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Article 73

In Search of Best Practice

A Review of Triadic Supervision Literature

Marlise R. Lonn

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Supervision is defined as “…an intervention provided by a more senior member of a profession to a more junior member or members of that same profession” (Bernard & Goodyear, 2009, p. 7). Supervision serves to monitor the quality of the counseling provided by students, counselors, and novice practitioners and to improve the professional abilities of the supervisee (Bernard & Goodyear, 2009). In counselor education, clinical supervision provides a significant amount of development, practice, and clinical skills assessment (Bernard & Goodyear, 2009; Haynes, Corey, & Moulton, 2003). Clinical supervision usually takes place in one of three different formats: individual (one-on-one), triadic (one supervisor with two supervisees), or group (one supervisor with three or more supervisees).

The triadic format of supervision, characterized by two supervisees meeting with one supervisor simultaneously, is used in counselor education programs across the country (Lyman, 2010). However, in practice, there is no single model for conducting triadic supervision. Several studies explored the processes, themes, benefits, and challenges of triadic supervision (Hein & Lawson, 2009; Stinchfield, Hill, & Kleist, 2010; Sturdivant, 2005). The purpose of this article is to provide a current review of the literature and to highlight the reported benefits and drawbacks of triadic supervision. It is outside the scope of this article to review and compare individual, group, and triadic supervision modalities. Instead, this summary of research findings is an effort to provide best practices based on evidence to supervisors utilizing triadic supervision.

Triadic Supervision Prevalence

The use of triadic supervision as an alternative or adjunct to individual supervision for counseling students enrolled in practicum and internship courses was approved by CACREP in 2001 (CACREP, 2001). Since two supervisees are simultaneously supervised, triadic supervision is considered an efficient use of time and financial resources (Lawson, Hein, & Getz, 2009; Goldberg, Dixon, & Wolf, 2012; Sturdivant, 2005).

Triadic supervision is used widely in counselor education programs (Derrick, 2010; Lyman, 2010). Lyman (2010) surveyed faculty of more than half (59%) of the 229 CACREP-accredited programs in the U.S. Sixty-four percent of participants reported regular triadic supervision use and 61% indicated they utilized triadic supervision and had been trained in the triadic supervision. Thirty-nine percent reported providing triadic supervision without previous triadic supervision training (Lyman, 2010). Although a single study is not enough to make definitive statements about counselor education programs as a whole, Lyman did provide evidence of the widespread use of triadic supervision in CACREP-accredited programs.

Lyman’s (2010) study also provided information related to the models of triadic supervision being utilized across counselor education programs. Almost half (46.9%) of the 276 respondents utilized split-focus approaches, 22.1% indicated use of the reflective model of triadic supervision (RMTS), and a minority (2.8%) reported using single-focus triadic supervision (Lyman, 2010). These models of supervision are briefly described in the following section.

Overview of Triadic Format Models

Triadic supervision is defined by two supervisees meeting with a single supervisor for supervision sessions. There is no single model or structure for conducting triadic supervision. Current literature describes a variety of triadic supervision models. Most models fit under the categories of either split-focus or single-focus and may have formal structures or be unstructured (Lyman, 2010; Nguyen, 2003). In split-focus supervision, each supervisee receives roughly half the time and attention during each session. Single-focus supervision is structured so that on alternating weeks one supervisee presents and receives the majority or all of the time available during a session (Nguyen, 2003). It is not uncommon for single-focus models to structure the time, presenting activity (e.g., video recording, case write-up), roles, and feedback format (Lawson, Hein, & Getz, 2009; Stinchfield, Hill, & Kleist, 2007). However, within this structure, a variety of supervisee interventions (e.g., role-play, reflection, feedback) may be used.

