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Psychoanalytic Constructs in Psychotherapy

Supervision

Article in American Journal of Psychotherapy · June 2010

DOI: 10.1176/appi.psychotherapy.2010.64.4.393 · Source: PubMed

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 Psychoanalytic Constructs in
Psychotherapy Supervision

C. EDWARD WATKINS, Jr., Ph.D.

While the constructs of the working alliance, parallel process, and counter-
transference have long had transtheoretical appeal for many supervision
practitioners, what empirical data— quantitative or qualitative—are there
that support their use in psychotherapy supervision? In this paper, I attempt
to address that question by: (1) identifying empirical, data-based efforts to
research the supervisory working alliance (n⫽17), parallel process (n⫽7),
and countertransference (n⫽1); (2) reviewing and determining for each study
sample characteristics, measures used, procedure, analyses used, findings, and
limitations; (3) identifying the primary conclusions that can be drawn from
that review and analysis; and (4) considering the implications and directions
for future supervision research and practice. While the data appear strongest
for the supervisory working alliance and tentatively support its place in
psychotherapy supervision, research on alliance, parallel process, and coun-
tertransference is still very much in its infancy and sorely limited empirically.
Some avenues for remedying previous study deficiencies are presented, and
the hope and caution of future research on these constructs are considered.

KEYWORDS: supervisory working alliance, parallel process, supervisor

countertransference, psychotherapy supervision, clinical supervision

INTRODUCTION
In the history of psychotherapy supervision, the role of psychoanalytic
supervision looms large: The very beginning of supervision is traced back
to Freud’s seminal work (Freud 1909/1959, 1914/1950; Gay, 1988; Jacobs,
David & Meyer, 1995), psychoanalysts were seemingly the first practitio-
ners/educators to grapple with defining supervision and its scope (Eiting-
ton, 1926, 1928, 1937). Some of the constructs (e.g., the working alliance)
that many supervisors, regardless of theoretical perspective, hold most
dear today owe their origin to psychoanalytic influence (Freud, 1912/1959,

Department of Psychology, University of North Texas Mailing Address: 1155 Union Circle
#311280, Denton, TX 76203-5017. e-mail: watkinsc@unt.edu
AMERICAN JOURNAL OF PSYCHOTHERAPY, Vol. 64, No. 4, 2010

393
AMERICAN JOURNAL OF PSYCHOTHERAPY

1913/1959; Greenson, 1965). As Bernard and Goodyear (2009) have

stated, “[p]sychoanalytic conceptions of supervision . . . have affected
supervision theory and practice more than those of any other model”
(p. 81); those conceptions helped us to see as never before that the
“person” of the supervisee and supervisor matter and matter substantially
(supervision was and is far more than pure didactics; Fleming & Benedek,
1966), the “personality” of the training program or institution matter
substantially as well ([the clinical rhombus and beyond] Ekstein & Waller-
stein, 1958; Szecsody, 2008), and the process of therapy can be “reflected”
in the supervision experience and vice versa (Gediman, 2001; Gediman &
Wolkenfeld, 1980; Searles, 1955). Those insights, now usually taken for
granted, were presented initially by psychoanalytic supervisors over half a
century ago and, currently, continue to resonate widely and forcefully
across the entirety of the supervision field (e.g., Bernard & Goodyear,
2009; Falender & Schafranske, 2004, 2008; Haber, 1996; Hess, Hess, &
Hess, 2008; Watkins, in press; Williams, 1995).
Within the last generation of supervision science and practice, we have
seen increasing interest in researching and applying specific psychoanalytic
ideas to the supervisory situation. That has been especially so for the
constructs of supervision working alliance and parallel process. Some
limited research attention has even been advanced toward understanding
the effects of countertransference in supervision. In my view, much of that
emerging empirical interest seems propelled foremost by the clinically
tested value and significance that those constructs have enjoyed across the
decades in supervision. The supervision working alliance, parallel process,
and supervisory countertransference seem to have increasingly gained
traction as useful, practical means by which to understand and explain
some crucial facets of the supervision process, whatever may be one’s
theoretical orientation.
The supervision working alliance has been operationalized as the bond,
goals, and tasks shared by supervisee and supervisor (see Bordin, 1983; cf.
Fleming & Benedek, 1966). The bond component has been referred to as
the rapport, trust, liking, and connection existing between supervisor and
supervisee; the goals component has been referred to as supervisor/
supervisee mutual understandings and agreements about the objectives to
be pursued in supervision, and the tasks component has been referred to
as supervisor/supervisee mutual understandings and agreements about the
activities to be executed in the service of goal attainment (Bordin, 1983).
Parallel process, an extension of the reflection process originally proposed
by Searles (1955), has been defined as themes, issues, or behaviors arising
394
Psychoanalytic Constructs in Psychotherapy Supervision

