Psychotherapy 2012, Vol. 49, No.

3, 330 343

2011 American Psychological Association 0033-3204/11/$12.00 DOI: 10.1037/a0026246

Are There Parallel Processes in Psychotherapy Supervision? An Empirical Examination

Terence J. G. Tracey, Jamie Bludworth, and Cynthia E. Glidden-Tracey
Arizona State University
Parallel processes in supervision occur when (1) the therapist brings the interaction pattern that occurs between the therapist and client into supervision and enacts the same pattern but with the therapist trainee in the clients role, or (2) the trainee takes the interaction pattern in supervision back into the therapy session as the therapist, now enacting the supervisors role. We examined these processes in the interactions of 17 therapy/supervision triads (i.e., supervisor, therapist/trainee, and client). Each session was rated for dominance and affiliation, and the similarity of these dimensions across equal status pairs (supervisor-therapist and trainee-client) was examined. It was hypothesized that if parallel process existed, there would be more similarity in dominance and affiliation between equal status pairs in contiguous sessions than would be true relative to general responses; the dominance and affiliation would be more closely matched than would be expected given general response tendencies. This was examined separately for each supervision triad using single-case randomization tests. Significant results were obtained for each dyad indicating the presence of parallel processes in each supervision triad. Additionally, the relation between parallel processes over the course of treatment and client outcome was examined using hierarchical Bayesian modeling. Results indicate that a positive client outcome was associated with increasing similarity of therapist behavior to the supervisor over time on both affiliation and dominance (increasing parallel process) and an inverted U pattern of high-low-high similarity of client behavior to trainee behavior over time. This study provides support for the existence of bidirectional parallel processes at the level of interpersonal interaction. Implications for therapist training and supervision are discussed. Keywords: parallel process, supervision, interpersonal behavior, interpersonal circumplex

Psychotherapy supervision is a process whereby a clinical supervisor meets with a therapist/trainee to discuss the trainees work as a therapist with one or more clients with the goals of helping the client achieve good outcomes and the therapist increase therapeutic skills. Supervision is inherently a triadic process, involving a therapist meeting with a client which is then discussed in supervision with a supervisor. Most supervision involves discussion of the therapeutic work of one trainee with several clients, thus forming several triads, each involving the same supervisor and therapist but different clients. Research on the process aspect of therapy is extensive, and there is a growing body of research on the supervision process. However, there is relatively little on the overlap of these two domains and the inherent triadic nature of supervision. Parallel process as a supervision phenomenon and its use as a supervision tool are constructs that could be exhibited only in the triad of therapeutic supervision. The focus of the present study was on examining the processes of supervision and

This article was published Online First December 19, 2011. Terence J. G. Tracey, Jamie Bludworth, and Cynthia E. Glidden-Tracey, Counseling and Counseling Psychology, Arizona State University. Appreciation is expressed to Monica Adams, Tyler Barratt, Sara Dixon Staley, David Hauser, Jessica Rohlfing, and Brandon Yabko who served as raters in this study. Thanks also to the supervisors, therapists and clients who consented to be part of the study. Correspondence concerning this article should be addressed to Terence J. G. Tracey, 446 Payne Hall, MC-0811, Arizona State University, Tempe, AZ 85287-0811. E-mail: Terence.Tracey@asu.edu 330

therapy conjointly. Specifically we sought to determine whether parallel processes existed in supervision, and if so their relation to therapy outcome. Parallel process was first proposed in the psychodynamic literature as the unconscious replication of the therapeutic relationship in supervision (Searles, 1955; Ekstein & Wallerstein, 1972). The therapist brings into the supervision session issues that arise in reaction to the client, by recreating the dynamic of the therapy session and enacting the clients role with the supervisor. The supervisor in turn is then pulled into the role of the therapist, thus recreating the therapeutic relation in supervision but with the person who is both therapist and trainee switching roles from expert to help seeker. This process is considered to involve the underlying issues of power, authority, dependency, intimacy, and evaluation that are common across the masterapprentice relationship of supervision and the therapist client relationship of psychotherapy (Doehrman, 1976; Grey & Fiscalini, 1987). Without endorsing unconscious determinants, parallel process is also recognized as an important aspect of supervision in developmental (Loganbill, Hardy, & Delworth, 1987; Stoltenberg & Delworth, 1987) and interactional (Kell & Mueller, 1966; Mueller & Kell, 1972) models of supervision. A survey of both therapists and supervisors demonstrated that parallel process was recognized as part of supervision, and there were no differences in this recognition across theoretical orientation (Raichelson, Herron, Primavera, & Ramirez, 1997). Very few denied its existence, but there were varying definitions of parallel process.

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The literature examining parallel process relies almost exclusively on case examples (e.g., DeLucia, Bowman, & Bowman, 1989; McNeil & Worthen, 1989) or formal case studies (Alpher, 1991; Doehrman, 1976; Friedlander, Siegel, & Brenock, 1989; Jacobsen, 2007; Lombardo, Greer, Estadt, & Cheston, 1997). However, case studies, even several, beg the question of generalizability. Does parallel process occur for all supervisions, or only for certain select triads? Given the noted variety of definitions of parallel process, we sought to focus on aspects that were most common across all definitions. The issues of power and intimacy have been noted to characterize the roles adopted in parallel process (Doehrman, 1976; Grey & Fiscalini, 1987). These are the same two dimensions that underlie the interpersonal circle (Kiesler, 1983; Wiggins, 1979). According to interpersonal theory, all behaviors can be characterized in terms of the varying amounts displayed on the independent dimensions of dominance and affiliation, with the interpersonal circle representing the full range of blendings across these two dimensions. While there is great commonality among the different interpersonal circles, the version used in this study was proposed by Strong (Strong, Hills, Kilmartin, et al., 1988; Strong, Hills, & Nelson, 1988), and it is presented in Figure 1. For example, behaviors high in dominance and moderately high in affiliation/friendliness would be leading, and behaviors low in dominance (i.e., high in submission), and moderately low in friendliness would be self-effacing. The key to the interpersonal circle is that the various blendings of the two underlying dimensions can be spatially represented as a circle, with behaviors closer together more similar than those more distal. Furthermore, these behaviors carry information regarding the interaction desired by each participant (Kiesler, 1983; Tracey, 1993). Each behavior is a statement about how the individual views himself or herself relative to the other. If one person is dominant, the other is expected to respond as submissive to validate the relationship expectations of the first. If one acts friendly, the other person is also expected to be friendly in response. Each interpersonal behavior thus is an attempt to define how the other is to act: opposite on dominance and similar on affiliation. The extent to which the other participant responds with the behaviors expected by the first is called complementarity, and it is related to

SelfEnhancing Critical

Leading

Nurturant
Affiliation

Distrusul SelfEffacing

Cooperave

Docile

Figure 1. Complementarity of Interpersonal Communication Rating Scales. Arrows indicate complementary scales. Reprinted from Tracey, T. J. G. (2005). Interpersonal rigidity and complementarity. Journal of Research in Personality, 39, 592 614.

