Statement of Originality - epubs.surrey.ac.ukepubs.surrey.ac.uk/842054/1/Ethesis 1.docx · Web viewPart 1 - Literature Review7. ... Part 2 - Empirical Paper ... to allow for in-depth

ATTACHMENT THEORY AND THE SUPERVISORY RELATIONSHIP

Attachment Theory and the Supervisory Relationship:An Interpretative Phenomenological Analysis of Supervisee

Experiences

Kirsty Read

Submitted for the Degree of

Doctor of Psychology(Clinical Psychology)

School of PsychologyFaculty of Health and Medical Sciences

University of SurreyGuildford, SurreyUnited KingdomSeptember 2017

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Statement of Originality

This thesis and the work to which it refers are the results of my own efforts. Any

ideas, data, images, or text resulting from the work of others (whether published or

unpublished) are fully identified as such within the work and attributed to their

originator in the text. This thesis has not been submitted in whole or in part for any

other academic degree or professional qualification.

Name: Kirsty Read

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Overview

Part one and two of this e-thesis present a major research project that aimed to

explore the applicability of Attachment Theory to our understanding of the

psychotherapy supervisory alliance.

Part one shows a narrative literature review of what we currently know about

Attachment Theory and its relevance to the supervisory relationship. The findings of

the review revealed inconsistencies as to whether the attachment styles of supervisors

and supervisees were associated with the quality of the supervisory alliance. This

highlighted that we may not yet have fully understood the attachment-supervision

construct. Part two of this e-thesis presents an empirical paper that improved our

understanding of the construct by exploring how trainee clinical psychologists

experienced and understood the supervisory relationship and exploring what within

this may be relevant to Attachment Theory. Overall, the findings suggested that

Attachment Theory is a useful way to think about the supervisory relationship, in

terms of the alliance benefitting from supervisor secure attachment qualities, a

goodness-of-fit between both relational styles and the supervisor’s attunement to

supervisee needs. However, the presence of attachment dynamics, rather than a full-

blown attachment bond, appears to provide a more meaningful way of understanding

the supervisory relationship.

The remainder of this e-thesis presents a summary of clinical experience gained

across five placements (part three) and a table of academic assessments (part four)

completed during the three year clinical psychology training programme.

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Table of contents

Statement of Originality...............................................................................................2Overview.......................................................................................................................3Acknowledgements.......................................................................................................5Part 1 - Literature Review.............................................................................................7

Abstract.....................................................................................................................8Introduction.............................................................................................................10Method....................................................................................................................14Results.....................................................................................................................19Discussion...............................................................................................................50References...............................................................................................................55

Part 2 - Empirical Paper..............................................................................................61Introduction.............................................................................................................64Method....................................................................................................................71Results.....................................................................................................................74Discussion...............................................................................................................87References.............................................................................................................100Appendices...........................................................................................................106

Appendix A.......................................................................................................106Appendix B.......................................................................................................107Appendix C.......................................................................................................108Appendix D.......................................................................................................109Appendix E.......................................................................................................112Appendix F.......................................................................................................113Appendix G.......................................................................................................114Appendix H.......................................................................................................116Appendix I........................................................................................................117Appendix J........................................................................................................118Appendix K.......................................................................................................119Appendix L.......................................................................................................121Appendix M......................................................................................................124

Part 3 - Summary of Clinical Experience.................................................................126Part 4 - Table of Assessments Completed During Training.....................................129

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Acknowledgements

I am extremely grateful to a number of people who contributed to my clinical

psychology training. First of all, I would like to express my sincerest thanks to Dr

Kate Gleeson, my research supervisor, for providing the opportunity to conduct a

research project in an area that I am so passionate about. I am thankful for her

incredible guidance and support over the past three years and for going ‘above and

beyond’ what I would have expected, on so many occasions. Nothing has ever

seemed too much to ask. Thank you also to Dr Sue Jackson for her co-supervision

support at the beginning of this project and for helping me, alongside Kate, to

develop the research focus. This research would also not have been possible without

the participation of seven trainee clinical psychologists who kindly offered to be

interviewed. I would like to express my gratitude for their contribution.

Thanks also go to my placement supervisors for providing such interesting and

enriching learning experiences and to the people I have helped to support during

these placements. You continually reminded me of the importance of clinical

psychology and why I chose to enter this profession. Thank you to my clinical tutors

Dr Noelle Blake and Dr Victoria Petch for their consistent support and guidance in

my personal and professional development throughout the three years of training. I

am also extremely grateful to my personal therapist for the role she has played in this

process of growth.

To Dr Melanie Orchard; my mentor and a valued friend. There are not enough words

to convey my gratitude for your support both before and during training. You are a

true inspiration and role model to me. I would not have been in the position I am

today, without you.

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To the members of Cohort 43, particularly my Personal and Professional

Development group; thank you for a memorable journey of ups and downs and for

your unwavering support throughout. I will forever treasure these three years with

you all. Finally, I would like to express thanks to my parents, family and friends,

who gave me the love, patience, belief and encouragement that I needed to complete

this course. I cannot end this acknowledgement section without a special thank you

to my partner, John. Thank you for being my rock during training and for bringing

two gorgeous cats, Max and Bella, into my life. I don’t think I could have reached

this achievement without the three of you.

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Part 1 - Literature Review

Attachment Theory and the Supervisory Relationship: A Systematic Review of the Literature

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AbstractBackground

Within the profession of psychotherapy, clinical supervision aims to provide the

means for the development and evaluation of a professional’s practice and the

monitoring of client welfare. This ensures safe and effective practice and enhances

quality of care. It is widely accepted within the literature, that a positive supervisory

relationship or supervisory working alliance is essential for supervision to meet these

aims. Recently, the literature has paid increasing attention to Attachment Theory as a

framework for understanding factors which may impact on the quality of the

supervisory alliance.

Objectives

To identify and evaluate the empirical evidence base addressing the relevance of

Attachment Theory in understanding the supervisory relationship and to identify

directions for future research.

Method

Psychology Cross Search, Web of Science and Scopus databases were searched

alongside manual searches, yielding 30 studies for review.

Results

Although some studies showed that securely attached supervisees and supervisors

predicted a positive alliance, others found no significant correlation. Recent studies

suggest the supervisory relationship may be best understood and explained by leader-

follower attachment dynamics rather than a “full-blown” attachment relationship

influenced by attachment styles.

Conclusion

The inconsistent findings as to whether attachment styles predict the quality of the

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supervisory relationship, highlight that we may not yet have fully understood the

attachment-supervision construct. To improve our understanding and address the

inconsistent findings, in-depth exploration of the construct is recommended. This

could help to inform ways to improve the alliance and thus the supervisee’s

development and quality of care provided.

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Introduction

In the psychotherapy field, supervision can be defined as “the formal provision of a

relationship-based education and training that is work-focussed and which manages,

supports, develops and evaluates the work of colleague/s” (Milne, 2007, p.439). It

occurs within a hierarchical relationship from a senior to junior professional member

(Bernard & Goodyear, 2014) and is valuable at all developmental stages, particularly

for trainee psychotherapists (Milne & James, 2002). Supervision aims to “protect the

best interests of the client” (British Association for Counselling and Psychotherapy,

1987, p.2) and enhance their experience of therapeutic services, by evaluating and

developing the supervisee’s quality of practice. This is achieved by ensuring

maintenance of ethical and organisational standards (normative), supporting the

supervisees’ coping (restorative) and developing and maintaining their skills and

general effectiveness (formative) (Proctor, 1988). Supervision therefore forms an

integral component in the effective provision of psychotherapeutic services to the

public (Milne, 2007).

It is widely accepted that the most important factor in supervision effectively

meeting its aims is the quality of the supervisory relationship (Holloway & Neufeldt,

1995). Bordin (1983) suggested that a positive supervisory relationship is fostered

through a strong supervisory working alliance; that is, the attainment of supervisory

goals, an agreement on tasks necessary for this and a strong emotional bond between

supervisor and supervisee (Horvath & Greenberg, 1989).

Research has since investigated factors which impact upon the strength of the

supervisory working alliance such as gender of the supervisory dyad and level of

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identification of psychodynamic transference and countertransference issues

(Lichtenberg & Goodyear, 2000; Watkins, 2011). The past 20 years of research has

also paid attention to the potential role that Attachment Theory may have in

highlighting factors that influence the alliance strength, such as supervisor and

supervisee attachment styles (Bowlby, 1969; Pistole & Watkins, 1995). Given that

early psychotherapeutic practice involves anxiety, threat and dependence (Rønnestad

& Skovholt, 2003), and is thus likely to activate the therapist’s attachment system

(Fitch, Pistole & Gunn, 2010), much of the research in this area has occurred within

the context of trainee therapists from a variety of psychotherapy disciplines. These

disciplines include clinical psychology, counselling, and clinical social work (which

in the United States, includes the provision of therapy).

Hill (1992) was amongst the first to theorise about Attachment Theory and the

supervisory relationship by introducing the supervisor as a secure base (attachment

figure) for the supervisee. A supervisor who is available, reliable and sensitive in

their responses to a supervisee’s needs is likely to be viewed as a secure base from

which a supervisee can safely learn, function and explore, thus facilitating a positive

supervisory alliance. This is important, particularly for trainee therapists needing

support in the face of anxiety-provoking novel experiences (Fitch, Pistole & Gunn,

2010). In insecure attachment relationships, the supervisor does not function as a

secure base (due to being dismissive or inconsistent in their responses), thus

impeding the supervisory working alliance. In a descriptive paper of an attachment

based training programme, Bennett (2008) stated that supervisors who completed

this, reported being better able to provide a secure base for their supervisees.

Although a supervisor may attempt to offer a secure base, it was later theorised that

trainee therapists exhibiting insecure ‘pathological’ attachment styles, negatively

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impact the relationship with their supervisor (Neswald-McCalip, 2001; Pistole &

Watkins, 1995; Robbins, 1995; Watkins, 1995). These studies show, that while

securely attached supervisees are more likely to view their supervisor as dependable,

believe in their abilities, explore and take learning risks, supervisees with

preoccupied attachment are more likely to doubt their abilities and cling to the

supervisor or seek excessive reassurance. Supervisees with dismissing attachment

tend to distrust and avoid their supervisor, thus becoming overly self-reliant on their

own abilities.

In addition to the secure base, Bennett and Saks (2006) emphasised the supervisor as

a safe haven, allowing the supervisee to return to them when threatened or needing

support. Furthermore, Bennett and Saks (2006) presented examples of problematic

supervisee and supervisor attachment styles, positing that the alliance benefits from a

goodness-of-fit between these and a supervisor’s attunement to their supervisees’

attachment needs. Pistole and Fitch (2008) extended this by emphasising that

supervisors unable to respond to their supervisee’s attachment style, hinder

development of a positive supervisory alliance. However, Bennett and Deal (2009)

later posited that the influence of attachment styles on the quality of the supervisory

relationship reduces over time when a supervisee becomes more developed and

experienced in their practice, and their attachment system is less activated.

Despite a dominance of theoretical and conceptual articles in the literature, a model

explaining the role of attachment in supervision has only recently been developed

(Fitch et al., 2010). The Attachment-Caregiving Model of Supervision, which

remains untested, incorporates caregiving and attachment processes in the

supervisory relationship and how this links to supervisee development and learning

experiences. Attempts have also been made to empirically investigate the role of

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attachment in supervision, although this has given rise to some conflicting results

(Watkins & Riggs, 2012).

Rationale and aim of the literature review

The conceptual and empirical literature appear to agree on the value of Attachment

Theory in understanding the supervisory relationship and how this can be improved

in order to enhance supervisee and client outcomes. However, this research area has

thus far received scant attention (Menefee, Day, Lopez & McPherson, 2014). It is

therefore reasonable to question what we really know about supervision and

Attachment Theory to date and what else may be helpful to explore? Watkins and

Riggs (2012) attempted to answer these questions in a previous literature review of

seven empirical and 10 conceptual articles. While the review gave a helpful summary

with fruitful recommendations for future research, it could be criticised for ignoring

the grey literature of unpublished doctoral research. In addition, new empirical

research in this area has been published since their review. Thus, it is useful and

timely to provide an updated review of a broader range of literature. This review will

seek to answer the following question: What do we know about Attachment Theory

and the relationship between a supervisor and supervisee? This review aims to

answer this question by identifying and evaluating empirical research on Attachment

Theory and the supervisory relationship within the psychotherapy field. This will

include professional disciplines such as clinical psychology, counselling psychology,

counselling, family therapy and clinical social work. Although the clinical social

work role includes a range of non-therapeutic components, within the United States

where much of supervisory-attachment evidence base sits, clinical social work is

considered to be a psychotherapeutic discipline because it involves the provision of

therapy to clients. Furthermore, all of these psychotherapy professions have

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similarities in supervision style, with an emphasis on reflective learning and process

issues (Morrison, 2005) and use of psychological theories, such as Attachment

Theory, to understand human behaviour (Evans, 1976; Parrish, 2009).

Unsurprisingly, much of the key referenced literature on Attachment Theory and

supervision is thus related to these professional disciplines (Watkins & Riggs, 2012).

The review will highlight the current state of knowledge in this area, what has been

concluded and what future research directions may be useful to consider.

MethodData Sources and Search Strategy

Titles, abstracts and full text from the following databases were systematically

searched: Psychology Cross Search, Web of Science and Scopus, to identify

empirical articles published in peer reviewed journals from the first available year of

publishing to 5 May 2016. To avoid publication bias, unpublished empirical studies

were also searched for in these databases as well as Dissertation Express and

ProQuest Dissertation and Theses Global databases. A wider search was also

considered important in order to identify appropriate research within a small and

fairly novel literature field. Search terms related to Attachment Theory and

supervision were used (Table 1). Additionally, reference sections of key articles were

examined manually alongside titles of papers citing key articles, for additional

publications meeting the inclusion criteria (Table 2). The following searches yielded

no novel results: reference sections of relevant books, Google Scholar, research lists

by key authors on ResearchGate, indices of key journals over the last 10 years,

DARE at CRD, Cochrane Library, Trip Index and social media websites.

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Table 1. Systematic Search Strategy

Search number

Databases searched Search terms Search results

1 Psychology Cross Search (PsycINFO, PsycARTICLES, Psychology and Behavioural Sciences Collection, PsycBOOKS, MEDLINE)

(supervis*) TI Title 23, 040


(attachment OR object OR "leader follower") AB Abstract

286,127


(relation* OR interpersonal OR bond* OR alliance or dyad) TX All Text

4,056,279


(supervis*) TI title AND (attachment OR object OR "leader follower") AB Abstract AND (relation* OR interpersonal OR bond* OR alliance or dyad) TX All Text

188 (147 after duplicates removed)

5 Web of Science (supervis*) Title AND (attachment OR object OR "leader follower") Topic AND (relation* OR interpersonal OR bond* OR alliance or dyad) Topic

177

6 Scopus supervis* Title AND (attachment OR object OR "leader follower") Abstract AND (relation* OR interpersonal OR bond* OR alliance or dyad) All Fields

263

7 Dissertation Express supervis* AND (attachment OR object OR "leader follower") AND (relation* OR interpersonal OR bond* OR alliance or dyad)

40

8 ProQuest Dissertations and Theses Global

supervis* AND (attachment OR object OR "leader follower") AND (relation* OR interpersonal OR bond* OR alliance or dyad)

96

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Selection of Studies

The inclusion criteria are detailed in Table 2. No limitations were placed on

publication year due to the reported paucity of literature in this area.

Table 2. Inclusion and Exclusion Criteria

Inclusion Exclusion Published peer reviewed

empirical quantitative or qualitative articles

Unpublished empirical qualitative and quantitative articles (dissertations/theses)

Articles with a main aim of exploring the supervisory relationship in terms of Attachment Theory

Articles exploring the supervisory relationship and Attachment Theory in psychotherapeutic professions (including social work for U.S. studies)

Published literature reviews Articles written in English Articles published from the

first available year of publishing to 5 May 2016

Non-peer reviewed published articles

Articles exploring the supervisory relationship solely in terms of non-attachment based factors

Articles exploring the supervisory relationship and Attachment Theory outside of psychotherapeutic professions

Articles solely exploring Attachment Theory in terms of the therapeutic relationship

Conceptual/theoretical papers of the supervisory relationship and Attachment Theory.

Articles not written in the English language

Extraction of data and method of review

A review of the literature was performed following the Prisma guidelines (Moher,

Liberati, Tetzlaff & Altman, 2009). Excluding duplicates, 507 articles were

identified by the initial search. Following screening and deeper scrutiny, 30 papers

were retained eligible for review. Figure 1 outlines the search process with detail of

how the results compare to the previous review by Watkins and Riggs (2012).

All 30 papers were evaluated in terms of the quality of their aims, methodology,

sample, design, measures, findings and conclusions. The majority of the studies

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retained for review used an ex post facto/quasi-experimental design, with the

exception of two using a Randomised Controlled Trial (RCT) design and one a

qualitative design. While the inclusion of non-experimental studies in systematic

reviews is debated due to their susceptibility to biases (Shrier et al., 2007), these

designs appear to have been the most efficient and possible way of studying this area

of research. Many tools have been proposed to assess the methodological quality of

studies using an ex post facto design. However, these can be criticised for not being

developed in line with standardised procedures (Carretero-Dios & Pérez, 2007). As

such, according to Jarde, Losilla and Vives (2012), there is still little consensus on

which tool is the most appropriate for ex post facto designs (Sanderson, Tatt, &

Higgins, 2007; Wells & Littell, 2009). To guide and inform the assessment of the

quality and credibility of findings, the Standard Quality Assessment Criteria for

Evaluating Primary Research Papers (Kmet, Lee & Cook, 2004) was used for each

paper. This tool was chosen due to being appropriate for RCTs, but also ex post facto

designs, due to the option of eliminating non-applicable items. For qualitative

methodology, the Critical Appraisal Skills Programme Qualitative Research

Checklist was used (CASP, 2013).

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Figure 1. Flowchart of the Search Process

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ResultsCharacteristics of Studies

Of the 30 papers (dated between 1997-2016), one is a previous systematic review

(Watkins & Riggs, 2012), 14 are peer reviewed empirical published articles and 15

are non-published empirical dissertations/theses. Details of study characteristics

relevant to this literature review’s scope are displayed in Table 3.

Participants. The majority of studies (n=17) investigated attachment and the

supervisory relationship from the perspective of supervisees and three studies from

the perspective of supervisors (however with both, the focus varied with regards to

whether the supervisee or supervisor attachment style was being reported). The

remaining studies investigated this using supervisor-supervisee dyads.

Supervisees. Eighty-one percent of supervisees were female, 17% were male

and 2% were unspecified. It was not possible to calculate the average age of

supervisee participants due to heterogeneous reporting methods. Seventy-seven

percent of studies using supervisee participants consisted of any one or a

combination of the following: doctoral or masters level clinical or counselling

psychology trainees. Eleven percent included a combination of these in addition to

marital and family therapist trainees and social work students. Twelve percent solely

used masters level social work students. Supervisees of various pre-qualification

training levels were used in a variety of settings (mental health centres, hospitals,

college/university counselling centres).

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Table 3. Characteristics of Studies Retained in the ReviewAuthors Focus Sample/Setting Measuresa Design Sampling/data

collectionSupervisee attachmentBennett et al. (2008)

Supervisees’ self-reported general and supervision-specific attachment styles and their perceptions of the supervisory working alliance

Foundation level masters social work students/supervisees (n=72); American field placements

RSQ; ECR-RS; WAI-T

Ex post facto; cross sectional

Convenience; Questionnaire

Duffy (2003) Supervisors’ perspectives of the impact of supervisee general insecure attachment styles on the supervisory alliance

Qualified Psychotherapist supervisors (n=9); practicing in America

N/a Qualitative interview (Grounded Theory)

Semi structured interviews

Foster et al. (2007)

Similarity between supervisees’ self-reported general and supervision-specific attachment styles.

Supervisor-supervisee dyads (n=90 dyads); across America; supervisors held a psychotherapy/social work doctoral/master’s degree; supervisees were psychotherapy/social work trainees with four semesters of clinical experience

RSQ Ex post facto; cross sectional

Volunteer; Questionnaire

Gnilka et al. (2016)

Supervisees’ self reported general attachment styles and their perception of the supervisory working alliance

Counselling doctoral and masters students/supervisees (n=170); American internships

ECR-R; SWAI- T



Gunn & Pistole (2012)

Supervisees’ self-reported supervision-specific attachment styles and their perception of the supervisory working alliance

Trainees/supervisees (n=480); American clinical/counselling psychology doctoral and masters programmes; 6.4 semesters of supervision experience

ESS; SWAI-T



Gustafson (2015)

Supervisees’ self-reported general attachment styles and their perception of the supervisory working alliance

Trainees/supervisees (n=86); American clinical psychology doctoral programmes; final internships

AORI; TPRS-R



Huber et al. Supervisees’ self-reported general Trainees/supervisees (n=109); American ECR; Ex post facto; Volunteer;

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(2010) attachment styles and their perception of the supervisory working alliance

counselling psychology doctoral programmes/placements

AWAI-S cross sectional

Questionnaire

Kaib (2010) Supervisees’ self-reported general attachment styles and their perception of the supervisory working alliance

Masters level counselling students/supervisees (n=62); American programmes/placements; internship stage

ASQ; WAI-T

Ex post facto; longitudinal


Kim (1998) Supervisees’ self-reported general attachment styles and their perception of the supervisory working alliance

Trainees/supervisees (n=233); American masters and doctoral clinical/counselling psychology programmes; clinical experience level mode of eight months

ASQ; SSQ; SSI; WAI-T



Marmarosh et al. (2013)

Supervisees’ self-reported general/romantic and supervision-specific attachment styles and their perception of the supervisory working alliance

Trainees/supervisees (n=57); second year of an American graduate psychology training program/placement

ECR; TASS; WAI-T



Menefee et al. (2014)


Trainees/supervisees (n=352); American and Canadian masters and doctoral counselling/clinical psychology programmes/ placements

SASS; ECR; SWAI-T

Ex post facto; cross-sectional


Remington (2015)

Supervisees’ self-reported general and supervision-specific attachment styles and their perception of the supervisory working alliance

Trainees/supervisees (n= 181); American doctoral psychology programmes/ placements

ECR-RS; SWAI-T

Ex post facto; cross-sectional


Renfro –Michel & Sheperis (2009)


Masters level counselling students/supervisees (n=117); American programmes/placements; three different experience levels

RQ; SWAI-T



Shaffer (2015)

Supervisees’ self-reported general attachment styles and their perception of the supervisory working alliance and supervisor relational behaviours

Trainees/supervisees (n=141); American masters and doctoral counseling/clinical psychology, social work and family therapy programmes/placements

ECRS-R; WAI-T; RBS


Volunteer and snow-ball; Questionnaire

Smothers (2010)

Supervisees’ self-reported general attachment styles and their perception of

Trainees/supervisees (n=232); American masters and doctoral counselling, mental

ECRS; WAI-T

Ex post facto; cross


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the supervisory working alliance health, marriage/family therapy or school/career counselling programmes/placements

sectional

Spelliscy (2007)

Supervisees’ self-reported general attachment styles and their perception of the supervisor’s supervisory style and the supervisory working alliance.

Trainees/supervisees (n=200); American masters and doctoral counseling psychology programmes/placements

ECRS-R; SSI; SWAI-T



Tsong (2004) Supervisees’ self-reported general attachmentstyles and their perception of the supervisor’s general and multicultural competencies and the supervisory working alliance

Trainees/supervisees (n=310); American doctoral clinical/counselling psychology or combined psychology programmes/placements

ECRS-S; SPF-C; CCCI-S; WAI-TS



Supervisor attachmentArmoutliev (2015)

Supervisors' self-reported general attachment style, supervisory style and care giving style (deemed crucial to the quality of the supervisory relationship).

Qualified clinical supervisors (n=123); practicing in America; 78% psychologists, rest counsellors, social workers, marriage and family therapists; at least one year supervising experience

ECRS; SSI; ACQ



Bennett et al. (2013)

The impact of attachment based supervisor training on the relationship between supervisor/supervisee general attachment style, the supervisory working alliance and supervision-related affect from the perspectives of supervisor and supervisee

Supervisor-supervisee dyads (n=100 dyads); two American universities; supervisors were social worker field instructors receiving training/control group; supervisees were foundation or final year masters social work students

RSQ; PNAS; WAI-S/T

Randomised controlled trial intervention

Convenience and random assignment to intervention or control group; Questionnaire

Day (2006) Supervisors’ self-reported general attachment style and their perception of the supervisory working alliance

Doctoral student supervisors (n=176); enrolled in American programmes that supervise masters level counselling students

ASQ; SWAI-S



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Deal et al. (2011)

The impact of attachment based supervisor training on the relationship between supervisee general attachment style, the supervisory working alliance and supervisee competency ratings from the perspectives of supervisor and supervisee.