in the therapeutic relationship that manifest themselves in the supervisory

relationship or vice versa (Doehrman, 1976; Gediman, 2001; Mothersole,
1999). Unresolved or problematic matters that reverberate between ther-
apist and patient can be unconsciously transported and enacted in the
supervisory relationship, for example, the patient might elicit a harsh,
judgmental response from the therapist who, when discussing the patient
in supervision, elicits like treatment from the supervisor (see Langs &
Searles, 1980, p. 132); conversely, matters between supervisor and super-
visee may make their way into the therapeutic relationship (e.g., where the
supervisor repeatedly acts toward the supervisee in an unnecessarily harsh
fashion and the supervisee carries that rage forth, treating the patient with
anger). Parallel process, no longer a one-way street, can best be concep-
tualized now as a multi-lane highway full of communication possibilities.
Countertransference in supervision has been defined either in a more
classical, traditional manner or in totalistic fashion. The traditional view
would consider countertransference to be a product of long-standing
unresolved issues that get displaced from supervisor to supervisee. In the
totalistic vision, however, countertransference is defined far more broadly—
as any and all supervisor reactions to the supervisee (cf. Ladany, Constan-
tine, Miller, Erickson, & Muse-Burke, 2000).
Virtually all of the alliance, parallel process, and countertransference
research, while acknowledging psychoanalytic provenance, has been con-
ceptualized as pan-theoretical in nature (i.e., having relevance for all of
supervision, regardless of theory; see Bernard & Goodyear, 2009; Ladany,
2004; Ladany et al, 2000; McNeill & Worthen, 1989). Much as the
construct of “working alliance” has been profitably generalized beyond
psychoanalytic psychotherapy and psychoanalysis (Bordin, 1979, 1994;
Horvath, 2001), there has been thinking that certain psychoanalytic con-
structs might profitably applied to—and even generalized beyond— psy-
choanalytic supervision (cf. Bordin, 1983; Falender & Schafranske, 2008;
Gill, 2001; Rock, 1997). But at this time, what is really known beyond the
theory and speculation? Does the research offer any support for the use
and application of these three psychoanalytic constructs in psychotherapy
supervision?
In this paper, I would like to consider those questions. Specifically, I
would like to examine research— qualitative and quantitative—that has
evaluated the role of the working alliance, parallel process, and counter-
transference in clinical supervision. In doing so, I hope to (1) identify
which data have emerged to confirm or disconfirm the relevance of those
variables for the supervision experience, (2) identify strengths and limita-
395
396
Table 1 STUDIES OF WORKING ALLIANCE IN PSYCHOTHERAPY SUPERVISION

Study Sample Characteristics Measures/ Procedure Analyses Used Findings Limitations

Assessment Used

Chen & 1 high-alliance and 1 low- Supervisory Styles Questionnaires Chi-square tests Higher degree of Relatively small
Bernstein alliance dyad selected Inventory, completed and complementary sample pool
(2000) from 10 supervision Critical by correlational interaction found in Limited evidence
dyads overall (9 White Incidents supervisor/ data “high-rated alliance” to support
female and 1 White Questionnaire, supervisee dyad as opposed to validity of
male supervisees in first Supervisory dyads prior “low-rated alliance” Complementarity
counseling practicum; x Working to first dyad Indices in
age⫽36; 6 White Alliance supervision supervision
female and 1 white Inventory meeting and research
male doctoral student (Trainee and during the Age and experience
supervisors [in Supervisor three differences in
supervision course], x Versions), supervision high-alliance
age ⫽ 33) Complementarity meetings versus low-
AMERICAN JOURNAL OF PSYCHOTHERAPY

Indices held alliance dyads

Efstation, 185 supervisors (69 Supervisory Questionnaire Principal Positive relationship found Advanced
Patton, & female, 114 male, 2 not Working packets components between supervisee self- practicum and
Kardash specified; x age⫽ 42 Alliance mailed out factor efficacy expectations and intern-level
(1990) years; 122 clinical Inventory analysis perceptions of students only
psychologists, 45 Supervisory Styles Hierarchical supervisory working
counseling Inventory regression alliance
psychologists, 12 other; Self-Efficacy
outpatient clinics 33%, Inventory
university/college
counseling centers
31%; VAs 13%,
psychiatric hospitals
21%); 178 supervisees
(103 female, 73 male; 2
not specified; x age ⫽
30 years)
 Gatmon, 289 predoctoral psychology Working Alliance Inventory Questionnaire Frequency Positive relationship Ex post facto
Jackson, interns (203 female, 86 male; Supervision Questionnaire— packets and found between design
Koshkarian, 73.4% European-American, Revised distributed correlational discussions of Focused
Martos- 6.6% African-American, Cultural variables questions analyses, cultural variables exclusively on
Perry, 5.9% Asian-American, 5.2% ANOVAs in supervision perceptions of
Molina, Chicano/Latino, 8% other) and and supervisees’ supervisees
Patel, & MANOVAs reported
Rodolfa satisfaction with
(2001) supervision and
supervisory
working alliance
Inman (2006) 147 marriage and family therapy Supervisor Multicultural Questionnaire Structural Positive relations Ex post facto
trainees (121 females, 26 Competence Inventory packets equation found between design
males; 103 White, 12 African- Working Alliance Inventory- distributed modeling supervisory Focused
American, 13 Asian- Trainee Version working alliance exclusively on
American, 13 Hispanic- Coding of multicultural case and supervisor perceptions of
American, 3 conceptualization ability multicultural supervisees
biracial/bicultural, 2 competence and 22.6% return
unspecified; x age⫽33.4 years; supervisee rate
32 beginning level, 63 satisfaction;
advanced level, 32 intern supervisory
level, 19 post-master’s) working alliance
a significant
positive mediator
Ladany, 105 supervisees (81 female, 23 Cultural Identity Attitude Questionnaire Factorial Expected relations Ex post facto
Brittan- male; 1 unspecified; 71% Scale, White Racial packets MANOVA found between design
Psychoanalytic Constructs in Psychotherapy Supervision