relationship quality (Dryer & Horowitz, 1997) and relationship productivity (Estroff & Nowicki, 1992). This model has been used extensively to study interpersonal behavior in interaction (Strong, Hills, Kilmartin, et al., 1988; Tracey, 1994, 2004, 2005) as well as in therapy contexts (Tracey & Guinee, 1990; Tracey, Sherry, & Albright, 1999) and supervision (Friedlander et al., 1989; Tracey & Sherry, 1993). In activating parallel process, the levels of dominance and affiliation demonstrated by the therapist trainee in supervision would reflect the interpersonal style and expectations communicated by the client. The degree to which the supervisor complemented those behaviors demonstrated and expectations communicated by the client and reenacted by the therapist/trainee would initially mimic the therapists response to the client (e.g., if the client were cooperative, the complementary therapist would be nurturant, or a noncomplementary therapist response would be critical or distrustful). Given the principle of complementarity, the trainee is likely to complement the clients implicit expectations, behaving in a manner consistent with what the clients interpersonal style typically elicits from other people. The therapist trainee would enact the clients role in the next supervision session with the supervisor, in the complementary case acting in a more cooperative manner than usual. According to parallel process predictions, the supervisor would, in response, enact a more nurturant role than usual, similar to how the therapist trainee responded to the client in the therapy session. So the dominance and affiliation enacted in therapy would be brought to supervision but with the roles reversed for the therapist/trainee. An example of parallel process frequently experienced may illustrate this process. A client comes into therapy seeking guidance because things are not going well in her relationships. She desires structure and direction from the therapist (client submissive behavior). The therapist attempts to help the client by providing guidance (therapist dominant behavior). The client then starts to see problems with each of the suggestions offered by the therapist (the common Yes, but. . . which is distrustful on the interpersonal circle). The therapist over time starts to become subtly critical, complementing the behavior of the client. This pattern continues over time, and the therapist comes into supervision complaining about the client and how the therapist needs help and direction because nothing is working (trainee increases his submissive behavior in parallel enactment of the client). As the supervisor provides some direction (supervisor increases her dominance), the trainee also engages in Yes, but. . . (i.e., distrustful behavior). The supervisor also engages in more critical behavior than usual in response. The supervision interaction becomes a relative replication of the therapy relationship, captured in the relative amounts of dominance and affiliation exhibited by the participants. So parallel processes would be indicated by greater similarity between the interpersonal behaviors exhibited by both participants in corresponding roles (help-seeker or expert) across the dyads comprising each supervision triad, compared with either participants more typical behaviors. In other words, parallel process would be indicated in two similar ways within each supervision triad. With respect to the client and trainee (equivalent helpseeker roles across therapy and supervision dyads), their behaviors in respective therapy and supervision sessions will be more similar than either would be to the others behavior generalized across all interactions. For the therapist and supervisor (in equivalent expert

Dominance

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roles across the two dyads comprising one triad), their behaviors in consecutive sessions will also be more similar than either participants behavior corresponding to that triad, compared with the other participants typical behavior across all clients or all trainees, respectively. Many theorists view parallel process as arising in the therapeutic interaction and then being transported up into supervision (e.g., Searles, 1955). However, some theorists view the process as bidirectional, where not only does the therapist/trainee bring the therapy interaction into supervision, but the trainee/therapist also brings the supervision interaction back to therapy (Clarkson, 1994; Doehrman, 1976; Jacobsen, 2007). In this view, skillful supervision occurs when the supervisor enacts the parallel of the therapist role in therapy, but then deliberately alters this pattern in supervision. This alteration of the pattern by selectively complementing only certain behaviors of the client (or trainee in the clients role) provides a model for the therapist to similarly engage in selective complementarity with the client. So the therapist brings the client interaction into supervision by adopting the client (help-seeking) role, and the supervisor adopts the therapist (expert) role, then alters it, helping the therapist then use this deliberate alteration in subsequent therapy interaction to communicate different expectations and elicit alternative behaviors from the client. Figure 2 depicts the bidirectional pattern of parallel process examined in this study. The equivalent role of expert is seen as being shared by supervisor and therapist within the contexts of supervision and therapy, respectively (depicted by the upper arrow pointing from one session to the next consecutive session). The equivalent role of help-seeker is seen as being shared by client and trainee within the contexts of therapy and supervision, respectively (depicted by the lower arrow pointing from one session to the next consecutive session). Consecutive therapy and supervision sessions were coupled together to examine interactional influence from the therapy session to the subsequent supervision session (depicted by brackets labeled with numbers). Likewise, consecutive supervision and therapy sessions were coupled together to examine interactional influence from the supervision session to the subsequent therapy session (depicted by brackets labeled with letters).

The supervision transaction is expected to look increasingly similar to the therapy transaction over time if parallel process is present. Then if the client is to benefit, the supervisor deliberately changes this pattern to selective noncomplementary behavior in supervision, and the therapist learns to then apply it in therapy. So this conception of a bidirectional parallel processwhere the supervisor models how to alter an interaction, and the trainee/ therapist carries this intentional strategy down to the therapy suggests a curvilinear pattern of parallel processes being associated over time with positive client outcomes. As the therapist applies different behavior in the therapy session and the client responds, ideally complementing the new alternatives offered by the therapist, there would be less carry over into the supervision, and the participants could behave in manners more typical of their own interpersonal styles and less representative of the roles carried over from specific previous therapy sessions. The goals of this study were to examine the interaction patterns of many different supervision triads to see if parallel processes occur in most, and also to examine whether the curvilinear pattern of the presence of the parallel processes would be related to client outcome.

Method Sample
The sample was composed of 17 supervision triads (supervisor, trainee/therapist, and client) who met over the course of a semester in a southwestern university counseling training clinic that served a community population. These triads were composed of 17 clients meeting with seven different therapists, who in turn were supervised by three different supervisors. The clients (13 female and 4 male) had a mean age of 32.5 years (SD 5.5). Thirteen of the clients were White, one was Native American, two were Latino/a, and one was biracial. The self-reported problems of the clients were depression, interpersonal/relationship difficulties, and anxiety. Therapy was conducted by 7 female therapists (2 Latina and 5 White) in their first practicum of a masters degree counseling program. Each therapist met with two to three clients who agreed

Figure 2. Depiction of bidirectional parallel process in a supervision triad. Brackets indicate couplings of therapy and supervision sessions. Numbered couplings represent pattern of influence wherein therapy interactions influence subsequent supervision interactions. Lettered couplings represent pattern of influence wherein supervision interactions influence subsequent therapy interactions.

