) would be easily perceived as relationship-oriented and helpful in rapport building (one indicator of the supervisory working alliance) for supervisees early on in their training. Similarly, task-oriented supervisors are content-focused, goal-oriented, thorough, focused, practical, and structured (Friedlander & Ward, 1984).


Figure 3
Moderation Effect of Self and Other Awareness With the Task-Oriented Style on the Supervisory Working Alliance

Note. N = 113. Predictor = Task-Oriented Style; Moderator = Self and Other Awareness; Outcome = Supervisory Working Alliance. The three lines of color represent three regressions with the task-oriented style as predictor and the supervisory working alliance as outcome at different levels of self and other awareness (one indicator of supervisee levels). The blue regression line denotes the group in which supervisee self and other awareness was one standard deviation (SD) below the mean, the green denotes the group in which supervisee self and other awareness was at the mean, and the pink denotes the group in which supervisee self and other awareness was one SD above the mean.

Task-oriented supervisors can be perceived as particularly helpful and informative with client focus (a second indicator of the supervisory working alliance) for beginning supervisees (as indicated by their lower self and other awareness) who commonly experience substantial anxiety or fear pertaining to their lack of confidence in knowing what to do, being able to do it, and being evaluated by their clients or supervisors (Stoltenberg & McNeill, 2010).

Therefore, supervisees at lower levels of professional development were more likely to report a stronger supervisory working alliance as they perceived more interpersonally sensitive or task-oriented supervisor characteristics. As they progress to higher levels of development with accumulated knowledge, skills, and competencies, supervisees become more aware of clients and themselves, intrinsically and consistently motivated, and autonomous as practitioners (Stoltenberg & McNeill, 2010), which may in part explain why their ratings of the supervisory working alliance were less related to their perceptions of supervisor characteristics but generally higher than supervisees at lower levels of development.

In the present study, the moderator of supervisee levels as a composite score was only significant when the interpersonally sensitive style was the predictor; the moderator of self and other awareness (one indicator of supervisee levels) was also significant when the task-oriented style was the predictor. These findings resonated with the existing literature in that compared to the attractive style, the interpersonally sensitive and task-oriented styles tend to have stronger discriminating effects (Friedlander & Ward, 1984). For instance, practicum and internship students differed significantly in rating the task-oriented and interpersonally sensitive styles of their supervisors, but their perceptions about the attractive style were similar at both levels (Friedlander & Ward, 1984). Li, Duys, and Vispoel (2020) also found that supervisory state–transitional patterns differed significantly only based on the interpersonally sensitive style but not the other two styles.

Implications for Clinical Supervision
     The supervisory working alliance is inextricably intertwined with supervisees’ willingness to disclose (Ladany et al., 1996), supervisee satisfaction with clinical supervision (Cheon et al., 2009; Ladany, Ellis, & Friedlander, 1999), supervisee work satisfaction and work-related stress (Sterner, 2009), and therapeutic working alliance (DePue et al., 2016; DePue et al., 2022), among others. Nelson et al. (2001) proposed that a key task in early supervision is to build a strong supervisory working alliance that serves as a foundation to manage future potential dilemmas in supervision, and the ongoing maintenance of this working alliance should be the supervisor’s responsibility throughout the supervisory relationship. Although the three supervisory styles appear to be clear-cut with distinguishable characteristics and roles (Friedlander & Ward, 1984), supervisors are encouraged to adopt a composite of different styles to varying degrees to better serve supervisees’ needs. As revealed by the present study, and also the extant literature (Efstation et al., 1990; Ladany, Walker, & Melincoff, 2001; Li et al., 2021), supervisees were more likely to report a stronger supervisory working alliance as they perceived their supervisors to adopt a mixture of three supervisory styles (i.e., higher overall ratings of supervisory styles).

