Although the supervision practice has existed since the beginning of the history of humankind, where novice prophets, healers and maestros performed before their mentors expecting feedback and direction, it was not until the mid 20th century when supervision began to be studied and seen as a separate discipline with its body of knowledge and set of particular skills.

Clinical supervision was practiced by Arab physicians (Abouleish, 1998) in the 9th and 10th century of the CE as medical students would follow and consult experienced physicians regarding difficult cases they were facing in their practicum. In the mental health field, clinical supervision started with Freud (1914, 1986), who gathered small group of students and practitioners to discuss pertinent clinical cases. Cabot (1926) introduced specific guidelines to review patient health situations from the psychiatric, social and spiritual perspectives. He advocated the importance of clinical practice and supervision in the process of developing professional skills. Boisen (1931) was convinced that trainees could become competent clinicians as they learn to read “living human documents,” reflect on their experiences with the assistance of senior practitioners and receive systematic feedbacks from supervisors and patients.

Today most helping professions including psychology, counseling, medicine, chaplaincy, and social work require clinicians to undergo rigorous supervision training with the intention of assuring quality of care for both clients and trainees.

Definitions

The conceptualization of clinical supervision remains a challenge because this profession is informed by many disciplines. Clinical supervision uses techniques of counseling, but it is more than that. It takes a lot from group dynamics but it goes beyond group process and group therapy. It takes advantages of the knowledge from psychological consultation, mentoring and coaching but the practice of clinical supervision extends further than this. It utilizes teaching theories and learning techniques but it is more than education. Clinical supervision emphasizes theological thinking and pastoral formation but it reaches more extensively than that. In brief, clinical pastoral supervision is a complex discipline that intends to make this world a better place by equipping helpers with knowledge, skills, attitudes and patterns of relationships conducive to healing and growth.

Clinical Supervision could be defined as a dynamic, collaborative, professional, and reciprocal relationship between a clinical supervisor, a supervisee and the patients/clients seeking care. In this professional relationship, an experienced professional provides consistent observation, relevant feedback, and integrative evaluation to supervisees whom are committed to attain knowledge, define professional identity, improve their skills, deepen their cultural sensitivity, and strengthen their professional relationships and networks. The ultimate purpose of this supervisory relationship is providing high quality ethical care to patients/clients, protecting the wellbeing of the public and enhancing the interest of the profession (Haynes, Corey, and Moulton, 2004; Bernard and Goodyear, 2004).

Clinical supervision is also seen as a mutual relationship between two or more professionals who recognize the magnitude of human complexity and agree that people are better served when their situations are seen from various angles and perspectives. A clinical supervisor is a person who is able to see beyond the obvious, offer his or her assistance to aid supervisees explore motivations, delve into attitudes, observe dynamics and behaviors, conceptualize processes, and listen to emotions as well as implement and maintain changes. A clinical supervisor is a person who learned and is learning simultaneously with patients and mentors the art of seeing beyond the “four fingers”, beyond the obvious, and mutually engaged with supervisees in the process of helping others.

A clinical pastoral supervisor is a person who helps supervisees see beyond the scope, enabling them to “read living human documents” in critical and reflective ways, acquiring understanding, gaining insight and acting ethically and competently in their work with people. A clinical pastoral supervisor is a person trained to help supervisees think, feel, act and reflect theologically on their encounters with “living human documents” and “living relational webs.” A clinical pastoral supervisor is a person who has accepted the calling from the Eternal, the commission from a religious body and the certification from a professional agency to form and equip people in the ministry of pastoral care and counseling.

Literally a clinical pastoral supervisor is a person who has learned at the bedside of human joy and suffering to see beyond the obvious while concentrating on the meaning and dynamics of experiences. This reflective process is done with the intention of assisting supervisees as they help their patients/clients/parishioners grow, develop their potential, and become whole by being connected to self, others, nature, cosmos and the Transcendent.

The Goal of Clinical Pastoral Supervision

Haynes, Corey and Moulton (2004) propose that the goals of clinical supervision are fourfold: (1) promoting supervisee growth and development, (2) protecting the welfare of the client, (3) monitoring supervisee performance and gate keeping for the profession; and (4) empowering the supervisee to self-supervise and carry out these goals as an interdependent professional. In clinical pastoral supervision the goal also includes helping supervisees reflect, feel and act theologically as well as to engage in meaning-making existential inquiries.

Clinical pastoral supervisors who are well informed about human nature, relationship dynamics, counseling and consulting expertise, teaching abilities, ethical decision-making aptitude, multicultural competence, assessment skills and diverse theological dialogues can accomplish these goals. As in most helping professions, a safe and trusting supervisory relationship provides the necessary foundation and context for professional growth.