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to participate in the study. There were 3 female supervisors. One supervisor (supervisor X) was a White licensed psychologist with 16 years of postdoctoral experience including 6 years of conducting therapy and 10 years of supervision experience. This supervisor supervised 3 therapists with 3, 3, and 2 clients participating in the study. The other 2 supervisors were advanced doctoral students (one Native American and one Latina) enrolled in a supervision practicum under the direction of the first supervisor. One of these student supervisors (supervisor Y) had 1 trainee with 3 clients participating and another with 2 clients. The other (supervisor Z) had two trainees each with 2 clients participating. All supervisors endorsed an interpersonal model of psychotherapy, and the practicum class was structured along interpersonal theory lines using the Teyber (2006) text as a primary source.

Measures and Variables

Outcome Questionnaire-45. Outcome Questionnaire-45 (OQ; Lambert et al., 1996) is 45-item measure of client distress that was rationally created to assess three areas of distress: Symptom Distress, Interpersonal Relations, and Social Role Performance, as well as Total Distress. Participants respond to each item using a 5-point Likert-type format (0 never, 4 almost always). For the purpose of this study, only the total score was examined, summing the responses over all the items with higher scores indicating greater distress. Psychometric properties of the instrument have been well supported in the literature (e.g., Bludworth, Tracey, & Glidden-Tracey, 2010; Burlingame, Lambert, Reisinger, Neff, & Mosier, 1995; Lambert et al., 1996; Mueller, Lambert, & Burlingame, 1998; Wells, Burlingame, Lambert, Hoag, & Hope, 1996). In the present sample, internal consistency estimates of .90 were obtained for client ratings from the first session and .96 for client ratings over all sessions. Interpersonal Communication Rating Scale. Interpersonal Communication Rating Scale (ICRS, Strong, Hills, & Nelson, 1988) is a manualized coding system based on Learys (1957) interpersonal circle. The ICRS provides definitions for the rating of behavior into one of the eight types distributed around the interpersonal circle (i.e., self-enhancing, critical, distrustful, selfeffacing, docile, cooperative, nurturant, and leading), and at one of four levels of extremity. This system has been used extensively to study interpersonal behavior in interaction (Strong, Hills, Kilmartin, et al., 1988; Tracey, 1994, 2004, 2005) as well as in therapy contexts (Tracey & Guinee, 1990; Tracey, Sherry, & Albright, 1999). While the ICRS is typically used to rate speaking turns, it was adapted in this context to provide the structure with which to rate continuous behavior using the computer joystick apparatus. Computer joystick apparatus and program. A computer joystick apparatus and program (Sadler et al., 2007) was used to rate the moment-by-moment interpersonal interaction of the participants. Specifically, the rater would push the joystick to the corresponding section of the interpersonal circle using the ICRS definitions. The program would record the movements in two dimensions of dominance and affiliation (1000 to 1000 units; extreme dominance 1000, extreme submissiveness 1000; extreme affiliation 1000, and extreme hostility 1000) two times every second. This rating was done separately for each participant in a single triad; that is, each rater would use the

joystick to rate statements of only one participant at a time. The moment by-moment transcription of dominance and affiliation was averaged to yield a mean dominance and a mean affiliation score for each session. Therapy sessions were rated by four advanced doctoral students. Raters were provided with copies of the ICRS manual and also given practice in using the joystick to rate therapy tapes. Training reliability was estimated using a counseling audio tape not involved in the study. Each rater independently rated each of the participants on the training tape, such that each rater rated each tape twice, once for the client and again for the therapist. The pairwise reliability for the sequence ratings over the tape ranged from Intraclass Correlation Coefficient (ICC) .67 to .92 with a collective ICC of .81. This level was judged to be sufficient. The raters were then given access to the study audiotapes of therapy sessions and rated one of the participants. Each participant in each tape was rated by at least two of the raters. Because the study used the mean dominance and affiliation scores for each session, these scores were examined for reliability of rating. The pairwise ICC reliability estimates over all the study audiotapes ranged from .79 to .93 with a collective ICC of .87. To further enhance the reliability of the data, we used the means of the dominance and affiliation scores across the raters to represent the dominance and affiliation for each participant for each session. So for each therapy session, we obtained the mean levels of client dominance, client affiliation, therapist dominance, and therapist affiliation. Supervision sessions were rated identically but these supervision sessions were rated by two different advanced doctoral students. The reliability for these raters was ICC .88. Again the means across the two raters were used as the measures of supervisor and trainee dominance and affiliation in this study. Because the trainee and supervisor would discuss several different clients in each supervision session, we matched the client with the period in the supervision session where he or she was being discussed. As such, the amount and sequencing of discussion for each client could be determined, and this could be easily matched with the moment-by-moment dominance and affiliation ratings. In this manner, the mean dominance and mean affiliation ratings for both the supervisor and trainee when talking about each client could be determined. So for each client discussed in each session, we obtained separate mean levels of trainee dominance, trainee affiliation, supervisor dominance, and supervisor affiliation. Behavioral dissimilarity. As noted, parallel process involves an increase in behavioral similarity across the similar roles of trainee with client and therapist with supervisor. To represent this similarity, the ratings on each participant of dominance and affiliation from each therapy session were compared with the scores from the subsequent supervision session segment in which that therapy dyad was discussed. So for each pair of adjacent sessions, the clients behavior in the preceding therapy session was compared with the trainees behavior in the subsequent supervision, and the therapists behavior in the preceding therapy session was compared with the supervisors behavior in the subsequent supervision session. Given that dominance and affiliation are orthogonal components of the interpersonal circle, each was examined separately, and we used an absolute value of the difference (D) between the either affiliation or dominance behavior scores for triad par-

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ticipants in equivalent roles to calculate behavioral similarity. Hence, the score is really one of dissimilarity, with greater scores indicating greater differences in the behavior in question. There were four absolute value dissimilarity indices calculated: clienttrainee dominance D (client dominance in the preceding therapy session minus trainee dominance in the subsequent supervision session when talking about the same client), client-trainee affiliation D (client affiliation in the preceding therapy session minus trainee affiliation in the subsequent supervision session when talking about the same client), therapist-supervisor dominance D (therapist dominance in the preceding therapy session minus supervisor dominance in the subsequent supervision session when talking about the same client), and therapist-supervisor affiliation D (therapist affiliation in the preceding therapy session minus supervisor affiliation in the subsequent supervision session when talking about the same client).

discussed in any given week in supervision. If a client was not discussed (or discussed for less than 5 minutes), these sessions obviously could not be used to calculate the measures for that client. So overall, there was an irregular pattern of data across time. However, in general, there were at least 4 paired sessions (supervision and therapy occurring within one week of each other) for each dyad.