Particularly, beginning supervisees are characteristic of a strong focus on self, extrinsic motivation, and high dependency on supervisors (Stoltenberg & McNeill, 2010). Supervisors’ emphases on relationship-building (interpersonally sensitive style) and task focus (task-oriented style) would help build a safe, predictable supervision environment and enhance the working alliance with supervisees. Notably, although the strengths of the correlation between the interpersonally sensitive or task-oriented style and the supervisory working alliance were stronger for beginning supervisees, they did not suggest that these styles would not be effective in augmenting the alliance for supervisees at higher levels of professional development. The positive correlations still existed, albeit smoother, for more advanced supervisees, and they reported higher levels of supervisory working alliance in general, which may imply that these styles help maintain the working alliance that has been established early on in supervision.

Another point that is worth noting is that although no significant moderator was detected between the attractive style and the supervisory working alliance in the present study, the attractive style explained the most variance (68.1%, p < .001) in the supervisory working alliance, compared to the interpersonally sensitive (55.9%, p < .001) and task-oriented styles (24.1%, p < .001). This finding made it clear that the warm, supportive, friendly, open, and flexible features of attractive style supervisors are foundational to building and maintaining the supervisory working alliance, which does not differentiate across different levels of supervisees. As such, supervisors are encouraged to bring these qualities to their supervision and make them perceived by supervisees.

Limitations and Future Research
     This study is not exempt from limitations that may be addressed in future research. Although two moderators (supervisee levels, self and other awareness) were found to be significant in the present study, the effect sizes of both were small to medium (f 21 = .07 and f 22 = .05), which were lower than the speculated medium effect size (f 2 = .15) during the a priori power analysis. Provided the effect sizes of .07 and .05 for the moderation effect, to achieve the statistical power of .80 with the α error probability of .05, the required sample size would be 115 and 159, respectively. Researchers need to be more mindful when recruiting participants to ensure the sufficient sample size. Additionally, although supervisees were asked to respond to the questionnaires consistently based on their perceptions of one supervisor, a constellation of factors could have affected their perceptions—for example, the timing of a participant’s supervisee status (e.g., currently receiving supervision vs. received supervision in the past), the potential dual role that a participant may be in (e.g., a doctoral student who is both a supervisee and a supervisor), the level of supervision (e.g., practicum, internship), and the length of the supervisory relationship (e.g., 2 months vs. 2 years). Researchers in future studies could also collect more information about participants (e.g., geographic distribution) to help readers better contextualize study results. Also, the current data set was collected in 2017–2018, which would not be able to capture more recent societal, cultural, political, and economic changes (e.g., the COVID-19 pandemic) that could have affected supervisee perceptions.

In the present study, the association between supervisory styles and the supervisory working alliance was examined in the context of different supervisee levels. Indeed, this alliance could be subject to many other factors, such as discussions of cultural variables in supervision (Gatmon et al., 2001), supervisor adherence to ethical guidelines (Ladany & Lehrman-Waterman, 1999), and relational supervision strategies (Shaffer & Friedlander, 2017), among others. Scholars may include more related variables to expand the current model so as to further disentangle the complex relationships among predictors of the supervisory working alliance.

Last, although multiple moderation effects identified in the present study were statistically significant and theoretically coherent, exactly how supervisees experience the supervisory working alliance in relation to different supervisory styles as they proceed along the professional development is less known. A longitudinal track of the same sample using repeated measures or a qualitative inquiry into participants’ lived experiences of the targeted phenomenon could enrich our understanding of the study variables in this research.

Conclusion

Although the positive correlation between supervisory styles and the supervisory working alliance is well documented in the existing literature, the present study examined such relationships specifically in the context of supervisee levels. Both supervisee levels (as a whole) and self and other awareness (one indicator of supervisee levels) appeared to be significant moderators under different contexts. These findings further revealed the intricacies embedded in the broad relationship between supervisory styles and the supervisory working alliance, pointed out future research directions concerning supervisee development, and encouraged supervisors to adopt a composite of styles to varying degrees to better support supervisee growth.

Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.

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Dan Li, PhD, NCC, LSC (NC, K–12), is an assistant professor of counseling at the University of North Texas. Correspondence may be addressed to Dan Li, Welch Street Complex 2-112, 425 S. Welch St., Denton, TX 76201, Dan.Li@unt.edu.

Book Review—Complex Integration of Multiple Brain Systems in Therapy

by Beatriz Sheldon and Albert Sheldon

 

Beatriz Sheldon, MEd, and her partner, Albert Sheldon, MD, describe their novel therapeutic approach, Complex Integration of Multiple Brain Systems (CIMBS), in this new publication. Throughout the book, references are made to the Sheldons’s 20 years of working together, 15 years of clinical experience, and 10 years of training other practitioners in CIMBS therapy. The authors emphasize that they “are practical, empirical therapists” (p. xvii). The book is seeded with references to scientists who inspire the duo, especially Daniel J. Siegel, Joseph LeDoux, Antonio Domasio, and the late Jaak Panksepp. It must be noted that CIMBS therapy as laid out in this text contains no peer-reviewed qualitative or quantitative studies; instead, the authors utilize vignettes to discuss their methods.

The brain systems referred to in CIMBS are organized into sections much like those of the triune brain model, with an additional peripheral system in the heart, lungs, and intestines. What the triune brain model labels the lizard brain relates to the primary level, the mammal brain is the secondary level, and the human brain is the tertiary level. The Sheldons assign awareness, attention, authority, autonomy, and agency (the “A Team”) to the conscious tertiary level. The secondary level holds nonconscious, inhibitory systems of fear, grief, shame, and guilt. The primary level, also nonconscious, contains the systems of safe, care, connection, sensory, assertive, play, and seeking.

The patient accesses the hidden strengths of the nonconscious mind via the CIMBS therapist’s use of techniques like Transpiring Present Moment, Go the Other Way, and Initial Directed Activation. Transpiring Present Moment is reminiscent of Fritz Perls’s emphasis on the “here-and-now.” Go the Other Way asks the patient to avoid getting bogged down in traumatic memories and instead reach for personal strengths. The CIMBS therapist cultivates the therapeutic alliance using the Therapeutic Attachment Relationship, which includes physical postures that suggest safety, reminding us of Egan’s SOLER stance taught in many counseling programs. This intervention also recommends intense focus on the patient’s micro-expressions as a guide to their conscious and nonconscious processes. Ultimately, the patient will integrate all 20 brain systems effectively and reach Fail-Safe Complex Network, a new, durable neural structure generating improved mental health.

Although the authors refer several times to the text’s internal contradictions or incongruence, the writing has the same appeal as the work of the Sheldons’s mentor, Dan Siegel, who wrote the Foreword. The book asks readers to lean on their intuition, often reminding them to “trust the process.” Nicola Swaine has provided line drawings to clarify central concepts, much as Siegel uses a curled fist to describe the triune brain. The authors relate that this text was written expressly to provide an overview of the Sheldons’s 16-part CIMBS training series (recorded and live) for students and trainees, who will find the glossary and bibliography especially useful.

In the Foreword, Siegel refers to the “cross-disciplinary framework known as interpersonal neurobiology . . . [using] universal principles discovered by independent pursuits of knowledge” (p xii). It would be useful to know which principles are considered universal in this book. Psychology sits forever on the fence between hard and soft science; some declarations of fact are based on microscopic studies of physical structures, and some are useful models that are at least partly philosophical. This text contains both. Neurologists have observed neural repairs and rerouting; thus, neuroplasticity is a demonstrable fact. The Sheldons describe 20 brain systems while noting that “one could certainly make the case for more or fewer systems” (p. 26). Clearly the number and definition of these brain systems can be thought of as helpful metaphors, a bit like Marsha Linehan describes a “wise mind” that is not a physical structure existing in the brain.