Some supervisors provide theory-based supervision (Bernard & Goodyear, 2009; Haynes et al., 2003). These theories provide frameworks for the role of the supervisor and the expectations and characteristics of the supervisee but do not necessarily define a specific process or interventions for conducting each supervision session. In their supervision textbook, Bernard and Goodyear (2009) break these theories into three major categories: (a) models grounded in psychotherapy theory (i.e., person-centered cognitive- behavioral, systemic), (b) developmental models (i.e., Stoltenberg, McNeil, & Delworth), and (c) social role models (i.e., Bernard, Holloway). These major categories of supervision models are not exclusive to triadic supervision but may also be used in individual or group supervision.

Current Literature

A thorough review of the counseling literature revealed a limited number of triadic supervision research studies. Using the electronic databases PsychINFO, Google Scholar, SAGE, and EBSCOhost with the search term “triadic supervision” yielded 20 results related to the format of triadic supervision in counselor education discussed in this manuscript. Of these peer reviewed articles and dissertations, only 17 were relevant to triadic supervision research in counseling. Using these studies, this article summarizes research examining the perspectives of both the supervisor and the supervisee. Furthermore, specific aspects of the triadic supervision format present in the literature are outlined.

Types of Studies

Three articles described models of supervision (Goldberg & Dixon, 2012; Lawson Hein, & Getz, 2009; Stinchfield et al., 2007). Three studies were comparative in nature, examining perceptions, preferences, and effectiveness of individual, triadic, and group supervision (Bland, 2012; Borders et al., 2012; Nguyen, 2003). A single study examined an intact triad (Derrick, 2010) and a dissertation investigated the use of a creative intervention in triadic supervision (Dunbar, 2011). Another dissertation examined the frequency with which triadic supervision is utilized in CACREP-accredited counselor education programs (Lyman, 2010).

Most triadic supervision articles are qualitative. One grounded theory study (Oliver, Nelson, & Ybanez, 2010) described the processes occurring in triadic supervision. Several studies described the experiences of supervisors (Hein & Lawson, 2009; Hein, Lawson, & Rodriguez, 2011, 2013; Lawson, Hein, & Stuart, 2010; Sturdivant, 2005) while two studies described the experiences of supervisees (Lawson, Hein, & Stuart, 2009; Stinchfield et al., 2010). While several studies are examined, full descriptions of each study are beyond the scope of this article and readers are respectfully referred to the original articles referenced. Major themes identified by the studies are provided and serve as a basis for best practice implications.

Triadic Supervision Processes

Guided by constructivist grounded theory, Oliver et al. (2010) analyzed and interpreted individual interviews, focus group interviews, and video recordings in an effort to understand and describe what ensues during triadic supervision. Five processes occurring in triadic supervision were theorized: systemic engagement, synergy, recursiveness, presence of the supervisor, and community (Oliver et al., 2010). While an understanding of what occurs during triadic supervision at the process level is limited to the Oliver et al. study, several qualitative studies have examined supervisors and supervisees experiences and perceptions.

Supervisor Perspectives

Sturdivant (2005) examined supervisors’ triadic supervision experiences. Not all participants viewed triad supervision more favorably than individual or group supervision. Participant responses to triadic supervision ranged from positive to neutral to negative (Sturdivant, 2005). Participants noted that when supervisees were incompatible, triadic supervision became more difficult and individual supervision was seen as the more appropriate modality. Sturdivant identified five recurring categories: vicarious learning, feedback/multiple perspectives, vulnerability/support/intimacy, time saver, and supervisor and supervisee challenges.

Participants identified perceived benefits of triadic supervision as enhancing the supervision process, providing multiple perspectives and learning experiences, and increasing supervisee comfort level (Sturdivant, 2005). Disadvantages of triadic supervision also emerged from the data. The primary disadvantages identified were: personality problems, meeting the needs of supervisees, differing developmental levels, managing supervision dynamics, and supervisee intimacy/safety/vulnerability (Sturdivant, 2005).

These findings were similar to themes from doctoral student supervisors’ interviews as reported by Hein and Lawson (2009). Hein and Lawson identified two major categories and several subthemes related to the triadic supervision process. The general categories related to the process of triadic supervision included both the enhancement and the impairment of aspects of the supervision process.