Results Presence of Parallel Processes

It was hypothesized that parallel process would be indicated by lower dissimilarity (D) scores for each of the four dissimilarity indices within equivalent roles across the two dyads composing of each supervision triad relative to the amount of dissimilarity demonstrated between the members of the triad generally. We used each triad as its own control, looking for lower dissimilarity scores than would be demonstrated in a triad if the members acted as they typically would. This acting in a manner typical across all recorded transactions is what we defined as chance. Did a particular participants behavior with anyone (generalized across all triads) deviate from how the participants in a specific triad usually acted with each other? However, to examine this alteration from typical behavior, we needed to compare the behaviors of each triad with the typical pattern of behavior for members of that triad generalized across all triads. The key was an intraindividual comparison. To do this, we adopted a single-case approach where each individual served as his or her own control. To generate this self-as-control comparison, we used a single-case randomization analysis (Edgington, 1987, pp. 245249). The patterns of each of the dissimilarity indices over the course of treatment for each supervision triad were separately compared with distributions based on all the permutations of the session behavior values of a particular individual in that specific role (or a random sample of 1000 permutations if there were more than 1000 permutations). As elaborated below, we calculated the dissimilarity indices derived from random pairings of one triad participants behavior within their shared triad to any behavior of the corresponding individual across all sessions recorded for that individual. The number of times those many comparison dissimilarities (1000 for each participant, in each role) were equal to or lower than the total dominance or affiliation dissimilarity index obtained for a particular triad served as the numerator, which was divided by 1000. This ratio then served as an inferential probability value (i.e., p). A crucial issue in the use of randomization tests is that an appropriate comparison distribution be selected (Levin & Wampold, 1999). Because we were testing whether each of the supervision dyad participants adjusted his or her behavior to the behavior of the corresponding participant in the therapy dyad, we selected each participants typical behavior as the appropriate comparison. Supervisor behavior with a specific trainee in discussing a specific client was repeatedly compared with all behaviors from that supervisor (i.e., including behavior discussing this and other clients, as well as behavior with other trainees). So what we tested were behaviors in key segments of sessions relative to general behavior patterns. For the trainee in the role of supervisee, the comparisons were behaviors demonstrated with the same su-

Procedures
The training program where this study was conducted has a supervision practicum experience for the advanced doctoral students. Under the instructors guidance, advanced students supervise two trainees who then see anywhere from 3 to 5 clients per week over the span of a semester. At the start of the study, supervisors and supervisors-in-training were approached and asked to participate in a study on the supervision process which would involve audio recording their interaction with their trainees. Of the 4 supervisors approached, three agreed. The therapists who worked with each of the consenting supervisors were then asked to participate by allowing their supervision and therapy sessions to be audio recorded. Of the eight therapists approached, seven agreed to participate. Following this step, those clients assigned to the consenting therapists who were not in major crisis or clearly pathological (as determined in the intake interview) were provided with an information packet detailing participation. All that was required of the clients was allowing audio recording of the therapy sessions. Of the 38 clients approached, 17 consented to be part of the study. All clients seen at the center were requested to complete a symptom checklist (OQ-45) before intake and before their last session, regardless of their participation in the study. Therapy and supervision went on as usual with no experimental intrusion. Sessions were audio taped and the middle 20 minutes from each therapy session were used to rate the behaviors of the therapist and client as this provided enough data to rate but not too much to tax the raters. All supervision sessions were used to rate the supervisor and trainee. To be included in the study, there needed to be audible tapes from contiguous sessions of the therapy and the supervision. If a client came in at the beginning of the semester and then continued until the end, there could be a maximum of 12 sessions. Many clients in the study started therapy mid way through the semester and thus their number of sessions was curtailed, and some ended before the end of the semester. There were several holes in the data set due to missed tapings, inaudible tapes, or not having audible tapes from both the supervision and therapy session in the same week (i.e., contiguous). A majority of the total possible session data were included in this study (62%), and these were distributed widely over the course of treatment. There were holes also due to some clients not being

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pervisor, but in talking about all clients (both the same and other clients). For the trainee in the role of therapist, the multiple comparisons were made to all therapist behaviors demonstrated across all participating clients. Finally, for the client, the comparisons were drawn from all the behaviors demonstrated by all the participating clients seen by the therapist in the triad of interest. In order to use each person in the study as her or his own control compared with that same participants behavior of interest within each triad of participation, these sets of multiple comparisons of dissimilarities of dominance and affiliation behavior within and across triads were conducted for every coupling of equivalent role pairs across every supervision triad we studied. To illustrate this randomization process, the client-trainee dissimilarity test will be described. Since this test is done separately for each triad, the example of supervisor X meeting with therapist A, who met with client #1 will be used. The dominance dissimilarity (D) indices for client (#1)-trainee (A) were calculated for each of the five therapy and supervision sessions that were recorded for this triad. The mean client-trainee dominance D was then calculated across the 5 sessions. This mean was then compared with the random distribution of all recorded and rated behaviors for that client-trainee pair. However, there were two conceivable random distributions in this example, one based on client behavior, the other on trainee behavior across all triads of participation. First, the client dominance ratings for each of the five sessions were compared with the trainee dominance scores from five randomly drawn supervision sessions involving the same trainee discussing any client. We then calculated the mean client-trainee dominance D from this pairing of the actual client with the random trainee behaviors. This procedure was repeated 1000 times (without replacement) thus providing a distribution of the mean dissimilarities between the client and random trainee behaviors against which the actual client-trainee dissimilarity data for this triad could be compared. The number of times that the mean dissimilarity from the random data matched or was lower than the real data, divided by 1000, provided the probability value for the actual dominance data deviating from chance. A similar set of tests was done by calculating comparison dissimilarity indices, keeping the trainee behavior constant and varying the client data. In this second set of analyses on the same pair, the actual client dominance score over the five sessions was compared with five randomly drawn therapy sessions within this triad using the pool of all sessions involving all the participating clients seen across all triads by this therapist (therapist A). The mean dissimilarity was calculated for this random pairing, and the process was repeated 999 more times. The number of times that the real mean dissimilarity was matched or was lower in the random sample divided by 1000 yielded the probability of actual deviating from chance. So in this extended example with one equivalent roles pair within one triad, there were two randomization tests applied to each dissimilarity index. This pattern of two tests for each supervision triad was replicated for each of the four dissimilarity indices (affiliation and dominance dissimilarities for clienttrainee and therapist-supervisor pairs). So across the sample there were two separate randomization tests on each of the four dissimilarity indices calculated for each supervision triad, and these were conducted separately (N 1) for each equivalent

roles pair by interpersonal type within each client-therapistsupervisor triad. The results of these tests are summarized in Table 1 for the dominance indices, and in Table 2 for the affiliation indices. The tables summarize the equivalent roles being examined (therapist with supervisor, or client with trainee) for each supervision triad and the comparison sets of this randomization test (varying therapist or supervisor in the therapist with supervisor comparison, or alternatively varying client or trainee in the client with trainee comparison). In addition, the tables summarize the mean dissimilarity D obtained using the actual data specific interactions among that triad, as well as the Random D (the mean dissimilarity obtained using the random permutations), and the p value of the randomization test. As can be seen from Table 1, each comparison of the dominance D and corresponding Random D indices was significant. The dominance dissimilarity indices for each behavior-in-role comparison within a specific triad was significantly lower than expected by chance in every case. So the dominance behavior of a particular client and trainee in each week was more similar (i.e., less dissimilar) compared with either the dominance from the same trainee in general across clients, or with the behavior of all clients interacting with the same therapist. There was clear parallel process with each dyad in both role pairings for dominance. Identical results were obtained when looking at affiliation behaviors (Table 2). All tests were significant. For both dominance and affiliation, there is a clear pattern characterized by the trainee behaving in supervision in ways that resemble more the clients behavior in the preceding therapy session compared with the trainees behavior in general. There is also a pattern of the supervisors behavior matching the therapists behavior in the preceding therapy session. While the absolute magnitude of the matching of affiliation and dominance between the equivalent roles varied appreciably across the different triads, the same relative pattern of adapting interaction in a parallel manner was supported.