Supervisor-supervisee dyads (n=100 dyads); two American universities; supervisors were social worker field instructors receiving training/control group; supervisees were foundation or final year masters social work students

RSQ; WAI-S/T; CBE, SLQ-R

Randomised controlled trial intervention

Convenience and random assignment to intervention or control group; Questionnaire

Foster et al. (2006)

Supervisors’ self-reported general attachment style and their perception of supervisee development (the accuracy of which may impact on supervisory working alliance)

Supervisor -supervisee dyads (n=90 dyads); across America; supervisors university, mental health/counselling centre based; supervisees in clinical/counselling psychology, marriage/family therapy and social work programmes/placements; four semesters of clinical experience

RSQ; SLQ-R



Supervisor/ supervisee attachmentDickson et al. (2011)

Supervisee and supervisor general attachment styles and perceptions of the supervisory working alliance from the perspective of supervisees.

Trainees/supervisees (n=259); British clinical psychology doctoral programmes/placements; across different year groups

RQ; RAQ; MOPS; WAI-T



Epps (2000) Supervisor and supervisee self-reported general attachment styles and their perceptions of the supervisory working alliance

Supervisor-supervisee dyads (n=96 dyads); counselling department at an American university; supervisors were doctoral students/supervisors; supervisees were masters students enrolled in counselling programmes/placements

ASQ; SWAI-T/S



Hartig (2004) Supervisors and supervisees self-reported general/adult attachment styles and their perceptions of the supervisory working

Supervisor-supervisee dyads (n=124 dyads); across America; supervisors were based in colleges, universities, and school

RQ; SWAI-T/S



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alliance counselling settings; supervisees were students enrolled in masters or doctoral counselling programmes/placements

Riggs & Bretz (2006)

Supervisor and supervisee general attachment styles and perceptions of the supervisory working alliance from the perspective of supervisees

Trainees/supervisees (n=86); American doctoral clinical/counselling psychology or school psychology programmes/placements; advanced level of training

RQ; MOPS; RAQ; WAI-T;



Smith (2009) Supervisor and supervisee self-reported general adult attachment styles and their perceptions of supervisors’ supervisory style and the supervisory working alliance

Supervisor-supervisee dyads (n=123 dyads); British universities; supervisors were qualified psychotherapists; supervisees were students/trainees enrolled in doctoral clinical psychology programmes, currently on clinical placements; across all three years of training

ECR-R; SSI; WAI-T/S



White & Queener (2003)

Supervisor and supervisee self-reported general attachment styles, and their perceptions of the supervisory working alliance

Supervisor-supervisee dyads (n=67 dyads); three American universities; supervisors were doctoral students/supervisors or qualified psychotherapists; supervisees were masters or doctoral students enrolled in counselling programmes/placements; majority in final year

AAS; SWAI-T/S



Wrape (2015) Supervisor and supervisee self-reported general and supervision-specific attachment styles, leader-follower attachment and their perceptions of the supervisory working alliance

Supervisor-supervisee dyads (n=39 dyads); American university; supervisors were doctoral psychology students/supervisors; supervisees were doctoral psychology students enrolled in clinical counselling, health and

RQ; ECR-RS; LMX; WAI-T/S



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behavioural medicine programmes/placements; first year to fifth year students

Literature reviewWatkins & Riggs (2012)

Examination of the literature on Attachment Theory and the psychotherapy supervisory relationship

Seven empirical studies and ten conceptual papers exploring the role of attachment styles in the supervisory relationship. Details of individual studies are included above.

n/a n/a n/a

aNote to clarify the acronyms of measures. AAS = Adult Attachments Scale; ACQ = Adapted Caregiving Questionnaire; AORI = Attachment and Object Relations Inventory; ASQ = Attachment Style Questionnaire; AWAI-S = Advisory Working Alliance Inventory-Student version; CBE = Competency Based Evaluation; CCCI-S = Cross-Cultural Counselling Inventory-Revised; ECR(-R) = Experiences in Close Relationships Scale long form (–revised short form Questionnaire); ECR-RS = Experiences in Close Relationships - Relationship Structures Questionnaire; ESS = Experiences in Supervision Scale; LMX = Leader-Member Exchange; MOPS = Measure of Parental Style; PNAS = Positive and Negative Affect scale; RAQ = Reciprocal Attachment Questionnaire; RBS = The Relational Behavior Scale; RSQ = Relationship Scales Questionnaire; RQ = Relationships Questionnaire; SASS = Supervisee Attachment Strategies Scale; SLQ-R = Supervisee Levels Questionnaire-Revised; SPF-C = Supervisor Competence Perception Form; SSI = The Supervisory Styles Inventory; SSQ = Supervisory Satisfaction Questionnaire; SWAI-T/S = Supervisory Working Alliance Inventory–Trainee/Supervisor versions long and short versions; TASS = Therapist Attachment to Supervisor Scale; TPRS-R = Trainee Personal Reaction Scale-Revised; WAI-T/S = Working Alliance Inventory – Trainee/Supervisor versions long and short versions).

25


Supervisors. Seventy-four percent of supervisors were female, 25% were male and

1% were unspecified. Due to heterogeneous reporting methods, the average age of

supervisors could not be calculated. Sixty-seven percent of studies using supervisor

participants consisted of qualified clinical or counselling

psychologists/psychotherapists, 8% included doctoral level counselling trainees

enrolled as supervisors and 8% included a combination of the two. Seventeen percent

included social work field instructors.

Ethnicity. Seventy-nine percent of supervisees and 85% of supervisors were

Caucasian. Two studies were conducted in the U.K. and the remainder in the United

States or Canada. Although the predominantly white female supervisee samples do

not address the experience of minority groups, they are representative of and

generalizable to the target population.

Methods. Design, sampling methods, data collection methods and analysis

for the included studies are outlined in Tables 3 and 4. One empirical study used a

qualitative design and 28 used quantitative methodology in order to investigate how

attachment style of the supervisor or supervisee affected the supervisory relationship

(or associated variables). Twenty-six of the quantitative studies used non-

experimental (quasi/ex post facto) designs (23 cross-sectional, three longitudinal)

with self-report survey/questionnaire data from a range of measures. Thus, many of

the studies are limited by correlational data and possible response biases. A variety

of questionnaires were used to measure supervisee/supervisor general and/or

supervision-specific attachment. Seventy-nine percent of studies used the Working

Alliance Inventory (Horvath & Greenberg, 1989) as a measure of the supervisory

26


alliance. The remaining two quantitative studies used an experimental RCT

intervention.

Sampling methods were not consistently stated across studies. However, aside from

one study (Duffy, 2003), it was possible to decipher this from the procedure of 28

studies. Twenty-two studies used self-selected/volunteer sampling, six used

convenience/opportunity sampling (and within this two studies also reported a

random assignment of participants.)

Of the quantitative studies, 71% used correlation and/or regression for analysis,

meaning causation could not be established. 14% used structural equation

modelling/path analyses and 21% used Analysis of Variance. Two studies reported

additional analysis methods in combination with those aforementioned, such as

standard error and t-tests. The single qualitative study in this review employed a

Grounded Theory analysis.

Effect size estimates. Effect sizes were reported or could be calculated from

all but two of the quantitative studies (Epps, 2000; Remington, 2015). Effect sizes

across studies ranged from small to large (see Table 4).

Findings

The literature included in this review has investigated a range of supervisory

variables in relation to attachment, such as supervisee disclosure level and supervisor

self-efficacy for giving corrective feedback. However, this review is interested in

understanding the supervisory relationship and will thus focus on findings

specifically related to the supervisory alliance and attachment. Three main themes

emerged in the study findings. These included findings related to the association

between supervisee attachment style and the supervisory relationship, findings

related to the association between supervisor attachment style and the supervisory

27


relationship and findings suggesting the supervisory relationship is a leader-follower

relationship (involving attachment dynamics) rather than an attachment relationship.

Study findings exploring each of these themes will be reported and critically

evaluated. A summary of findings and evaluation relevant to this literature review’s

scope is in Table 4.

28


Table 4. Key Findings of Studies Retained in the ReviewAuthors Analysis Key findings/conclusions Limitations/strengths Effect

sizesSupervisee attachmentBennett et al. (2008)

Multiple regression analysis; correlation analysis

Supervisee supervision-specific attachment style (avoidant) was a stronger predictor of a weak supervisory alliance (bond), than general attachment style (avoidant).

Strengths: Investigated both general and supervision-specific attachment; Limitations: RSQ may be less suited to study of professional relationships

Large. R2= 0.72**; 0.83**

Duffy (2003) Grounded Theory

Supervisors reported having weaker supervisory alliances with insecurely attached supervisees

Strengths: only qualitative explorative study; validated credibility of analysis; Limitations: transferability of findings unclear

n/a

Foster et al. (2007) Standard error to give confidence intervals

Supervisees were similarly attached to their supervisor as they were in their adult close relationships (no distinction between supervision-specific and general attachment)

Strengths: controlled for duration of supervisory relationship; Limitations:10% return rate (unrepresentative sample); RSQ not previously used to evaluate supervisory relationship (unclear psychometric properties)

aNR. 100% found to be attached to supervisor as RSQ score fell above confidence interval for RSQ (general)

Gnilka et al. (2016)

Correlation analysis

Supervisory alliance ratings were lower when supervisees self-reported higher insecure general attachment scores

Strengths: larger sample size; Limitations: no control of supervision format(individual/group); no measure of supervision-specific attachment

Small. r = -0.21*/0.23*

Gunn & Pistole (2012)

Structural equation modelling; correlation analysis

Supervisory alliance ratings were higher when supervisees self-reported higher levels of supervision-specific attachment security

Strengths: assessed supervision-specific attachment; Limitations: ESS adapted from ESR measure has not been fully validated

Large. r = 0.7**;

Gustafson (2015) Structural equation modelling; correlation analysis

Supervisory alliance ratings were higher when supervisees self-reported higher general secure attachment scores

Strengths: dimensional measures of attachment more valid than categorical measures; Limitations: poor model fit found and sample size inadequate for structural equation modeling

aNR. Standardised weight = 0.49** (positive path but model had a poor fit (RMSEA= 0.13***)); Large. r= 0.45**

Huber et al. (2010) Correlation Supervisory alliance ratings were higher Strengths: included length of supervisory relationship; Large. r= - 0.78**

29


analysis when supervisees self-reported lower general insecure attachment scores (only relationships up to one year long)

controlled for type I error; Limitations: no supervision-specific attachment measure

(supervised for <6 months); Medium. r= - 0.41** (supervised for 7-12 months)

Kaib (2010) Regression analysis

Supervisory alliance ratings were higher when supervisees self-reported higher secure general attachment scores (only at time 1 <3 month long supervisory relationship)

Strengths: high response rate reduced chance of self-selection bias; Limitations: convenience sample (reduced generalisability)

Small. Cohen’s Fstandardised β= 0.32**

Kim (1998) Correlation analysis

A combined model of supervisee attachment dimensions predicted ratings of the supervisory alliance/bond.

Strengths: Control over social desirability bias; Limitations: small amount of variance explained by attachment; 30% met with supervisors less than 10 times (authors suggested attachment not yet formed)

Medium. R2= 0.19**

Marmarosh et al. (2013)

Correlation analysis

Supervisory alliance ratings were lower when supervisees self-reported higher supervision-specific fearful-avoidant attachment scores; general attachment unrelated to alliance

Strengths: investigated general and supervision specific attachment; Limitations: small sample size limits power of analyses; measure of supervision-specific attachment not fully validated

Large. r= - 0.75**

Menefee et al. (2014)

Correlation analysis; regression analysis

Supervisory alliance ratings were lower when supervisees self-reported higher avoidant/insecure supervision-specific attachment scores

Strengths: controlled for experience level, training year and length of supervisory relationship; SASS reliable; Limitations: SASS validity unclear

Large. r= -0.84**; 0.76***; β= - 0.88***

Remington (2015) Mean of thestandard deviations;T-tests; correlation analysis

Supervisees’ attachment to their supervisor and general attachment to their friend showed the least amount of differentiation; Supervisory alliance ratings were higher when supervisees had lower differentiation scores across different relationships (secure)

Strengths: 85% response rate; attachment assessed via within-person standard deviation across relationships; Limitations: Supervisees relationship with their supervisor may have not developed into an attachment relationship comparable to infant-caregiver relationships due to being relatively short

aNR; Large. r= -0.56**

Renfro –Michel & Sheperis (2009)

Two-way Analysis of variance;

Supervisory alliance ratings were higher when supervisees self-reported secure rather than insecure supervision-specific

Strengths: longitudinal measurement across experience levels; Limitations: adapted wording on RQ to reflect power differential in supervisory relationship may have

Large-medium. ηp0.229***(time 1) ηp0.116** (time 2)

30


insecure attachment (across time and experience levels)

artificially inflated fearful attachment.

Shaffer (2015) Regression analysis; correlation analysis

Working alliance ratings were higher when supervisors were perceived to use relational behaviours (supervisee attachment style non-significant).

Strengths: first extensive use of the Relational Behavior Scale; Limitations: artificial inflation of association due same supervisors reported on

Large. R2= 0.38***; r = 0.62***

Smothers (2010) Structural equation modelling

Supervisory alliance ratings were lower when supervisees self-reported higher insecure anxious general attachment scores. Avoidant attachment non-significant.

Strengths: investigated whether attachment style and alliance ratings varies between ethnic groups; Limitations: unclear if non-significant finding is due to avoidance of negative feelings

Medium. β= - 0.15*

Spelliscy (2007) Path analysis; correlation analysis

Supervisees’ perception of the supervisor’s style as attractive, warm and interpersonally sensitive predicted the supervisory alliance (supervisee attachment style non-significant).

Strengths: model with good fit; Limitations: social desirability bias leading to low level of self-reported insecure attachment and non-correlations with alliance

Large. r= 0.92*** Cr = 30.95*** (path coefficient; supervisory style and alliance)

Tsong (2004) Multiple regression analysis

The best predictor of the supervisory alliance (bond) was supervisees’ perception of the supervisors’ ability to affect their personal growth.

Strengths: explored role of supervisor; Limitations: no supervisor data/perspective; unknown response rates

Large. R2= 0.581*

Supervisor attachmentArmoutliev (2015) Hierarchical

multiple regression analysis

Supervisor self-reported general attachment style was unrelated to supervisor care giving style or supervisory style (both conducive to a positive supervisory relationship); Supervisory style was found to explain significant variance in care giving style and thus the relationship

Strengths: considered supervisor attachment and their perspective of the supervisory alliance; Limitations:small sample size; variance in care giving style explained by supervisory style was fairly small

Medium. R2= 0.14***; - 0.34***

Bennett et al. (2013)

Multilevel regression

Supervisor training did not allow supervisors to work more effectively

Strengths: randomised controlled trial; Limitations: only 16 hour training intervention (not long enough to allow

Medium. r= 0.35*; R0.24*

31


analysis with their own or their students’ attachment styles nor improve the supervisory alliance; Training did improve supervisor negative affect about the relationship over time.

supervisors to change how they work with their own/supervisees’ attachment styles); statistically significant findings must be treated with caution due to the lack of control over type 1 errors.

Day (2006) Correlation analysis

Supervisors self-reporting insecure/preoccupied general attachment styles were less likely to emphasise the bond component (and more likely to emphasise client focus component) of the supervisory alliance; this may lead to a weaker supervisory alliance

Strengths: considered supervisor attachment and perspective of supervisory alliance; Limitations: doctoral level supervisors (may lack ecological validity); focus on component of the supervisory relationship identified with rather than its quality (difficult to compare to other studies)

Medium. r= 0.4*

Deal et al. (2011) Multiple regression analysis

Supervisor training improved the supervisory relationship and supervisee competence from the perspective of supervisors, but not supervisees. Findings were not moderated by supervisees’ general attachment style.

Strengths: randomised controlled trial; Limitations - Supervisors not blind to which condition they were allocated to; chance of Type 2 errors (false negatives) due to smaller supervisee sample size (lack of statistical power); no measure of change mechanisms

Large. dGMA-raw= 0.82-0.99*; Large. R2

Medium. R2= 0.18*

Foster et al. (2006) Hierarchical multiple regression analysis

Supervisors self-reporting insecure/preoccupied general attachment styles were most likely to give supervisees lower developmental ratings; this may lead to a weaker supervisory alliance due to supervisees perceiving this as inaccurate

Strengths: controlled for level of supervisee psychological reactance and number of supervision sessions; Limitations: heterogeneous sample of supervisors; SLS lacks validity; small effect size for relationship between preoccupied attachment and lower developmental rating; RSQ lacks reliability

Small. R2= 0.08**

Supervisor/supervisee attachmentDickson et al. (2011)

Multivariate analysis of variance;

Supervisory alliance ratings were higher from the perspectives of supervisees when supervisors were perceived to

Strengths: larger, more homogenous sample; looked at a different (British) culture to most research; Limitations: supervisee perspective of supervisor general

Large. ηp2 = 0.19***; Medium. r= - 0.41***

32


correlation analysis;

have lower insecure general attachment scores; supervisee attachment did not predict the alliance

attachment; no supervisor perspective

Epps (2000) Analysis of Variance

Supervisory alliance ratings were higher when supervisees self-reported secure general attachment styles, regardless of the supervisor’s attachment style; supervisor alliance ratings were not associated with either self-reported attachment style or supervisee attachment style

Strengths: looked at both supervisor and supervisee attachment styles and their perspectives of the alliance; Limitations: no report of supervisor experience level which may confound relationship between attachment and alliance

aNR

Hartig (2004) Multivariate analysis of variance

Supervisory alliance ratings were higher when supervisees self-reported secure general attachment styles, regardless of the supervisor’s attachment style; supervisor alliance ratings were not associated with either self-reported attachment style or supervisee attachment style

Strengths: explored the dyadic nature of supervisor and supervisee attachment styles; Limitations: supervisor supervision experience may have confounded relationship between attachment and alliance

Medium. ηp2 = 0.08

Riggs & Bretz (2006)

Multivariate analysis of variance

Supervisory alliance ratings were higher from the perspectives of supervisees when supervisors were perceived to have a secure general attachment styles. Supervisee attachment did not predict the alliance

Strengths: considered attachment style of supervisor and supervisee; more heterogeneous sample; Limitations:only supervisee’s perception; 50% return rate; only included supervisees at an advanced level of training which may confound results

Large. ηp2 = 0.17**

Smith(2009)

Hierarchical multiple regression analysis; correlation analysis

Supervisory alliance ratings were higher when supervisors and supervisees self-reported secure general attachment styles (low anxiety and low avoidance respectively) and supervisors self-reported an attractive supervisory style (both perspectives)

Strengths: measured supervising experience level and supervision length; first study to use large sample of UK Clinical Psychology Doctorate trainees and theirsupervisors; Limitations: Supervisor perception of supervisee style only; no measure of supervision-specific attachment; non peer-reviewed

Medium. r= -0.33**/-0.32;Small. r= 0.23*/0.57**Large. R2=42*** model)

33


White & Queener (2003)

Simultaneous regression analysis

Supervisory alliance ratings were higher from the perspectives or supervisors and supervisees when supervisors self-reported secure general attachment styles. Supervisee attachment did not predict the alliance.

Strengths: looked at both supervisor and supervisee attachment styles and their perspectives of the alliance; Limitations: 50% return rate; homogenous sample; missing demographic data (e.g. age or ethnicity of participants); method of recruitment unclear.

Large. r= 0.57***; 0.33***; β=0.52***; Medium. r= 0.4*; 0.16*; β= 0.37*

Wrape (2015) Analysis of variance; hierarchical regression analysis

Supervisory alliance ratings were lower when supervisees self-reported higher supervision-specific attachment related avoidance scores (but this is repairable over time); Supervisee leader-member exchange score explained more of the variance in supervisory alliance scores than their general attachment style or supervision-specific attachment style

Strengths: first study to empirically investigate the leader-follower hypothesis of the supervisory relationship; Limitations: small non representative supervisor sample meaning that supervisor analysis not available; non-peer reviewed.

Large. R2= 0.72***; 0.85***, ηp2 = 0.73*; Large. R2= 0.17**; 0.43***, ηp2 = 0.2**; Large. β= 0.42* (LMX explained an additional 3% variance in alliance over supervision specific attachment).

Literature reviewWatkins & Riggs (2012)

n/a The supervisory relationship has the potential to develop into an attachment relationship but might be best viewed as having an affective component that can lead to attachment dynamics rather than “full-blown attachment”

Strengths: highlighted new hypotheses and recommendations for future research; first paper to situate the supervisory relationships within a leader-follower attachment framework; Limitations: no explicit search strategy or criteria; effect sizes not reported

aNR: no report of effect sizes

aNR= Effect size not reported or not able to be calculated. *p<0.05; ** p<0.01; ***p<0.001

34

ATTACHMENT THEORY AND THE SUPERVISORY RELATIONSHIP 35

Supervisee attachment style and the supervisory relationship

The majority of studies (n=26) focused solely or partly on the supervisee’s attachment

style and its relationship to the supervisory alliance. This is an interesting finding in

itself, possibly accounted for by the early conceptual literature mainly focusing on

supervisees with ‘pathological’ attachment styles affecting the supervisory alliance

(Robbins, 1995; Watkins & Riggs, 2012; Watkins, 1995). Additionally, a trainee’s

attachment pattern is considered primary in the supervisory relationship because the

supervisor is motivated more by caregiving style than attachment style (Gunn &

Pistole, 2012).

In support of the conceptual literature, several studies report significant associations

between supervisee attachment and the supervisory relationship. In 1998, Kim found

that a combined model of supervisee general attachment dimensions predicted a

significant amount of variance in satisfaction with supervision and the supervisory

bond. The credibility of self-report findings is increased by control over social

desirability bias. However, only a small amount of variance was explained by

attachment and it was the model of combined rather than individual attachment

dimensions, which predicted alliance rating. This could be accounted for by the fact

that 30% of respondents met with their supervisor less than 10 times, meaning the

attachment system might not have impacted on the relationship yet. However, it could

be argued that by three to five supervision sessions, both supervisor and supervisee

have some degree of trust and rapport which may be influenced by attachment styles

(Burke, Goodyear & Guzzardo, 1998; Horvath & Greenberg, 1989). Huber, Sauer,

Mrdjenovich and Gugiu (2010) addressed this by looking at varying lengths of the

supervisory relationship (from less than six months to more than 48 months). It is not

clear whether the category of less than six months included fewer than 10 sessions.


However, regardless of whether the length of the supervisory relationship was less

than six months or up to one year, Huber et al. (2010) found that supervisees with

higher levels of insecure attachment, rated the supervisory alliance weaker than those

who had lower levels. Supervisory relationships longer than one year did not show

this association. On the contrary, using a longitudinal design, Kaib (2010) found

supervisee attachment was no longer a significant predictor of the supervisory alliance

at as early as three months (time two). This may suggest that supervisee attachment

style is much more influential during the very early stages of the supervisory

relationship/supervisee development when anxiety is higher, triggering the attachment

system (Mikulincer & Shaver, 2007). Kaib (2010) postulated that at a later stage when

anxiety is likely to have decreased, supervisees may be more able to rate the quality of

the supervisory relationship based on the reality of the interaction rather than their

perceptions based on the internal working model. Although Kaib’s (2010) findings

may lack generalisability due to the convenience sample used, a high response rate at

both time points meant that further threats to generalisability, such as self-selection

bias, were reduced.

Gustafson (2015) similarly found securely attached supervisees reported stronger

satisfaction with the supervisory alliance. However, the results are difficult to trust as

the sample size was too small for the structural equation modelling analyses.

Nevertheless, in a peer-reviewed study by Gnilka, Rice, Ashby and Moate (2016),

using a larger sample size, similar findings were found with insecurely attached

supervisees, (particularly anxious), rating the working alliance weaker. Smothers

(2010) also demonstrated that supervisees with an anxious attachment style rated the

supervisory alliance weaker than those with a secure style. While this supports the

notion that supervisee insecure attachment predicts a weaker supervisory alliance,


attachment avoidance did not have a significant effect. Without qualitative evidence,

it is unclear whether this reflects a discounting of negative feelings about the

relationship (Wei, Mallinckrodt, Larson, Zakalik, 2005) or whether avoidant

attachment truly does not impact the supervisory alliance.

In the only identified qualitative study, supervisee attachment and its impact on

the supervisory relationship was explored from the perspective of supervisors (Duffy,

2003). Using grounded theory, Duffy found supervisors considered the supervisory

relationship weaker when working with an insecurely attached supervisee of all

categories (preoccupied/anxious, dismissing/avoidant or disorganised/fearful.) The

author concluded supervisors are able to identify insecurely attached supervisees from

their interpersonal dynamics in supervision and therefore have a responsibility to

intervene to protect patients from ineffective or harmful therapy. This study provides

an important first step in the qualitative exploration of attachment in the supervisory

relationship and provides support for others’ findings. However, data saturation may

not have been reached due to the small sample size (n=9). Therefore the study may

not represent a complete account of the author’s research question. Additionally,

based on the interviews, the author presented descriptions of supervisee attachment

characteristics and the quality of the supervisory relationship. No direct quotes were

presented. Researcher bias and interpretation may have thus affected data analysis.