Professional counselors who like eclectic methods and enjoy pulling inspiration from many sources will appreciate CIMBS and this flagship text. The authors caution practitioners not to use CIMBS for patients who struggle with borderline personality disorder or dissociative, bipolar, or psychotic disorders. Although the Sheldons encourage clinicians to practice with their highest-functioning patients, the wise professional counselor will first disclose methods and procedures to patients.

 

Sheldon, B., & Sheldon, A. (2021). Complex integration of multiple brain systems in therapy. W. W. Norton.
Reviewed by: Christine Sheppard, MA, LCPC, NCC
The Professional Counselor
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2021 TPC Outstanding Scholar Award Winner – Concept/Theory

 

 

 

 

 

 

Shaywanna Harris-Pierre, Christopher T. Belser, Naomi J. Wheeler, and Andrea Dennison received the 2021 Outstanding Scholar Award for Concept/Theory for their article,A Review of Adverse Childhood Experiences as Factors Influential to Biopsychosocial Development for Young Males of Color.”

Shaywanna Harris-Pierre, PhD, LPC, is an assistant professor of professional counseling at Texas State University. Her research centers on the psychological and physiological impact of trauma and race-based traumatic stress. Dr. Harris-Pierre serves her community through facilitating free workshops for couples where she provides psychoeducation on communication skills. Dr. Harris-Pierre also serves the counseling profession through her position as secretary for the Association for Assessment and Research in Counseling, and her role as an editorial board member for the Journal of Addictions & Offender Counseling, Counseling Outcome Research and Evaluation, and the Journal of Multicultural Counseling and Development.

Christopher T. Belser, PhD, NCC, is an assistant professor in the counselor education program at the University of New Orleans. He earned his PhD in counselor education and supervision at the University of Central Florida and his MEd in school counseling at Louisiana State University. Dr. Belser has experience in Louisiana public and charter schools as a middle school counselor and a high school career coach. His research interests include school counselor preparation/practice and interdisciplinary P–16 STEM career development initiatives. Dr. Belser has delivered dozens of presentations at local, state, national, and international conferences and has published numerous articles and book chapters on counseling and career-related topics. He is the current associate editor of the Journal of Child & Adolescent Counseling, served as Chi Sigma Iota’s 2020–2021 Edwin Herr Fellow, and previously won The Professional Counselor’s 2018 Dissertation Excellence Award.

Naomi J. Wheeler, PhD, NCC, LPC, LMHC, is an assistant professor in counselor education and supervision at Virginia Commonwealth University. Her research builds on her professional and clinical experiences to examine relationship health across the life span, including the role of early life family adversity (such as ACEs) and couple stress as contributors to health disparities. Dr. Wheeler is also the co-director for the Urban Education and Family Center at VCU, which serves as a hub for community-engaged research and program services that address educational attainment, economic mobility, and individual and family well-being for historically marginalized populations living in poverty from a two-generational approach. The Center strives to harness research to improve the quality of life for Black and Latinx families in the greater Richmond area through community-based work.

Andrea Dennison, PhD, is an assistant professor at Texas State University.

Read more about the TPC scholarship awards here.

2021 TPC Outstanding Scholar Award Winner – Quantitative or Qualitative Research

 

 

 

 

 

 

 

Fei Shen, Yanhong Liu, and Mansi Brat received the 2021 Outstanding Scholar Award for Quantitative or Qualitative Research for their article, “Attachment, Self-Esteem, and Psychological Distress: A Multiple-Mediator Model.”

Fei Shen, PhD, is a staff therapist at the Barnes Center at the Arch – Counseling at Syracuse University. Her clinical and research interests include attachment and trauma healing. She specifically focuses on understanding the impact and prevention of adverse childhood experiences (ACEs) in marginalized communities, as well as identifying mediating and moderating factors that can protect survivors from the negative effects of trauma.

