Practicing Clinical Supervision in Chile: Lessons from 28 Years of Training

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https://doi.org/10.1007/s10879-021-09494-8 ORIGINAL PAPER

Practicing Clinical Supervision in Chile: Lessons from 28 Years of Training

María Inés Pesqueira¹ · Ivonne Ramírez¹ · Paola Ceruti¹ · John W. Carter^2,3

Accepted: 4 March 2021 / Published online: 26 March 2021

Abstract

This article describes a model of supervision developed by Centro MIP in Santiago, Chile. This model is situated in the cultural history and legal context of psychotherapeutic practice in Chile, as well as in the unique pioneering spirit governing the institute since its founding in 1992. This psychotherapy-based model draws from constructivist and strategic orientations and includes elements of structural, solution-focused, and client-centered practice. The work has an overarching goal of serving the therapeutic growth of the supervisee and is guided by three primary principles: unwavering leadership (lider- azgo irrenunciable), pursuing excellence (excelencia), and intervision (intervisión). It is argued that enhancing supervisees’

therapeutic effectiveness and their own well-being is facilitated by eschewing within-session summative evaluation in favor of encouragement and bidirectional formative feedback. Several excerpts of supervisory sessions are provided to illustrate the method.

Keywords Clinical supervision · International psychotherapy · Latin America · Constructivism · Strategic therapy

Caminante, no hay camino, Se hace camino al andar.

—Antonio Machado

The practice of clinical supervision is relatively well-doc- umented, both in terms of the varieties of models practiced and the roles and tasks that define the practice (Bernard

& Goodyear, 2019; Corey, Haynes, Moulton, & Muratori, 2010). But as recent reports from international sources have noted (Falender et al., 2021; Duan, 2018), the existing supervision literature is dominated by practices in English- speaking Western nations. In this light, we present a unique tradition of clinical supervision developed over the better part of three decades at Centro de Entrenamiento en Psico- terapia y Coaching (Centro MIP), a post-graduate psychotherapy training institution in Santiago, Chile. Although

many elements of this model may be familiar to Western audiences, we believe it is of interest how these elements have been integrated and developed in a specifically Chilean context, situated in Chile’s history of psychotherapy training and regulation.

Psychotherapy Training and Supervision in Chile

Chile was one of the first countries in Latin America to offer study and careers in psychology. The first school of psychology was founded at the Universidad de Chile in 1946;

the second at the Pontificia Universidad Católica de Chile in 1954. During this time, Chilean psychotherapy training and practice was dominated by psychodynamic perspectives, though cognitive-behavioral approaches challenged this dominance by the late 1960s (Urzúa, Vera-Villarroel, Zúñiga, & Salas, 2015).

Prior to 1980, psychology training remained restricted to the two institutions noted above; however, the passage of the General University Law in 1981 paved the way for an explosion of psychology programs. By 2005 there were 40 psychology programs nationally; by 2020 this had grown to 145 (Consejo Nacional de Educación, 2020).

* Ivonne Ramírez

ivonne.ramirez@centromip.cl

1 Centro de Entrenamiento en Psicoterapia y Coaching (Centro MIP), Vitacura 5250, oficina #506, Vitacura, Santiago, Chile

2 Department of Counseling and Human Services, University of Redlands, Redlands, CA, USA

3 Carter Strategic Research, Granada Hills, CA, USA

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In Chile, both the title of psychologist and the right to practice psychotherapy are conferred by undergraduate (licenciado) degree programs (Winkler, Pasmanik, Alvear,

& Reyes, 2007). These are 5-year courses of study com- prising 3 years of standardized coursework in psychology, 1 year of specialization in a specific sub-field (for example in clinical, educational, organizational, or community psychology), and 6–12 months of supervised clinical practice. The Consejo Nacional de Educación, an office of the Ministry of Education, sets curriculum standards and certifies the universities which may offer these degree programs.

Chile has no formal training requirements for becoming a clinical supervisor. Traditionally, supervisors have come from the ranks of respected professors and clinicians and have been largely self-taught. Through the 1980s, there was no consensus that supervision required any special skills and competencies (Daskal, 2008; Loubat, 2005).