Competent Clinical Supervisors

Competent clinical pastoral supervisors base their approaches to supervision on a clear cognitive, emotional, experiential and theological map that allows them to effectively help supervisees see beyond the obvious. Competent clinical supervisors are aware of their assumptive world (life experience, training, values, philosophy of life), their theoretical orientation (e.g. behavioral, psychoanalytic, person centered), their roles or style (teacher, mentor, consultant, counselor), and their format or method and their strategies (Falender and Shafraske, 2004; Bernard and Goodyear, 2004).

Competent clinical pastoral supervisors are open to learn and grow along with their supervisees or mentees. They use their capacity for self-reflection and remain open to feedback about their performance from supervisees, clients and peers. Competent clinical pastoral supervisors are willing and committed to create a supervisory relationship that is characterized by trust, respect, mutuality, compassion, integrity and transparence. They enter the supervisory relationship with a hopeful spirit, a gracious attitude, a warm stance, and having in mind the wellbeing of the supervisee, care-seekers and self. They read their relational experiences through theological lenses and adhere to strict ethical practices.

Competent clinical pastoral supervisors respect and value the knowledge and experience that supervisees bring to the supervisory relationship. They provide honest constructive feedback to supervisees in a grateful, loving, respectful, and professional manner. They make a healthy use of power and authority and champion anti-oppressive practices (Frawley-O’Dea and Sarnat, 2000).

Competent clinical pastoral supervisors have a clear professional identity and recognize their limit of practice. They use theories of group dynamics and lead educational and experiential groups and avoid transforming the growth-group experience into group therapy. They use theories and techniques of psychotherapy and counseling, but abstain from making their group and individual supervision into counseling sessions. They use psychological consultation techniques, mentoring strategies, and coaching skills but retain their pastoral identity. They utilize theories and techniques of learning and teaching but respect the path of growth, professional development and pastoral experience of supervisees.

Competent clinical pastoral supervisors are multicultural and multidimensional sensitive by being aware of their own cultural values and biases, understanding and respecting others’ worldviews, possessing a multi-perspective view of life, the world and the cosmos and by developing culturally appropriate intervention strategies and techniques (Arredondo, 1996). Competent clinical pastoral supervisors have a healthy non-hostile, and culturally sensitive sense of humor.

Roles of the Clinical Pastoral Supervisor

The role of the supervisor will vary according to supervisee’s needs. Clinical pastoral supervisors simultaneously offer services such as counseling, consulting, teaching, mentoring, coaching, group leading, and pastoring as ways of helping supervisees to provide effective services to their clients. However, they are aware that the therapeutic effect of these interventions is collateral and not the reason for the clinical supervision.
Clinical pastoral supervisors use techniques of counseling when helping supervisees to deal with issues of personal strengths and limitations, explore transferences issues, and cope with stress and burnout (Haynes, Corey and Moulton, 2004). They use techniques of psychological consultation when assisting supervisees to solve present, particular and caretaking-related problems and prepare for future caring issues. Also, they make use of psychological consultation to provide feedback and evaluation to supervisees regarding performance and goal achievement (Brown, Pryzwansky, and Schulte, 2005).

They utilize strategies of teaching to instruct supervisees on assessment, diagnosis, counseling approaches, ethics, legal issues, supervisory process, and a host of other topics that arise in supervision (Haynes, Corey and Moulton, 2004). In addition, they make use of counseling strategies to help trainees explore and clarify thinking, feeling and fantasies which underlies their pastoral and clinical practice. Clinical pastoral supervisors apply mentoring approaches to provide supervisees with direction and guidance as they assess their current abilities and future goals as clinicians and pastoral educators (Stone, 1998).

Competent clinical pastoral supervisors make use of coaching techniques to show and demonstrate specific pastoral and clinical intervention skills to supervisees as well as to model effective problem-solving abilities. They employ group dynamics strategies to emphasize to supervisees healthy social patterns of relationships and style of functioning in community. In addition, clinical supervisors utilize group process to create a safe and accepting atmosphere within the supervision group that is conducive to meaningful sharing and growth. Clinical pastoral supervisors use a pastoral posture to provide supervisees with opportunities to grow, make meaning, and realize who they are in relationship with the Eternal, others and themselves. Also, they use a pastoral and prophetic posture to invite supervisees to embrace ethical and just approaches to pastoral care (Dayringer, 1998; Pohly, 2001; Montilla and Medina, 2006).