Powell, & White, 11% African- Identity Attitude Scale, distributed supervisees’ Focused
Pannu American, 5% Asian- Perceptions of Supervisor to graduate perceptions of exclusively on
(1997) American, 11% Latino, 3% Racial Identity, Working training racial identity perceptions of
other; x age ⫽ 29.9 years; Alliance Inventory- programs interaction and supervisees
clinical psychology 17%; Trainee Version, Cross- supervisory
counseling psychology/ Cultural Counseling working alliance
counselor education 71%; Inventory—Revised
doctoral 43%, master’s 50%;
university/college counseling
center 38%, mental health
center 22%, schools 27%)

397
398
Table 1 (Continued)

Ladany, Ellis, 107 supervisees (72 Working Alliance Questionnaire Multivariate Emotional bond Ex post facto
& female, 35 male; 86% Inventory- packets multiple component of alliance design
Friedlander White, 7 African- Trainee distributed regression significantly related to Focused exclusively
(1999) Americans, 3% Latino, Version analysis supervisee satisfaction on perceptions
2% Asian-Americans, Self-Efficacy with supervision of supervisees
3% unspecified; x age Inventory
⫽29.9 years; clinical Trainee Personal
psychology 36%, Reaction
counseling psychology/ Scale—Revised
counselor education
59%; doctoral 71%,
master’s 29%;
university/college
counseling center 40%,
mental health center
AMERICAN JOURNAL OF PSYCHOTHERAPY

25%, VA 22%)
Ladany & 123 supervisees (81 Working Alliance Questionnaire Multivariate Expected relations found Ex post facto
Friedlander female, 42 male; 85% Inventory- packets multiple between supervisory design
(1995) White, 8% African- Trainee distributed regression working alliance and Focused exclusively
American, 2.4% Version analysis supervisees’ perceptions on perceptions
Latino, 1.6 Asian- Role Conflict and of role conflict and role of supervisees
American, 2.4% Role Ambiguity ambiguity Advanced sample
unspecified; x age ⫽ 30 Inventory of supervisees
years; 54% counseling
psychology, 37%
clinical psychology;
68% doctoral 27%
masters; university/
college counseling
center 41%, mental
health center 23%, VA
20%)
 Ladany & 105 supervisees (82 Supervisor Self- Questionnaire Univariate and Positive relationship found Ex post facto
Lehrman- female, 23 male; 84 Disclosure packets multivariate between supervisor self- design
Waterman White, 12 African- Questionnaire distributed regression disclosure frequency and Focused exclusively
(1999) American, 5 Hispanic, Supervisor Self- analyses supervisory working on perceptions
1 unspecified; x age ⫽ Disclosure alliance components of supervisee
30.4 years; clinical Index (goals, tasks, and bond) Used supervisee
psychology 30%, Supervisory Styles recall
counseling psychology/ Inventory
counselor education Working Alliance
67%) Inventory-
Trainee
Version
Ladany, 151 supervisees (114 Supervisor Ethical Questionnaire Multivariate Expected relations found Ex post facto
Lehrman- females, 36 males, 1 Practice packets multiple between supervisee design
Waterman, unspecified; 121 White, Questionnaire distributed regression perceptions of Focused exclusively
Molinaro, 12 African-American, 4 Supervisor Ethical to graduate analysis supervisors’ ethical on perceptions
& Wolgast Latino, 1 Native Behavior Scale training behaviors and working of supervisees
(1999) American, 4 Working Alliance programs alliance components
unspecified; x age ⫽ Inventory- and training
31.5 years; clinical Trainee sites
psychology 26%; Version
counseling psychology Supervisee
68%; 58% doctoral, Satisfaction
Psychoanalytic Constructs in Psychotherapy Supervision

36% master’s; Questionnaire

university/college
counseling center 41%,
mental health center
18%; schools 9%;
prisons 4%; private
practice 2%)

399
400
Table 1 (Continued)