While the author attempted to reduce this by using two outside professionals to

review and validate the analysis, there was a lack of reflexive attention paid to the

relationship between the researcher and participants. It is therefore unclear how

meaning from the interviews may have been co-constructed based on this,

highlighting that the texts could have been under analysed (Charles, Billig, Edwards


& Potter, 2003). Additionally, the transferability of the findings is unclear due to

under-reporting of supervisor demographic data.

So far, the reviewed quantitative studies have all used general measures of supervisee

attachment and have shown a significant relationship between this and the supervisory

alliance. In contrast, within the review by Watkins and Riggs (2012), studies using a

measure of general/adult attachment showed non-significant results, whereas those

using a supervision-specific attachment measure showed more significant results. The

difference between the two reviews could be explained by the present review’s

inclusion of unpublished doctoral theses. However, of the studies mentioned thus far,

two peer reviewed studies (Gnilka et al., 2016; Huber et al., 2010) also show a

significant result using a general attachment measure. Nevertheless, three further

unpublished theses (Shaffer, 2015; Spelliscy, 2007; Tsong, 2004) are not entirely

consistent with these findings. Using a general attachment measure, Tsong (2004)

found that although insecurely attached supervisees perceived the supervisory alliance

to be weaker, the best predictor of the alliance was the supervisee’s perception of the

supervisor’s ability to affect their personal growth. Similarly, Spelliscy (2007) found

the strongest predictor of the supervisory alliance was a warm and interpersonally

sensitive supervisory style. Insecure supervisee general attachment styles (avoidant

and anxious) did not correlate significantly with the supervisory alliance. In support

of Spelliscy’s (2010) findings, Shaffer (2015) also found no significant correlation

between supervisee insecure/avoidant general attachment and supervisory alliance

ratings. However, a significant positive association was found between supervisors’

relational behaviour in supervision and the supervisory alliance. These three theses

introduce new findings emphasising the supervisor’s role in the supervisory

relationship. However, the reliance on supervisee perception of supervisors’


competence and style, rather than supervisor self-report may not be accurate, thus

reducing the external validity of the results. Furthermore, in the Shaffer (2015) study,

different supervisees may have reported on the same supervisor, possibly artificially

inflating the association between supervisor relational behaviour and the alliance.

Non-significant correlations could also be accounted for by low self-reported insecure

supervisee attachment scores, possibly due to social desirability bias (Spelliscy,

2007). The generalisability of these findings are also unclear due to unknown

response rates (Tsong, 2004).

The discrepancy between the aforementioned studies, which found significant and

non-significant associations between supervisee attachment style and supervisory

relationship variables, could be due to the studies being of unequal quality. The latter

three studies suggesting that supervisee attachment was of no significance or less

importance to the alliance, were unpublished doctoral theses which may lack the

methodological rigour/scrutiny of peer-reviewed published research. The discrepancy

could also highlight the supervisor being more important in the quality of the

supervisory relationship than the supervisee attachment style (Shaffer, 2015;

Spelliscy, 2007; Tsong, 2004). Alternatively, the discrepancy could reflect general

supervisee attachment style being an unreliable or invalid construct in the supervisory

relationship. The latter two possibilities will now be explored.

Bennett, Mohr, BrintzenhofeSzoc and Saks (2008) postulate that supervision-specific

attachment is a stronger predictor of the supervisory alliance than general attachment.

The alliance was lowest when supervisees reported high supervision-specific

avoidance, although there was a weak positive correlation between general attachment

avoidance and supervision-specific attachment avoidance. However, the

Relationships Structures Questionnaire used was originally designed to assess


attachment to a parent, friend or romantic partner and may be less suited to the study

of professional relationships such as supervision.

Nevertheless, Bennett et al’s. (2008) findings are supported by several studies (Gunn

& Pistole, 2012; Marmarosh et al., 2013; Menefee et al., 2014; Renfro-Michel &

Sheperis, 2009). Renfro-Michel and Sheperis (2009) found supervisees reporting

secure supervision-specific attachments rated the supervisory alliance stronger than

those insecure and this remained stable over time and experience level. This supports

the aforementioned study by Huber et al. (2010), but not Kaib (2010). Gunn and

Pistole (2012) also found a positive association between supervisee supervision-

specific attachment security and the alliance. Replicating Bennett et al’s (2008)

findings, Marmarosh et al. (2013) showed working alliance ratings were weakest in

fearful-avoidant supervisees. General attachment style was largely unrelated to the

supervisory alliance but general avoidance did correlate with fearful supervision-

specific attachment.

These studies suggest supervision-specific attachment is a more valid construct within

the supervisory relationship and may help to explain the inconsistent findings of those

using general attachment measures previously. However, the measures used have not

been fully validated (Gunn & Pistole, 2012; Marmarosh et al., 2013). They were all

adaptions of existing scales/questionnaires measuring general attachments in

relationships such as those with romantic partners. Changing the item wording to

reflect a supervisory relationship with a power differential may have artificially

inflated the proportion of fearful attachments due to beliefs about being judged by the

supervisor (Renfro-Michel & Sheperis, 2009).

To overcome this limitation, Menefee et al. (2014) developed the Supervisee

Attachment Strategies Scale (SASS). Using this, findings revealed satisfaction with


the supervisory alliance was higher, when supervisees self-reported secure

supervision-specific attachments. These findings are enhanced by control over

possible confounding variables of experience level, training year and supervisory

relationship duration and the SASS’ strong reliability. The validity of the SASS

measuring supervision-specific attachment as a distinct construct from general

attachment and the supervisory alliance was unclear. A correlation, albeit small, was

found between the SASS and ECR (general attachment). Additionally, a large

correlation occurred between the SASS (avoidance subscale) and WAI (supervisory

alliance). Thus the SASS avoidance scale may just be an alternative indicator of a

weak supervisory alliance, rather than attachment.

Indeed, the SASS items could be criticised due to being developed via meta-analytic

review of Attachment Theory and supervision (Netemeyer, Bearden & Sharma, 2003)

and face validity assessment rather than an exploratory approach ascertaining what

may be relevant to the target population. Furthermore, SASS data was only collected

at one time point, meaning that the measure’s long term validity is unclear and in need

of longitudinal exploration.

Additionally, two studies (Foster, Lichtenberg & Peyton, 2007; Remington, 2015) did

not find a distinction between supervision-specific and general attachment,

contradicting findings by Bennett et al. (2008) and Marmarosh et al. (2013). Using the

Relationships Scales Questionnaire, Foster et al. (2007) found supervisees were

similarly attached to their supervisor as they were in their adult close relationships.

However, the Relationship Scales Questionnaire’s psychometric properties for

evaluating the supervisory attachment relationship were unclear. Furthermore, there

was only a 10% response rate, meaning the sample may not be as representative as

previous studies. Nevertheless, Remington’s (2015) thesis had similar findings with a


higher response rate of 85%. Supervisee’s attachment relationships to their supervisor

and to their friend showed the least amount of differentiation compared to attachment

relationships to parents and a romantic partner. Therefore, while supervision-specific

attachment may be distinct from infant-caregiver attachment, it may more closely

resemble a general attachment friend relationship. However, the supervisory

relationship may not have developed into an attachment relationship akin to an infant-

caregiver attachment due to the short and disrupted duration of the supervisory

relationship. Although the study also found supervisees who demonstrated insecure

general attachment styles reported a weaker supervisory alliance, the method of this

classification was based on high differentiation scores across the supervisee’s

attachment relationships in life, rather than a validated measure of general attachment.

While this may question the validity of results, Remington (2015) argues “within-

person standard deviation across specific relationships better explains the variance

within attachment relationships (p.21)” Nevertheless, it presents an original method

of measuring attachment in this review.

Five out of these seven supervision-specific attachment studies support this construct

being distinct from and more meaningful than general attachment in the supervisory

relationship. Thus, inconsistent correlations in previous studies between general

supervisee attachment and the supervisory relationship may be due to this being a less

relevant, unreliable construct.

As previously mentioned, inconsistent correlations could also reflect the supervisor’s

attachment pattern, competence or supervision style being equally as or more

important than the supervisee’s attachment pattern (Shaffer, 2015; Spelliscy, 2007;

Tsong, 2004). Indeed Pistole and Fitch (2008) postulated supervisors could become

an attachment figure for supervisees, providing a secure base and safe haven. This


promotes a positive relationship as supervisees feel contained and protected, free to

explore and able to return in times of need (Neswald-McCalip, 2001). The majority of

studies reviewed so far can be criticised for ignoring the role and perspective of the

supervisor in the supervisory relationship. To address this, some studies have

employed supervisor-supervisee dyads. However, Epps (2000) and Hartig (2004) still

found supervisee rather than supervisor attachment more important in the relationship.

Supervisee alliance ratings were stronger when they self-reported secure general

attachment styles, regardless of the supervisor’s attachment style. However,

supervisor alliance ratings were not associated with either their self-reported

attachment style or the supervisee’s attachment style (Epps, 2000; Hartig, 2004). This

contradicts the notion that both supervisor and supervisee attachment styles interact in

positive or negative ways and influence the relationship, with the ideal dyad

combination being secure supervisor-secure supervisee (Bennett & Saks, 2006).

However, without either study reporting supervisor experience level, it is unclear

whether the non-significant association between supervisor attachment and the

supervisory relationship has external validity or if this is more a result of highly

experienced supervisors who have learned to build strong relationships despite their

attachment style.

In contrast, Smith’s (2009) findings support the ideal dyad combination of secure

supervisor-secure supervisee (Bennett & Saks, 2006). Supervisory alliance ratings

were strongest when supervisors and supervisees self-reported secure general

attachment styles and the supervisor had an attractive supervisory style.

Although these doctoral studies found supervisee attachment equally as, or more

important than supervisor attachment style in the supervisory relationship, they can be

criticised for lacking the methodological rigour/scrutiny of peer reviewed studies.


Indeed when considering published empirical research in this area, many studies have

found the opposite result of significant effects for the supervisor rather than

supervisee attachment. This research will now be evaluated.

Supervisor attachment style and the supervisory relationship

In direct contrast to Epps (2000) and Hartig (2004), White and Queener (2003) found

supervisor rather than supervisee self-reported general attachment style was predictive

of the supervisory alliance from both perspectives. Alliance ratings were higher when

supervisors reported a positive-affiliative/secure attachment. White and Queener

(2003) concluded that supervisee perceptions of the alliance may be more defined by

a task orientated professional relationship than an attachment relationship based on

closeness and self disclosure. The credibility of findings is increased by self-reported

supervisor attachment style rather than the supervisee’s perception of this. However,

the findings’ generalisability is reduced by the homogenous sample (first year masters

students from three universities), unclear recruitment method, unreported participant

age or ethnicity data and a small 50% return rate. Nevertheless, findings by Riggs and

Bretz (2006) complemented White and Queener’s (2003). Supervisee attachment style

was not significantly associated with the three working alliance components (bond,

task, goal). By contrast, a secure supervisor attachment style was associated with

higher supervisory alliance ratings. They postulated that supervisees’ attachment style

might be linked to the big picture view of the supervisory process rather than the three

specific alliance elements. Although Riggs and Bretz (2006) used a more

heterogeneous sample than White and Queener (2003), the return rate was the same

and only included supervisees at an advanced level of training. This may have

confounded the non-significant effect found between supervisee attachment and the

supervisory alliance. So far, all but one study (Smith, 2009) have used American or


Canadian participants. The generalisability of findings to other cultures has remained

unexplored. Dickson, Moberly, Marshall and Reilly (2011) addressed this by using a

larger, more homogenous sample of British Clinical Psychology Doctoral Trainees

than those by Riggs and Bretz (2006), and gleaned a replication of the findings.

The studies by Riggs and Bretz (2006) and Dickson et al. (2011) could be criticised

for basing supervisor attachment style on supervisee perception, rather than

supervisor self-report. However, research on romantic partners suggests relationship

functioning is more strongly associated with an individual’s perception of their

partner’s attachment style than the accuracy of this (Cobb, Davila, & Bradbury,

2001). Thus, supervisees’ perceptions of supervisor attachment style may still be valid

(Riggs & Bretz, 2006). Regardless of supervisor attachment style being self-reported

or perceived and regardless of supervisee attachment style, these three studies show

supervisors with a self-reported or perceived secure attachment style best predicted a

positive supervisory alliance. This may reflect the hierarchical nature of the

supervisory alliance where the supervisor holds the power for supervisory outcomes

(Riggs & Bretz, 2006). This questions Gunn and Pistole’s (2012) postulation that

trainee attachment pattern is more important in the relationship as the supervisor is

motivated by caregiving, not attachment.

Foster, Heinen, Lichtenberg and Gomez (2006), Day (2006) and Armoutliev (2015),

provide further support for the importance of the supervisor in the supervisory

relationship. These were the only identified studies focusing exclusively on supervisor

self-reported attachment and their perspective of the supervisory relationship or

associated variables. Foster (2006) found supervisors self-reporting insecure

preoccupied general attachment styles were most likely to give supervisees low

professional development ratings. It was postulated that this may serve to protect


supervisors’ low clinical self-esteem and in-turn this may have a negative impact on

the supervisory relationship due to supervisees perceiving the evaluation as

inaccurate. However, the effect size found was small, possibly accounted for by the

poor validity and reliability of supervisee development and supervisor attachment

style measures respectively. While the study’s quality is improved by control of

supervisee psychological reactance level and number of supervision sessions, the

heterogeneous supervisor sample makes it difficult to generalise to one type of

professional group.

Despite the limitations, Day’s (2006) thesis supported Foster et al’s (2006)

conclusion. Supervisors self-reporting preoccupied general attachment styles were

less likely to emphasise the bond component of the supervisory alliance. This could

lead to a weaker supervisory alliance, however it is difficult to make any firm

conclusions as no validated measures were used to rate the alliance quality. The

results’ ecological validity is also questionable, given supervisors were doctoral

students trained in supervision, rather than qualified clinician supervisors who may

have emphasised alliance components differently.

In contrast, Armoutliev (2013) found no support for supervisor general attachment

dynamics being related to the supervisory alliance. This was based on results that

supervisor attachment style was unrelated to supervisor caregiving or supervisory

style (which may be understood as fundamental to the supervisory relationship;

Spelliscy, 2007). Instead, supervisory style was linked to caregiving style, although

the variance was fairly small (14-37%) and based on a small sample size. Armoutliev

(2013) concluded that supervisor’s style of supervision may therefore be more

important in the supervisory alliance than supervisor attachment style. This suggests

supervisors could improve the supervisory alliance by learning effective


supervisory/caregiving styles attuned to supervisee attachment styles, through training

interventions (Neswald-McCalip, 2001).

Two studies (Bennett, Mohr, Deal & Hwang, 2013; Deal, Bennett, Mohr & Hwang,

2011) used a training intervention for social work supervisors. The 16-hour training

model was based on the Developmental-Relational Approach to Field Supervision,

aiming to educate supervisors about attachment and supervisory/caregiving styles

conducive to a positive supervisory alliance. In their RCT, Deal et al. (2011)

investigated whether the intervention could improve the supervisory relationship and

whether this could reduce the negative impact of insecure supervisee attachment on

their professional development. Compared to controls, the supervisor training

improved the supervisory relationship and supervisee competence from the

perspective of supervisors, regardless of supervisee attachment style. A training focus

on attunement to supervisee attachment needs, may have improved supervisors’

understanding of their supervisees, helping foster a more collaborative supervisory

relationship that improved supervisee competence. Although the RCT design

improves the study’s conclusions, supervisors were not blind to their allocated

condition. This may have biased their self-report of the alliance and supervisee

development. Additionally, the intervention’s effectiveness was only partial, as it had

no impact on the alliance from the supervisees’ perspective. However, this could be

due to shortcomings in the design including a small supervisee sample size that may

have lacked statistical power and resulted in false negatives (non-correlations). The

effectiveness of this intervention is also questionable based on the findings by Bennett

et al. (2013).

Using the same intervention, Bennett et al. (2013) found that the training model did

not allow supervisors to work more effectively with their own or their supervisee’s


attachment style nor improve the working alliance. Despite training not improving

initial poor alliance scores, supervisors were able to develop positive feelings about

the supervisory relationship over time, suggesting training helped them to separate

these two components. However, it is difficult to trust this finding due to the study’s

lack of control over type 1 errors (false positives). While these studies demonstrate an

important first step in the use of RCT interventions in this research area, it is unclear

how findings relate to more pure psychotherapeutic professions outside of social

work.

The intervention’s limited effect on the alliance could be due to 16 hours being

inadequate for producing change in how supervisors work with their own or their

supervisees’ attachment styles. It seems the supervisory alliance may be difficult to

improve via current training models and more research is needed. It is also possible

that interventions were not targeting the right factors for improving the alliance. The

final two papers in this review (Watkins & Riggs, 2012; Wrape, 2015) argue that the

supervisory relationship is best understood and improved by leader-follower

attachment dynamics rather than a “full-blown attachment bond” (Mayseless &

Popper, 2007, p. 73)

The supervisory relationship as a leader-follower relationship

Watkins and Riggs’ (2012) literature review suggested that while the supervisory

relationship has the potential to develop into an attachment relationship, leader-

follower attachment dynamics, as conceptualised and investigated in business

relationships, may be a more meaningful way of understanding it. The leader-follower

dynamic also complements the hierarchical nature of the supervisory relationship

(Watkins & Riggs, 2012). Although the review did not explicitly state a search

strategy, criteria or any effect sizes, it provides a good evaluation of the current


conceptual and empirical literature up to publication and proposes several hypotheses

for future research. Specifically, the authors identified a need for conceptual models

and further empirical studies investigating leader-follower attachment dynamics in

supervisor-supervisee interactions.

Wrape (2015) explored this in a doctoral study. Consistent with previous studies,

findings showed supervisee supervision-specific attachment (avoidance) was a

significant predictor of poorer alliance ratings above general attachment style.

Supporting Renfro-Michel and Sheperis (2009) and Huber et al. (2010), the alliance

was virtually stable over the semester. However, supervisees with supervision-

specific avoidant styles showed significant improvements in alliance ratings. Thus,

while supervisees with an avoidant style may have a poorer supervisory alliance that

interferes with their clinical skills and development (Deal et al., 2011; Dickson et al.,

2011), this is repairable over time. Consistent with Watkins and Riggs’ (2012) review,

supervisee leader-member exchange explained more of the variance in the alliance

than general or supervision-specific attachment style (avoidance). There were no

significant interaction findings between supervisor-supervisee attachment styles,

leader-member attachment and the alliance. However, the small supervisor sample

resulted in a lower frequency of insecure attachment styles, reducing the study’s

ability to effectively examine the dyadic attachment interaction hypotheses.

Additionally, the small non-representative supervisor sample and poor reliability for

the leader-follower exchange scale within this, meant individual supervisor analysis

was not fully available. These results show a promising start for empirical

investigation of leader-follower exchange in the psychology/psychotherapeutic

profession. However, it would be beneficial to repeat this study using a larger, more

representative supervisor sample in a peer-reviewed study to improve the credibility


of findings in this new area.

Discussion

Although Attachment Theory’s relevance to the supervisory relationship was

conceptualised over twenty years ago, empirical research in this area is still in its

infancy. The present review overlaps with the literature identified by Watkins and

Riggs (2012), but also provides an update of the research since. Additionally,

although potentially poorer in quality than peer reviewed published studies, the broad

inclusion of unpublished material in this review minimises publication bias,

demonstrates some unique contributions to this research area and helps to clarify the

developing picture. Overall, with the exception of one study being excluded as it

could not be translated into English, this review presents a rigorous and

comprehensive evaluation of the literature about Attachment Theory and the

psychotherapy supervisory relationship.

Numerous empirical studies have sought to investigate the theorised attachment-

supervision association. Although the majority appear to support the application of

Attachment Theory to the supervisory relationship, the findings have been

inconsistent. Some studies have found correlations between supervisee attachment

style and the alliance while others have not. This inconsistency could be for a number

of reasons. Firstly, it could be argued that those showing no association were weaker

in methodological quality as they were doctoral theses rather than peer-reviewed

published studies. Secondly, it may be due to general attachment being an unreliable,

less valid construct than supervision-specific attachment (Bennett et al., 2008.) The

inconsistency could also be explained by the supervisor rather than supervisee

attachment being most important in the relationship. Indeed, studies in this review

have highlighted the influential role of supervisor attachment style in terms of


providing a secure base. However, results in this area have also been inconsistent,

with some studies of supervisee-supervisor dyads finding that supervisee attachment

is still more pertinent and others finding supervisor style rather than attachment is the

most important factor in the alliance.

Inconsistent findings could also be due to methodological limitations across studies.

For example, quasi-experimental, correlational designs threaten the validity of

findings and self-report questionnaires expose findings to response bias. Future

research may benefit from more RCTs and objective attachment measures such as

observation of attachment behaviours. Additionally, the developmental level of

supervisee participants and the length of the supervisory relationship varied across

cross-sectional studies. This may have led to inconsistent correlations between

attachment and the supervisory relationship since attachment style is perhaps most

influential on the alliance during the initial rather than later stages of supervisee

development/the supervisory relationship (Bennett & Deal, 2009; Kaib, 2010). This

contrasts with infant-caregiver and adult attachment relationships where attachment

appears important throughout. It would therefore be helpful for supervisee

developmental level/the length of the supervisory relationship to remain consistent

across cross-sectional studies to aid comparisons and reduce confounding effects.

Alternatively, more longitudinal designs may be beneficial for investigating variations

in the impact of supervisee development/experience level on the attachment-

supervisory relationship association further. In turn, this could highlight whether

supervisor training about attachment-based strategies being implemented early on is

warranted. Indeed, the reason why supervisor training on attachment strategies did not

have a consistent positive impact on the supervisory relationship (Bennett et al.,


2013; Deal et al., 2011) could have been because the strategies were not implemented

at the right stage (Kaib, 2010; Pistole & Fitch, 2008).

It is also possible that the inconsistent findings are a reflection that we have not yet

got the attachment-supervision construct quite right. This argument could also explain

why supervisor training on attachment strategies did not consistently improve the

supervisory relationship (Bennett et al., 2013; Deal et al., 2011), since it may not have

targeted the right factors to improve the supervisory alliance. Indeed some authors

have queried the appropriateness of applying an attachment framework to therapeutic

and supervisory relationships at all (Bartholomew & Thompson, 1995; Mallinckrodt,

1995), arguing that they may not even be attachment relationships. Instead, the

relationship may be best understood in terms of a leader-follower exchange where

attachment dynamics may be evoked, instead of “clear-cut attachment” (Mayseless &

Popper, 2007). This seems plausible, given supervisory relationships do not fit neatly

with the relationships defined by Attachment Theory. For example, supervisees and

supervisors are aware from the beginning that their relationship will be short-term and

transitory. In leader-follower relationships (typically conceptualised in business

relationships), the affective component can lead to attachment dynamics (Hess &

Hess, 2008). Thus, leaders can still represent attachment figures, providing a safe

haven and secure base for their followers (Mayseless, 2010) but this remains largely

context specific when anxiety arises in relation to psychotherapy sessions and training

experiences (Pistole & Fitch, 2008). Indeed, findings from a recent doctoral thesis

(Wrape, 2015) found supervisee leader-follower exchange explained more variance in

the alliance than supervisee general or supervision-specific attachment style.

Consistent with previous studies, no interaction effects were found between

supervisor-supervisee attachment styles or leader-follower exchange and the alliance.


It is perhaps unsurprising that we do not fully understand the attachment-supervisory

construct, given the distinct dearth of any in-depth exploratory studies investigating it

from supervisor and supervisee perspectives. Continuing to conduct quantitative

studies using different attachment measures is unlikely to resolve the issue of

inconsistent findings. Rather, trying to explore and identify what the actual construct

is, is likely to provide a better basis for future research. In order to identify a valid and

reliable attachment-supervision construct, it would be helpful to explore in depth, how

the target population actually think about the supervisory relationship and what within

this is relevant to Attachment Theory. In particular, future research of this kind would

benefit from exploring leader-follower attachment dynamics (Watkins & Riggs, 2012)

to see if this is a more relevant construct to the target population. While the paucity of

any existing studies of such an explorative nature may reflect limitations of the search

terms or strategy in this review, it may also suggest a significant limitation and gap in

the current research base. Given that the literature search was rigorous, wide and

expansive, to take account of the novel literature base and the potential difficulty in

identifying appropriate papers, the latter is considered more likely. In the only

identified qualitative study (Duffy, 2003), the perspectives of supervisors were

explored. However, most research to date has used supervisee participants in the view

that the supervisee’s perception of the supervisory relationship is primary (Gunn &

Pistole, 2012; Riggs & Bretz, 2006). It is therefore considered important and timely to

explore how supervisees experience and understand the supervisory relationship and

the role attachment may play within this.

This kind of explorative research would have several benefits in this research area.

Firstly, it could provide new knowledge that accounts for some of the previous

inconsistent findings. This in turn could help to build more valid supervision-specific


measures by informing what items may be most relevant to the target population.