Relation of Parallel Process to Client Outcome

Based on theory (Doehrman, 1976; Kell & Mueller, 1966), we anticipated that there would be a curvilinear pattern, whereby the therapist trainee brings in the dynamics of the therapist-client interaction into the earlier supervision sessions, and then the supervisor helps the trainee change this pattern which is then brought down to the later interactions of therapist and client. However, before examining this pattern, we reversed the association of behavior to take account of the bidirectional nature of supervision (Jacobsen, 2007). Instead of looking at the match between the preceding therapy session and the subsequent supervision session as we did above, we reversed the direction by looking at the match of the preceding supervision session with the subsequent therapy session to capture the pattern of the supervision leading to change in the subsequent therapy session. To represent this switch in temporal ordering, we reversed the role names. So instead of referring to therapist-supervisor dissimilarity (where we focused on how much the supervisor matches the therapists behavior from the previous therapy session as given earlier), we adopted the term supervisor-therapist dissimilarity to represent the amount of therapist dissimilarity in the therapy session from the behavior of the supervisor in the previous supervision session. We also switched

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Table 1 Summary of Randomization Tests on Dominance Dissimilarity (D) Across Each Supervision Triad
Comparison Therapist A Client 1 N 5 Ses equivalent roles Supervisor X Therapistsupervisor Clienttrainee A 2 5 Therapistsupervisor Clienttrainee B 3 5 Therapistsupervisor Clienttrainee B 4 5 Therapistsupervisor Clienttrainee B 5 7 Therapistsupervisor Clienttrainee C 6 7 Therapistsupervisor Clienttrainee C 7 4 Therapistsupervisor Clienttrainee C 8 6 Therapistsupervisor Clienttrainee Supervisor Y Therapistsupervisor Clienttrainee D 10 6 Therapistsupervisor Clienttrainee E 11 7 Therapistsupervisor Clienttrainee E 12 7 Therapistsupervisor Clienttrainee E 13 7 Therapistsupervisor Clienttrainee Supervisor Z Therapistsupervisor Clienttrainee Distribution Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee D 50.7 50.7 84.6 84.6 47.8 47.8 70.7 70.7 32.9 32.9 41.3 41.3 43.3 43.3 132.3 132.3 79.6 79.6 102.7 102.7 19.5 19.5 35.2 35.2 190.6 190.6 50.8 50.8 175.4 175.4 11.7 11.7 Random D 159.3a 199.1b 210.3c 182.0d 118.5 152.6 172.0 155.9 188.0 173.5 144.4 176.7 317.2 263.5 288.1 325.2 185.2 221.9 311.5 252.7 209.7 188.3 216.7 175.0 300.5 257.3 187.6 210.7 325.2 277.4 146.7 192.6 p .009 .001 .001 .001 .011 .001 .002 .003 .024 .008 .010 .001 .015 .007 .001 .008 .043 .009 .003 .001 .021 .008 .002 .001 .030 .001 .041 .001 .012 .021 .005 .001

Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee

132.3 132.3 223.7 223.7 141.6 141.6 337.9 337.9 40.7 40.7 91.0 91.0 46.7 46.7 88.2 88.2 62.7 62.7 182.3 182.3

288.5 243.2 321.7 342.6 295.6 274.0 445.6 469.0 221.3 199.7 217.6 238.9 167.9 212.5 245.6 322.7 248.3 197.7 330.9 297.3

.011 .015 .001 .001 .031 .001 .005 .001 .022 .016 .001 .001 .026 .018 .001 .010 .036 .014 .001 .031

14

Therapist Supervisor Client Trainee

24.2 24.2 102.6 102.6

245.3 164.5 200.1 188.7

.013 .006 .011 .001

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Table 1 (continued)
Comparison Therapist F Client 15 N 3 Ses equivalent roles Therapistsupervisor Clienttrainee G 16 6 Therapistsupervisor Clienttrainee G 17 7 Therapistsupervisor Clienttrainee Distribution Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee D 21.0 21.0 30.7 30.7 50.4 50.4 105.1 105.1 33.0 33.0 81.7 81.7 Random D 145.6 21.99 157.6 192.3 188.8 225.5 310.0 221.2 172.3 205.4 191.7 209.8 p .025 .008 .020 .010 .008 .001 .005 .001 .022 .014 .008 .001

a Mean dominance dissimilarity between therapist and supervisor when using random selection of therapist session values. b Mean dominance dissimilarity between therapist and supervisor when using random selection of supervisor session values. c Mean dominance dissimilarity between client and trainee when using random selection of client session values. d Mean dominance dissimilarity between client and trainee when using random selection of trainee session values.

the naming of trainee-client dissimilarity in a similar manner to help clarify the order of events (i.e., matching of client behaviors to the previous trainee behaviors in supervision.). To detect any relation between the presence of parallel process and therapy outcome, we used the OQ-45 total scores from the first and last sessions as indicators of outcome. Specifically we used as outcome scores the residual gain score in the client post OQ-45 after taking account of the client pre OQ-45 score. Lower values indicated less distress and thus a better outcome. This residual gain score was the criterion in a multilevel model (i.e., hierarchical linear model) of the dissimilarity indices over the course of treatment. We examined the four dissimilarity indices (the 2 interpersonal behaviors of dominance and affiliation 2 equivalent role comparisons of trainee with client and supervisor with therapist) separately as they varied over treatment. This was accomplished by looking at the intercept (overall level association with outcome), linear trend (rising or lowering pattern of interpersonal similarity over time being associated with outcome), and the curvilinear trend (a pattern of rising and lowering being associated with the outcome). The ideal model for use in this investigation would have been a four-level hierarchical linear growth curve model, with session interaction at level 1, dyad (with outcome) at level 2, therapist at level 3, and supervisor at level 4. However there were not enough data to support this model as there were only 17 dyads, 7 therapists, and 3 supervisors. We sought a simplified model, therefore we examined three-level models with either therapist or supervisor as the top level, using HLM (Raudenbush, Bryk, & Congdon, 2004). In each examination, the variance of the top level (either therapist or supervisor) was not significant; however, the power of this test is low due to the sample size. An examination of the ICC reliability estimates showed that the ICCs were all very low for the supervisor level (ranging from .001 to .05) but more substantial for the therapist level (ranging from .10 to .18). The low values for the supervisor level indicated that there was not much variance at this level, and that it could be deleted. The ICCs at the therapist level indicated that this level needed to be included. However examining such a small data set using Hierarchical Linear Modeling (HLM) would result in tests of extremely low