Supervisory Relationship

Humans are social beings that develop, grow and flourish in relation with others. The web of relationships that human beings create for their survival and total wellbeing are as diverse as humankind itself. It is clear that for a relationship to exist respect, mutuality, love and acceptance need to be present. This is not an easy task because people bring into the human relationship a number of things such as culture, illusions, failures, dreams, fantasies and pseudo-expectations that in great manner determine the kind and quality of the relationship (Montilla, 2004).

Relationships tend to be dynamic and growth-oriented; and therefore need the nurturing and continuous care of the parts involved in order to be maintained. The existence of the relationship is dependent on the commitment of supervisors and supervisees to keep it alive. This reciprocal responsibility is the main factor of a relationship. This is important to understand because of the dynamic nature of relationships. There are no universal ways to keep a relationship alive. People involved in the relationship need to create their own ways of nurturing and growing it.

Supervisor-supervisee is a relationship that people have found crucial in the process of sustaining, guiding, supporting and protecting a living community. In this context supervision could be seen as the function a person occupies within a specific setting and with a particular group of people who, in accord, pursue a dream or goal believed to be in the best interest of the community (Montilla and Medina, 2006).

The social nature of supervision entails that people participate in this kind of relationship with their whole being: mind, body and spirit. This holistic experience uses stories and narratives as the main media to keep the people involved in the supervisory relationship. This professional relationship is most effective when practiced with a sense of reciprocity, mutuality and equality.

Most helping processes begin with the development of a professional relationship. This seems to be the necessary foundation and context for personal and professional development. Clinical supervision is about a dynamic, mutual and complex relationship between supervisor, supervisees, and care-seekers characterized by ethical interactions and dialogues intended to provide excellent and relevant care (Frawley-O’Dea, and Sarnat, 2000).

Boisen (1936), referring to the efficacy of psychotherapy, mentions that the relationship between clinician and patient is far more effective than the procedure or technique itself. For Boisen procedures and strategies have their place in the healing process, but relationship is paramount. He states that “psychotherapy is far less dependent upon technique that it is upon the personal relationship between physician and patient. Wherever the patient has come to trust the physician enough to unburden himself of his problems and wherever the physician is ready to listen with intelligent sympathy, good results are likely to follow regardless of the correctness of the physician's particular theories or procedures…The techniques and methods of procedure are...of vanishing importance compared with the qualities of heart and mind, the genuine interest in the patient and his problems, together with the balanced judgment and insight and tact necessary to win the patient’s confidence and establish the rapport which is the sine qua non of all effective psychotherapy work" (pp. 240, 245).

Clinical supervision is about relationship and relationship is about community. Community implies a shared culture and history: a group of equal people who recognize that life is best lived when lived in togetherness and in unity of goal and purpose. This unity, characterized for the diversity of thoughts, ideas, affections, values, principles and social engagements of its members, is at the heart of success or failure. People feel part of the corporate community when their thoughts, values, emotions, and culture are respected and honored. Clinical pastoral supervisors who recognize this reality and commit themselves to uphold the mission and values of the group will have the blessing and support of the community.

Bandura (1997) suggests that integrated communities who cherish a belief in their members’ conjoint capabilities to organize and execute the courses of action required will produce positive results, and accomplish their common goals with joy and persistence. This group or collective efficacy is best displayed when the supervisory relationship is more horizontal and empowering (Jung and Sosik, 2002).

Methods of Clinical Supervision

Clinical pastoral supervision is generally provided through individual and group supervision where many tools or instruments are used to assist trainees or supervisees in their pastoral and professional development. Some of these tools include Case Study Review, Critical Incident Report, Verbatim, Audio-Video recordings, and Interpersonal Process Recall (IPR). Clinical pastoral supervisors encourage a continuous process of self-evaluation with the intention to assess trainees’ strengths and areas of growth, level of professional competence, consultation needs, and celebration of services. Clinical pastoral supervisors provide feedback and evaluation through verbal exchanges, direct observation, live supervision, peer review and written notes (Steere, 2002; Falender and Shafraske, 2004; Estadt, Compton and Blanchette, 2005; Ward, 2006).

Culturally competent clinical pastoral supervisors, when using group supervision, provide appropriate levels of structure and guidance, formulate thought-provoking questions, enhance therapeutic factors operating within the group dynamic, promote meaningful self-disclosure and self reflection while also intervening at critical points to protect members and preserve a climate of safety (Jacobs, Masson and Harvill, 2006). Clinical pastoral supervisors working with diverse populations are most effective when using a more active and direct approach of group supervision (Dies, 1994). Damaging group experiences are more likely to occur if clinical supervisors are passive in respect to protecting members and leading the group (Forsyth, 2006).