This would allow for more accurate investigation of whether supervisee, supervisor or

both attachment styles impact the supervisory relationship (Menefee et al., 2014) in

future empirical research. An improved understanding from in-depth explorative

research may also help to inform the development of a conceptual model of the

supervisory relationship and attachment. Indeed, Watkins and Riggs (2012) highlight

that a valid conceptual model is still lacking in this area. Importantly, a better

understanding of this field from explorative research could help inform the

development of a training model for supervisors to improve the supervisory

relationship. The content of the training may need to include attachment based

strategies or elements about leader-follower exchange or something entirely different.

Future research could explore the success of supervisor training in an RCT

intervention study. Finally, this kind of explorative research could open up further

important research directions that have not yet been identified. Ultimately it is hoped

that in depth explorative research could help further our understanding of the

applicability of Attachment Theory to the supervisory relationship and how this can

be used to improve the alliance. This will hopefully help to maximise the training

experience and development of the supervisee, client experiences and thus the quality

of clinical and psychotherapeutic service provision.


References

Armoutliev, E. M. (2015). Attachment, supervisory style and caregiving in clinical supervisors. Unpublished Doctoral Dissertation, the University of Akron.

Bartholomew, K., & Thompson, J. M. (1995). The application of Attachment Theory to counseling psychology. The Counseling Psychologist , 23, 484-490.

Bennett, C. S. (2008). Attachment-informed supervision for social work field education. Clinical Social Work Journal, 36, 97-107.

Bennett, S., Mohr, J., BrintzenhofeSzoc, K., & Saks, L.V. (2008). General and supervision-specific attachment styles: Relations to student perceptions of field supervisors. Journal of Social Work Education, 44, 75-94.

Bennett, S., & Deal, K. H. (2009). Beginnings and endings in social work supervision: The interaction between attachment and developmental processes. Journal of Teaching in Social Work, 29, 101-117.

Bennett, S., Mohr, J., Deal, K. H., & Hwang, J. (2013). Supervisor attachment, supervisory working alliance, and affect in social work field instruction. Research on Social Work Practice, 23, 199-209.

Bennett, S., & Saks, L. V. (2006). Field notes: A conceptual application of Attachment Theory and research to the social work student-field instructor supervisory relationship. Journal of Social Work Education, 42, 669-682.

Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision. (5th

ed.). Boston, MA: Pearson.

Bordin, E. S. (1983). A working alliance model of supervision. The Counseling Psychologist, 11, 35-42.

Bowlby, J. (1969). Attachment and loss: Vol 1. Attachment. New York: Basic Books.

British Association for Counselling and Psychotherapy (BACP). (1987). How Much Supervision Should You Have? Rugby: BACP.

Burke, W. R., Goodyear, R.K., & Guzzardo, C.R. (1998). Weakenings and repairs in supervisory alliances. American Journal of Psychotherapy, 52, 450-462.

Carretero-Dios, H., & Pérez, C. (2007). Standards for the development and review of instrumental studies: Considerations about test selection in psychological research. International Journal of Clinical and Health Psychology, 7, 863-882.

CASP. (2013). Critical Appraisal Skills Programme (CASP) Qualitative Research Checklist (1st ed). Oxford: CASP UK.


Charles, A., Billig, M., Edwards, D., & Potter, J. (2003). Discourse Analysis Means Doing Analysis: A Critique of Six Analytic Shortcomings. Discourse Analysis Online, 1, 1-24.

Cobb, R. J., Davila, J., & Bradbury, T. N. (2001). Attachment security and marital satisfaction: The role of positive perceptions and social support. Personality and Social Psychology Bulletin, 27, 1131–1143.

Day, M. S. (2006). The Relationship of Supervisors’ Attachment Styles to their Perceptions of Self-efficacy in Providing Corrective Feedback and to the Working Alliance in Counselor Education. Unpublished Doctoral Dissertation, University of New Orleans.

Deal, K. H., Bennett, S., Mohr, J., & Hwang, J. (2011). Effects of field instructor training on student competencies and the supervisory alliance. Research on Social Work Practice, 21, 712-726.

Dickson, J. M., Moberly, N. J., Marshall, Y., & Reilly, J. (2011). Attachment style and its relationship to working alliance in the supervision of British clinical psychology trainees. Clinical Psychology and Psychotherapy, 18, 322–330.

Duffy, S. (2003). The insecurely attached intern in clinical supervision: implications for supervision. Unpublished doctoral dissertation, the Chicago School of Professional Psychology.

Epps, A. M. (2000). The effect of attachment styles on the working alliance in counselor supervision. Unpublished Doctoral Dissertation, Texas A&M University.

Evans, R. (1976). Some Implications of an Integrated Model of Social Work for Theory and Practice. British Journal of Social Work, 6, 177-200.

Fitch, J. C., Pistole, C., & Gunn, J. E. (2010). The bonds of development: An attachment-caregiving model of supervision. The Clinical Supervisor, 29, 20-34.

Foster, J. T., Heinen, A. D., Lichtenberg, J. W., & Gomez, A.D. (2006). Supervisor attachment as a predictor of developmental ratings of supervisees. American Journal of Psychological Research, 2, 28-39.

Foster, J. T., Lichtenberg, J. W., & Peyton, V. (2007). The supervisory attachment relationship as a predictor of the professional development of the supervisee. Psychotherapy Research, 17, 353-361.

Gnilka, P. B., Rice, K. G., Ashby, J. S., & Moate, R. M. (2016). Adult Attachment, Multidimensional Perfectionism and the Alliance Among Counselor Supervisees. Journal of Counseling and Development, 94, 285-296.

Gunn, J. E. & Pistole, M. C. (2012). Trainee supervisor attachment: Explaining the alliance and disclosure in supervision. Training and Education in Professional Psychology, 6, 229-237.


Gustafson, M. L. (2015). Relationships between attachment and object relations and supervisees' satisfaction in supervision. Unpublished doctoral dissertation, the California School of Professional Psychology.

Hartig, N. A. (2004). The relationship between supervisors' and supervisees' attachment patterns and their perceptions of the supervisory working alliance. Unpublished Doctoral Dissertation, University of Northern Colorado.

Hess, T.H., & Hess, A.K. (2008). On being supervised. In A.K. Hess et al. (Eds.), Psychotherapy supervision: Theory, research, and practice (2nd ed). Hoboken, NJ: Wiley.

Hill, E. W. (1992). Marital and family therapy supervision: A relational-attachment model. Contemporary Family Therapy, 14, 115-125.

Holloway, E.L., & Neufeldt, S. A. (1995). Supervision: its contributions to treatment efficacy. Journal of Consulting and Clinical Psychology, 63, 207-213.

Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the working alliance inventory. Journal of Counseling Psychology, 36, 223-233.

Huber, D. M., Sauer, E. M., Mrdjenovich, A. J., & Gugiu, P. C. (2010). Contributions to advisory working alliance: Advisee attachment orientation and pairing methods. Training and Education in Professional Psychology, 4, 244-253.

Jarde, A., Losilla, J. M., & Vives, J. (2012). Suitability of three different tools for the assessment of methodological quality in ex post facto studies. International Journal of Clinical and Health Psychology, 12, 97-108.

Kaib, N. (2010). Attachment style, affect regulation, and supervision outcomes. Unpublished Doctoral Dissertation, the George Washington University.

Kim, S. (1998). Influence of trainee attachment on satisfaction with supervision, the supervisory relationship, and perceptions of supervisory style. Unpublished doctoral dissertation, University of Maryland.

Kmet, L.M., Lee, R.C. & Cook, L.S. (2004). Standard Quality Assessment Criteria for Evaluating Primary Research Papers From a Variety of Fields. Canada: Alberta Heritage Foundation for Medical Research.

Lichtenberg, J., & Goodyear, R. (2000). The Structure of Supervisor-Supervisee Interactions. The Clinical Supervisor, 19, 1-24.

Mallinckrodt, B. (1995). Attachment Theory and counseling psychology: Ready to be a prime time player? The Counseling Psychologist, 23, 501-505.

Marmarosh, C. L., Nikityn, M., Moehringer, J., Ferraioli, L., Kahn, S., Cerkevich, A.,….Reisch, E. (2013). Adult attachment, attachment to the supervisor, and


the supervisory alliance: How they relate to novice therapists’ perceived counseling self-efficacy. Psychotherapy, 50, 178-188.

Mayseless, O. (2010). Attachment and the leader-follower relationship. Journal of Personal and Social Relationships, 27, 271-280.

Mayseless, O., & Popper, M. (2007). Reliance on leaders and social institutions: An attachment perspective. Attachment and Human Development, 9, 73-93.

Menefee, D. S., Day, S. X., Lopez, F. G., & McPherson, R. H. (2014). Preliminary development and validation of the supervisee attachment strategies scale (SASS). Journal of Counseling Psychology, 61, 232-240.

Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. New York, NY: Guildford Press.

Milne, D. (2007). An empirical definition of clinical supervision. British Journal of Clinical Psychology, 46, 437-447.

Milne, D. L., & James, I. A. (2002). The observed impact of training on competence in clinical supervision. British Journal of Clinical Psychology, 41, 55-72.

Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., The PRISMA Group. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Open Med, 3, 123-130.

Morrison, T. (2005). Staff Supervision in Social Care: Making a Real Difference to Staff and Service Users, (3rd edit.) Brighton: Pavilion.

Neswald-McCalip, R. (2001). Development of the secure counselor: Case examples supporting Pistole & Watkins’s (1995) discussion of Attachment Theory in counseling supervision. Counselor Education and Supervision, 41, 18-27.

Netemeyer, R. G., Bearden, W. O., & Sharma, S. (2003). Scaling procedures: Issues and applications. Thousand Oaks, CA: Sage.

Parrish, M. (2009). Social Work Perspectives on Human Behaviour. Maidenhead: Open University Press.

Pistole, M. C., & Fitch, J. C. (2008). Attachment Theory in supervision: A critical incident experience. Counselor Education and Supervision, 47, 193-205.

Pistole, M. C., & Watkins, C. E. (1995). Attachment Theory, counseling process, and supervision. The Counseling Psychologist, 23, 457-478.

Proctor, B. (1988). Supervision: A Cooperative Exercise in Accountability. In J. Fowler (Ed.), (1999). The Handbook of Clinical Supervision: Your Questions Answered. Wiltshire: Mark Allen Publishing Limited.

Remington, J. R. (2015). Clinical psychology interns' attachments to clinical supervisors: Do they resemble other close relationships, and can they predict


individual differences in working alliance? Unpublished Doctoral Dissertation, Fielding Graduate University.

Renfro-Michel, E., & Sheperis, C. J. (2009). The relationship between counseling supervisee attachment orientation and personal bond with supervisor. The Clinical Supervisor, 28, 141-154.

Riggs, S., & Bretz, K. (2006). Attachment processes in the supervisory relationship: An exploratory investigation. Professional Psychology: Research and Practice, 37, 558-566.

Robertson, J. R. & Dean, A. (1997) General professional training: consultant supervision of trainees. Advances in Psychiatric Treatment, 3, 347-351.

Robbins, S. B. (1995). Attachment perspectives on the counselling relationship: Comment on Mallinckrodt, Gantt, and Coble (1995), Journal of Counselling Psychology, 42, 318-319.

Rønnestad, M. H., & Skovholt, T. M. (2003). The journey of the counselor and therapist: Research findings and perspectives on professional development. Journal of Career Development, 30, 5-44.

Sanderson, S., Tatt, I. D., & Higgins, J. P. (2007). Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: A systematic review and annotated bibliography. International Journal of Epidemiology, 36, 666-676.

Shaffer, K. S. (2015). Supervisee avoidant attachment and supervisors' use of relational behavior: Contributions to the working alliance. Unpublished Doctoral Dissertation, State University of New York at Albany.

Shrier, I., Boivin, J.F., Steele, R.J., Platt, R.W., Furlan, A., Kakuma, R., …..Rossignol, M. (2007). Should meta-analyses of interventions include observational studies in addition to randomized controlled trials? A critical examination of underlying principles. American Journal of Epidemiology, 166, 1203-1209.

Smith, A. (2009). Attachment patterns, supervisory style and the supervisory working alliance. Unpublished Doctoral Dissertation, Lancaster University.

Smothers, M. K. (2010). Counseling self-efficacy: The contributions of early attachment and the supervisory relationship. Unpublished Doctoral Dissertation, the University of Wisconsin-Milwaukee.

Spelliscy, D. (2007). Predicting supervisee role conflict/ambiguity: A model of attachment, supervisory style, and supervisory working alliance. Unpublished Doctoral Dissertation, Fordham University.

Tsong, Y. V. (2004). The roles of supervisee attachment styles and perception of supervisors' general and multicultural competence in supervisory working


alliance, supervisee omissions in supervision, and supervision outcome. Unpublished Doctoral Dissertation, University of Southern California.

Watkins, Jr., C. E., (1995). Pathological attachment styles in psychotherapy supervision. Psychotherapy, 32, 333-340.

Watkins Jr., C. E. (2011). Toward a tripartite vision of supervision for psychoanalysis and psychoanalytic psychotherapies: Alliance, transference-countertransference configuration, and real relationship. Psychoanalytic Review, 98, 557-590.

Watkins Jr., C. E., & Riggs, S. A. (2012). Psychotherapy supervision and Attachment Theory: Review, reflections, and recommendations. Clinical Supervisor, 31, 256-289.

Wei, M., Mallinckrodt, B., Larson, L. M. & Zakalik, R. A. (2005) Adult attachment, depressive symptoms, and validation from self versus others. Journal of Counseling Psychology, 52, 368-377.

Wells, K., & Littell, J. H. (2009). Study quality assessment in systematic reviews of research on intervention effects. Research on Social Work Practice, 19, 52-62.

White, V., & Queener, J. (2003). Supervisor and supervisee attachments and social provisions related to the supervisory working alliance. Counselor Education & Supervision, 42, 203-218.

Wrape, E. R. (2015). Attachment Theory within clinical supervision: Application of the conceptual to the empirical. Unpublished Doctoral Dissertation, University of North Texas.


Part 2 - Empirical Paper

Attachment Theory and the Supervisory Relationship:An Interpretative Phenomenological Analysis of Supervisee

Experiences


Abstract

Background

A positive supervisory relationship is considered essential in ensuring a

psychotherapist’s safe and effective practice. Attachment Theory (AT) has been used

to investigate factors that may impact upon the quality of the supervisory relationship,

for trainee psychotherapists. A literature review revealed inconsistent findings as to

whether attachment styles of supervisors and supervisees were associated with the

quality of the alliance, suggesting an incomplete understanding the attachment-

supervision construct.

Objectives

To improve our understanding of the attachment-supervision construct, this study

aimed to explore, in-depth, how supervisees experienced and understood the

supervisory relationship and to explore what within this may be relevant to AT.

Method

Interpretative Phenomenological Analysis (IPA) was used to interview and analyse

data from seven trainee clinical psychologists (supervisees).

Results

Several participant experiences resonated with AT, including the supervisor

demonstrating secure attachment figure qualities, which help the supervisee feel

worthwhile. Rather than the supervisory relationship merely being influenced by past

infant-caregiver attachment, it appears that there is the potential for a new attachment

to form, similar to the freshness of an infant-caregiver attachment. However, unlike

an infant, the supervisee has more influence over the attachment, in a collaborative

effort with the supervisor, where the relationship seems to benefit from a goodness-


of-fit between both relational styles. Non-attachment factors such as reciprocal

disclosure were also important in the supervisory relationship.

Conclusion

Overall, AT appears a useful way to think about the supervisory relationship,

particularly for inexperienced trainees. However, as trainee clinical psychologists are

trained to think in attachment terms, it remains unclear whether the supervisory

relationship is truly a “full-blown” attachment relationship (rather than one consisting

of attachment dynamics), or whether this is just the way that trainees approach it.

Regardless, the findings suggest that the supervisory alliance may be improved via

supervisor attunement to supervisee needs.


Introduction

Within the psychotherapy field, clinical supervision is defined as “the formal

provision of a relationship-based education and training that is work-focussed and

which manages, supports, develops and evaluates the work of colleague/s” (Milne,

2007, p.439). Supervision’s primary functions are to develop the therapist’s self-

awareness, skills and competencies and to monitor client welfare, in order to ensure

the therapist’s safe and effective practice and enhance client outcomes (Bornsheuer-

Boswell, Polonyi, & Watts, 2013; Wheeler & Richards, 2007). Supervision is

valuable at all stages of a psychotherapist’s development, particularly for trainee

psychotherapists (Milne & James, 2002). For trainees within some psychotherapist

disciplines, such as clinical psychology, supervision takes place in relation to research

projects as well as clinical work. In addition, different clinical supervisory approaches

are used, such as cognitive-behavioural, systemic or psychodynamic models.

Irrespective of the approach used, or the context this relates to, it is widely accepted

that the most important factor in supervision meeting its aims, is the quality of the

supervisory relationship (Bernard & Goodyear, 2014; Holloway & Neufeldt, 1995;

Mainhard, van der Rijst, van Tartwijk & Wubbels, 2009).

Bordin (1983) posited that a good quality supervisory relationship depends upon a

strong supervisory working alliance, where the supervisor and supervisee share a

strong emotional bond and agree on supervision goals and tasks (Horvath &

Greenberg, 1989). Research has since explored additional factors, such as supervisory

dyad gender and identification of psychodynamic countertransference issues that may

impact upon the alliance’s quality (Lichtenberg & Goodyear, 2000; Watkins, 2011).

Over the past 20 years, increasing attention has also been paid to the role that

Attachment Theory may have in identifying factors that impact on the alliance, such


as supervisor and supervisee attachment styles (Bowlby, 1969; Pistole & Watkins,

1995). Conceptual and empirical research has explored this using trainees from

various psychotherapy disciplines such as clinical psychology, counselling, and

clinical social workers (which in the U.S. includes therapy provision). Trainees are a

relevant population in this research field, as according to Fitch, Pistole and Gunn

(2010), trainee psychotherapists are likely to experience an activation of their

attachment system, because early therapeutic practice involves anxiety, threat and

dependence (Rønnestad & Skovholt, 2003).

Hill (1992) and Bennett and Saks (2006) theorised that the supervisor acts as a secure

base and safe haven for the supervisee. A supervisor who is available, reliable and

sensitive in their responses to a supervisee’s needs in times of threat (safe haven) is

likely to be viewed as a secure base from which a supervisee can safely learn,

function and explore, thus facilitating a positive supervisory alliance. In insecure

attachment relationships, the supervisor does not function as a secure base or safe

haven due to providing insensitive responses, which are cold, rejecting, inconsistent

or non-existent, thus impeding the supervisory working alliance. In a descriptive

paper of an attachment based training programme, Bennett (2008) stated that

supervisors who completed this training, reported being better able to provide a secure

base for their supervisees.

Although a supervisor may attempt to offer a secure base, it was later theorised that

trainee therapists exhibiting insecure ‘pathological’ attachment styles, negatively

impact the relationship with their supervisor (Watkins, 1995). While securely attached

individuals are more likely to view their supervisor as dependable, believe in their

own abilities and be able to explore and take learning risks, Watkins (1995) posits that

supervisees with preoccupied attachment styles are more likely to doubt their abilities


and cling to the supervisor or seek excessive reassurance. On the contrary, supervisees

with dismissing attachment tend to distrust and avoid their supervisor, thus becoming

overly self-reliant on their own abilities.

According to Bennett and Saks (2006) both supervisor and supervisee can exhibit

problematic attachment styles. They posit that the supervisory alliance benefits from a

goodness-of-fit between supervisor and supervisee attachment styles and how attuned

the supervisor is to their supervisees’ attachment needs. Pistole and Fitch (2008)

extended this by arguing that supervisors who are unable to respond to their

supervisee’s attachment style, hinder the development of a positive supervisory

alliance. However, using a case example, Bennett and Deal (2009), suggested that

attachment styles have less influence over the supervisory relationship quality, over

time, as the supervisee becomes more confident and experienced. Despite the

literature’s dominance of theoretical/conceptual articles, a model explaining

Attachment Theory’s role in supervision has only recently been developed. The

Attachment-Caregiving Model of Supervision (Fitch et al., 2010) incorporates

caregiving and attachment processes in the supervisory relationship and the link to

supervisee development and learning experience.

Numerous empirical studies have investigated the theorised attachment-supervision

association. The majority appear to support this, with more securely attached

supervisees reporting more positive alliances (Gnilka, Rice, Ashby & Moate, 2016;

Gustafson, 2015; Huber, Sauer, Mrdjenovich & Gugiu, 2010; Kaib, 2010; Kim, 1998;

Remington, 2015; Smothers, 2010). However, the findings have been inconsistent.

While some studies have found correlations between supervisee attachment style and

the alliance, others have shown alternative factors, such as supervisory style, to be a


stronger predictor (Tsong, 2004) and some have shown no correlation at all (Shaffer,

2015;Spelliscy, 2007).

This inconsistency could be for a number of reasons. Firstly, those showing no

association may be weaker in methodological quality as they were doctoral theses

rather than peer-reviewed published studies. Secondly, it may be due to general

attachment style being an unreliable, less valid construct than supervision-specific

attachment style when measuring the supervisory relationship quality (Bennett, Mohr,

Brintzenhofeszoc & Saks, 2008). While the former relates to a supervisee’s

attachment style in their general adult relationships, the latter refers to a supervisee’s

attachment towards their supervisor within the supervisory relationship. Indeed, many

studies, support the supervision-specific attachment style construct being distinct from

the general attachment construct, and a stronger and more reliable predictor of the

supervisory alliance (Bennett et al., 2008; Gunn & Pistole, 2012; Marmarosh et al.,

2013; Menefee, Day, Lopez & McPherson, 2014; Renfro-Michel & Sheperis, 2009).

However, some studies found no distinction (Foster, Lichtenberg & Peyton, 2007;

Remington, 2015).

In addition, the inconsistent correlations between supervisee attachment style and the

alliance could also reflect the supervisor’s attachment pattern, competence or

supervision style being equally as or more important than the supervisee’s attachment

pattern in the relationship (Pistole & Fitch, 2008; Shaffer, 2015; Spelliscy, 2007;

Tsong, 2004). However, results in this area have also been inconsistent. While some

studies suggest that irrespective of supervisee attachment style, supervisors with self-

reported or perceived secure attachment styles best predict a positive alliance over

those with insecure styles (Day, 2006; Dickson, Moberly, Marshall & Reilly, 2011;

Foster, Heinen, Lichtenberg & Gomez, 2006; Riggs & Bretz, 2006; White & Queener,


2003), others show that supervisor and supervisee secure attachment style are equally

important in predicting a positive alliance (Smith, 2009). Furthermore, some

supervisor-supervisee dyad studies found that supervisee attachment style is still more

pertinent, with supervisor attachment style not reaching significant correlations with

the supervisory alliance (Epps, 2000; Hartig, 2004). In addition, other studies have

found no correlation, instead finding that supervisor style rather than attachment style

is the most important factor in the alliance (Armoutliev, 2013). Indeed, if supervisor

attachment style were to have a role in predicting the supervisory alliance, one would

expect training on attachment and attunement to supervisee needs would improve the

relationship. However, Randomised Controlled Trials (RCTs) of such interventions

have presented mixed findings, with one study showing a positive impact on the

alliance (Deal, Bennett, Mohr & Hwang, 2011) and another showing no impact

(Bennett, Mohr, Deal & Hwang, 2013).

While the intervention’s limited effect could be due to 16 hours of training being

inadequate for producing change in how supervisors work with their own or their

supervisee’s attachment styles, it could also be argued that the strategies were not

implemented at the right stage (Pistole & Fitch, 2008). Indeed, attachment style is

perhaps most influential on the alliance during the initial rather than later stages of

supervisee development or the supervisory relationship (Bennett & Deal, 2009; Kaib,

2010), however this is not consistently supported (Huber et al., 2010; Renfro-Michel

& Sheperis, 2009; Wrape, 2015). It is also possible that the supervisor training

intervention did not consistently improve the supervisory relationship, because it did

not target the right factors. This perhaps questions whether we have yet got the

attachment-supervision construct quite right. The very inconsistent findings across

studies, as a whole, would suggest not.


Indeed, some authors have queried the appropriateness of applying an attachment

framework to the supervisory relationship at all (Bartholomew & Thompson, 1995;

Mallinckrodt, 1995), arguing that they may not even be attachment relationships. In

addition, it has been posited that while the supervisory relationship has the potential to

develop into an attachment relationship, it may be best understood as a leader-

follower exchange where attachment dynamics are evoked, instead of there being a

“full-blown attachment” (Mayseless & Popper, 2007, p.73; Watkins & Riggs, 2012).

This seems plausible, given supervisory relationships do not fit neatly with the infant-

caregiver relationships defined by Attachment Theory. For example, supervisees and

supervisors are aware from the beginning that their relationship will be short-term and

transitory. In leader-follower relationships, typically conceptualised in business

contexts, leaders can still represent attachment figures who present a safe haven and

secure base for their followers (Mayseless, 2010) but this remains largely context-

specific when significant anxiety arises regarding work related experiences (Pistole &

Fitch, 2008), rather than being a given for all followers and all contexts. Consistent

with the notion that the alliance is best explained as a leader-follower relationship, a

study by Wrape (2015) found that supervisee leader-member exchange score

explained more variance in the supervisory alliance than either general or supervision-

specific attachment style.