power and thus questionable value. To obviate this, we adopted a Bayesian estimation of the three-level hierarchical model using Monte Carlo Markov Chain analysis (e.g., Gelman, Carlin, Stem, & Rubin, 1995; Ntzoufras, 2009) as implemented in the WinBugs software program. As Draper (1995) demonstrated, this Bayesian approach is superior to typical HLM approaches in that the many issues related to maximum likelihood estimation are avoided. It is also very amenable to small sample sizes and levels with few objects (as is true in the present case). This approach fits a Bayesian model to the data, and then creates data sets which are then recreated using the output as input for the next iteration (in a Markov Chain manner). With many iterations, the data reach an equilibrium point which indicates stable parameter estimates, as well as estimates of precision (95% confidence bands). Generally, because this iterative Markov Chain process relies upon prior distributions, which typically are unknown, the estimates from early iteration tend to show great variability. To avoid reliance on these poor initial estimates, a burn in number of iterations is often used to start the process, but these burn in iterations are discarded and not used as estimates of the model. In our analysis, a separate analysis was conducted on each of the four different types of dissimilarity indices using a three-level hierarchical model (identical to one that would have been examined in HLM) with a burn in period of 1000 iterations and an analysis period of the next 2000 iterations. The results of the Bayesian hierarchical modeling are summarized in Table 3. Of interest were the terms that included the outcome variable, because they tested variance in the pattern of the dissimilarity index as related to outcome. For the supervisortherapist dominance D, there was a significant relation for the outcome x linear pattern (parameter .17; 95% band .05 to .20), indicating that better outcome (lower residual score) was associated with lower dissimilarity (i.e., greater similarity) in supervisortherapist dominance over time. Over time, the more the therapist acted like the supervisor did in the previous supervision session on dominance, the better the therapy outcome. None of the other terms (except the overall intercept) were different from zero, including the hypothesized curvilinear terms.

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Table 2 Summary of Randomization Tests on Affiliation Dissimilarity (D) Across Each Supervision Triad
Comparison Therapist A Client 1 N 5 Ses equivalent roles Supervisor X Therapistsupervisor Clienttrainee A 2 5 Therapistsupervisor Clienttrainee B 3 5 Therapistsupervisor Clienttrainee B 4 5 Therapistsupervisor Clienttrainee B 5 7 Therapistsupervisor Clienttrainee C 6 7 Therapistsupervisor Clienttrainee C 7 4 Therapistsupervisor Clienttrainee C 8 6 Therapistsupervisor Clienttrainee Supervisor Y Therapistsupervisor Clienttrainee D 10 6 Therapistsupervisor Clienttrainee E 11 7 Therapistsupervisor Clienttrainee E 12 7 Therapistsupervisor Clienttrainee E 13 7 Therapistsupervisor Clienttrainee Supervisor Z Therapistsupervisor Clienttrainee F 15 3 Therapistsupervisor Distribution Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee D 20.3 20.3 10.7 10.7 120.5 120.5 8.7 8.7 88.7 88.7 175.9 175.9 91.6 91.6 145.4 145.4 185.3 185.3 56.0 56.0 57.6 57.6 39.7 39.7 99.2 99.2 91.3 91.3 15.4 15.4 305.6 305.6 Random D 162.3a 217.4b 225.6c 177.2d 189.7 247.6 187.2 245.6 221.3 312.4 337.0 315.2 234.2 287.6 322.7 289.7 287.2 259.0 189.7 224.3 197.2 205.6 225.7 186.2 321.2 247.3 298.2 267.3 211.3 187.7 425.2 381.2 p .031 .004 .010 .007 .022 .019 .012 .001 .021 .001 .013 .001 .021 .036 .015 .001 .022 .029 .001 .001 .005 .001 .009 .001 .013 .001 .020 .001 .001 .031 .001 .017

Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee

27.3 27.3 297.4 297.4 57.6 57.6 126.7 126.7 30.3 30.3 40.9 40.9 57.7 57.7 44.6 44.6 72.0 72.0 112.4 112.4

282.7 262.3 387.2 426.7 187.7 221.6 312.2 252.3 243.7 262.7 197.6 228.9 142.3 133.5 222.5 182.7 191.1 223.8 210.1 189.7

.001 .001 .031 .042 .001 .001 .005 .001 .001 .001 .012 .001 .019 .021 .001 .001 .016 .010 .001 .011

14

Therapist Supervisor Client Trainee Therapist Supervisor

67.8 67.8 47.3 47.3 46.7 46.7

217.2 187.5 167.2 221.2 188.7 145.6

.001 .030 .009 .001 .012 .001

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Table 2 (continued)
Comparison Therapist Client N Ses equivalent roles Clienttrainee G 16 6 Therapistsupervisor Clienttrainee G 17 7 Therapistsupervisor Clienttrainee Distribution Client Trainee Therapist Supervisor Client Trainee Therapist Supervisor Client Trainee D 37.5 37.5 18.9 18.9 50.6 50.6 66.4 66.4 11.1 11.1 Random D 233.4 177.2 149.7 230.0 194.2 148.4 186.4 201.7 145.6 238.2 p .021 .001 .010 .001 .005 .018 .024 .031 .001 .001

a Mean affiliation dissimilarity between therapist and supervisor when using random selection of therapist session values. b Mean affiliation dissimilarity between therapist and supervisor when using random selection of supervisor session values. c Mean affiliation dissimilarity between client and trainee when using random selection of client session values. d Mean affiliation dissimilarity between client and trainee when using random selection of trainee session values.

