Managing Clinical Supervision Dilemmas: A Mixed-Methods Vignette Study

Clinical supervision plays a pivotal role in training the next generation of health service psychologists. Given the dyadic nature and multiple priorities of supervision, dilemmas are common; however, few data exist on the frequency and types of dilemmas, and more importantly, how they are navigated. Of the limited data that are available on this topic, few encompass the perspectives of both supervisors and supervisees. This study aims to address these gaps by surveying supervisor (N = 29) and supervisee (N = 65) responses to eight vignettes of supervision dilemmas. We use a mixed-methods approach to investigate quantitative ratings of perceived dilemma frequency and harmfulness, and content analysis to identify themes in qualitative responses assessing how participants navigate dilemmas. A supervisor failing to provide adequate critical feedback to a supervisee was perceived by participants as the most frequent and harmful dilemma. Strong consistency in frequency and harmfulness ratings of vignettes was found among supervisors and supervisees. Content analysis revealed four main themes among reported strategies: relational, reflective, direct, and indirect. The majority of strategies reported were direct, involving confrontation and problem solving. However, there were situational and temporal nuances in how participants described they would use strategies. Supervisees reported greater use of indirect strategies involving passivity and avoidance. Overall, our study underscores the potential for a decision-making framework that could help standardize supervision guidelines and recommends that such a framework incorporate an assessment of the severity, frequency, and temporal aspects of each dilemma.