It is perhaps unsurprising that we do not fully understand the attachment-supervision

construct, given the distinct dearth of any in-depth exploratory studies investigating it

from either supervisor or supervisee perspectives. Continuing to conduct quantitative

studies using different attachment measures is unlikely to resolve the inconsistent

findings. Rather, trying to explore and identify what the actual construct is, is likely to

provide a better basis for future research. In order to better understand and identify a


valid and reliable attachment-supervision construct, it would be helpful to explore in

depth, how the target population actually think about the supervisory relationship and

what within this is relevant to Attachment Theory. In particular, it would be helpful to

ascertain whether leader-follower attachment dynamics (Watkins & Riggs, 2012) is a

more relevant construct to the target population, or perhaps whether the construct is

best defined by general or supervision-specific attachment. In depth, explorative

research could solve the aforementioned problems in the literature in several ways.

Firstly, as well as opening up new unidentified research directions, it could provide

new knowledge of the attachment-supervision construct, possibly accounting for the

previous inconsistent findings. This in turn could help to build more valid

supervision-attachment measures by informing what items are most relevant to the

target population. This would allow for more accurate empirical investigation of

whether supervisee, supervisor or both attachment styles impact the supervisory

relationship (Menefee et al., 2014). An improved understanding from in-depth

explorative research may also help to develop a conceptual model of the supervisory

relationship and attachment (Watkins & Riggs, 2012) and a supervisor training model,

which could be tested via RCTs.

In the only identified qualitative explorative study in the supervision-attachment

literature, supervisor perspectives were explored (Duffy, 2003). However, most

research to date has used supervisee participants in the view that the supervisee’s

perception of the supervisory relationship is primary (Gunn & Pistole, 2012; Riggs &

Bretz, 2006). It is therefore considered important and timely to conduct research with

the below aim.


Study aim

To explore in depth how supervisees within a psychotherapeutic profession,

experience and understand the supervisory relationship, and what within this may be

relevant to Attachment Theory.

MethodDesign

An Interpretative Phenomenological Analysis (IPA; Smith & Osborn, 2003) design

was used to interview and analyse a small purposive volunteer sample of participants.

IPA was deemed an appropriate design for the following reasons. Firstly, data

collection is unstructured and detailed to allow for in-depth exploration of how

participants make sense of the supervisory relationship. Secondly, IPA is useful for

broad and open research aims, particularly those surrounding the way people

understand their experiences as IPA sees cognitions as accessible, through language.

Thirdly, the research aims to clarify understanding of the attachment-supervision

construct. As different individuals will have different accounts of this, IPA’s

ideographic, nuanced approach is well suited, treating each interview as a separate

case, representing a unique worldview, while still capturing something in detail about

the participant group (see appendix B for an expanded rationale).

Participants

Recruitment. An email invitation (Appendix C) was sent to three cohorts of

trainee clinical psychologists, enrolled on a DClinpsy programme. The email

contained the participant information sheet (Appendix D), so participants could make

an informed decision about whether to contact the researcher to arrange an interview.

Sampling strategy. A sample of 7 participants were used, in keeping with

recommendations of a small sample between four to 10 for professional doctorate IPA


research (Smith, Flowers & Larkin, 2009), and the opinion that fewer participants

examined at a greater depth is preferable (Reid, Flowers & Larkin, 2005).

A homogenous sample was recruited to give a closely defined group for whom the

research question is significant and transferable (Smith & Osborn, 2003). The

literature suggests that being a trainee psychotherapist is a relevant factor to

homogeneity in a supervisee sample, (as this activates the attachment system, Fitch et

al., 2010). Thus trainees, as opposed to qualified psychotherapists were used.

Homogeneity of a trainee sample was achieved through recruiting trainee clinical

psychologists from the same university, with pre-training/training experiences of

individual supervision from a psychologist in a clinical or research setting. This

sample also allowed for ease of recruitment, to provide sufficient data.

Sample. Participants were five women and two men currently undertaking

their clinical psychology training at a University in England. Three participants were

in their first year, three in their second year and one in their third year. In order to

protect participant confidentiality, gender, age and ethnicity neutral alias names have

been used (Table 1). Supervisees discussed their experiences of the supervisory

relationship during and before training, across a number of different

psychotherapeutic clinical care and research settings. Participants largely discussed

supervision by clinical psychologists, but reference was made to both counselling

psychologists and academic research psychologists.

Table 1. Participant alias namesParticipant Number Participant Alias

1 Charlie2 Lou3 Ashley4 Sam5 Perrie6 Alex7 Frankie


Ethical considerations

This study was granted favourable ethical approval by the Faculty of Health and

Medical Sciences Ethics Committee (Appendix E; See Appendix F for further ethical

considerations.)

Data collection

Semi-structured interviews were conducted at a university location that enabled

anonymity to be preserved. Prior to interview, it was ensured that participants had

fully understood the information sheet before being given the consent form to read

and sign if they were happy to proceed (Appendix G). A semi-structured interview

schedule was developed (Appendix H), in accordance with the research question,

guidance on IPA interview development (Shinebourne, 2011; Smith & Osborn, 2003)

and research supervisor expertise. The schedule was short with broad questions that

could be used flexibly, to allow for in-depth exploration of unforeseen areas and to

maintain a careful collaborative balance between guiding and being led. This also

ensured that the interviews and participant narratives were not constrained by the

researcher’s beliefs (Smith et al., 2009). Audio-recorded interviews lasted between 63

and 85 minutes and were transcribed and anonymised by the researcher.

Data analysis

Data was analysed using the IPA process described by Smith and Osborn (2003):

Single-case analysis. Multiple in-depth readings of the first interview were

completed to identify emergent themes, before repeating this for the remaining six

interviews (see Appendix I for further detail).

Emergent themes. For each interview, emergent themes were listed

chronologically to identify connections between them. Themes were re-ordered and

condensed to form clusters and hierarchies of similar themes, which were then


translated into superordinate and subordinate themes (see Appendix I for further

information on theme identification.) Subordinate themes for each superordinate

theme were then linked with identifiers to indicate supporting transcript evidence.

Cross-case analysis. Patterns of themes across cases were identified and

clustered into master-themes and sub-themes for the group (Table 2). Research

supervision discussions helped to condense the number of themes, to allow for a more

thorough and synthesised analysis (Hefferon & Gil-Rodriguez, 2011).

Validity and quality

As recommended for IPA (Smith et al., 2009), Yardley’s (2000) guidelines were used

to guide all stages of the study and focused on: sensitivity to context; commitment and

rigour; transparency and coherence; and impact and importance (see Appendix J for

related evidence). Sensitivity towards participant material, and a rigorous, transparent

and coherent approach to study design and analysis is demonstrated via an audit trail

(Appendix K), a self-reflexive account (Appendix L) and an example of a credibility

check by the researcher’s supervisor (Appendix M).

Results

Interpretative Phenomenological Analysis of the seven semi-structured interviews

revealed the following master-themes and sub-themes:

Table 2. Master-Themes and related Sub-themesMaster-theme Sub-themes

I am worth something to the supervisorThey are sensitive and responsive to my needsThey nurture me like a caring family member wouldThey trust in me/help me to trust in myselfThey are willing to share themselves with meThey prioritise my needs

They are available for me


We both play a part in creating the supervisory alliance

The quality of the relationship depends on the supervisorThe way I relate to a supervisor is different to other relationshipsSupervisory experiences can change the way I relate to other supervisors and people in my lifeThe quality of the relationship depends on there being a good fit between supervisor and supervisee

Themes will be now explored and interpreted in a narrative account and illustrated via

verbatim interview extracts, paying careful attention to the nuances between

participant experiences. The readability of extracts has been improved by making

some minor alterations. These include participants and supervisors being referred to

with female pronouns (see appendix I for further information on alterations).

I am worth something to the supervisor

Participants talked about a good supervisor being sensitive and responsive to their

needs, in the same kind of ways that a nurturing family member might be. Supervisors

would trust in the supervisee/help supervisees to trust in themselves and be willing to

disclose something of themself. They would also prioritise the supervisees’ needs and

be available for them. Collectively, these features suggested to participants that they

are worth something to the supervisor, and are thus worth something as a person.

They are sensitive and responsive to my needs. Participants valued a

supervisor’s ability to notice their distress and provide a flexible and meaningful

response to this, that would allow them to learn and develop. Lou appreciated that the

supervisor made a point of finding time for her when she was struggling:

…if they [supervisors] could see you flagging a bit or if you looked particularly like I

need you then they would see you if they could see you right then or they would cut a

bit of time out for you later…(Lou)


Alex describes responsiveness as the supervisor providing gentle validation and a

space for exploring and learning:

…I just kind of burst into tears in the supervision room because I was distressed and

she completely changed and responded to what I needed in that moment […] she gave

me space to explore […] and then she was also really validating […] normalising as

well […] and then would explore whether there were personal triggers as well. She

was very gentle and I think that is what I needed…(Alex)

Reflecting on this later, Alex added that her supervisor’s response was “containing”

and “made me able to continue my work.”

For Perrie and Ashley, responsiveness to their needs was particularly important in the

early stages of their work, when they felt like they knew “nothing,” to guide, comfort

and reassure them. This helped build trust in their supervisor. However,

responsiveness goes beyond the provision of emotional support to incorporate

providing clear, practical and theoretical guidance:

I definitely feel a lot safer when someone can show me a backup of what it is that we

are doing […] and this new supervisor […] she pulls out all of these papers all of the

time, explains theory so well. (Charlie)

Where this is missing, Perrie, Ashley and Frankie reported feeling a pressure to

manage alone, and find other ways of learning and gaining feedback, by becoming

“self-sufficient” with independent reading and alternative team member support:

…it didn’t feel like there was much warmth or maybe interest even, that I looked for

other sources of support in the team to support my development. (Perrie)

They nurture me like a caring family member would. Participants made

several references to the supervisor’s qualities mirroring those of key family

members, particularly a mother or older sister, with a warm and caring nature. Charlie


suggested that her supervisor’s “big sister” role developed through her “caring”

qualities, although Charlie also recognised that she may have fallen into a younger

sister role due to her vulnerabilities as a less experienced and “insecure” assistant.

Most participants, like Frankie, compared their supervisor to a mother figure with

similar qualities:

My supervisor reminded me of my mum […] there is just something about clinical

psychologists, there is something about them that feels warm and safe […] you don’t

get judged and that does remind me of my mum. My mum was very warm and

containing and very non-judgemental…(Frankie)

Perrie also likened a former supervisor to a mother figure. She described feeling quite

“comforted” by this, and slotting into a child role due to it being her “first” experience

of supervision. Sam qualified that rather than being like a perfectly caring mother, the

supervisor can be “good enough:”

…maybe it is baby accepting that mummy can make mistakes […] and that not

necessarily meaning that mummy is a bad person. (Sam)

Alex is also reminded of a parent when she thinks about the supervisor’s role, in terms

of nurturing and preparing the supervisee to almost ‘fly the nest’ and become

independent:

…it does kind of remind me of what parenting is about […] the point of being a good

parent is that your child leaves and doesn’t need you so much anymore. (Alex)

They trust in me/help me to trust in myself. Participants placed importance

on the supervisor trusting in them. Explicit messages of trust facilitated self-trust, self-

belief and confidence to independently explore their role:

I was thinking, one of the biggest things for me is feeling a sense that the supervisor

trusts in your abilities. And kind of that you are capable. And if there is not that


feeling, then there isn’t that trust, then I find it really difficult to trust in myself […]

that’s when I feel unsafe, because I feel my supervisor feels unsafe. (Perrie)

Participants highlighted that implicit messages of trust are important. For Ashley, this

was conveyed through the supervisor providing opportunities above and beyond her

contract:

…my supervisor finding new things for me to do, I think I have gone over my

contracted number of clients […] I think I definitely need that reinforcement from a

supervisor to tell me that they think I am doing well and I need their actions to show

me that. (Ashley)

For Alex, implicit trust was conveyed through the supervisor allocating her

“important” tasks, without prior conversation:

…it wasn’t just what she was saying, it was just so obvious, she would dump

something on my desk […] the fact she trusted me to get something that was

potentially quite important done, just by putting it on my desk, and knew I would

respond, there is just that implicit trust as well. (Alex)

However, when a supervisor conveyed a sense of doubt in Alex’s ability, this served

to maintain her existing anxiety and lack of self-trust:

…the fact that she responded in that way [took over supervisee risk assessment in

session], being anxious about my ability to do it in that moment when I was anxious

about my abilities to do it […]made me feels like my fear was a founded one. (Alex)

Along similar lines, Perrie described a supervisor who was perhaps restrictive or

limited in their degree of trust, likening this to only being able to play within the


boundaries of a “play den.” Rather than helping her to trust herself, Perrie said that

this left her feeling “disempowered.”

They are willing to share themselves with me. Participants valued

supervisors being willing to disclose something of themselves with the supervisee, in

order to build a close relationship. This seemed particularly important for Ashley:

…I want to kind of know a bit about people and see the supervisor as a bit of a

colleague as much as a supervisor […] my current supervisor, we have just started

doing cultural genograms […] there is a lot more personal information shared

through the nature of the cultural genogram. But I think there is something about

sharing a bit about yourself that brings a closeness that I maybe need. (Ashley)

Alex also valued a reciprocal relationship, as it would make her feel “close” to her

supervisor:

…there was no real discussion about what had led her to the career of clinical

psychology or her background […]it would be kind of nice to have something back a

little bit. To get a sense of her personal identity as well as her professional one. […] I

am just trying to think what I was looking for, I think it was that sense of it being like

a reciprocal relationship…(Alex)

However, several participants reflected that there is a careful balance to be achieved

in terms of supervisor self-disclosure and maintenance of appropriate boundaries.

Sam emphasised the importance of the supervisor only disclosing information if this

“benefits” the supervisee’s learning and development and gave an example of what

this may look like:

…it is useful if the supervisor discloses the struggles they may have had when they

were a trainee or maybe mistakes they have made in clinical work in the past and how

they managed that…(Sam)


The impact of a supervisor who “disclosed too much,” for their own benefit, was

evident in Frankie’s interview when she said that she found this “very distressing.”

They prioritise my needs. This sub-theme theme represents the value of

supervisors prioritising the supervisee’s needs over their own/others, in order to

convey the supervisee’s importance. In her experience of work place bullying, Lou

described needing to talk to her supervisor about this in order to feel protected “under

their wing.” However, Lou had a sense that the supervisor would betray her needs for

the “bully’s” needs, as she had a closer relationship with them:

…she will go behind my back and she’ll take it to the woman who is bullying me, so I

definitely can’t talk to her about being bullied because she is in cahoots. (Lou)

Lou also described the supervisor putting her needs for career advancement first, and

feeling used as a result:

My supervisor was a perfectionist and very ambitious. She saw me as a way to get to

band 8 because she needed to get supervisory experience […] she kept saying in

supervision ‘we need to get you flawless […] you are a reflection of me. If you do

well, I will be seen well. If you’re doing badly, they will wonder what I am doing

wrong.’ (Lou)

This appeared to leave Lou in a frightening and vulnerable position, where she felt

unable to express her feelings, out of fear that these may be criticised. She also felt

unable to comfortably “self-reflect, think about diversity or take a risk” in her role.

Frankie spoke about a supervisor who prioritised her own needs in a different way.

This was through offloading “distressing” personal experiences and emotional needs

onto Frankie. As a consequence, Frankie “didn’t feel heard” and instead, almost

found herself in the reversed role of having to hear and offer support for her


supervisor’s issues. This gave Frankie a sense that her supervisor was unable to

prioritise or meet her needs, over her own:

…I couldn’t get through to her when I needed her […] I couldn’t trust her when times

were tough, you know, if I had an issue I really needed to talk about, I knew it would

never be about me […] you couldn’t bring up your own topics because it might upset

her…(Frankie)

Frankie seemed to view her supervisor as vulnerable and did not feel she could

express her needs in case this upset or burdened her supervisor. She later said that she

felt “much more safe” with a different supervisor, in talking about her experiences, as

she didn’t feel like she was “going to break her.”

They are available for me. The final sub-theme captures the importance of

supervisors being physically present for supervisees and having consistent time for

their needs, as well as an availability to explore process issues. Some participants

spoke about the difficulties associated with a supervisor who was not always available

due to taking leave at short notice or being very busy. Lou described feeling like “an

after thought” in her supervisor’s “busy schedule” when she informed her last minute

about a month-long period of annual leave. In the supervisor’s absence, Lou said she

found it hard to take “risks” in her role as the supervisor didn’t “have my back.”

Perrie also struggled with having a busy supervisor, as this left her feeling like a

“burden” and needing to compete for the supervisor’s attention:

I think the most difficult supervisor I had was because of her position in the team. She

was very busy […] I felt like quite a nuisance whenever I was trying to have

supervision and supervision was really infrequent […] I felt like I was trying to

capture her interest through showing her different things I could be doing. (Perrie)


Perrie’s sense of her supervisor being unavailable also seemed affected by an

inconsistency in the supervisor’s responses. It seemed difficult for her to predict

whether her supervisor would have any time for her or not:

…that particular relationship could have been ambivalent, as in kind of being unsure

whether she was approachable and how she would react and whether I would be

rejected in certain situations and not another…(Perrie)

Within Sam’s account, she described supervisor unavailability as the supervisor being

“dismissive” of psychodynamic process-based discussions. Charlie also described her

supervisor as being unavailable to discuss process issues because she considered it to

be “a whole load of baloney.” Process-based discussion was highlighted as an

important need for many of the participants, and for Charlie, if this was unavailable,

she described feeling “unsafe” in the relationship.

We both play a part in creating the supervisory alliance

Within this theme, the quality of the supervisory alliance is determined by the

relational style of the supervisor as well as the supervisee and how well these fit

together.

The quality of the relationship depends on the supervisor. Some

participants spoke about the variance in quality between each supervisory relationship

and how this was due to the supervisor’s behaviour. This was apparent in Lou’s

account when she described her first supervisory relationship as positive and her

second as negative. Lou later stated that she was “securely attached” to her first

supervisor because she believed “they were there for me no matter what.” Lou put her

negative experience of the second supervisory relationship down to the supervisor’s

untrustworthy quality and described this rupturing her view of positive supervisory

relationships:


That sticks out as such a defining moment for me when the trust was just gone. It was

something I had said in supervision in confidence, then before I knew it, it got

bounced to this woman within a day without me knowing and one of my colleagues in

another site text me saying there are rumours going around about you […] what you

said wasn’t safe. I do really wonder if that ruptured my template, my blueprint. (Lou)

Although Lou’s subsequent relationships seemed to suffer as a result of her “ruptured

template,” she did hint that this had started to change. Again, the influential factor

appeared to be the presence of a supervisor who demonstrated a relational style that

Lou valued, and perhaps felt able to take a risk with. This included an explicit rather

than secretive nature, taking an interest in Lou and promising to stay in the

relationship long-term:

…when I had my research supervision, it felt really different. It felt safe. I must admit

this is the first time I have felt safe in supervision since because I know I have got the

same person from three years […] which feels quite supportive […] they have made it

obvious they are interested in me as well as the research. I think it’s their nature, they

are quite explicit. Its not secretive. (Lou)

The way I relate to a supervisor is different to other relationships. This

sub-theme captures the uniqueness of the supervisory relationship. Participants

described the potential for new and different relationships to form with their

supervisors, compared to relationships outside of supervision. Again, this seemed to

be dependent on the way the supervisor behaved. Frankie hinted that despite usually

forming “secure” attachments with people, she had a different type of attachment

towards a supervisor who demonstrated a “disorganised” style:

I don’t know what attachment I had to her. I am not someone who has non-secure

attachments usually. (Frankie)


Perrie also related very differently to a supervisor, compared to how she would with

her parents, due to the dismissive nature of the supervisor:

I mean it doesn’t feel like there is a big overlap or match [between supervisory and

parental or general relationships]. Just thinking about parental relationships. I don’t

think there was ever, I didn’t feel dismissed certainly by my parents whereas in that

[supervisory] relationship I did. (Perrie)

Similarly, Sam described having a “secure” and “trusting” relationship with her

mother and the people around her, where she feels comfortable to rely on them.

However, she highlighted that if a supervisor were “cold,” the relationship would

differ by her becoming more self-reliant.

Supervisory experiences can change the way I relate to other supervisors

and people in my life. Some participants discussed how negative supervisory

experiences reduced their faith in people and relationships, and changed their

relational behaviours. This appeared to impact the quality of subsequent supervisory

and general relationships, regardless of how the supervisor behaved. This was

relevant for Lou who described a damaged sense of trust in supervisors, with a

“feeling that they are about to get me,” after her second supervisory relationship

“went so bad.”

Lou identified that she now also feels “hyper-sensitive to criticism” and her

behaviours have become quite self sufficient: “I don’t need you..I will just get on with

it and do it” or inconsistent: “And now I just really push, pull, push, pull. I really

want them to like me but I will so happily push them away…”

Lou acknowledged the impact of her expectations and behaviour on the quality of the

relationship:


What is affecting our relationship is that I am really struggling to open up to them for

fear of what might come; whether that is rejection of criticism. (Lou)

For Lou, her supervisors didn’t seem to have much influence over the quality of the

relationship. Despite them being “nice,” and “there being so much evidence on the

contrary” to them being untrustworthy, she still struggled to develop faith in them or

closeness and said, “I purposely kept my distance.”

In addition to Lou’s negative experience of supervision affecting her subsequent

supervisory relationships, it has also appears to have altered the quality of her

previously “secure” general relationships outside of supervision:

In some sense I do feel quite stable, quite secure and that people around me will be

there for me. But, on the other hand, the minute someone rejects me I think right, do

one, I don’t care. I don’t know if I had that so much before that experience in the

working capacity. (Lou)

The quality of the relationship depends on there being a good fit between

supervisor and supervisee. This final sub-theme conveys the importance of having a

good fit between supervisor and supervisee relational styles. To some participants,

this seemed more influential in determining the quality of the relationship, than what

either of the supervisor or supervisee does alone. This is illustrated well by an extract

from Charlie’s interview when she was asked what influences the quality of the

supervisory relationship:

…I think it is a mixture of both of them [supervisor and supervisee relational styles]

together isn’t it. (Charlie)

She later added:

…how someone responds to you, you are going to interpret that in a way of how you

interpret your world […] if you had someone who comes in who is a bit more


ambivalent, whether you can manage it or not is going to be dependent on your

attachment style…(Charlie)

Charlie seemed to suggest that the supervisory relationship benefits from the

supervisee having a certain relational style which fits well with an anxious or

unpredictable supervisor. In line with this, Sam suggested that her “easy-going”

relational style has fitted well with supervisors, as it has allowed her to “manage” and

remain accepting of any “mistakes” such as supervision being cancelled or double-

booked. Part of Sam being able to “manage” and fit with her supervisor surrounded

adapting to their relational style:

….I guess I kind of adapt […] I had experience of a supervisor who was quite critical

[…] you know that was their style […] and you adapt to that really […] did she word

things in the best way sometimes? No. But did that matter? No. (Sam)

Alex also hinted that a good fit in the relationship is created through “adaptation.”

However, unlike Sam, she spoke about this in terms of the supervisor adapting to her

relational style by not joining in with her anxiety:

I probably tend towards that attachment style, being more anxious and hyper-vigilant.

So if my supervisor’s joined me in that, I think that would be really unsafe. (Alex)

For Lou, a good fit seemed particularly important, given her difficulties trusting in the

supervisor and supervisory relationship. It is perhaps not surprising that a supervisor

with explicit “trustworthy” qualities suited her well and that the good fit has allowed

some of Lou’s faith in the supervisory relationship to be restored, as well as her

willingness to take risks:

It could be alright […] I do think it could be a secure base and I already noticed I am

more willing to take risks…(Lou)


Discussion

Inconsistent findings regarding how supervisor and/or supervisee attachment styles

impact upon the supervisory relationship suggest an incomplete understanding of the

attachment-supervision construct. This study aimed to explore how supervisees,

within the trainee clinical psychologist profession, experience and understand the

supervisory relationship and to explore what within this may be relevant to

Attachment Theory.

This study has clarified the attachment-supervision construct by identifying two key

paths to a good supervisory relationship: feeling worth something to the supervisor

and collaborating to create a positive alliance. Beginning with a summary, the

importance of these findings will now be developed in the exploration of their

relationship to Attachment Theory and the evidence base.

Overall, findings are congruent with Attachment Theory in that many of the features

of a positive supervisory relationship emphasised the supervisor demonstrating

qualities associated with a secure attachment figure; responsiveness, attunement to the

supervisee’s needs, being nurturing and showing they trust in the supervisee’s

abilities, all demonstrating the supervisee’s worth. Similarly, many of the features of a

negative supervisory relationship emphasised the supervisor showing qualities

associated with an insecure attachment figure. These included being unresponsive to

supervisee needs, prioritising their own needs above the supervisee’s, being over-

protective and untrusting of the supervisee and being unavailable in some way.