The usefulness of an additional perspective and increased diversity arose as a general sentiment related to enhancement of the triadic supervision process (Hein & Lawson, 2009). Participants described enriched feedback dynamics in triadic supervision, including the value of feedback from the peer supervisee Participants also reported growth through observational learning and peer validation (Hein & Lawson, 2009). The third subtheme related to triadic supervision was improvement of the general supervision atmosphere (Hein & Lawson, 2009). Doctoral student supervisors indicated that the process of triadic supervision felt more relaxed, allowed a team-oriented atmosphere to develop, and fostered collaboration during supervision sessions (Hein & Lawson, 2009).

Two aspects of the supervision process were reported impaired or diminished by the triadic supervision modality: feedback dynamics and assistance provided to supervisees (Hein & Lawson, 2009). In general, participants concurred that providing feedback (positive/supportive or negative/challenging) to supervisees was more difficult with a second supervisee present. Hein and Lawson (2009) noted this was especially true when supervisees differed significantly in their counseling skill levels. The second subtheme in Hein and Lawson’s study related to difficulties in simultaneously providing assistance and meeting both supervisees’ needs. Specifically, when a supervisee needed extra assistance, the process and structure of triadic supervision limited the amount of time available. Related to the single-focus supervision format, participants expressed concern as to whether or not presenting a client video every other week for feedback was sufficient (Hein & Lawson, 2009).

Supervisor perspectives on incompatibility. Supervisee incompatibility was a theme in triadic supervision as noted by Hein et al. (2011) and in Stinchfield et al. (2007). Supervisee incompatibility is an area that received additional study. Specifically, Hein et al., (2011) examined the influence of supervisee incompatibility on triadic supervision as experienced by doctoral student supervisors. Participants noted a variety of forms of supervisee incompatibility: skill level, receptivity to feedback, and motivation level. Participants also named negative impacts on: supervision content, supervision process, and supervision atmosphere. Similarly, when participants in Hein et al. (2013) were interviewed about the impact of supervisee incompatibility, both benefits and negative impacts for both the supervisee and the supervisor were revealed (see Hein et al., 2013, for study results).

Supervisee Perspectives

In order to understand the experiences of supervisees receiving triadic supervision, Lawson, Hein, and Stuart (2009) interviewed six supervisees from a single master’s level counselor education program. The triadic supervision in this study followed a particular single-focus format which included each supervisee preparing and presenting a videotape every other week (see Lawson, Hein, & Getz, 2009, for a full description). A form of whole-text analysis was utilized to code the interview transcripts.

In response to, “What are the experiences of supervisees in triadic supervision?” (Lawson, Hein, & Stuart, 2009, p. 450), five themes emerged. These included: limited time and attention, need for supervisee compatibility, introduction of new feedback dynamics, valuable learning from peer, and peer support. Participants generally desired more time for focusing on their clients, addressing particular concerns, and counseling skill development. At the same time, supervisees acknowledged the supervision format of alternating weeks for case presentations decreased their workload, and they did not have to be the primary focus of attention during every supervision session (Lawson, Hein, & Stuart, 2009).

With regard to being compatible with one’s peer supervisee in the triad, predictably, participants expressed positive experiences when they felt compatible with their peers. Specifically, participants expressed increased comfort being open during supervision when they shared similar interests (Lawson, Hein, & Stuart, 2009). Conversely, this data implied a poorly matched supervisee pair may contribute to less desirable supervision outcomes.

In general, participants in the study valued feedback from their peer supervisee. This was true for feedback that identified areas of strength and feedback on areas for improvement (Lawson, Hein, & Stuart, 2009). It is important to note that Lawson, Hein, and Stuart’s (2009) participants expressed concern about the difficulty of providing feedback to their peers, especially when the feedback was perceived as challenging or negative. As a result, there were times when the reluctance to deliver negative feedback to a peer led to a sequence where neither supervisee provided feedback that might be perceived as negative (Lawson, Hein, & Stuart, 2009). Participants were sensitive to supervisor feedback dynamics as well. Supervisees felt it was tricky for supervisors to provide positive feedback to one supervisee without chancing making the other supervisee feel lacking. This study also revealed participant discomfort receiving praise during supervision in the presence of their peer.