Yanhong Liu, PhD, NCC, is an associate professor in the Counseling & Human Services Department at Syracuse University. She also serves as the MS in School Counseling P–12 Program Coordinator. Her scholarship centers around marginalized youth and supporting systems. She has published widely and consistently in counseling as well as interdisciplinary journals on the topics of adopted youth, school bullying, school-based programs, and counselor training.

Mansi Brat, PhD, LPC, LMHC, is an adjunct professor at Syracuse University. Dr. Brat’s scholarship focuses on mindfulness-based programs (MBP), social justice, counselor professional identity and advocacy, contemplative sciences, and humanistic psychology. She has published across interdisciplinary journals and is extremely passionate about furthering her research in highlighting the many layers of implicit bias that remain critical in dismantling racism and oppression amongst dominant groups.

Read more about the TPC scholarship awards here.

2022 Dissertation Excellence Awards

In the ninth year of TPC‘s Dissertation Excellence Award program, the award was expanded to include two winning dissertations, one in qualitative research and one in quantitative research. After receiving submissions from across the United States and through implementation of an improved selection process, the committee selected Anabel Mifsud and Chelsey Zoldan-Calhoun to receive the 2022 Dissertation Excellence Awards. Dr. Mifsud received the award in qualitative research for her dissertation entitled Exploring Community- and Society-Level Interventions for Healing Historical Trauma: A Grounded Theory Study, and Dr. Zoldan-Calhoun received the award in quantitative research for her work entitled The Contribution of Spiritual Well-Being to the Self-Efficacy, Resilience, and Burnout of Substance Use Disorder Counselors.

 

Anabel Mifsud, PhD, NCC, is an assistant professor of professional practice in the counselor education program at the University of New Orleans. She earned her PhD in counselor education and supervision from the University of New Orleans and her MSc in health psychology from University College London and King’s College London. Dr. Mifsud’s research interests include historical and intergenerational trauma; multicultural issues; social justice and advocacy; the internationalization of counseling and counselor education; the role of counseling in community healing and development; and behavioral health services for immigrants, refugees, and persons with HIV. She has worked with individuals and couples experiencing homelessness and comorbid issues, persons with HIV, immigrants, and asylum seekers. Dr. Mifsud has presented at local, state, national, and international conferences and seminars and has published articles and book chapters on social justice, immigrants, and counseling ethics.

 

Chelsey Zoldan-Calhoun, PhD, NCC, LPCC-S, LICDC, earned her MSEd in clinical mental health counseling from Youngstown State University and her PhD in counselor education and supervision from the University of Akron. She is an adjunct faculty member in both the Department of Psychological Sciences and Counseling at Youngstown State University and the School of Counseling at the University of Akron. She enjoys teaching courses on diagnosis, counseling interventions, and ethics, as well as supervising counseling trainees during their practicum experiences.

In clinical practice, Dr. Zoldan-Calhoun specializes in the treatment of adults presenting with PTSD, trauma-related issues, and substance use disorders. She is a Certified EMDR Therapist and has a special interest in working with military service members, veterans, and emergency first responders. Additionally, she has a passion for working with both those in recovery from substance use disorders and their loved ones. Dr. Zoldan-Calhoun has experience providing and supervising counseling services in university and community-based mental health and addiction counseling centers across northeastern Ohio.

Dr. Zoldan-Calhoun has contributed numerous book chapters and peer-reviewed journal articles to the professional counseling literature. Her research has focused on spiritual well-being, resilience, and burnout among counselors treating substance use disorders. Dr. Zoldan-Calhoun is a member of the Editorial Review Board of The Professional Counselor and has served on boards for the American Counseling Association, Ohio Counseling Association, and Association for Humanistic Counseling. She is a previous recipient of the Ohio Counseling Association’s Graduate Student Award and the Association for Humanistic Counseling’s Emerging Leader Award.

TPC looks forward to recognizing outstanding dissertations like those of Drs. Mifsud and Zoldan-Calhoun for many years to come.

Read more about the TPC scholarship awards here.