Participants noted that as a consequence of insecure supervisor behaviour, and

supervisee anxiety (particularly in a novel role), a new attachment can form in the

supervisory relationship, which may be separate to the supervisee’s secure parental

and more general relationships, and is more akin to a fresh caregiver-infant


attachment. However there are several differences between the supervisory

attachment relationship and that of an infant and caregiver. Ultimately, the

supervisory attachment is based on a more adult like collaboration, adaptation and

goodness-of-fit between both supervisor and supervisee relational styles and places

more value on mutual disclosures in building the relationship. Findings consistent and

inconsistent with Attachment Theory will now be explored in greater depth, alongside

the associated evidence base.

Firstly, like a secure attachment figure, a good supervisor was sensitive and

responsive to supervisee needs (George & Solomon, 2008), facilitating a secure

relationship (Feeney & Collins, 2004) and giving them a sense that they mattered and

were worthwhile to their supervisor. Indeed, Attachment Theory posits that in the

experience of a sensitive and responsive mother, an infant develops a model of

themselves as being worthy of love and support and being able to trust or depend on

others (Bell & Ainsworth, 1972; Bowlby, 1988). A responsive attachment figure

offers soothing and comforting responses during times of distress (safe haven) or

guidance responses (secure base), when needed, to allow the infant to safely explore

and learn about their world (Bowlby, 1988). Indeed, participants made several

references to feeling “anxious” or “uncontained” and benefitting from safe haven or

secure base type responses from their supervisor to help them feel “comforted,”

“guided” and “more confident” to do their work independently or “take risks.” This

supports supervisory conceptual accounts, which suggest that a secure supervisory

relationship is based on the supervisor providing safe haven and secure base

functions, which deactivates the supervisee’s attachment system and activates their

exploratory/learning system (Bennett & Saks, 2006; Fitch et al., 2010; Hill, 1992).

Within the Attachment-Caregiving Model of Supervision, Fitch et al. (2010) posit that


the supervisor’s response must be flexible, based on the needs associated with the

supervisee’s experience level. According to Rønnestad and Skovholt (2003), a novice

trainee therapists’ attachment system is more likely to be activated due to early

practice involving anxiety, threat and dependence and thus requires more direct safe

haven responses (Knox, 2003). Indeed, Ashley and Perrie relayed uncertainty about

their competence at the “beginning” of their development, in their “first post” and a

need for someone to “hold their hand.” This offers support for the findings by Kaib

(2010) that a supervisory safe haven and secure base is most needed and influential

over the alliance, at the start, when the attachment system is more heavily activated.

Like a secure attachment figure, a good supervisor also demonstrated the supervisee’s

worth by nurturing them like a mother would their infant, particularly in the early

training stages. For example, Charlie and Perrie described falling into a child role due

to insecurity associated with their first supervisory relationship or job experience. In

these cases, participants described their supervisor being imperative in determining

the relationship quality. This resonates with the hierarchical way in which Attachment

Theory describes the bond forming between a more experienced and powerful

caregiver and a somewhat vulnerable child (Bowlby, 1988) and also complements

research suggesting that the supervisor’s relational style is key in influencing a secure

relationship (Dickson et al., 2011; Riggs & Bretz, 2006; White & Queener, 2003).

Nurturing qualities included being “warm,” “caring” and “containing” and preparing

the supervisee to become more independent over time. These qualities are commonly

used in Attachment Theory when referring to a secure attachment figure who

promotes an infant’s self-worth, confidence and independence (Bowlby, 1988).

Qualities also included being “trustworthy”, “interested” in the supervisee and

promising to be available for a long-term relationship. This relates to Attachment


Theory in which a secure mother reliably meets the infant’s needs, is interested in

their thoughts/feelings (known as ‘mind-mindedness’) and demonstrates long term

availability (Bowlby, 1988; Meins, Fernyhough, Fradley & Tuckey, 2001). These

qualities seemed to provide a particularly good fit for Lou and supported the theorised

importance of a supervisor being attuned to the particular needs of a supervisee

(Bennet & Saks, 2006). This also resonates well with Attachment Theory, which

posits that the relationship benefits from a mother being in synchrony with her

infant’s specific needs (Rees, 2007; Skowron, Kozlowski & Pincus, 2010). However,

participants noted that supervisor qualities went beyond being perfectly nurturing and

attuned to being a “good enough” mother who sometimes makes mistakes. Although

not strictly stemming from Attachment Theory, Bowlby (1969) adopted Winnicott’s

(1953) conception of “good enough” mothering, where a key part of developing a

secure attachment is allowing the infant to experience tolerable frustrations (Oates,

Lewis & Lamb, 2005).

A “good enough” supervisor, like a secure attachment figure, also trusts in the

supervisee’s abilities and helps them to trust in themselves. This provides the

supervisee with a sense that the supervisor approves of them and values their worth.

Indeed, Attachment Theory posits that, to children, trust and approval tells them they

have done something right and are valued, and helps them feel worthwhile. It also

helps to build self-trust, encouraging the child to try new things on their own. In this

way, approval seeking is an intrinsic drive within infants (Ainsworth, 1968). A

supervisor who provides trust and messages of approval could be likened to an

authoritative parenting style in which a parent offers guidance when needed but trusts

the infant to independently explore. This parenting style complements the secure base

function of an attachment figure and has also been found to correlate with a secure


attachment style in parents (Nanu & Nijloveanu, 2015). While supervisor trust in

supervisee abilities links with Attachment Theory, trust can also be a feature of

attachment dynamics within leader-follower relationships (Watkins & Riggs, 2012).

Leader-Member Exchange Theory (Graen & Uhl-Bien, 1995) posits that in business

contexts, positive relationships form through the manager developing trust in a team

member’s ability to do their role reliably, thus positioning them as an in group

member. It is therefore possible that a trusting supervisor reflects a positive leader-

follower relationship, with attachment dynamics, rather than a “full-blown” secure

attachment.

However, findings also reveal a number of themes that resonate with the supervisor as

an insecure attachment figure. Firstly, where a supervisor was unresponsive to the

supervisee’s needs, participants described relying on additional independent reading

or seeking support from another team member. This relates to Attachment Theory

where an infant becomes self-sufficient in response to an avoidant insecure

attachment figure who is unresponsive to their needs (Bowlby, 1988). This is perhaps

even more pronounced in the supervisory relationship where there is a pressure, as

Frankie put it, to “perform.” While this type of self-reliance is much more

sophisticated than an infant’s response of this kind, it still relates to an avoidant

distancing approach and also to Bowlby’s (1988) notion that infants can form

separate, multiple attachments to people.

Like an insecure attachment figure, a supervisor who is over protective and non-

trusting of a supervisee’s abilities can leave the supervisee feeling “disempowered”

and as though their fear about their competence is “founded.” This is comparable to

an authoritarian parent with an anxious/ambivalent attachment style which often

results in infants with anxiety and dependence, discouraged autonomy and exploration


and a resulting lack of self-confidence (Hudson & Rapee, 2005; Wood, McLeod,

Sigman, Hwang & Chu, 2003). In addition, a supervisor prioritising their own needs

above the supervisee’s, is similar to an insecure attachment figure’s behaviour

(Mikulincer & Shaver, 2007). In these cases, participants reported a sense that they

were not important or worthwhile to their supervisor. Lou described feeling

“terrified” in her relationship with a supervisor who prioritised her own needs and

was overly “critical.” This is potentially comparable to a fearful attachment, in which

the person who is meant to provide comfort is also a source of fear. Furthermore, Lou

felt unable to express her needs safely and often supressed them, which is a strategy

that resonates with insecure avoidant attachment relationship (Bowlby, 1988). Indeed,

Lou’s supervisor did not seem to function as a secure base or safe haven (Davidovitz,

Mikulincer, Shaver, Ijzac & Popper, 2007), as she later added that she was not able to

self-reflect or take any risks in her role. Frankie also described a supervisor who

prioritised her own needs by offloading personal distress. This self-focus and

vulnerable presentation, prevented Frankie from expressing her own needs, in case

she “broke” her supervisor. Again, this can be compared to an insecure attachment

relationship, which tends to prevail with mothers who are vulnerable (e.g. suffer with

severe depression; Santona et al., 2015).

A poor supervisor, like an insecure attachment figure, would also present as being

unavailable for the supervisee, through taking annual leave at last minute, being

dismissive of talking about “process issues”, being very busy, or being inconsistent as

to whether they had any time for the supervisee. This is similar to an insecure

attachment relationship where an infant feels unable to rely on the caregiver to meet

their needs and thus feels unsafe (Bowlby, 1969). Indeed participants referred to

feeling “unsafe” in these situations and unable to “take risks.” Within Perrie’s account


she described struggling to predict whether her supervisor would have any time or not

and actually described her relationship with her supervisor as “ambivalent.” Indeed,

while some Attachment Theory links may have been found through the researcher’s

own data interpretation, several participants did in fact make explicit links to “full-

blown” attachments forming with their supervisors. However, some only referred to

attachment dynamics such as “secure base” (Mayseless & Popper, 2007). Supporting

Watkins and Riggs (2012), it seemed that when supervisees felt particularly anxious

in their role (such as in the early experience stages) and continually needed to turn to

their supervisor for safe haven and secure base functions, they were more likely to

speak in terms of “full-blown” attachments (Mayseless & Popper, 2007; Pistole &

Fitch, 2008).

Participants noted that as a consequence of having an insecure supervisor, and

supervisee anxiety/continual need for support (particularly in a novel role) a new

attachment has the potential to form, that is separate from their secure parental,

general and past supervisory attachments. This was particularly evident in Lou’s case

whereby an abuse of her trust by the supervisor led to a “ruptured blueprint” of

supervisory relationships. In this way, the type of supervisory attachments formed,

seem to be dynamic, rather than fixed across experiences. This complements the

findings that supervision-specific attachment style is a distinct and more meaningful

way of understanding the supervisory relationship than general attachment style

(Bennett et al., 2008; Gunn & Pistole, 2012; Marmarosh et al., 2013; Menefee et al.,

2014; Renfro-Michel & Sheperis, 2009). Although participants with a reported secure

attachment in their parental and general relationships, seemed to buffer somewhat

against a problematic insecure supervisor style, Sam hinted that this may weaken with

time and a new insecure attachment may eventually form (Davidovitz et al., 2007).


The development of an original or new attachment, bears some resemblance to the

fresh attachment which develops between an infant and their caregiver. Indeed, there

is a power imbalance inherent in both relationship types where one member is there to

support the development of the other. However, there are some important differences.

Firstly, the supervisee, unlike an infant, has more influence over attachment that

forms. This is because the supervisee is likely to already have a template or internal

working model of the supervisory alliance, that impacts on their expectations of, and

behaviours in, subsequent supervisory relationships. In Attachment Theory, this is

more similar to the impact of the internal working model on adult attachment

relationships. This was the case with Lou, whose ruptured template led her to have

difficulty trusting her next supervisor and to engage with self-reliant strategies, which

collectively presented a barrier to a secure relationship forming. This complements

studies finding that supervisee attachment style/behaviours are equally as or more

important in determining the relationship quality (Epps, 2000; Hartig, 2004; Smith,

2009). Secondly, in Attachment Theory, rupture-repair cycles normally occur within

the same infant-caregiver secure relationship (Biringen, Emde & Pipp-Siegel, 1997;

Tronick & Gianino, 1986). However, in Lou’s case, the repair of her faith in the

supervisory relationship did not occur in the same relationship as the rupture, rather a

later one. Instead, this is perhaps more applicable to Attachment Theory’s notion that

repairs or earned-security can occur in later life through the provision of a secure

attachment with a therapist or romantic partner (Lewis, 2000; Roisman, Padron,

Sroufe & Egeland, 2002; Safran, 1993). Thirdly, not all participants referred to the

supervisor as a motherly attachment type figure. Charlie described her supervisor as a

“big sister” and Ashley described needing a supervisor to be “a little bit of a friend.”

Indeed, this complements findings by Remington (2015), which suggested that the


supervisory relationship more closely resembles a friend attachment relationship than

an infant-caregiver attachment relationship. Fourth, unlike infant-caregiver

relationships, the supervisory relationship benefitted from a goodness-of-fit between

relational styles. This was not just about the supervisor being attuned to the

supervisee’s needs, but also the supervisee being able to adapt to the supervisor’s

relational style. For participants, the supervisory relationship thus seemed to mirror

more of an adult like interactional dance, with both supervisor and supervisee playing

a part in fostering a good alliance (Bennett & Saks, 2006).

Thus far participant experiences of the supervisory relationship that resonate well

with Attachment Theory (either in caregiver-infant or adult relationships) have been

discussed. However, some elements of participant experiences are less consistent and

challenge the validity of an attachment-supervision construct. This includes a close

relationship being formed by mutual disclosures, rather than attachment factors. Many

participants described feeling of worth and “close” to their supervisor when they were

willing to share some of themselves, such as their “personal identity.” Indeed

reciprocal disclosure building close relationships features heavily in the western

relationship literature (Derlega, Metts, Petronio & Margulis, 1993; Kelly, 2002;

March, 2005). One could argue that the “boundaried” disclosures valued in the

supervisory relationship do conform to the moral idea in infant-caregiver attachments

that information is only disclosed to benefit the growth of the infant. However,

participants compared this more to therapeutic relationships, rather than a caregiver-

infant attachment relationship. Furthermore, reciprocal disclosure is not a necessary

component of what builds a secure attachment relationship in Attachment Theory.

The current study’s findings have demonstrated strong support for a link between

Attachment Theory and the supervisory relationship, particularly the supervisor


demonstrating secure attachment behaviours like a mother would to their child and the

relationship being influenced by the supervisee’s previous internal working models of

the supervisory relationship. The study has therefore helped to improve our

understanding of the attachment-supervision construct. Although this is a novel

exploratory study with an intentionally small sample, and thus all interpretations are

tentative, there are good reasons to rely on the credibility of findings and

interpretation of them. Careful attention was paid to the interview schedule design,

using appropriate guidance to create an appropriate reflective approach. The

researcher also paid reflexive attention to her shared experience as a trainee clinical

psychologist. Furthermore, research supervision and peer supervision was used to

develop the collection, analysis and interpretation of data. The small sample size

further adds to the analysis credibility as it allowed time for a good level of

engagement with the text, where a thorough, detailed and careful analysis of

participant experiences, ensured that all voices were heard (Smith et al., 2009). In

addition, adherence to the guidelines by Yardley (2000), ensured the validity and

reliability of findings (Appendix J.)

It is recognised that the knowledge produced by this study is based on the researcher’s

interpretation and that it is open to reinterpretation. However, the fact that the data

both resonates and diverges from Attachment Theory suggests that the analytic

process did more than confirm an assumption of the relevance of attachment in

supervision. It is also possible that attachment was only relevant to the way

participants thought about the supervisory relationship, because the significance of

attachment underpinning relationships is a key part of clinical psychology training

and knowledge. Regardless, the data suggests that supervisees do think of it in this

way and it is thus important to pursue further. However, this way of thinking can only


be transferred to supervisees from one psychotherapeutic profession and within this,

one clinical psychology training programme. In addition, it cannot be transferred to a

supervisor population. It remains unclear whether supervisors think about the

supervisory relationship in the same way as supervisees, and it would therefore be

helpful to repeat this study using a supervisor sample.

The study’s findings suggest that future attachment-supervision research should take

several things into account. Firstly, as participants referred to a new attachment

forming with their supervisor, that may be different to their general attachment style,

it is recommended that future research measures supervisee supervision-specific

attachment style. Secondly, based on the themes in this study, self-report attachment

measures would benefit from incorporating items about supervisor responsiveness to

supervisee needs, nurturing qualities, availability, attunement and fit with supervisee

style, ability to repair any current or previous ruptures, priority of supervisee needs,

and trust in the supervisee (within Attachment Theory or leader-follower terms). They

would also benefit from items that address the supervisee’s role in the developing

attachment. This should include the impact of previous negative supervisory

relationships on the current one, such as supervisee difficulties with trusting the

supervisor or engaging in self-reliant strategies and also how well the supervisee is

able to adapt, collaborate or fit with the supervisor’s style to form a positive alliance.

Thirdly, as “full-blown” attachment and safe haven/secure base functions of the

supervisor were particularly pertinent to the relationship during the early training

stages, research may benefit from measuring the impact of supervision-specific

attachment on the alliance, in less experienced trainees. In more advanced trainees,

leader-follower questionnaires which measure the impact of attachment dynamics

such as trust on the alliance, rather than “full-blown” attachment, may be more


suitable and would benefit from further study. Finally, as the findings revealed that

both supervisor and supervisee play a part in creating the supervisory alliance, future

research would benefit from using supervisor-supervisee dyads and exploring the

interaction between their relational styles. It is hoped that these recommendations may

serve to explain and reduce further inconsistencies within the literature findings as to

whether attachment styles impact upon the quality of the supervisory relationship.

However, before other research is pursued, it would be helpful to further our

understanding of the attachment-supervision construct from the perspective of trainee

psychotherapists in other professions such as counselling or family therapy and also

from a supervisor perspective, as they may too inform what future research needs to

take into account.

In conclusion, this study’s findings suggest that Attachment Theory is a useful way to

think about the supervisory relationship, particularly for less experienced trainee

clinical psychologists. Rather than the supervisory relationship merely being

influenced by past caregiver-infant attachment, it appears that a new attachment

forms, similar to the freshness of a caregiver-infant attachment. However, unlike an

infant, the supervisee has more influence over the attachment, in a collaborative effort

with the supervisor. While most findings resonate with Attachment Theory, this is not

surprising given that trainee clinical psychologists are trained to think in this way

about relationships. This raises the question whether the supervisory relationship is

truly a “full-blown” attachment relationship (rather than one consisting of attachment

dynamics), or whether this is just the way that clinical psychology trainees approach

it. Regardless, for trainee clinical psychologists, it appears the supervisory

relationship benefits from a secure supervisor attachment figure and that supervisors

would therefore benefit from training on how to think and act in this way and be


attuned to their supervisee’s needs. It is hoped that the attachment findings of this

study can contribute to the development of such a training model. However, as the

findings suggest that more contributes to a positive supervisory alliance than just

attachment, it is hoped that non-attachment factors such as reciprocal disclosure are

also considered. Ultimately, it is hoped that this study’s findings, and any

contributions to supervisor training, will help to improve the supervisory relationship

and thus the development of the supervisee and psychotherapeutic service provision

to the public.


References

Ainsworth, M. D. S. (1968). Object relations, dependency, and attachment: A theoretical review of the infant mother relationship. Child Development, 40, 969-1025.

Armoutliev, E. M. (2015). Attachment, supervisory style and caregiving in clinical supervisors. Unpublished Doctoral Dissertation, the University of Akron.

Bartholomew , K. , & Thompson , J. M. (1995). The application of Attachment Theory to counseling psychology. The Counseling Psychologist , 23, 484-490.

Bell, S. M., & Ainsworth, M. D. S. (1972). Infant crying and maternal responsiveness. Child Development, 43, 1171-1190.

Bennett, C. S. (2008). Attachment-informed supervision for social work field education. Clinical Social Work Journal, 36, 97-107.

Bennett, S., & Deal, K. H. (2009). Beginnings and endings in social work supervision: The interaction between attachment and developmental processes. Journal of Teaching in Social Work, 29, 101-117.

Bennett, S., Mohr, J., BrintzenhofeSzoc, K., & Saks, L.V. (2008). General and supervision-specific attachment styles: Relations to student perceptions of field supervisors. Journal of Social Work Education, 44, 75-94.

Bennett, S., Mohr, J., Deal, K. H., & Hwang, J. (2013). Supervisor attachment, supervisory working alliance, and affect in social work field instruction. Research on Social Work Practice, 23, 199-209.

Bennett, S., & Saks, L. V. (2006). Field notes: A conceptual application of Attachment Theory and research to the social work student-field instructor supervisory relationship. Journal of Social Work Education, 42, 669-682.

Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision. (5th

ed.). Boston, MA: Pearson.Biringen Z., Emde, R. N., Pipp-Siegel, S. (1997). Dyssynchrony, conflict, and

resolution: positive contributions to infant development. American Journal of Orthopsychiatry, 67, 4-19.

Bordin, E. S. (1983). A working alliance model of supervision. The Counseling Psychologist, 11, 35-42.

Bornsheuer-Boswell, J. N., Polonyi, M. M., & Watts, R. E. (2013). Integrating Adlerian and integrated developmental model approaches to supervision of counseling trainees. Journal of Individual Psychology, 69, 328-343.

Bowlby, J. (1969). Attachment and loss: Vol 1. Attachment. New York: Basic Books.Bowlby, J. (1988). A secure base: clinical applications of Attachment Theory. Hove:

Psychology PressBurr, V. (2003). Social Constructionism (Second Ed.). Hove: Routledge.Davidovitz, R., Mikulincer, M., Shaver, P. R., Ijzak, R., & Popper, M. (2007). Leaders

as attachment figures: Leaders’ attachment orientations predict leadership related mental representations and followers’ performance and mental health. Journal of Personality and Social Psychology, 93, 632-650.

Day, M. S. (2006). The Relationship of Supervisors’ Attachment Styles to their Perceptions of Self-efficacy in Providing Corrective Feedback and to the Working Alliance in Counselor Education. Unpublished Doctoral Dissertation, University of New Orleans.

Deal, K. H., Bennett, S., Mohr, J., & Hwang, J. (2011). Effects of field instructor training on student competencies and the supervisory alliance. Research on Social Work Practice, 21, 712-726.

Derlega, V. J., Metts, S., Petronio, S., & Margulis, S. T. (1993). Self-disclosure. Thousand Oaks California: Sage Publications.


Dickson, J. M., Moberly, N. J., Marshall, Y., & Reilly, J. (2011). Attachment style and its relationship to working alliance in the supervision of British clinical psychology trainees. Clinical Psychology and Psychotherapy, 18, 322–330.

Duffy, S. (2003). The insecurely attached intern in clinical supervision: implications for supervision. Unpublished doctoral dissertation, the Chicago School of Professional Psychology.

Eatough, V., & Smith, J. A. (2008) Interpretative phenomenological analysis. In: Willig, C, Stainton-Rogers, W. (Eds.) The Sage handbook of qualitative research in psychology. Los Angeles: Sage.

Epps, A. M. (2000). The effect of attachment styles on the working alliance in counselor supervision. Unpublished Doctoral Dissertation, Texas A&M University.

Feeney, B. C., & Collins, N. L. ( 2004 ). Interpersonal safe haven and secure base caregiving processes in adulthood . In W. S. Rholes, & J. A. Simpson (Eds.), Adult attachment: Theory, research, and clinical implications. New York: Guilford Publications.

Fitch, J. C., Pistole, C., & Gunn, J. E. (2010). The bonds of development: An attachment-caregiving model of supervision. The Clinical Supervisor, 29, 20-34.

Foster, J. T., Heinen, A. D., Lichtenberg, J. W., & Gomez, A.D. (2006). Supervisor attachment as a predictor of developmental ratings of supervisees. American Journal of Psychological Research, 2, 28-39.

Foster, J. T., Lichtenberg, J. W., & Peyton, V. (2007). The supervisory attachment relationship as a predictor of the professional development of the supervisee. Psychotherapy Research, 17, 353-361.

George, C., & Solomon, J. ( 2008 ). Attachment and caregiving: The caregiving behavioral system. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications. New York: Guilford Publications.

Gnilka, P. B., Rice, K. G., Ashby, J. S., & Moate, R. M. (2016). Adult Attachment, Multidimensional Perfectionism and the Alliance Among Counselor Supervisees. Journal of Counseling and Development, 94, 285-296.

Graen, G. B., & Uhl-Bien, M. (1995). Relationship-Based Approach to Leadership: Development of Leader-Member Exchange (LMX) Theory of Leadership over 25 Years: Applying a Multi-Level Multi-Domain Perspective. Leadership Quarterly, 6, 219-247.

Gunn, J. E., & Pistole, M. C. (2012). Trainee supervisor attachment: Explaining The alliance and disclosure in supervision. Training and Education in Professional Psychology, 6, 229-237.

Gustafson, M. L. (2015). Relationships between attachment and object relations and supervisees' satisfaction in supervision. Unpublished doctoral dissertation, the California School of Professional Psychology.

Hartig, N. A. (2004). The relationship between supervisors' and supervisees' attachment patterns and their perceptions of the supervisory working alliance. Unpublished Doctoral Dissertation, University of Northern Colorado.

Hefferon, K., & Gil-Rodriguez, E. (2011). Reflecting on the rise in popularity of interpretive phenomenological analysis. The Psychologist, 24, 756-759.

Hill, E. W. (1992). Marital and family therapy supervision: A relational-attachment model. Contemporary Family Therapy, 14, 115-125.

Holloway, E.L., & Neufeldt, S. A. (1995). Supervision: its contributions to treatment efficacy. Journal of Consulting and Clinical Psychology, 63, 207-213.


Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the working alliance inventory. Journal of Counseling Psychology, 36, 223-233.