Participants reported the extra perspective provided by having a third person involved in supervision afforded valuable learning opportunities (Lawson, Hein, & Stuart, 2009). Specifically, learning related to counseling techniques and styles occurred through observing videotapes of peer supervisee’s counseling sessions. Beyond observational learning, participants also described vicarious learning, which occurred when supervisees witnessed interactions between their peer and the supervisor (Lawson, Hein, & Stuart, 2009). Participants expressed being impacted and encouraged by the risk- taking exhibited by their peer when that person shared a portion of a counseling session where the peer was struggling. Vicarious learning also occurred when supervisees witnessed interactions between the peer supervisee and supervisor (Lawson, Hein, & Stuart, 2009).

The final theme to emerge from Lawson, Hein, and Stuart’s (2009) study was peer support. A peer supervisee sharing his/her own experiences in supervision was often seen as supportive. Participants reported peer support was received both during supervision and outside of supervision sessions (Lawson, Hein, & Stuart, 2009). Participants reported benefitting from facilitated communication between the other peer and the supervisor and feeling validated by reports of similar experiences and perspectives (Lawson, Hein, & Stuart, 2009).

Two themes, vicarious learning and multiple perspectives, identified in Lawson, Hein, and Stuart (2009), reappeared in a study Stinchfield et al. (2010) conducted. Stinchfield et al.’s phenomenological study sought to understand the experiences of practicum level supervisees engaged in the Reflective Model of Triadic Supervision (RMTS; Stinchfield et al., 2007). The RMTS allots 45 minutes for each supervisee, making the average length of a triadic supervision session 90 minutes (see Stinchfield et al., 2007, for a complete description). The five themes that emerged from the study were: initial apprehensions related to power and sharing time, shared developmental process, vicarious learning, multiple perspectives, and trust and safety in relationships (Stinchfield et al., 2010).

Participants identified initial uneasiness which included concerns about having enough time in triadic supervision and the presence of a peer when giving and receiving feedback (Stinchfield et al., 2010). In general, Stinchfield et al. (2010) described participant’s recognition of collaboration that built over time among the triad. In part, this collaboration as well as the RMTS structure attended to the power differential inherent in the supervisor-supervisee relationship (Stinchfield et al., 2010). Supervisees reported they felt valued for their feedback and were able to more easily exchange ideas. The authors’ emphasized members of the triad indicated this feeling of “more equal” developed as a result of the relationship that was built throughout the semester (Stinchfield et al., 2010).

Participants valued the ability and opportunity to relate to a peer supervisee going through a similar experience and working on similar issues as counselors-in-training (Stinchfield et al., 2010). Relatable experiences included: managing feelings of fear, thoughts of inadequacy, struggling to get direct client hours, and making mistakes (Stinchfield et al., 2010).

In Stinchfield et al.’s (2010) study, vicarious learning emerged as a theme. Supervisees framed opportunities to see and experience different client concerns and different techniques presented by their peer in supervision as examples of vicarious learning (Stinchfield et al., 2010). Participants also valued the multiple perspectives present in the triadic supervision relationships. Supervisees reported the supervision experience was enhanced by the opportunity to hear multiple viewpoints and different approaches to case conceptualization (Stinchfield et al., 2010).

An overarching aspect identified was the context of a trusting relationship which influenced all of the preceding themes (Stinchfield et al., 2010). Stinchfield et al. (2010) noted some participants entered supervision with a sense of trust and some described trust as developing over time. Participants communicated feeling a sense of safety in the triadic relationship which, for many, increased over the course of the semester. Simultaneously, participants also acknowledged the structure of the RMTS held the possibility of one person feeling left out or excluded by the other two members of the triad. And supervisees noted it was hard being vulnerable in supervision (Stinchfield et al., 2010).