Ladany, 137 supervisors (80 Supervisory Styles Questionnaire Multivariate Positive relationship found Ex post facto
Walker, & female, 55 male, 1 Inventory packets multiple between supervisory design
Melincoff other; 119 White, 6 Working Alliance mailed regression style and working Focused exclusively
(2001) African-American, 3 Inventory- analysis alliance components on perceptions
Latino, 1 other; x age Supervisor of supervisors
⫽ 45 years; clinical Version Could not
psychology 18%; Supervisor Self- determine return
counseling psychology/ Disclosure rate
counselor education Inventory
68%; 110 doctoral, 27
master’s; university/
college counseling
center 33%, mental
AMERICAN JOURNAL OF PSYCHOTHERAPY

health center 15%;

academic 15%)
Mena & 51 supervisors (47 female, Supervisory Questionnaire Hierarchical Positive relations between Ex post facto
Bailey 4 male; 49 White, 1 Working packets linear alliance rapport and design
(2007) African-American, 1 Alliance distributed modeling workers’ job satisfaction; One point in time
other); 80 workers (all Inventory negative relations found sampled
female; 69 White, 7 (Supervisor and between alliance rapport
African-American, 3 Worker and workers’ emotional
Hispanic, 1 other) Versions) exhaustion and
Minnesota depersonalization
Satisfaction
Questionnaire
Maslach Burnout
Inventory
 Patton & 75 graduate-level pre- Working Alliance “Clients” seen by Hierarchical Positive relationship Focused only on
Kivlighan practicum supervisees Inventory beginning graduate- linear found between perceptions of
(1997) (53 female, 22 male; 64 Supervisor level, pre-practicum modeling supervisees’ supervisees and
European-American, 11 Working students for 4 50- perceptions of clients
African-American; x Alliance minute sessions; supervisory “Clients” were
age⫽27.7 years); 77 Inventory “supervisees” then working alliance compensated
clients (59 female, 16 (Supervisee seen for supervision and clients’ undergraduate
male; 69 European- Form) session after each perceptions of volunteers who
American, 8 African- Vanderbilt client meeting; time- therapeutic had not actually
American; x age⫽20 Therapeutic limited dynamic working alliance sought treatment
years; compensated Strategies Scale psychotherapy the
undergraduate treatment focus
volunteers)
Quarto 72 supervisees (78% Supervision Questionnaire packets Exploratory Negative Ex post facto
(2002) female, 22% male; Interaction distributed factor relationship design
86% White, 6% Questionnaire analysis found between Perceptions
African-American, 4% Supervisory One-factor supervision sampled at only
Hispanic, 4% Other; x Working ANOVA conflict and one point in
age⫽33.5 years; all Alliance supervision time
counselor education Inventory working alliance
graduate students; (Trainee and
university counseling Supervisor
centers 28%, agencies versions)
21%, psychology
clinics 3%, other
15%); 74 supervisors
(61% female, 39%
male; x age⫽44.4 years;
Psychoanalytic Constructs in Psychotherapy Supervision

73% doctoral-level
professionals in
counselor education,
counseling psychology,
or clinical psychology,
23% other)

401
402
Table 1 (Continued)

Ramos- 126 practicum students Relationship Questionnaire Correlational, Expected relations found Ex post facto
Sanchez, and interns (73% Questionnaire packets multivariate between supervisee design
Esnil, female, 27% male; Working Alliance distributed ANOVA, developmental level, Focused exclusively
Goodwin, 79% European- Inventory and negative supervisory on perceptions
Riggs, American, 21% Other; Supervisee Levels qualitative events, and perceptions of supervisee
Touster, x age⫽30.7 years) Questionnaire- analyses of supervisory working
Wright, Revised alliance
Ratanasiripuns,
& Radolfa
(2002)
Sterner 71 mental health Supervisory Survey Correlational Positively perceived Ex post facto
(2009) counselors either now Working questionnaire analyses and supervisory working design
AMERICAN JOURNAL OF PSYCHOTHERAPY

being supervised or Alliance completed canonical alliance related to Focused exclusively

having been supervised Inventory- on Internet correlational greater work satisfaction on perceptions
post degree (48 female, Trainee website by analysis and less work-related of AMHCA
22 male, 1 no response; Version American stress supervisees
90% White, 4% Minnesota Mental Unclear how many
Latino-American, 1% Satisfaction Health “supervisees”
Native American; x Questionnaire- Counseling were not actually
age⫽51; 83% held Short Form Association in supervision
master’s degree, 17% Occupational members and how long
doctoral; 39% private Stress (AMHCA) they had not
practice, 27% mental Inventory- been
health agency, 16% Revised
private, nonprofit
agency, 4% hospital,
14% other)
 Walker, 111 female graduate Gender-Related Questionnaire packets Multivariate Supportive gender- Ex post facto
Ladany, & student supervisees (91 Events Survey distributed multiple related events design
Pate- White, 9 African- Working Alliance regression found to be Focused exclusively
Carolan American, 4 Asian, 3 Inventory- analyses positively related on perceptions
(2007) biracial, 3 Latina, 1 Trainee to supervisory of supervisees
other; x age⫽31 years; Version working alliance; Could not
18% clinical Trainee converse found determine
psychology, 70% Disclosure for non- response rate
counseling psychology; Scale supportive
university/ college gender-related
counseling centers events
58%, mental health
centers 18%, schools
6%; VAs 5%; state
hospitals 5%)
Wester, 103 male psychology Gender Role Questionnaire packets t tests Male supervisees Ex post facto
Vogel, & interns (93 White, 9 Conflict Scale distributed ANOVAs working with design
Archer Hispanic, 1 African- Supervisory male as opposed Focused exclusively
(2004) American; x age⫽33.3; Working to female on perceptions
64 doctoral students 35 Alliance supervisors of supervisees
master’s) Inventory- perceived
Trainee supervisory
Version working alliance
Counseling Self- less favorably,
Estimate lending initial
Inventory support to
Psychoanalytic Constructs in Psychotherapy Supervision