Huber, D. M., Sauer, E. M., Mrdjenovich, A. J., & Gugiu, P. C. (2010). Contributions to advisory working alliance: Advisee attachment orientation and pairing methods. Training and Education in Professional Psychology, 4, 244-253.

Hudson, J. L., & Rapee, R. M. (2005). Parental perceptions of overprotection: Specific to anxious children or shared between siblings? Behavior Change, 22, 185-194.

Kaib, N. (2010). Attachment style, affect regulation, and supervision outcomes. Unpublished Doctoral Dissertation, the George Washington University.

Kelly, A. E. (2002). The psychology of secrets. New York: Kluwer Academic/ Plenum Publishers.

Kim, S. (1998). Influence of trainee attachment on satisfaction with supervision, the supervisory relationship, and perceptions of supervisory style. Unpublished doctoral dissertation, University of Maryland.

Knox, S. ( 2003 ). I sensed you with me the other day: A review of the theoretical and empirical literature on clients' internal representations of therapists. Psychotherapy Bulletin, 38, 2-5.

Lewis, J. M. (2000). Repairing the bond in important relationships: A dynamic for personality maturation. The American Journal of Psychiatry, 157, 1375-1378.

Lichtenberg, J., & Goodyear, R. (2000). The Structure of Supervisor-Supervisee Interactions. The Clinical Supervisor, 19, 1-24.

Mainhard, T., van der Rijst, R., van Tartwijk, J., & Wubbels, T. (2009). A model for the supervisor-doctoral student relationship. Higher Education, 58, 359-373.

Mallinckrodt, B. (1995). Attachment Theory and counseling psychology: Ready to be a prime time player? The Counseling Psychologist, 23, 501-505.

March, D. (2005). The Relationship Between Self-disclosure, Self-efficacy, and The Supervisory Working Alliance of Counselor Education Practicum A. Unpublished Doctoral Dissertation, the University of Central Florida.

Marmarosh, C. L., Nikityn, M., Moehringer, J., Ferraioli, L., Kahn, S., Cerkevich, A.,….Reisch, E. (2013). Adult attachment, attachment to the supervisor, and the supervisory alliance: How they relate to novice therapists’ perceived counseling self-efficacy. Psychotherapy, 50, 178-188.

Mayseless, O. (2010). Attachment and the leader-follower relationship. Journal of Personal and Social Relationships, 27, 271-280.

Mayseless, O., & Popper, M. (2007). Reliance on leaders and social institutions: An attachment perspective. Attachment and Human Development, 9, 73-93.

Meins, E., Fernyhough, C., Fradley, E., & Tuckey, M. (2001). Rethinking maternal sensitivity: Mothers’ comments on infants’ mental processes predict security of attachment at 12 months. Journal of Child Psychology and Psychiatry, 42, 637–648.

Menefee, D. S., Day, S. X., Lopez, F. G., & McPherson, R. H. (2014). Preliminary development and validation of the supervisee attachment strategies scale (SASS). Journal of Counseling Psychology, 61, 232-240.

Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. New York: Guildford Press.

Milne, D. (2007). An empirical definition of clinical supervision. British Journal of Clinical Psychology, 46, 437-447.

Milne, D. L., & James, I. A. (2002). The observed impact of training on competence in clinical supervision. British Journal of Clinical Psychology, 41, 55-72.

Nanu, E. D., & Nijloveanu, M. D. (2015). Attachment and Parenting Styles. Procedia Social and Behavioral Sciences, 203, 199-204.


Oates, J., Lewis, C. & Lamb, M.E. (2005). Parenting and attachment in Ding, S. and Littleton, K. (Eds.) Children’s Personal and Social Development. Oxford: Blackwell.

Pistole, M. C., & Fitch, J. C. (2008). Attachment Theory in supervision: A critical incident experience. Counselor Education and Supervision, 47, 193-205.

Pistole, M. C., & Watkins, C. E. (1995). Attachment Theory, counseling process, and supervision. The Counseling Psychologist, 23, 457-478.

Rees, C. (2007). Childhood attachment. British Journal of General Practice, 57, 920-922.

Reid, K., Flowers, P., & Larkin, M. (2005). Exploring lived experience. Psychologist, 18, 20-23.

Remington, J. R. (2015). Clinical psychology interns' attachments to clinical supervisors: Do they resemble other close relationships, and can they predict individual differences in working alliance? Unpublished Doctoral Dissertation, Fielding Graduate University.

Renfro-Michel, E., & Sheperis, C. J. (2009). The relationship between counseling supervisee attachment orientation and personal bond with supervisor. The Clinical Supervisor, 28, 141-154.

Riggs, S., & Bretz, K. (2006). Attachment processes in the supervisory relationship: An exploratory investigation. Professional Psychology: Research and Practice, 37, 558-566.

Roisman, G., Padron, E., Sroufe, A., & Egeland, B. (2002). Earned-secure attachment status in retrospect and prospect. Child Development, 73, 1204-1219.

Rønnestad, M. H., & Skovholt, T. M. (2003). The journey of the counselor and therapist: Research findings and perspectives on professional development. Journal of Career Development, 30, 5-44.

Safran, J.D. (1993). Breaches in the therapeutic alliance: an area for negotiating authentic relatedness. Psychotherapy, 30, 11-24.

Santona, A., Tagini, A., Sarracino, D., De Carli, P., Pace, C. S., Parolin, L., & Terrone, G. (2015). Maternal depression and attachment: the evaluation of mother–child interactions during feeding practice. Frontiers in Psychology, 6, 1235.

Shaffer, K. S. (2015). Supervisee avoidant attachment and supervisors' use of relational behavior: Contributions to the working alliance. Unpublished Doctoral Dissertation, State University of New York at Albany.

Shinebourne, P. (2011). Interpretative Phenomenological Analysis. In N. Frost (Ed). Qualitative Research Methods in Psychology: Combining core approaches. Maidenhead: Open University Press.

Skowron, E. A., Kozlowski, J. M., & Pincus, A. L. (2014). Differentiation, self-other representations, and rupture-repair processes: Predicting child maltreatment-risk. Journal of Counselling Psychology, 57, 304-316.

Smith, A. (2009). Attachment patterns, supervisory style and the supervisory working alliance. Unpublished Doctoral Dissertation, Lancaster University.

Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative Phenomenological Analysis: Theory Method and Research. London: Sage

Smith, J. A. & Osborn, M. (2003). Interpretative phenomenological analysis. In J. A. Smith (Ed.) Qualitative Psychology: A practical guide to research methods. London: Sage.

Smothers, M. K. (2010). Counseling self-efficacy: The contributions of early attachment and the supervisory relationship. Unpublished Doctoral Dissertation, the University of Wisconsin-Milwaukee.


Spelliscy, D. (2007). Predicting supervisee role conflict/ambiguity: A model of attachment, supervisory style, and supervisory working alliance. Unpublished Doctoral Dissertation, Fordham University.

Tronick, E. Z., & Gianino, A. F. (1986). Interactive mismatch and repair: Challenges to the coping infant. Zero to Three, 6, 1-6.

Tsong, Y. V. (2004). The roles of supervisee attachment styles and perception of supervisors' general and multicultural competence in supervisory working alliance, supervisee omissions in supervision, and supervision outcome. Unpublished Doctoral Dissertation, University of Southern California.

Watkins, Jr., C. E. (1995). Pathological attachment styles in psychotherapy supervision. Psychotherapy, 32, 333-340.

Watkins Jr., C. E. (2011). Toward a tripartite vision of supervision for psychoanalysis and psychoanalytic psychotherapies: Alliance, transference-countertransference configuration, and real relationship. Psychoanalytic Review, 98, 557-590.

Watkins Jr., C. E., & Riggs, S. A. (2012). Psychotherapy supervision and Attachment Theory: Review, reflections, and recommendations. Clinical Supervisor, 31, 256-289.

Wheeler, S. & Richards, K. (2007). The impact of clinical supervision on counsellors and therapists, their practice and their clients. A systematic review of the literature. Counselling and Psychotherapy Research, 7, 54-65.

White, V., & Queener, J. (2003). Supervisor and supervisee attachments and social provisions related to the supervisory working alliance. Counselor Education & Supervision, 42, 203-218.

Winnicott, D. (1953). Transitional objects and transitional phenomena. International Journal of Psychoanalysis, 34, 89-97.

Wood, J. J., McLeod, B. D., Sigman, M., Hwang, W. C., & Chu, B. C. (2003). Parenting and childhood anxiety: Theory, empirical findings, and future directions. Journal of Child Psychology and Psychiatry, 44, 134-151.

Wrape, E. R. (2015). Attachment Theory within clinical supervision: Application of the conceptual to the empirical. Unpublished Doctoral Dissertation, University of North Texas.

Yardley, L. (2000). Dilemmas in qualitative health research. Psychology and Health, 15, 215-228.


List of Appendices

Appendix A – Journal of Choice: Guidelines for Authors

Appendix B - Rationale for using IPA

Appendix C - Recruitment email invitation

Appendix D - Participant information sheet

Appendix E - Favourable ethical approval

Appendix F - Ethical considerations

Appendix G - Participant consent form

Appendix H - Semi-structured interview schedule

Appendix I - Data analysis and presentation

Appendix J - Demonstrating the study’s quality and validity

Appendix K - Audit trail

Appendix L – Self-reflexivity

Appendix M - Credibility checks


Appendices

Appendix A

Journal of Choice: Guidelines for Authors

[Removed]


Appendix B

Rationale for using Interpretative Phenomenological Analysis

Interpretative Phenomenological Analysis (IPA) is a qualitative approach, which aims to “explore in detail how participants are making sense of their personal and social world” (Smith & Osborn, 2003), in particular, the meaning people attach to their life experiences (Smith et al., 2009). It was chosen as an approach to meet the research aim for the following reasons. Firstly, it aims to say something in detail about the idiographic perceptions and understandings of a particular group of people, about a particular event, process or relationship, in a particular context. This complements the research aim of exploring in depth how supervisees experience and understand the supervisory relationship, which is likely to vary from person to person ideographically.

IPA is also a useful approach for broad and open research questions surrounding the way people think about or understand their experiences, as IPA sees cognitions as accessible, through what a person says. Furthermore, although this phenomenological approach, of looking at people’s words, provides an insight into their experience “in its own terms,” it is recognised that this cannot be done “directly or completely” (Smith et al., 2009). This can only be achieved through a double hermeneutic interpretation whereby the researcher is trying to make sense of the participant trying to make sense of their experiences (Smith & Osborn, 2003; Smith et al., 2009). This involves consideration of context and reflexivity of the researcher. IPA is therefore in keeping with my own epistemological position, which leans towards social constructionist. IPA also complements my own stance that the importance of what someone says is not determined by the frequency with which it is mentioned or whether others also say it in a group. IPA has the benefits concerned with revealing something about the particular nuanced experiences of each of the individuals involved, while also being able to say something in detail about the participant group.


Appendix C

Recruitment email invitation

Dear Trainees,

I am conducting a Major Research Project (MRP) to explore how supervisees experience and understand the supervisory relationship and the role, if any, that attachment may play within this. This project is an opportunity to contribute to qualitative research that aims to help enhance the experience of supervision for future supervisors and supervisees. Participation in this study involves attending a face-to-face interview with me at your university for approximately one hour, to discuss your experience(s) of supervision. The interview will be audio recorded, transcribed and anonymised for the purposes of data analysis. To be eligible to take part in the study, you must be currently undergoing doctoral training in clinical psychology. You must have experience (current or historical) of being supervised by a psychologist on an individual (face-to-face) basis in a psychology related clinical or research setting. You must be able to recall and reflect on your experience(s) of the supervisory relationship. It is important to highlight that your participation and responses in this study will remain anonymous and confidential. Supervisor anonymity and confidentiality will also be maintained. For further information, please refer to the information sheet attached. If you are interested in taking part or have any questions, please reply to this email. With best wishes,

KirstyTrainee Clinical PsychologistUniversity of Surrey


Appendix D

Participant information sheet

Exploration of the potential relevance of attachment in the supervisory relationship using an Interpretative

Phenomenological Analysis (IPA)

IntroductionMy name is Kirsty Read and I am a Trainee Clinical Psychologist at the University of Surrey. I would like to invite you to take part in a research project, the details of which are below. Please take the time to read the following information carefully and ask questions about anything you do not understand. Talk to others about the study if you wish.

What is the purpose of the study?This study seeks to explore how supervisees experience and understand the supervisory relationship and the role, if any, that attachment may play within this. Not only would an improved understanding in this field open up other important aspects to research, it could also help inform the development of items for a supervision-specific attachment measure to empirically investigate whether attachment is associated with the quality of the supervisory relationship. In turn, this could further our knowledge of how the supervisory relationship can be improved, through implementation of attachment based strategies. Improvements to the supervisory relationship may have the potential to maximise the training experience, development of the trainee, therapeutic outcomes and thus the quality of clinical and service provision.

Why have I been invited to take part in the study?You have been invited to take part in this study because, as a Trainee Clinical Psychologist, you are likely to have had experience of a supervisory relationship. To be eligible to take part in the study, you must currently be undergoing your doctoral training in clinical psychology. You must have experience (current or historical) of being supervised by a psychologist on an individual (face-to-face) basis in a psychology related clinical or research setting. You must be able to recall and reflect on your experience of the supervisory relationship.

What will my involvement require?If you would like to take part, please email the investigator at: [email protected] time will be arranged with you to attend a one-hour interview with the investigator. Before the interview, you will be asked to sign a consent form after having read this information sheet. You will be given a copy of your signed consent form and this information sheet to keep. Your gender will be recorded alongside your unique participant identifier number. This is only for the purpose of characterising the sample and will not be matched to your interview data. During the interview, you will be asked some questions about your experience of supervision, particularly the supervisory relationship. The role attachment may play within this will be explored. You can choose to discuss any face-to-face individual


supervision experience(s) (research or clinical) during or before clinical psychology training.

What will happen to data that I provide?The interview will be audio recorded, transcribed and anonymised for the purpose of data analysis. With your permission I would like to use anonymous verbatim quotation in reports. Password-protected audio recordings and anonymised transcription data will be stored separately from each other on password-protected computers and an encrypted memory stick. After completion of the research (September 2017) and anticipated publication, the audio recordings will be deleted. Research data (including the anonymised text files of transcripts) and project data (related to the administration of the project, e.g. your consent form) will be stored securely for at least 10 years, following their last access, in line with University policies.

Will my taking part in the study be kept confidential?Yes. Your details will be held in complete confidence and I will follow ethical and legal practice in relation to all study procedures. I will not disclose or draw attention to your identity or participation in the study. Interviews will take place in a different building to your psychology department. Your participation and data will be confidential and anonymous, including to members of your course team, peers and supervisors.Only anonymised transcriptions will be shared with research supervisors, who are involved in the clinical psychology training programme at my University. Should peer supervision be used as part of discussing IPA analysis of anonymised transcripts, ground rules regarding confidentiality will be set to maintain participant and supervisor identity in the rare case that this becomes apparent. Anonymised transcripts may also be seen by other researchers and examiners. To protect the identity of supervisors, you will be asked not to disclose supervisor names or other identifying details (e.g. service name or context of supervision) in the interview. Any identifying details of supervisors and/or participants will be removed from the transcripts to maintain anonymity before they are seen by any others, including the research supervisor. Data will be stored securely in accordance with the Data Protection Act 1998 so that unauthorised individuals will not have access to it. All of the information you give will be anonymised so that those reading reports from the research will not know who has contributed to it.In certain exceptional circumstances, should you disclose that you or someone else is at risk of harm, then the researcher may need to report this to an appropriate authority. This would usually be discussed with you first.

What are the possible disadvantages or risks of taking part?It is not anticipated that you will experience significant distress as a result of this study. However, discussing relationships and attachments within supervisory experiences, which have not been positive, may cause some distress. If you experience any distress or have any concerns raised by participation in this study, you will be advised to discuss this with your clinical tutor. Alternatively, you may wish to contact the university wellbeing centre and/or your mentor (if these are provided by your PsychD Clinical Programme) for additional support.


What are the possible benefits of taking part?It is unlikely that you will benefit directly but it is hoped that through the process of reflection in interviews, you may gain an improved awareness of/insight into personal supervision experiences (in terms of Attachment Theory). In addition, the results from this study could be used to inform attachment-based strategies to improve the supervisory alliance, thus improving trainee skills, performance and therapeutic outcomes. You may therefore indirectly benefit from the results of this study in the future either as a supervisee and/or supervisor.

Do I have to take part?No, you do not have to participate. There will be no adverse consequences on your training experience (studies, employment, supervision) if you decide not to participate or withdraw at a later stage. You can withdraw your participation and data from the study up to the point at which data is analysed, without giving a reason and without prejudice. An estimated date will be provided for this at your interview. You will not be able to remove your data following data analysis as the anonymity and analysis process will mean that your data will be difficult to identify. If you choose to withdraw participation during an interview, you will be asked if you also wish to withdraw your data or if this can still be retained and used for the study. If you do decide to withdraw participation and your data from the study before the date given for data analysis, this will mean that both identifiable (audio) and anonymised (transcribed) will be destroyed. No further data would be collected from you.

What if there is a problem?Any complaint or concern about any aspect of the study will be addressed; please contact me, Kirsty Read, (principal Investigator) in the first instance or alternatively my Supervisor. You may also contact the Head of School if more appropriate. Please find details below.

Contact details

Kirsty Read (Principle investigator)Trainee Clinical Psychologist [address and email address]

Professor Derek Moore Head of the School of Psychology[address and email address]

Who has reviewed the project?This study has been reviewed by and received a favourable ethical opinion from the Faculty of Health and Medical Sciences Research Ethics Committee at the University of Surrey.

Thank you for taking the time to read this Information Sheet

Dr Kate Gleeson (supervisor)Research Director/Lecturer in Clinical Psychology[address and email address]


Appendix E

Favourable ethical approval


Appendix F

Ethical considerations

Informed consentInformed consent to take part in the study was confirmed through providing a Participant Information Sheet (Appendix D) in the recruitment invitation. This clearly laid out information about the purpose of the study, the requirements of involvement, how data is stored, possible advantages and disadvantages of taking part and the freedom to choose not to participate or to withdraw. Participants were not put under any time pressure to respond to the recruitment email, so they could consider their decision over time. They were also made aware that they could decide not to take part and there would be no adverse consequences on their training experience. Prior to the interview, it was ensured that participants had read and fully understood the contents of the information sheet before they were given the consent form to read (Appendix G). Participants were then asked to sign the form if they were happy to proceed with the interview. The consent process was also audio recorded and revisited at the end of the interview to confirm if consent had been maintained. Participants were made aware that they could withdraw up to the point of data analysis.

ConfidentialityParticipants were reassured that their participation and data would be confidential and anonymous. Participants were told that interviews would be transcribed and anonymised, may be seen by supervisors and representatives from academic and professional bodies and would be stored securely in accordance with the Data Protection Act 1998. They were also made aware that although verbatim quotes would be used in the empirical paper and journal article, all identifying information about themselves would be removed. To protect the identity of supervisors, participants were asked not to disclose supervisor names or other identifying details (e.g. service name or context of supervision) in the interview and in the case that they were, these were removed from the transcripts.

Appendix G


Participant consent form

Consent form: Trainee Clinical Psychologists

Please initial each box

I the undersigned voluntarily agree to take part in the study on ‘Exploration of the potential relevance of attachment in the supervisory relationship using an Interpretative Phenomenological Analysis.’

I have read and understood the Information Sheet provided (version 1, date 18/10/15). I have been given a full explanation by the investigator of the nature, purpose, location and likely duration of the study, and of what I will be expected to do.

I have been advised about the possible disadvantages of taking part in the study. I have been given the opportunity to ask questions on all aspects of the study and have understood the advice and information given as a result.

I agree to comply with the requirements of the study as outlined to me to the best of my abilities. I shall inform the investigator immediately if I have any concerns or suffer any deterioration of any kind in my well-being.

I agree for my anonymised data to be used for this study and any future research that will have received all relevant legal, professional and ethical approvals.

I give consent for the interview to be audio recorded.

I understand that full anonymised transcripts may be seen by the principal investigator’s supervisor, peers during supervision on IPA analysis, other researchers and examiners.

I give consent to anonymous verbatim quotation being used in reports.

I understand that the data may be published in an academic journal but the information I provide will be kept confidential and remain anonymous.

I understand that all project data and all research data will be held for at least 10 years in accordance with University policy and that my personal data is held and processed in the strictest confidence, and in accordance with the UK Data Protection Act (1998).

I understand that I am free to withdraw my participation and data from the study up until the point of data analysis without needing to justify my


decision, without prejudice and without my legal rights, studies and employment being affected. I understand that following a request to withdraw my data and participation, all data already collected from me will be destroyed. I understand that following a participation withdrawal request during an interview, I will be asked whether my data can still be used or not.

I consent to my university email address being used for the purposes of communication between the principle investigator and me.

I would like to receive a lay summary of the study results (optional) and consent to my email address being used to receive this (before September 2017).

I confirm that I have read and understood the above and freely consent to participating in this study. I have been given adequate time to consider my participation and agree to comply with the instructions and restrictions of the study.

Name of participant (BLOCK CAPITALS) ......................................................

Signed ......................................................

Date ......................................................

Name of researcher/person* taking consent

…….............................................. (BLOCK CAPITALS)

Signed ....................................................

Date ....................................................

Appendix H

Semi-structured interview schedule


1. Experience of supervision Could you tell me something about your experience of supervision?

Prompts: What kinds of supervision have you experienced so far? Details about supervisors and what kinds of people they were Contexts of supervision (e.g. service type, research/clinical psychologist,

frequency, duration, similarities and differences etc)

2. Experience of the supervisory relationship (quality) I would like to know about your experience of the supervisory relationship. Could

you tell me something about a relationship you have had with one of your supervisors?/Could you tell me about your experiences of the supervisory relationship?

Positive relationship Can you think of a supervisory relationship that went well?/Can you think of

times when the supervisory relationship went well?

Prompts: So when the relationship was going well, what was that like/what kinds of things

happened? What do you think made the supervisory relationship go so well? What qualities did the supervisor have? What did you value about them? Does this remind you of any other relationship you’ve had/person in your life?

Difficulties in the relationship Can you think of a supervisory relationship that didn’t go so well?/ Can you think

of times when the supervisory relationship went less well?

Prompts: And when it went less well, what was happening? Why do you think that happened? What made the relationship difficult? What were they like at these times? Does this remind you of any other relationship you’ve had/person in your life? What impact, if any, did this have? What could have improved the relationship?

Ending: Is there anything else you would like to share?/Are there any other things we ought to talk about?/Is there anything you would like to change about the interview and what you said?/Is there anything you would say differently if I weren’t a trainee clinical psychologist?

Appendix I

Data analysis and presentationSingle-case analysisAnnotations of initial responses to the text were made in one margin. Annotations surrounded initial thoughts about the content, associations and connections, use of


language and preliminary interpretations. Returning to read the beginning of the transcript, the initial notes were then translated into emergent higher order themes and recorded in the other margin, ensuring that these captured the essence of what had been found in the text and were grounded in what the participant actually said.

Identification of emergent themesThe selection of themes was determined iteratively through relevance to the research question, depth/richness of material, explanatory power and reference to importance by the participant, rather than the frequency of reference. Themes and interpretative sense making were verified by re-checking the transcript to ensure that they were linked with the primary words of the participant. Themes which lacked rich evidence in the transcript or didn’t appear to fit well with the emerging structure were dropped.

Alterations made to improve the readability of extractsDotted lines within square brackets indicate missing material and information within square brackets signifies added material to clarify what a participant is referring to. Dotted lines at the beginning or end of an extract highlight that the participant was speaking before or continued afterwards. Minor hesitations, small tangents and utterances have mostly been omitted, where these are not considered to remove significant meaning.

Appendix J

Demonstrating the study’s quality and validity

Yardley’s (2000) framework

Sensitivity to context. This principle was demonstrated through sensitivity to the existing literature and theory in the introduction section and the literature review.


Sensitivity to the socio-cultural setting of the study was met through the description of the sample in the method section. Sensitivity towards the material obtained from participants was also ensured through gentle, non-judgemental responses from the researcher and conducting an in-depth analysis of data, in which the voice of participants was preserved through the inclusion of supporting verbatim extracts.

Commitment and rigour. Commitment was demonstrated through an in-depth engagement with the topic. Thorough attention was paid to participants during data collection and great care was taken over the transcription and in-depth analysis, as demonstrated by an example audit trail of an analysis in Appendix K. While commitment and rigour towards IPA was somewhat impacted upon by my beginner status and the practical constraints of the training course, I have always endeavoured to be thorough, and used the training and supervision opportunities available. This has ensured my development in the competence and skills associated with IPA. In particular, it helped to ensure that the interviews were guided by the research question rather than my experience of therapeutic interviews and formulation. Training opportunities have included attendance at lectures on IPA as part of my clinical training, carrying out reading on the approach, attending three workshops on the development or interview schedules, interview technique and analysis skills. I have regularly sought the expertise of my supervisor who is a specialist in IPA. My supervisor, alongside peers practicing IPA, conducted credibility checks in which they reviewed the themes and verified how these had emerged from the transcripts. On occasions where my personal assumptions had influenced the validity of data collection or analysis, discussions with my supervisor helped to reduce this and ensure that the themes more accurately reflected the participants’ actual words. Examples of how my analysis was changed based on these discussions are shown in Appendices K-M.