Intact Triad Participant Perspectives

The only study to examine intact supervision triads sought to understand the experiences of the supervisor and each of the peer supervisees concurrently (Derrick, 2010). Two rounds of interviews analyzed using basic qualitative inquiry resulted in five broad themes (Derrick, 2010). These themes suggested by participants were: (a) the need for triadic supervision to have structure and organization, (b) specific roles and responsibilities for each person in the triad, (c) vicarious learning and examining multiple perspectives, (d) the impact of supervisor and supervisee matching, and (e) member power held within the triad (Derrick, 2010).

Derrick (2010) reported supervisee responsibilities as: willingness to receive feedback, maintaining responsibility for own learning, honesty and self-reflection, and ability to share time and attention. Supervisors were responsible for: willingness to challenge supervisees, allowing for peer supervision, monitoring power levels held and exerted by each member, meeting the needs of both supervisees and their clients, and providing intentionality and structure to the triadic supervision process (Derrick, 2010). Requirements for effective triadic supervision were perceived as: more than one hour in length, structure, a consultative atmosphere, and equal time for each supervisee. Additionally, participants remarked some individual supervision was also desired (Derrick, 2010).

Derrick (2010) outlined suggestions for supervisees, supervisors, and counselor educators. These recommendations included: increasing supervisee awareness of their role in supervision, effective use of time, and adequate preparation for supervision sessions. Additionally, Derrick recommended provision of opportunities for individual supervision and consultation as well as encouraging supervisees to act as their own advocates for additional or specific supervision needs.

Discussion

The purpose of this literature review was narrow in focus; aimed at providing a summary of information on triadic supervision research in search of recommendations for best practice within the triadic supervision format. This review did not attempt to compare triadic supervision to other forms of clinical supervision. Additionally, this literature review did not examine research related to the efficacy of triadic supervision on client or supervisee outcomes. The next sections note limitations of current research and suggestions for future research. Recommendations are proposed for supervisors and supervisor/counselor educators. Readers will note these suggested practices have not been evaluated for practicality or potential impacts on supervision delivery within educational or worksite settings.

Limitations of the Body of Research

The research this literature review is based on is limited. As noted in the introduction, a small group of researchers have contributed to this body of knowledge. While reflecting on the information gained by the studies which examined the perspectives and experiences of supervisees and supervisors, one must bear in mind that these studies came from only five counselor education programs. And because multiple studies occurred at a single institution that utilized a single-focus structure, this conceivably limits the potential for transferring implications, and assuming similar results to programs with a different structure or different setting. Also, participants in the studies were predominantly White/European American and female (Hein et al., 2011, 2013; Stinchfield et al., 2010; Sturdivant, 2005). Supervisees and supervisors from different cultural or ethnic groups and those with varying gender identities may have different experiences of triadic supervision.

Implications for Best Practice

Several common themes were reported; structure, vicarious learning, feedback, and compatibility were predominant in the discussion.

Supervision structure. Common to most studies, time was noted as a concern for both supervisors and supervisees engaged in triadic supervision (Derrick, 2010; Lawson, Hein, & Stuart, 2009; Stinchfield et al., 2010). When using triadic supervision, it appears the traditional 60 minutes of supervision per week is not sufficient. Best practice would extend triadic supervision to 90 minutes and include flexibility in the supervision structure and meeting times as needed. Supervisors and supervisees may benefit from additional individual supervision to address specific needs, provide additional training or support, and when giving evaluative feedback (Derrick, 2010; Hein et al., 2013). Furthermore, supervisors can instruct supervisees to advocate for themselves, making supervisees aware they can request additional consultation or individual supervision.

Supervisor roles and responsibilities. Based on the supervision literature, triadic supervision participants may benefit from increased awareness of: vicarious learning, feedback dynamics, and use of active interventions. The presence of a peer supervisee in supervision contributed to a sense of peer support, universality, and vicarious learning (Hein et al., 2010; Oliver et al., 2010; Stinchfield et al., 2010). As a best practice, supervisors encourage community and comment on universality and vicarious learning as they occur, until peer supervisees are able to make these connections themselves (Stinchfield et al., 2010).