A Multicultural Approach to Clinical Supervision

A model or theory implies the mental act of viewing, contemplating, or considering something in a conceptual and systematic way. A clinical supervisor needs a theory that guides his or her practice; otherwise the supervisor will run the risk of being ineffective and a deface professional. A supervisor without a theory cannot effectively understand the process of supervision. A supervision model serves as the theoretical roadmap for developing supervision techniques. In this sense, a model of supervision is a theoretical description of what supervision is and how the supervisee’s learning and professional development occur (Haynes, Corey, Moulton, 2004).

Clinical supervision can be seen as an evolutionary and developmental phenomenon that starts from the idea that human beings are continuously growing and becoming. A developmental approach to clinical supervision implies that people’s attitudes, knowledge and skills change over time. This development occurs in a context of interaction with a learning environment.

Most societies embrace a collectivistic view about life and the world. This cultural attribute needs to be reflected in the clinical supervisory experience. A culturally informed clinical supervisor incorporates theoretical and clinical approaches appropriate to its context. Culturally competent clinical pastoral supervisors respect the worldviews, values and psychological constructs of the people they serve. Therefore, traditional individualistic cultural values upon which most of the supervisory theories and techniques are based need to be viewed with caution as they can be potentially harmful to people and communities who hold collectivistic views (Ivey, D’Andrea, Ivey, M, and Simek-Morgan, 2006).

Traditional Euro-Norte-American supervisory theories and approaches have been very useful, however these paradigms reflect the values of a particular culture, and face challenges when applied outside the ethos in which they were developed. Difficulties can emerge when these models are used to indiscriminately study, understand, teach and treat people who embrace collectivist worldviews. It is therefore important for clinical pastoral supervisors to be familiar with the main tenets of collectivistic societies, with collectivism referring to a way of being in the world where connection to a group or community constitutes the most prevalent feature. This multifaceted cultural construct influences people in terms of identity formation, cognition, motivation, expression of emotions, communication, self-perception, wellbeing, and social connections (Hosftede, 1980; Markus and Kitayama, 1991; Triandis, 1995).

When supervising people ascribing to the collectivistic paradigm, it is important to understand their belief that keeping and nurturing healthy relationships is the main duty of human beings. Under this worldview, the measure of success and excellence is weighed by the quality of the relationships people maintain with their families, community and society. Life satisfaction and realization comes from successfully connecting with others by keeping the social rules, meeting collective expectations, and fulfilling its obligations (Kim, U. Park, Y. & Park, D., 2000). Principles such as respect, solidarity, mutuality, freedom, harmony, benevolence, communication and familismo serve as the guarantors of the person and collective wellbeing as well as for people’s relationships (Smith, and Montilla, 2006). These guiding principles permeate most decisions made by members of the collective.

In societies such as those in Latin America, and African and Asian countries where most people embrace collectivist worldviews, people’s identity or identities are connected, influenced and shaped by members of the family, group, cultural context, social rules, and norms established by the collective (Greenfield, 1994; Triandis, 1994). Thus, a person's way of thinking, expressing emotions, acting and relating can only be understood when the collective as a whole is considered and studied.
Collective societies emphasize the importance of being compassionate and empathic with others. Empathy, a core condition of the counseling profession, in this context refers to the ability to appreciate nonjudgmentally the positive and negative experiences of another person, while responding proportionally to their emotions. Empathy motivates people to do whatever is possible to alleviate or eliminate the suffering of others. Collectivist societies expect their members to be willing to dispose their own needs in order to show compassion and empathy with their neighbors. They believe that this demonstration of love empowers the person and the community (Kim, 1994).

Cultures also differ in the way they imagine, reason, process, and attach meaning to things. These cognitive functions highly reflect the socio-cultural surrounding and cultural background (Stephan and Stephan, 2002). Cultural values or attributes such as individualism and collectivism influence human thinking, perceiving, behaving and relating (Oyserman, Coon & Kemmelmeier, 2002). In collective societies, the reasoning and cognitive schemata are based on the social context and consider the ethical guidance of the community. Collectivists consider making and finding meaning a daily duty as memories and stories are retold, reinterpreted and embedded with detail.
Faith and religion are two elements present in most collective societies. The spiritual realm is consulted and used in issues related to life, education, health, economics, politics, and family and personal challenges. The religious phenomenon is so prevalent and pervasive among members of collective societies that it is not seen as something that people have, but who they are. Spirituality, religion and faith are central to collectivists’ survival and resilience (Triandis, 1995). Culturally competent clinical pastoral supervisors respect people’s belief system and use them to help supervisees provide effective care.
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Correspondence regarding this article should be sent to R. Esteban Montilla, Ph.D. Department of Counseling and Human Services. St. Mary’s University. One Camino Santa Maria. San Antonio, Texas. rmontilla@stmarytx.edu