The results of the supervisor-therapist affiliation dissimilarity mirrored those of supervisor-therapist dominance. The primary significant result was the outcome by linear pattern term (parameter .52; 95% band .10 to .96). For supervisor-therapist affiliation, the more the therapist acted in a manner similar to the supervisor over time, the better the client outcome. As demonstrated earlier, none of the other terms except the trivial overall intercept term were different from zero. The linear trend by outcome relation shows that better outcome is associated with lower dissimilarity on both affiliation and dominance over time. For trainee-client dominance dissimilarity, the only substantive term that was significant was the quadratic trend by outcome interaction term (parameter .08; 95% band .40 to .04). There was an inverted U relation of dominance dissimilarity with outcome, indicating that better outcome was associated with low client-trainee dissimilarity in the beginning and then increasing dissimilarity toward the middle and then decreasing at the end. Poorer outcome did not manifest this low, high, low pattern of dominance dissimilarity. There was no linear pattern for traineeclient dominance with outcome as there was for supervisortherapist dominance dissimilarity. The results for trainee-client affiliation dissimilarity were identical to those of the trainee-client dominance dissimilarity. The quadratic pattern by outcome term was significantly different from zero (parameter .14; 95% band .21 to .02). The inverted U pattern of trainee-client affiliation dissimilarity was associated with better outcome. There was no linear pattern of dissimilarity over time being related to outcome for the trainee-client affiliation dissimilarity either. So better outcome is associated with the inverted U pattern of dissimilarity between the trainee and client behaviors for both affiliation and dominance. Overall each of the tested dissimilarity indices was to some degree associated with client outcome, suggesting parallel processes, but the patterns were varied across roles. Improved client outcomes were associated with a decreasing linear trend of supervisor-therapist dissimilarity over time (i.e., increasing similarity) on both dominance and affiliation, and also with an inverted U trend of trainee-client dominance and affiliation dissimilarity over time.

Discussion
The results of this study provide convincing support for the presence of parallel processes in supervision where it was examined independently in 17 different individual supervision triads. For each of the replicated single-case examinations, we found significant evidence that participants altered their behavior from their own general patterns in line with what would be predicted by the theory of parallel processes in supervision. Therapists in the role of trainee altered their behavior away from their usual in supervision to act somewhat more like particular clients did in the previous therapy session. This was also true for the supervisors, who would act somewhat like the therapists in the previous therapy sessions with those particular clients. This pattern for therapist and supervisor was found for both dominance and affiliation. So if a client tended to act in a distrustful and self-effacing manner (submissive-critical) in the prior session and the therapist complemented this by acting in a critical manner in therapy, then the therapist in the role of trainee would enact some of the distrustful client behavior in the subsequent supervision session. The supervisor would also demonstrate this parallel process by acting in a manner similar to how the therapist acted in the previous therapy session; in this example, the supervisor would become more critical than typical. This is clear evidence for parallel process in supervision. Therapists bring the therapy interaction into supervision and engage the supervisor into reenacting this process. It is important to realize we focused only on changes in the presence of dominance and affiliation behaviors, not their overall value. This means that we did not hypothesize or test that parallel process signifies that an individual would exactly match the behavior of the other. If the therapist was acting in a hostile manner in the session, our examination of parallel process does not mean that the supervisor will adopt this same hostile manner in supervision. We hypothesized therapists and supervisors acting in their typical manner but with minor shifts in their behavior in response to the presentation of the other participant in the immediate interaction, influenced also by transactions with other triad participants in coupled sessions. Hence, the behavior changes are more subtle and nuanced, a matter of degree only. Further this shifting of

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Table 3 Posterior Summaries of Hierarchical Linear Model Parameters With Outcome for Each of the Dissimilarity Indices
Mean Parameter SD 2.5% 97.5%

Supervisortherapist dominance dissimilarity Intercept level 1 Intercept level 2 88.02 12.25 72.36 Outcome .02 0.98 1.95 Linear pattern Intercept level 2 .10 1.01 1.92 Outcome .17 1.00 0.05 Quadratic pattern Intercept level 2 .08 1.00 1.93 Outcome .24 0.87 1.48 Supervisortherapist affiliation dissimilarity Intercept level 1 Intercept level 2 77.72 9.63 61.3 Outcome .03 1.01 1.97 Linear pattern Intercept level 2 .15 0.97 1.31 Outcome .52 0.22 0.10 Quadratic pattern Intercept level 2 .24 0.88 0.37 Outcome .09 0.09 0.42 Traineeclient dominance dissimilarity Intercept level 1 Intercept level 2 75.23 13.62 54.31 Outcome .02 1.01 1.88 Linear pattern Intercept level 2 .09 0.99 1.97 Outcome .43 0.36 0.46 Quadratic pattern Intercept level 2 .18 0.41 0.62 Outcome .08 0.06 0.40 Traineeclient affiliation dissimilarity Intercept level 1 7.70 92.31 Intercept level 2 96.82 Outcome .02 1.01 1.78 Linear pattern Intercept level 2 .21 0.97 1.87 Outcome .31 0.25 0.53 Quadratic pattern Intercept level 2 .21 0.51 1.06 Outcome .14 0.09 0.21

102.74 2.04 2.15 0.20 1.85 1.21

99.62 1.01 1.82 0.96 0.91 0.29

99.65 1.97 1.88 0.71 1.02 0.04

110.16 1.95 1.59 0.54 1.44 0.02

Significantly different from zero as indicated by the 95% confidence band.

behavior by the participants in the triad cannot be explained by any general matching or responsiveness of the individuals. Clearly individuals alter their behavior with respect to those with whom they interact. This is the essence of the principle of complementarity (Tracey, 1994). However, in this study, we found that participants adapt to behavior that occurs elsewhere. Supervisors act in initial supervision sessions more like the therapists did in therapy sessions with the clients. Trainees act with their supervisors more like their clients acted in therapy. The key is that the therapist-trainee is the link between the two types of sessions, and the therapist-trainee carries the behaviors within a particular triad

back and forth between the roles. This process has been demonstrated to be different from how the individual usually acts in therapy or in supervision beyond one particular triad. The results of the preliminary analyses of the reverse pattern of therapists bringing the supervision interaction back into the therapy process were found to be related to client rated therapeutic gains. First, there was no overall relation of dissimilarity between any of the roles using either dominance or affiliation and outcome. So there was no indication that dissimilarity (i.e., parallel process) was related to outcome in general. Outcome was, however, related to the pattern of this dissimilarity over time, but in a complex manner. The pattern over time associated with outcome was different if we examined the parallel process of therapists adopting the supervisors behavior than if we examined the parallel process of the clients adopting the trainees behavior. The more therapists acted like their supervisors in previous supervision over time on both dominance and affiliation, the better the outcome. Presumably, the supervisors were modeling behavior for the therapists, and then as the therapists engaged more and more in this behavior over the course of treatment, the better the outcome. This increasing similarity was true for both affiliation and dominance. So the linear trend in supervisor-therapist dissimilarity over time appears to be a manifestation of the positive effects of supervisor modeling. The other time trend result was the curvilinear pattern in both dominance and affiliation dissimilarity between trainee behavior and subsequent client behavior. Good client outcome was associated with an inverted U pattern of trainee-client dissimilarity on both dominance and affiliation over time. In early sessions, the client would act in a manner similar to the trainee in the previous supervision session. Then the client would increase in dissimilarity from the trainees behavior in the previous supervision session in the middle sessions. Finally, in the later sessions, the client would evidence lower dissimilarity (i.e., greater similarity) with the trainees previous behavior. This inverted U pattern was related only to good outcome but not observed with poorer outcome. Clearly, this curvilinear pattern cannot be attributed to modeling, because the client has no direct knowledge of how the trainee acted in supervision. Presumably the trainee is better able to adapt to the behavior of the supervisor. The trainee brings in the less adaptive behavior of the client into supervision, and the supervisor and trainee enact a minor version of the same interaction. Then, as theorists note (i.e., Clarkson, 1994; Doehrman, 1976; and Jacobsen, 2007), the supervisor alters his or her behavior away from these client-defined patterns, theoretically with intentions to promote alternatives for the therapist to employ in session. The trainee then adapts to the supervisor change in behavior and brings these new behaviors into the therapy session, presumably with strengthened abilities to elicit client improvement. These new behaviors serve as a stimulus for the client to act differently. As noted in the therapy literature (e.g., Tracey & Ray, 1984; Tracey, 1993, 2002), introduction of change by the therapist away from initial behavior is stressful to the relationship and the client will not easily change in reaction, thus resulting in increased dissimilarity. As time goes on and with skillful management (learned and supported in supervision) of this discrepancy by the therapist, the dissimilarity should decrease. Thus, this curvilinear pattern of trainee-client dominance and affiliation over time is a mirror of the three stage model of therapy (Tracey, 2002), beginning with rapport building, moving into