possible male
socialization
explanation
Note: MANOVA⫽multivariate analysis of variance; ANOVA⫽ analysis of variance.

403
404
Table 2 STUDIES OF PARALLEL PROCESS IN PSYCHOTHERAPY SUPERVISION

Study Sample Characteristics Measures/ Procedure Analyses Used Findings Limitations

Assessment Used

Alpher (1991) 1 26-year old White Symptom Interpersonal process Structural Interdependence in Single patient,
female patient being Checklist-90- tracked over 25 Analysis of interactions therapist, and
seen at Outpatient Revised sessions of short- Social found to occur supervisor
Clinic; Structural term dynamic Behavior across therapy No comparison
rd
1 3 -year male psychiatric Analysis of psychotherapy and supervision case
resident as therapist; Social dyads; Generalization not
1 clinical psychology Behavior- perceptions of possible
supervisor INTREX interdependence
Questionnaire in psychotherapy
related to
perception of
interdependence
in supervision
Caligor 1 35-year old female Peer-supervision Weekly 2-hour peer- Study of Parallels observed Possible observer
AMERICAN JOURNAL OF PSYCHOTHERAPY

(1981) patient; study group supervision study supervisory across patient- and confirmation
1 female therapist and 1 (composed of group discussion/ tapes in peer therapist, bias
male therapist Caligor and analysis supervision therapist- Possible “allegiance
(co-supervisees); two of his study group supervisor, and effect” (cf.
1 male supervisor colleagues) supervisor- Luborksky et al,
(Caligor) discussion/ supervisory peer 1999)
analysis group
interactions
Doehrman 8 patients (5 female, 3 20 hour-long Interviews Descriptive Parallel process Naturalistic clinical
(1976) male) new to interviews with conducted with all data and found to occur research format
psychology clinic; 2 supervisor and parties at designated consideration and recur “in a Clinical analysis of
female and 2 male new supervisee times of interview remarkable data
clinic interns as Rating forms information multiplicity of Author primary
therapists; 1 female and Summary forms” (p. 82) interviewer
1 male supervisor interview
Patient interviews
Follow-Up
interview
 Friedlander, 1 31-year old female Supervisory Styles Pre-, in- Descriptive and Interactional Single client, therapist, and
Siegel, & being seen at university Inventory, process, and linguistic patterns supervisor
Brenock training clinic; 1 24- Counseling post- analyses considered to be No comparison case
(1989) year old White female Orientation measurement consistent with a Generalization not possible
counseling psychology Questionnaire, attempted parallel process
supervisee; 1 32-year Control Coding with all view of
old White female System, parties supervision; both
doctoral-level Communication therapy and
counseling psychology Rating Scale, supervision seen
supervisor Supervisory as quite similar
Feedback processes—
Rating System, “reciprocal and
Hill Counselor interlocking”
Verbal
Response
Category
System-Revised,
Session
Evaluation
Questionnaire,
Counselor
Rating Form,
Supervisor
Perception
Form,
Counselor
Perception
Questionnaire
Psychoanalytic Constructs in Psychotherapy Supervision

Jacobsen 1 male schizophrenic in Personal Review of Personal Parallels in process Single patient, therapist,
(2007) his mid-twenties; 1 assessment of content analyses between and supervisor but
male psychoanalytic patterns and from 2 employed psychotherapy supervision actually done
psychotherapist; 1 male themes psychotherapy and supervision in group setting with 2
psychoanalytic sessions observed female therapists
supervisor made by included
author and Only a single supervision
one outside session examined
observer No comparison case
Possible “allegiance effects”

405
406
Table 2 (Continued)

Study Sample Characteristics Measures/ Procedure Analyses Used Findings Limitations