Transparency and coherence. This principle was demonstrated through clear descriptions in the method section of the stages of the research process and transparency about the process of analysis in the audit trail (Appendix K). Consideration of self-reflexivity provides transparency about how personal assumptions and experiences influenced different stages of the study (see Appendix L). Coherence between the research carried out and the underlying theoretical assumptions of IPA was maintained at all stages of the study, from development of the interview schedule to the analysis, via workshops, readings and supervision discussion.

Impact and importance. Consideration of the useful and interesting knowledge this research tells the reader, alongside its clinical relevance and implications, is included in the discussion section.

Appendix K

Audit Trail

The following audit trails present the stages of analysis, for two interview extracts, from initial responses, to superordinate and subordinate themes, to the consequent master-themes and sub-themes for the group.

Table 3. Extract from Frankie’s interviewInitial responses Transcript extract Emergent themes


Special or different relationship.

Reference to word “safe” and “warm.”

The supervisor qualities reminding her of her mother

Supervisor being judged as good or bad.

Schema of clinical psychologists as warm, safe, non judgemental and containing

P: There is just something about clinical psychologists, there is something about them that feels warm and safe. And you can, I was going to say you can say what you want but you don't get judged and that does remind me of my mum. My mum was very warm and containing and very non judgemental, apart from for other people but not for the family (laughs) but I think there is something about them and I think that is what shocked me so much about the not very nice supervisor because she wasn't like that, she didn't contain me, she wasn't like my mum, she didn't fit my internal schema of what a psychologist is. So I kind of went why are you a psychologist? So yeah I have a certain schema of what a psychologist is.

Mother-child supervisory relationship: seeing the supervisor as a maternal, containing and safe attachment figure.

Transformation of the theme over time:1. Emergent theme: Mother-child supervisory relationship: seeing the supervisor as a maternal, containing and safe attachment figure. 2. Superordinate theme: The supervisor’s qualities mirroring the qualities of a mother attachment figure 3. Initial master-theme: The supervisor as an attachment figureInitial sub-theme: Familial supervisory relationship/A familial dyad4. Revised master-theme: The qualities of a good enough supervisor and supervisory allianceRevised sub-theme: Comparable qualities of the supervisor to key family members5. Final master-theme: I am worth something to the supervisorRevised sub-theme: They nurture me like a caring family member would

Table 4. Extract from Perrie’s interview“one of the biggest things” highlights trust being of personal importance to her.

Needing to feel that the

P: Yeah, I think I was thinking, one of the biggest things for me is feeling a sense that the supervisor trusts in your abilities. And kind of that

Supervisor trust in supervisee abilities leads to supervisee self-trust and sense of safety.


supervisor trusts the supervisee’s abilities.

Supervisor trust leading to supervisee self-trust (self-trust developed through a relational process).Sense of feeling “unsafe” when supervisor feels unsafe about supervisee abilities.

you are capable. And if there is not that feeling, then there isn't that trust, then I find it really difficult to trust in myself and also trust in, that's when I feel unsafe because I feel my supervisor feels unsafe.

Transformation of the theme over time:1. Emergent theme: Supervisor trust in supervisee abilities leads to supervisee self-trust and sense of safety.2. Initial superordinate theme: Level of supervisor trust/belief in supervisee3. Revised superordinate theme: Level of supervisor trust/belief in superviseeRevised subordinate theme: Supervisor trust in supervisee facilitating supervisee self-trust and safety to explore4. Initial master-theme: Supervisor trust/belief in supervisee facilitating supervisee self trust/belief and safety to exploreInitial sub-theme: Degrees of trust5. Revised master-theme: The qualities of a good enough supervisor and supervisory alliance Revised sub-theme: Supervisor demonstrating trust in supervisee abilities6. Final master-theme: I am worth something to the supervisorFinal sub-theme: They trust in me/help me to trust in myself

Appendix L

Self-reflexivity

IPA is an inductive approach. This means that meaning is derived from the data in order to build knowledge and theory. However, there is recognition that the study design, data collection and analysis will still have been influenced somewhat deductively by my beliefs, assumptions and experiences (Eatough & Smith, 2008). In this context, reflexivity is considered particularly important, that is, reflecting transparently on the impact of the researcher on the research process (Yardley, 2000.)


The following section therefore comprises a self-reflexive statement outlining my personal beliefs, assumptions and experiences, a reflection on how these impacted on different stages of the study and evidence of how these were revised through supervision.

Self-reflexive statement. I am a twenty-eight year old white British female and am currently a Trainee Clinical Psychologist in my last year of training. Prior to this, I worked in a working age adult mental health service for two years as an assistant psychologist, after completing my undergraduate degree in psychology. It was during this role that I encountered my first, and very positive, experience of the supervisory relationship with a clinical psychologist. Upon commencing my new job, I was uncertain about the novel experiences I would encounter and turned to my supervisor for support. During these times, I valued my supervisor’s ability to contain my feelings of uncertainty by offering normalising and validating responses, alongside offering guidance similar to that of a big sister figure. She was approachable, always provided time for support/guidance, and conveyed a real sense of belief in my abilities. Gradually, this gave me the confidence to engage more actively with my role and explore different opportunities and challenges, which in turn further developed my self-belief. I consider this relationship central in my ability to carry out my role at the time, and my subsequent career development.

Reflecting on the above statement, I recognise that there is an overlap between my understanding/experience of this supervisory relationship and some of the themes identified in the current study. Indeed, it is difficult to unpick any causal relationship between these, due to the circularity of this process. However, given that this reflexive statement has been written after data analysis, my understanding of my personal experience is likely to have been somewhat influenced by what I have learned from the current study.

Although at the time of this relationship I did not think of it in attachment terms (rather I simply thought of it in terms of helpful supervisor qualities), the experience generated a personal interest in what constitutes a positive supervisory relationship. This influenced my decision to explore the supervision research base further and subsequently led me to become aware of Attachment Theory conceptualisations of the relationship. Upon learning of this conceptualisation, I was struck by how well it fit with my experience of the above supervisory relationship. I began to believe that the quality of our relationship had been influenced by a secure attachment between us. Specifically, I believed that my supervisor had provided a secure base, from which I could explore, and a safe haven I could return to when feeling uncertain. Before further reviewing the literature, I was perhaps more aligned with positivism, in that I assumed that this single truth about the supervisory relationship being an attachment relationship would apply to others too. In particular, I assumed that on some level, due to the novel nature of training experiences, all supervisees would feel uncertain and need containment from their supervisor in order to explore their role. I believed that the supervisory relationship therefore had potential to be an attachment relationship, similar to that of an infant-caregiver attachment relationship.

However, after a combination of reading the supervision-attachment literature, progressing though systemic aspects of training and learning about IPA, I have become more influenced by social constructionism ideas (Burr, 2003). My beliefs changed to surround there being multiple truths and perspectives about the supervisory relationship, which we can reach through an individual’s eyes (idealism),


rather than there being an objective reality (realism) about this relationship. I subsequently became interested in this and rather than aiming to identify a truth from this research, I aimed to gain an understanding of the various ways supervisees think about and understand the supervisory relationship, which may or may not resonate with Attachment Theory. In terms of epistemology, I believed that there are many ways of knowing things (radical relativism), such as through science (positivism), religion, language and experience and it is about choosing the right approach to generate knowledge, in relation to the research question. In the case of this research, a more social constructionist, language and experience based explorative study fit best (see appendix B).

After collecting the data, I became aware of a shift in my personal beliefs about the supervisory relationship. While I still believe that the supervisory relationship has the potential to develop into a “full-blown” attachment bond, I think that this is dependent on several factors such as level of trainee anxiety and stage of training. In some cases, it makes sense that the relationship may only involve attachment dynamics and that non-attachment factors also have a role. Furthermore, I believe that the supervisory relationship being an attachment relationship may just reflect the way that trainee clinical psychologists approach it, based on our theoretical training. Regardless, it seems helpful for many to think of the relationship in this way and it would be interesting to investigate this further with a supervisor population.

Impact of the self on the study and subsequent revisions made. The below examples demonstrate how my beliefs, assumptions and experiences influenced the design of the study and how meaning was arrived at in the analysis. It also takes account of how the study design and analysis was revised, following feedback from my supervisor, to ensure that the study was consistent with IPA and more closely reflected participants’ real worlds.

Development of the interview schedule. My initial interview schedulewas very narrow, with specific predetermined questions. I had been keen to get the questions right and stick to this structure in order to produce knowledge. This was perhaps influenced by my beliefs that the power of producing knowledge was in the interview schedule, and that I held the responsibility for conducting a good interview. A predetermined and structured interview schedule also helped to manage some uncertainty about using the IPA approach which was novel to me. I noticed that the questions were also quite centred around Attachment Theory, which may have been influenced by my initial positivist ideas about the relationship being understood in these terms. In addition, my goal to publish this study may have influenced me wanting to demonstrate this particular truth in order to show something useful that could have real implications for supervisor training (e.g. attachment strategies).

Following a review of my initial interview schedule, my supervisor challenged me on the structured attachment questions I had chosen. This resulted in me reflecting upon the style of my interview schedule and how this may not have been very coherent with IPA. The structured attachment questions meant that I would potentially be leading the participant into my area of interest rather than following them into theirs. I began to realise that the power of producing knowledge was not in the interview schedule and having the right questions, but in the relationship and social exchange between the participant and me. In particular, the power was in how well I allowed the participant to talk freely about their experiences, how well I listened and


how well I clarified my understanding. It was also about how well I remained curious, explorative and flexible in engaging in a ‘dance’ with the participant of leading and following. In order to allow for this more collaborative production of knowledge, my list of questions was amended to be shorter and broader. They became less organised around attachment features and more focused around the qualities of a positive or negative supervisory relationship.

Analysis. When I first came to analyse the data, I appeared to view this through a lens of my attachment based research question and my initial underlying assumptions of the supervisory relationship being an attachment relationship. I had mainly focused on similarities between what participants said about the supervisory relationship and traditional infant-caregiver attachment relationships, for example being responsive to needs.

Following a review of my initial analysis, my supervisor challenged me on what my lens had allowed me to see of the real world for participants, and what it had perhaps prevented me from seeing. We reflected that I had been focusing a lot on the similarities between the supervisory relationship and more traditional infant-caregiver attachment relationships but had not noticed the differences between these as much. This was perhaps because the differences conflicted with my underlying initial beliefs about the supervisory relationship and also because it conflicted with what I had possibly wanted to see. As a result of this reflexive process, I began to let go of my assumptions. I also slowed down the analysis, emphasising more of a line-by-line approach to interpretation, to ensure I captured the detail of what participants were actually saying. This led me to notice new meanings and themes in the data, particularly related to the differences between the supervisory relationship and traditional attachment relationships, such as the level of reciprocal disclosures and the role of the supervisee in the relationship.

Appendix M

Credibility checks

To assess the credibility of my data analysis, both my supervisor (with IPA expertise) and two peers (familiar with IPA) conducted credibility checks to ascertain whether they could see how I got to the themes from the transcripts of data. Below is an example of a review conducted by my supervisor and how this subsequently changed my analysis.

Upon reviewing some initial master-themes and sub-themes, my supervisor challenged me on the attachment language I had used (Table 5). She wondered whether the themes I had generated truly reflected what participants had been saying


or whether these had been influenced by my research question, personal way of thinking about the supervisory relationship and what I may have wanted to see. Upon checking the transcript quotes against these themes and reflecting on my interpretations, it became apparent that the latter had perhaps been the case. As a result of this process, I began to interpret the data differently, in a way that was more linked with the actual words used. These were again reviewed and verified by my supervisor who deemed these credible.

Table 5. Example of initial master-themes and sub-themesMaster-Theme Sub-Themes IdentifierThe supervisor as an attachment figure

A secure base and safe haven

“…I was distressed and she completely changed and responded to what I needed in that moment.”

A familial dyad “My supervisor reminded me of my mum […] you don’t get judged”

An insecure base “I didn’t feel heard, I felt that I had to hear her issues…”“She was very busy […] I felt like quite a nuisance…”“…It didn’t feel like there was much warmth or maybe interest even, that I looked for other sources of support in the team to support my development.”

Table 6. Example of revised master-themes and sub-themesMaster-Theme Sub-Themes IdentifierThe qualities of a good enough supervisor and supervisory alliance

Supervisor sensitivity and responsiveness to supervisee needs


Comparable qualities of the supervisor to key family members

“My supervisor reminded me of my mum […] you don’t get judged”

The qualities of a poor Supervisor unavailability to “I didn’t feel heard, I


supervisor and supervisory alliance

meet supervisee needs felt that I had to hear her issues…”

Supervisee reliance on alternative support

“She was very busy […] I felt like quite a nuisance…”“…It didn’t feel like there was much warmth or maybe interest even, that I looked for other sources of support in the team to support my development.”

Table 7. Example of further revised master-themes and sub-themesMaster-Theme Sub-Themes IdentifierI am worth something to the supervisor

They are sensitive and responsive to my needs


They nurture me like a caring family member would

“My supervisor reminded me of my mum […] you don’t get judged”

They prioritise my needs “I didn’t feel heard, I felt that I had to hear her issues…”

They are available for me “She was very busy […] I felt like quite a nuisance…”

Part 3 - Summary of Clinical ExperienceYear 1 Acute Adult inpatient Mental Health Service In my first placement, I worked with adults aged 18-65 years old, presenting with a range of moderate to severe mental health difficulties, in an acute inpatient setting. The placement involved working with people with complex risk issues and highly sensitive difficulties including: depression, anxiety, panic disorder, bipolar affective disorder, psychosis, dissociative identity disorder, post traumatic stress disorder, complex grief, borderline personality disorder, a history of traumatic experiences e.g. child abuse, self-harm and suicidal behaviours. My work involved a combination of assessments (therapy and risk related) and interventions, on an individual and group basis, across the inpatient


service and home treatment team. Intervention models used in individual therapy included Cognitive Behavioural Therapy (CBT), Compassion Focused Therapy (CFT), Dialectical Behavioural Therapy (DBT e.g. distress tolerance), Solution Focused Therapy (SFT) and Acceptance and Commitment Therapy (ACT). Indirect work was also conducted to support staff with behaviour that challenges, using a range of systemic, behavioural and emotion focused models. In terms of group work, I co-facilitated two groups on the ward; one which was based on CBT and the other based on mindfulness. As part of service development, I amended the CBT group protocol and helped to develop an ACT group protocol. I also conducted an audit of service provision for people with BPD, comparing admission data against NICE guidelines, theory and the evidence base. I later presented this to psychologists across the trust to share best practice and recommendations. Other experience included conducting neuropsychological assessments and interventions with two people in a mental health rehabilitation setting, presenting with memory difficulties alongside a diagnosis of schizophrenia. As part of my placement, I also attended and contributed to many different meetings including ward rounds, handovers/Multi Disciplinary Team (MDT) meetings, family intervention meetings, psychology locality meetings, complex case discussions, community meetings, crisis formulation meetings, reflective practice and business meetings. In addition, I visited different mental health organisations to spend time with people with mental health difficulties outside of the therapeutic relationship. As part of my teaching and training competencies, I delivered a piece of training, alongside my supervisor, on ‘adapting CBT for people in crisis and with complex presentations’ to a variety of mental health professionals across the Trust. I also delivered a presentation on my experiences of my first year placement at an assistant psychologist support group.

Year 2 Child and Adolescent Mental Health Service (CAMHS) Tier threeDuring this placement, I worked with children and young people aged 8-17 years old and their families. Difficulties experienced by the children and young people I worked with included moderate to severe mental health difficulties such as depression, self-harm, suicidal ideation and behaviours, anxiety, panic disorder, sleep difficulties, social anxiety, obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD), motor tics, PTSD, low self-esteem, emotional intensity, behavioural difficulties, anger management, attention deficit hyperactivity disorder (ADHD) and Autism Spectrum Disorder (ASD). I used a range of models to inform my assessments and interventions including CBT, narrative therapy, behavioural (parenting) approaches and systemic theories. My interventions consisted of both individual, family-based and parent work and I also provided consultation to schools. In addition I carried out some brief joint work with a family therapist to support a transition from individual to family therapy based on the child and family’s needs. I undertook two neuropsychological assessments with children presenting with difficulties learning in the context of neurodevelopmental conditions such as ASD and ADHD. Alongside my supervisor, I was also able to carry out some joint deliberate self-harm assessments at A&E. This placement used an IAPT model and therefore provided me with experience in using a range of patent and clinician reported outcome measures to support my clinical work. In terms of leadership, I facilitated a workshop for my colleagues on working more creatively with children and young people. This led to some team initiatives to incorporate social media apps more into clinical work, which was directed to the youth advisory panel for further discussion. I had the chance to engage in a social event with this youth advisory panel as well as join their meeting on service improvements for children and young people. Additionally, I visited the local carers network to find out how carers are supported in the community.


Community Team for People with Learning Disabilities (Social Services) In this placement I worked in an integrated care setting (with social services) with adults aged 18-65 years of age who had been diagnosed with a Learning Disability. In addition to a learning disability (LD), some of the people I worked with also had a diagnosis of ASD and some were experiencing mental health difficulties such as depression and anxiety, issues around personal identity, managing transitions and adjustment issues, anger difficulties, self-harm, suicidal ideation and behaviours, relationship difficulties (including sexual knowledge assessment) and behaviour that challenges. A proportion of my work included working therapeutically with people with mental health difficulties (such as those mentioned above). Assessments and interventions were tailored and adapted to individual needs, taking into consideration the learning disability, communication difficulties and sensory difficulties. I carried out both individual and indirect (family, carers, staff) interventions using CBT, DBT and systemic based approaches, incorporating psychodynamic ideas and attachment theory. My work also included assessment, formulation, training and consultation to care home staff and family members regarding challenging behaviour using functional assessment and the Positive Behaviour Support (PBS) model. A significant proportion of my work involved joint working with other members of the MDT, including Occupational Therapists, Social Workers, Speech and Language Therapists and nurses in order to best meet people’s needs. As part of my placement, I delivered a workshop on ‘formulation’ to help promote psychological thinking within he MDT. I also attended several MDT meetings, local and countywide psychology meetings and a mental health tribunal. I learned about the perspectives and experiences of people with learning disabilities and their carers by attending a local carers group and several day centres. In terms of neuropsychological work, I conducted an Autism assessment, a dementia assessment and an LD eligibility assessment. Neuropsychological assessment also informed where adaptations were needed in therapy work. In addition, I also carried out assessments for a sexuality and relationships group for people with a learning disability.

Year 3 Specialist Placement – Paediatric Oncology Psychological Support Service In my specialist placement, I worked in a psychological support service for children and young people diagnosed with cancer, and their families. I worked with children between the ages of 5 and 17 years with a range of difficulties including procedural fear, behavioural difficulties, anger difficulties, low mood, anxiety, body image, identity and self-esteem issues, adjustment issues and cognitive impairment as a result of brain tumour and/or associated treatment and rehabilitation. Assessments and interventions were carried out on the ward with children who were inpatients as well as off the ward with outpatients. Much of my work also included liaising with other services and organisations such as schools, CAMHS and primary care. I also worked with parents experiencing emotional distress and anxiety regarding their child’s illness and relationship difficulties in the context of their child’s diagnosis and treatment. Interventions were tailored to the individual needs of the child and their families, taking place on a face-to-face basis or over telephone. The main models applied on this placement were narrative, brief solution focused, CBT, ACT, behavioural and systemic family therapy approaches, alongside psycho-education and basic therapeutic skills/interventions involving validation and listening. In addition, I took part in facilitating a sibling’s activity day for siblings of a child or young person with cancer. I also contributed to an ‘end of treatment’ day for parents to support them in the transition towards post treatment life as a family. A significant proportion of this placement included carrying out a number of neuropsychological assessments for children, following treatment for a brain tumour. This was part of a service evaluation project to improve service provision. Based on the


assessments, I provided feedback to families and schools regarding memory, concentration and attention issues following cancer and treatment. Leadership experience included providing psychology consultation within the late effects clinic alongside a Consultant Paediatric Oncologist and developing a leaflet for parents about skills to manage behavioural difficulties during/after their child’s treatment. I was also the psychology representative at weekly handover meetings on the ward. Further, alongside my supervisors, I delivered a day’s training to staff at a children’s hospice on grief, PTSD and risk assessment in oncology. Additional experience included presenting to the team at ‘journal club’ to share my doctoral research project, attending ‘Good Clinical Practice’ training, visiting the hospital school and informally supervising an assistant psychologist on a service evaluation about the ‘debrief’ service to support ward staff in their work. Older People’s Community Mental Health Team and Memory Assessment Service In my final placement, I worked with older people from the age of 62 to 88. I worked with a range of difficulties, which included organic issues (Alzheimer’s and dementia), adjustment issues, fatigue, challenging behaviour and mental health difficulties (panic disorder, generalised anxiety disorder, depression, trauma and suicidal ideation and behaviours). Work was carried out across a range of settings including an inpatient psychiatric ward, a community site, a nursing home, a staffed residential setting and client homes. Both individual and indirect interventions were conducted using a variety of CBT, systemic, ACT, behavioural, bio-psycho-social (Newcastle model) and Wellness Recovery Action Plan approaches. Ideas from attachment theory, cognitive analytic theory and psychodynamic approaches were also incorporated into my work. As part of the challenging behaviour work, I provided formulation, consultation and care planning sessions to staff at a nursing home. The majority of cases included close joint working with MDT colleagues including psychiatrists and community psychiatric nurses. A significant component included conducting neuropsychological assessments for the memory assessment service, feeding back results to colleagues, patients and their families and recommending psychological cognitive rehabilitation strategies to live well with dementia. In addition, I contributed to the MAS service by helping to support its adherence to the Memory Services National Accreditation Programme (MSNAP). For example I attended monthly service meetings, developed a document on the consent process in memory assessment services and delivered teaching the admin staff on dementia and communication skills. In terms of leadership skills, I developed, facilitated and evaluated an ACT for older people with depression and/or anxiety alongside a clinical psychologist colleague. Other experiences included attending the CMHT meetings, a neuroradiology meeting and a presentation on updated best practice treatment for dementia by a medical colleague. In addition, I learned about older people’s experiences outside of the therapeutic relationship by visiting a dementia charity, older people’s liaison psychiatry service and an psychiatric inpatient service.

Part 4 - Table of Assessments Completed During Training

PSYCHD CLINICAL PROGAMMETABLE OF ASSESSMENTS COMPLETED DURING TRAINING

Year I AssessmentsASSESSMENT TITLE

WAIS WAIS Interpretation (online assessment)Practice Report of Clinical A Cognitive-Behavioural assessment with a male client in his


ASSESSMENT TITLE

Activity early forties presenting with low mood and anxietyAudio Recording of Clinical Activity with Critical Appraisal

A critical appraisal of a Cognitive-Behavioural Therapy (CBT) intervention session with a gentleman in his late thirties presenting with auditory hallucinations and flashbacks in an acute inpatient setting

Report of Clinical Activity N=1

A Cognitive-Behavioural assessment, formulation and intervention with Andy; a male in his late thirties presenting with auditory hallucinations and flashbacks in an acute inpatient setting

Major Research Project Literature Survey

What do we know about Attachment Theory and the supervisory relationship between a trainee therapist and their supervisor?

Major Research Project Proposal

Exploration of the theory of attachment in the supervisory relationship using an Interpretative Phenomenological Approach

Service-Related Project Audit of Borderline Personality Disorder admissions in adherence with best practice in an inpatient setting

Year II AssessmentsASSESSMENT TITLE

Report of Clinical Activity – Formal Assessment

A neuropsychology assessment and formulation with a young boy of primary school age, presenting with difficulties in learning, social interactions and rituals

PPLD Process Account A reflective process account of my PPD group experiencesPresentation of Clinical Activity

A Positive Behaviour Support intervention with a male in his late teens, with a learning disability, displaying behaviour that challenges

Year III Assessments ASSESSMENT TITLE

Major Research Project Literature Review

Attachment Theory and the Supervisory Relationship: A Systematic Review of the Literature

Major Research Project Empirical Paper

Attachment Theory and the Supervisory Relationship:An Interpretative Phenomenological Analysis of Supervisee Experiences

Final Reflective Account A reflective account of my personal and professional development as a clinical psychologist over the course of training

Report of Clinical Activity

A systemic intervention with a couple in their thirties, presenting with maternal depression/anxiety and relationship difficulties, during their young son’s treatment for cancer.

Documents

Statement of Originality - epubs.surrey.ac.ukepubs.surrey.ac.uk/842054/1/Ethesis 1.docx · Web viewPart 1 - Literature Review7. ... Part 2 - Empirical Paper ... to allow for in-depth