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conflict exploration, and ending with resolution and relationship closure. The results of this study support the bidirectional nature of parallel processes depicted in Figure 2 and discussed in the literature (Clarkson, 1994; Doehrman, 1976; Jacobsen, 2007). We found that therapists brought the dominance and affiliation interaction pattern from therapy into supervision in the role of trainee acting like client. Our results of the separate randomization tests strongly support this first direction of parallel processes. Then our study supports the presence of a second direction of parallel process through examination of the extent to which trainees brought the pattern of dominance and affiliation in supervision back into the therapy in the role of therapist acting like the supervisor. We found a significant relationship of this direction of parallel process with successful therapy outcome. The link was the therapist/trainee. Theoretically, the therapist is the medium of this process as he or she brings the therapy interaction process up into supervision and then brings the supervision interaction process down into therapy. In their model of supervision, Stoltenberg and Delworth (1987) focus on the developmental level of the trainee. They proposed that parallel process may occur in supervision with any level of trainee, but that it might be most pronounced in supervision involving more novice supervisors because the more novice supervisors would be more prone to identify with the therapist considering there are fewer developmental differences between them. This could account for the strength of our results with respect to the presence of parallel process because two of our 3 supervisors were novice supervisors enrolled in a supervision practicum. However, we still found strong presence of parallel process with our third supervisor who had more than 10 years of supervision experience. So while the developmental level of some of the supervisors may have magnified the presence of parallel process, our results still support its presence in general. Future research will further explore the differences in parallel processes across supervisor developmental level. This study is noteworthy in that it is the only one that examines more than one supervision triad. We recorded, rated, and analyzed interactions of 17 triads. The amount of data coded and then analyzed was very large, and given the complexities involved, it is not surprising that there are not any similar studies in the literature. However, there are several limitations in this study. While it is an asset that there were several clients, therapists, and supervisors, the numbers of each are still limited. There were only 3 supervisors of differing experience levels and 7 therapists meeting with only 17 total clients. Further the supervision was nested, with one of the supervisors serving in addition as the supervisor for the other 2 who were supervisors in training. The extent to which these results generalize to a broader pool of supervisors beyond these three and with respect to a pool of experienced supervisors remains to be demonstrated. Also, all the therapists were beginning level trainees in their first practicum experience. It is not known if similar results would apply to therapist trainees further along in their development. The data used in rating the in-session therapy behavior consisted of only the middle 20 minutes of each therapy session. This was done to cut down on the amount of rating required, and we thought that this was representative enough of the interaction to yield a valid indication. But it still did not capture the entire interaction, which may have yielded different results. Finally, these results apply

only to dominance and affiliation. It makes sense to examine these dimensions as they are the two basic dimensions of interpersonal interaction (Wiggins, 1979), but these results may not apply to other dimensions of interpersonal interaction. There are several implications of the results of this study for supervision in the training of therapists. Perhaps primary is to clarify the impact of the therapeutic process on the supervision process and vice versa. How the client and therapist interact is brought into supervision by the trainee. As such, the subtle alterations of the supervision process provide indications of the experiences of the therapist in therapy with a particular client. Bidirectional parallel processes provide the supervisor with another vehicle, in addition to direct observation of therapy sessions and review of case notes, in which to understand what is transpiring in therapy with this trainee and the client. The subtle alterations in how both the trainee and the supervisor act when discussing a specific client provide key information on the behavioral dynamics of that particular therapy dyad. As these cues are recognized, the supervisor can alter his or her behavior away from the pattern that the trainee is subtly structuring. Then the trainee can bring this back down to the client, and in the process alter his or her behavior in the therapy session to assist the client into altering behavior. Thus, the actual supervision interaction provides both a diagnostic cue regarding the therapy process as well as a potential vehicle for affecting the therapy process. One factor that supervisors can consider is their metacommunication with the trainee regarding the parallel processes occurring across therapy and supervision sessions. When aware of a parallel process, metacommunication (Beier & Young, 1984; Watzlawick, Beavin, & Jackson, 1967) involves the explicit discussion of implicit, or latent, patterns of communication. The supervisor may choose to communicate with the trainee about how the trainee (in the therapist role) and client are communicating, as well as how the trainee and supervisor are communicating. In this way, the supervisor makes the implicit aspects of the parallel process more explicit for the trainee. The trainee then can make choices about how to best proceed based on the new understanding of the interactional pattern at the both process and content levels of interaction. Of course, metacommunication as a supervision intervention requires the awareness by the supervisor of the parallel process, but has the advantages of not being a complement to a specific eliciting behavior (Beier & Young, 1984) and creating a context in which alternative responses to and for the client can be suggested and explored. Additionally, in some cases, metacommunication may be used by the supervisor as a behavioral model for trainees regarding how to engage in communication with clients that helps make the implicit more explicit. The evidence supporting parallel processes in supervision is greatly strengthened by this investigation. While some theorists view parallel process as an integral part of supervision and one that requires overt focus (Caligor, 1981; Doehrman, 1976), others see it as important but not as primary (Clarkson, 1994). Morrissey and Tribe (2001) argue that parallel processes exist in supervision, and that they need to be recognized because the intentional use of parallel processes can be among the most potent interventions in supervision. However they also note that it can be overused, and that caution is warranted in its application. The results of this study will help inform future theory and research continuing to elucidate the extent to which the process of supervision replicates the

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process of therapy and vice versa, as well as the means by which awareness of these parallel processes can be deliberately and appropriately used to facilitate the parallel goals of client improvement and trainee professional development.

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Received June 24, 2011 Revision received October 3, 2011 Accepted October 7, 2011