Assessment Used

Lombardo, 7 clients; 7 master’s-level Independent Ratings of session Descriptive and No empirical No rater training
Greer, counselors; 6 doctoral- ratings of four material made by 2 correlational support found for or cross-checks
Estadt, & level supervisors (in specific “experienced” analyses empowerment or carried out
Cheston supervision class) “empowerment” (unspecified) conflict in parallel Likert rating scales
(1997) behaviors in supervisors process between used only
therapy and therapy and Gender/race not
supervision for supervision specified for any
7 therapy/ participants/raters
supervision Time of therapy
sessions interviews not
specified
Raichelson, 100 psychoanalytic Parallel Process Questionnaire packets Two-factor Belief in parallel Self-generated
Herron, supervisors (27 female, Survey mailed out fixed effects process found to measure
Primavera, 73 male; x age⫽56.5 ANOVA exist across Highly experienced
AMERICAN JOURNAL OF PSYCHOTHERAPY

& Ramirez years; 95 PhD, 2 CSW, analytic and non- sample

(1997) 3 MD); 100 analytic
psychoanalytic respondents
supervisees (42 female,
58 male; x age⫽50.4
years; 98 PhD, 2 MD);
50 non-analytic
supervisors (11 female,
39 male; x age⫽48.9
years; 45 PhD, 4
master’s, 1 MSW); 50
non-analytic
supervisees (17 female,
33 male; x age⫽ 47
years; 38 PhD, 8
master’s, 4 MSW, 2
MD)
Note: ANOVA⫽Analysis of variance.
 Table 3 QUALITATIVE STUDY OF SUPERVISOR COUNTERTRANSFERENCE IN PSYCHOTHERAPY SUPERVISION

Study Sample Characteristics Measures/ Procedure Analyses Used Findings Limitations

Assessment Used

Ladany, 11 supervisors: 8 female, Semi-structured Questionnaire packets Domain Coding Supervisor Limited
Constantine, 3 male; 10 White, 1 Interview and 45-60 minute and Cross- manifestations generalizability
Miller, African-American; x phone interview Analysis (e.g., affective) Only one counter-
Erickson, age⫽40.6; doctoral and sources (e.g., transference
& Muse- psychologists in clinical supervisor event focus of
Burke (1) or counseling (10) unresolved study
(2000) psychology; x years of personal issues) Supervisors of pre-
experience ⫽ 9 of counter- doctoral interns
transference only
identified; ways
of managing
counter-
transference (e.g.,
talking with
Psychoanalytic Constructs in Psychotherapy Supervision

colleagues)
identified as well

407
AMERICAN JOURNAL OF PSYCHOTHERAPY

tions of those data sets, and (3) if warranted, chart possible directions for
future supervision research. Considering the relative newness and paucity
of research study about psychoanalytic constructs in supervision, I chose
not to adopt any rigid exclusionary criteria that, I surmised, would only
further limit an already limited field of studies. Rather, I chose to accept
any quantitative and qualitative studies that emerged but subject them to
critical evaluation. While my initial plan was also to review studies dealing
with transference in supervision, my search revealed that no studies
focusing on that specifically have been conducted. The case could be made
that any study of parallel process is, to some degree, a study of transference
(see Frawley-O’Dea & Sarnat, 2001). Yet transference extends beyond
parallel process alone and seemingly is a topic in need of study in its own
right.
METHOD
To identify articles for review, four steps were taken:
(1) PsycInfo and Google Scholar database searches were conducted
using such key words as “supervisory alliance,” “supervisory
working alliance,” “parallel process,” “countertransference,” and
“psychotherapy supervision;”
(2) reference sections of identified articles were examined to further
identify other appropriate articles for inclusion;
(3) journals that publish material about supervision material were
examined for any recent articles;
(4) various texts on supervsion (e.g., Bernard & Goodyear, 2009;
Hess, Hess, & Hess, 2008; Watkins, 1997) were also examined to
find any possible missed works.
A total of 25 articles was identified—17 on supervisory working alliance,
seven on parallel process, and one on countertransference. The review
time period spanned from the mid-1970s through April 2010. Each article
was reviewed to determine sample characteristics, measures used, proce-
dure, analyses used, findings, and limitations. Tables 1, 2, and 3, respec-
tively, provide a summary of the features of the supervisory working
alliance studies, parallel process studies, and the countertransference
study.
RESULTS
Supervisory working alliance
The following findings emerged from the 17 supervisory-working-
alliance studies:
408
Psychoanalytic Constructs in Psychotherapy Supervision

