Unlocking Effective Psychotherapy Supervision: What Therapists Really Want

In psychotherapy, supervision plays a crucial role in a therapist’s professional development. It’s an essential space for discussing cases, gaining feedback, and honing clinical skills. But how well does the supervision that therapists receive align with what they actually need to improve their practice? A recent study suggests that there may be a significant gap between what therapists prefer during supervision and what they actually experience.

Researchers from Karolinska Institutet in Stockholm, Sweden, conducted the study to explore these discrepancies. Led by Åsa Spännargård, Simon Fagernäs, and Sven Alfonsson, the team surveyed 243 psychotherapists to find out what they valued in their supervision and how often those activities occurred. Published in Counselling and Psychotherapy Research, their findings offer valuable insights into enhancing supervision practices to better meet therapist needs.

One of the most striking findings from the research was the strong preference that therapists showed for active learning methods. Therapists reported wanting more hands-on activities, such as role-playing, reviewing recorded therapy sessions, and engaging in concrete exercises to develop their skills. These methods offer a more interactive and practical way to improve therapeutic techniques, providing real-time learning that verbal discussions alone may not be able to achieve.

However, despite these preferences, the study found that these active learning methods were rarely part of actual supervision sessions. Instead, case discussions, where therapists and supervisors talk through challenges or dilemmas with clients, remained the dominant activity. While case discussions can be helpful, especially for contextualizing client issues, they often lack the experiential component that therapists seem to crave. The disconnect between preference and practice raises the question of whether supervision, as it is currently structured, is fully serving the professional growth of therapists.

The researchers also found that the therapists’ orientation played a role in what they preferred from supervision. Therapists who followed cognitive-behavioral therapy (CBT) techniques were especially keen on active learning methods like concrete exercises and modeling. This might be because CBT itself often involves structured, practical approaches, so therapists trained in CBT may naturally gravitate toward similarly structured supervision. In contrast, therapists from other orientations may not seek as much active learning, though they too expressed a desire for more engaging and interactive supervision sessions than what they typically receive.

Interestingly, the study showed that not only did therapists want more active methods, but those who engaged in them also reported higher levels of satisfaction with their supervision. This makes sense: more practical, hands-on learning allows therapists to directly apply and refine their skills in a supportive setting, which can boost confidence and competence. Supervisors who incorporate these methods can help therapists develop a deeper understanding of therapeutic techniques, which, in turn, lead to better patient outcomes.

However, why do these active learning methods remain underutilized in supervision? One possibility is that case discussions are simply more comfortable or familiar for both therapists and supervisors. They require less preparation and can be less anxiety-inducing than role-playing or reviewing recorded sessions, which put therapists in a more vulnerable position. However, while it may be easier to fall back on discussions, this approach may not fully challenge therapists to develop the practical skills they need to excel.

The study’s findings clearly indicate that the structure of psychotherapy supervision could benefit from improvement. While case discussions will likely always have a place in supervision, the inclusion of more experiential learning activities could make a real difference in how effective supervision is for therapists. This is particularly important because therapists not only need to refine their techniques, but they also need to manage the emotional and professional challenges of their work. Supervisors who are willing to step outside of the traditional discussion-based model and engage therapists in more active learning can provide a richer, more dynamic supervision experience.

For therapists, this research highlights the importance of advocating for what they need in supervision. Therapists who feel that their current supervision sessions are too focused on verbal discussions might benefit from having an open conversation with their supervisors about incorporating more hands-on activities. Whether it’s reviewing recorded therapy sessions, engaging in role-playing, or practicing specific skills, these methods can offer valuable opportunities for growth that go beyond talking about cases.