The presence of two supervisees means feedback dynamics are more complex in triadic supervision (Lawson, Hein, & Stuart, 2009). Collectively, these studies speak to the self-consciousness and sensitivity of supervisees related to both positive and growth enhancing feedback. Supervisors need to attend to feedback dynamics between peer supervisees as well as between themselves and each supervisee (Derrick, 2010; Lawson, Hein, & Stuart, 2009). Best practice includes supervisors providing instruction on and expectations for giving feedback to the other members of the triad.

Although limited to a small number of programs, responses from supervisors and supervisees appear to support efforts at matching compatible supervisees and supervisors for triadic supervision (Derrick, 2010; Lawson, Hein, & Stuart, 2009; Sturdivant, 2005). Supervisees expressed a desire to have influence in the decisions about the members of their supervision triad (Stinchfiled et al., 2010). Best practice includes supervisor awareness of possible forms of supervisee incompatibility and to address the mismatch and relationship dynamics early, and directly.

Another aspect of supervisor’s role was the importance of the supervisor being fully present (Oliver et al., 2010) and well prepared (Derrick, 2010) for supervision. The authors noted this is not unique to triadic supervision but was crucial to the process of triadic supervision. Selecting interventions or utilizing a model that encourages and allows both supervisees to be active in every session is a supervisor responsibility (Hein & Lawson, 2009).

Supervisees expressed a need for structure (Derrick, 2010). Although not explicitly named in the literature, role induction for supervisees provides a way to address many supervisee needs (e.g., expectations, power dynamics, supervisee apprehension) early in the supervision process. The literature suggests counseling students often do not receive much preparation for supervision (Vespia, Heckman-Stone, & Delworth, 2002). Best practice includes the use of a supervision contract to aid in clarifying roles and expectations (ACES, 2011).

Recommendation for supervisor educators. For both ethical and practical reasons, supervisors engaging in triadic supervision should be trained in facilitating triadic supervision (Oliver et al., 2010). Current supervision theory textbooks (Bernard & Goodyear, 2009; Haynes et al., 2003) do not provide substantial coverage of triadic supervision dynamics and formats. Best practice would include specific triadic supervision training in the supervision curriculum. Educating supervisors-in-training about the importance of structure and pre-planning of sessions, managing multiple feedback dynamics, fostering a safe community, and being alert for supervisee incompatibility would benefit new supervisors and their supervisees (Derrick, 2010; Hein et al., 2013; Stinchfield et al., 2010). Modeling flexibility and setting the expectation that weekly triadic supervision sessions may be longer than 60 minutes in length may help core faculty, adjunct faculty, doctoral student supervisors, and students adjust their triadic supervision practice. Another suggested practice for counselor education programs is to model supervision best practices for site supervisors in the community and to provide continuing education and support for supervisors working with counseling students in community mental health and school settings.

Future Research Recommendations

Contributors to the literature on triadic supervision encouraged additional research studies to address varying levels of supervisee development and levels of trust in triadic supervisory relationships (Stinchfield et al., 2010). Supervisee incompatibility was mentioned in multiple qualitative studies (Hein, Lawson, & Rodriguez, 2011, 2013; Stinchfield et al., 2007). However, no data has been collected to indicate the effectiveness of supervisee matching in general or the most reliable matching methods. Counselor education supervision literature has focused more on the experiences of supervisors than on the perceptions and perspectives of supervisees. Given that getting equal and sufficient time was a supervisee concern (Derrick, 2010) and supervisors worried that presenting a case every other week may not be adequate for counselors in training (Hein & Lawson, 2009), research on the efficacy of the single-focus supervision format is warranted. Current research is limited to supervision occurring in a narrow range of counselor education programs. Therefore, future research needs to examine triadic supervision practices and experiences at a wider range of institutions as well as explore post-graduate supervision experiences as counselors are working toward licensure. However, evidence is beginning to elucidate the benefits and limitations of triadic supervision. This knowledge allows supervisors and counselor educators to evaluate and apply best practices within their specific setting or program.