(1) individually and collectively, support was found for the value of
“working alliance” in supervision;
(2) expected relations were found between a positively rated super-
visory working alliance and supervisee self-efficacy, satisfaction
with supervision and work (job), favorable perceptions of super-
visor ethical, cultural, gender senstive, (appropriate) self-disclo-
sure behaviors, and supervisor-supervisee interactional comple-
mentarity;
(3) expected relations were found between a negatively rated super-
vision working alliance and negative supervision events, greater
role conflict and role ambiguity, and lower racial-identity-attitude
agreement; and
(4) the majority of the studies involved completion of a questionnaire
packet, were ex post facto in design, focused primarily on the
perceptions of the supervisee, used participants who were White
or European-American (approximately 75% to 100% across all
studies) and female (approximately 66% overall), drew from
doctoral-level counseling psychology, clinical psychology, and
counselor education training programs and sites (though master’s
supervisees were also represented), and included college/univer-
sity counseling centers, community mental health centers, and
hospitals as work settings.
Of the 17 studies, only two involved the conduct of actual supervision
sessions—Chen and Bernstein (2000), where but two supervision dyads
were followed over three supervision meetings, and Patton and Kivlighan
(1997), where four supervision meetings were held between supervisors
and their graduate-level, pre-practicum supervisees (who were seeing
compensated, volunteer undergraduate students as clients). Of those 2
studies, the two-dyad study of Chen and Bernstein was the only real-life
supervision study that included a total of 2 patients.
Parallel process
For the seven parallel process supervision studies, the following find-
ings emerged:
(1) with but one exception (Lombardo, Greer, Estadt, & Cheston,
1997), support was found across investigations for a parallelism
between the therapy and supervision situations;
(2) most of the research was case study in nature (n⫽5), involved a
single therapist, patient, and supervisor (n⫽4), had no compari-
son case, and made limited to no claims of generalizability;
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(3) gender and/or race of the participants were not fully specified in
any study; and
(4) some of the research was based solely on opinion data (Raichel-
son, Herron, Primavera, & Ramirez, 1997) and seemed subject to
claims of observer bias, confirmation bias, or investigative con-
tamination (in terms of data collection and/or analysis; see Cali-
gor, 1981; Doehrman, 1976; Jacobsen, 2007).
Countertransference
For the one qualitative countertransference study, the following find-
ings emerged:
(1) manifestations and sources of supervisor countertransference
across supervisors were identified;
(2) ways of managing supervisor countertransference were identified;
and
(3) generalizability was limited because (a) only 11 supervisors of
predoctoral interns served as research participants and (b) they
were asked to focus on a single countertransference event.
(Though a most interesting qualitative supervision study,
Zaslavsky, Numes, and Eizirik [2004] was not included here
because its primary focus was on countertransference in the
analyst-analysand [not supervisor-supervisee] relationship.)
DISCUSSION
In reflecting on the findings of these 25 studies, what do they offer us
for psychotherapy supervision practice and research? What we see here are
challenging theoretical/conceptual constructs—supervisory working alli-
ance, parallel process, and countertransference—that make for highly
challenging research constructs. While some of these 25 studies stretch
back for decades, this body of work is still very much in its infancy and in
need of systematic and substantive programmatic inquiry. These 25 initial
efforts, however, provide us with a hint of quantitative and/or qualitative
support and the possibility for the place of these three psychoanalytic
constructs in psychotherapy supervision.
The strongest support emerges for the “supervisory working alliance”
(see Table 1). Most of that support comes from questionnaire studies in
which “supervisees’ perceptions” have been tapped; their much-valued
perceptions open an important window on one key view of some seeming
effects of “good” and “poor” alliances in supervision. As we might expect,
more favorably perceived alliances relate to more favorably perceived
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Psychoanalytic Constructs in Psychotherapy Supervision

supervision experiences (e.g., supervision satisfaction, ethical and appro-

priately self-disclosive supervisor behaviors, goal setting, role clarity) and
vice versa. While these data are only suggestive and noncausal in design, it
may indeed be that the “supervisory working alliance is at the heart of
effective supervision. . .” (Inman & Ladany, 2008, p. 502). This body of
data is at least a good beginning in working toward more decisively and
definitively confirming that possibility.
As these data give voice to the potential benefits of a good supervision
alliance, they also illuminate some of the limitations and cautions to
consider. Empirical understandings are largely restricted to White or
European-American participants; while preliminary data suggest that the
supervision alliance is equally important multiculturally (Bernard & Good-
year, 2009; Ladany, Brittan-Powell, & Pannu, 1997), we clearly need
studies that focus on ethnic groups beyond European-American (cf.
Toldson & Utsey, 2008) if we are to have a more sensitive, comprehensive
multiculturally informed perspective. Furthermore, nowhere is there a
real-life, in process study that tracks the development and growth of the
supervisory working alliance over time—the building, breaking, and repair
of the bonds that bind supervisor and supervisee in relationship. If we are
to most fully understand the supervisory alliance in action, then supervi-
sory alliance in action must be rigorously studied. In the quest to more
completely chart the place of alliance in psychotherapy supervision, those
needs seem most critical and pressing to address now.
While some interesting, creative work has been brought to bear on
parallel process study, the data considered here (see Table 2) seem at best
to hint at its reality. Case-study analysis and clinician opinion (Frawley-
O’Dea & Sarnat, 2001; Gediman, 2001; Jacobsen, 2007; Morrisey & Tribe,
2001) converge on the link, relation, and reverberation of the therapy
process in supervision and vice versa, but no study here provided a
compelling, unequivocal empirical case for that. Without question, this is
a most difficult subject to study; not only do these seven reviewed
investigations demonstrate that but also point to future problems that must
be avoided, e.g., observer bias. As Mothersole (1999) asserted, “[w]hat is
required is further study using structured data collection and analysis by
independent raters” (p. 116). More than a decade after that assertion, none
of that has been employed. The “clinical validity” of parallel process may
be abundant (e.g., Ekstein & Wallerstein, 1958; Frawley-O’Dea & Sarnat,
2001; Gediman & Wolkenfeld, 1980; Gill, 2001; McNeill & Northen,
1959; Morrisey & Tribe, 2001; Rock, 1997), but its empirical justification
is largely absent. As interest in and use of parallel process continues in the
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supervisory context, efforts to remedy that empirical absence seem very

much in order and could benefit from building on the strengths (e.g.,
grounded interpersonal analysis; Alpher, 1991) and addressing the limita-
tions (e.g., failure to include comparison cases) of the available research
conducted.
Countertransference study in supervision seems no less formidable a
task. The one investigation we do have (see Table 3) is indeed intriguing,
provides us with some thought-provoking data, and employs a well-
executed qualitative approach that can nicely serve as a model for future
countertransference/supervision research. But we are left wanting more.
Those data, which draw on eleven (mostly White female) supervisors (of
predoctoral psychology interns) who were asked to focus on but a single
countertransference event, are clearly limited, nongeneralizable, and can-
not be used as empirical justification for the use of countertransference in
supervision. The “clinical validity” of countertransference in supervision
may be abundant (e.g., Frawley-O’Dea & Sarnat, 2001; Gill, 2001; Lane,
1990; Langs, 1979; Rock, 1997) but, again, its empirical validity is not.
What this particular study does, however, is provide us with a rich
methodology and example of how we can begin to remedy that; it is a
model start that provides one direction by which meaningful countertrans-
ference/supervision study can proceed and potentially valuable data can be
collected.
INTO THE FUTURE
What, then, can we conclude from this body of studies? In my view, the
essential conclusions can be summarized as follows:
(1) there appears to be a tentative base of empirical support for the
“supervisory working alliance” and its place in clinical supervi-
sion;
(2) these data suggest that the supervisory working alliance functions
in ways consistent with supervision alliance theory and specula-
tion (i.e., a positively-viewed working alliance contributes posi-
tively to supervision process and outcome; a negatively-viewed
alliance functions conversely);
(3) those data are necessarily limited by (a) particular design features
and sample restrictions (e.g., most data based on supervisees’
one-time perceptions only; samples primarily White, female, and
from counseling psychology/counselor education training pro-
grams and sites) and (b) the reality that, beyond the Chen and
Bernstein (2000) two-dyad, three-supervision session investiga-
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Psychoanalytic Constructs in Psychotherapy Supervision

tion, no supervisory working alliance studies as yet have involved

the real-life, in process study of supervisors doing supervision
with supervisees over time;
(4) parallel process research, because of its failure to include com-
parison cases (see Chen & Bernstein, 2000), failure to include
independent raters (Mothersole, 1999), and the possible con-
founds of construct “cueing” or theoretical allegiance (Lombardo
et al, 1997), has thus far not provided empirical justification for
that construct’s use in supervision;
(5) what that research does, however, is provide us with some useful
approaches to studying this topic that, with empirical strengthen-
ing (e.g., including comparison cases, structured data collection,
independent raters), could indeed yield valid data about the place
of parallel process in psychotherapy supervision;
(6) with there being only one qualitative study (n⫽11) of counter-
transference in supervision, empirical justification is found lacking
there as well;
(7) this one study does, however, provide us with a beginning—again,
a nicely-done, well-executed investigation that could serve as a
model for subsequent qualitative studies to emulate.
In considering these 25 studies, 7 conclusions, and their implications, I
find both hope and caution. All of this supervision research is still very
much in its infancy. Even with the supervisory working alliance, where the
most data are available, there is no real-life, real-time, in-process study of
the supervisee-supervisor formation and maintenance of alliance across
supervision space. For this area to most fruitfully advance, the remedy of
that deficiency would seem preeminent. It may be that the supervisory
working alliance eventually becomes to supervision what the therapeutic
working alliance has been and is now to psychotherapy (cf. Orlinsky,
Ronnestad, & Willutzki, 2004), but that is a possibility that yet remains to
be realized empirically. Countertransference and parallel process, though
also unrealized empirically thus far, do present us with some intriguing,
uncharted territory that calls for methodologically sound, rigorous, and
systematic study, be it quantitative (e.g., Lombardo et al., 1997) or
qualitative (e.g., Ladany et al., 2000); such study would be a much-needed
complement to “clinical” belief in and anecdotal data in support of parallel
process and countertransference (e.g., Morrisey & Tribe, 2001; Raichelson
et al., 1997) and their supervision manifestations. Building the bridge more
effectively between the “clinical” and “empirical,” then, seems to be the
next step in further exploring and confirming/disconfirming the place of
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supervisory working alliance, parallel process, and countertransference in

psychotherapy supervision. In rising to meet that “empirical” challenge,
the place of those constructs in supervision practice could be far better
clarified, more fully defined, and further consolidated.

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