Between 1994 and 2017, however, the training requirements for psychotherapists and supervisors became more rigorous. Responding to concerns about the perceived decline in training quality in the 1980s (Arias, 2016), the College of Chilean Psychologists and the Chilean Society of Clinical Psychology joined forces with representatives from participating universities to form the Comisión Nacional de Acreditación Psicólogos Clínicos (CONAPC) in 1994. This organization set post-graduate certification requirements for both therapists and supervisors which then became the legal standard to practice in either of these roles. CONAPC set the numbers of hours for direct clinical care, theoretical training, and clinical supervision in the case of therapists;

for supervisors, additional hours of supervisory practice and meta-supervision (supervision of supervision) were also specified. Although figures differ, CONAPC certified between 1700–2000 psychotherapists and 350–950 supervisors between 1994 and 2017 (Bagladi, 2014; Pesqueira &

Esquivel, 2018).

This period of increased regulation did not last. A com- bination of influences (including increased societal demand for mental health services and widespread complaints about the costs of training psychotherapists) put pressure on the College of Chilean Psychologists to review the regulations in question. In 2015, the Chilean National Health Fund repealed the provision that made post-graduate certification mandatory for practice. In 2017, CONAPC disbanded. Cur- rently, both the College of Chilean Psychologists and the Chilean Society of Clinical Psychology advocate the use of their own certification standards (Sociedad Chilena de Psicología Clínica, 2019), but these standards carry no legal weight.

Legal and Ethical Considerations for Supervisors

Chilean supervisors have similar legal liabilities to supervisors elsewhere in the developed world. Supervisors of undergraduate psychology students are legally liable for any harm caused to the student’s clients. Despite post- graduate trainees being legally responsible for their own clients, their supervisors may still be the target of mal- practice lawsuits. As noted in another article in this issue (Falender et al., 2021), supervisors’ gatekeeping role is either reduced or absent in many non-Western international contexts; this holds true in Chile as well. For undergraduate psychotherapy trainees, the university program and particularly the final cumulative exam serve the primary gatekeeping function. For psychotherapists pursuing post-graduate training, there are no national evaluation standards; rather, it is left to each program to solve this issue in their own fashion.

History of Centro MIP

Centro MIP was founded by the first author (MIP) in 1992, upon the urging of several of her supervisees and former students, including the third author (PC). Its model of supervision was originated by the first author and co-developed and refined by the third and second (IR) authors—among others—over many years (Ceruti & Ibac- eta, 2014).

The first author began her undergraduate studies in psychology at Universidad de Chile in 1976. She was excited about what she learned of the theory and research on cognitive-behavioral approaches; however, her experiences in supervision did not live up to her expectations. Her supervisors were didactic in approach, referring her back to theory and established techniques; whereas, she wanted someone with the practical acumen to show her what to do in session—how to uniquely apply the techniques in her own way to each new case.

In the 1980s she received peer supervision from a num- ber of different theoretical orientations. In 1990, she met Hugo Hirsch, a visiting clinical scholar from Argentina promoting a systemic model of supervision—and immediately requested to begin supervision with him. She recalls feeling that for the first time a supervisor actually validated her therapeutic style, leading her to better conceptualize the client and more clearly discern a strategy for each case.

For his part, Hirsch had started his career as a psychologist in Buenos Aires in the 1970s. He then trained at the Mental Research Institute in Palo Alto, California, and was

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supervised there by Paul Watzlawick, John Weakland, and Richard Fisch. Although he returned to Argentina to build his own therapeutic and supervisory practice, he continued annual visits to the Mental Research Institute for many years. Hirsch’s practice of supervision, an integration of strategic, structural, and solution-focused models, was the single largest influence on the first author’s own practice, including the preference for group and direct (live) supervision, as well as the use of structured case presentations.

Centro MIP was legally incorporated in 1992, beginning with a simple supervisory practice conducted out of the first author’s home and welcoming its first cohort of trainees for a two-year post-degree certificate training program one year later. The center continued to grow over the next several years, moving out of the house itself but adding adjacent buildings on the same property. In a very real sense, the lack of regulations and established practice traditions for supervision in Chile at that time forced Centro MIP to create its training program out of whole cloth—it had to make its own rules, develop its own standards. Also, although not revolutionary to Western practitioners, the vein of experiential learning it offered ran decidedly against the grain of mainstream Chilean practice. Word of mouth spread quickly in the local psychotherapist community—of an innovative psychotherapy training center which both pursued clinical excellence and fostered therapists’ personal growth in a caring, family-like atmosphere.

In 1996, Centro MIP became the first brief psychotherapy training program accredited by the Comisión Nacional de Acreditación de Psicólogos Clínicos (CONAPC). In 2000, it added a 3-year supervisor training program to its offerings.

From the beginning, detailed and systematic feedback from trainees has been instrumental in developing and refining the Center’s programs—and continues to this day.

Centro MIP’s Supervision Training Program

The center currently offer five lines of service:

• 2-year training program in systemic brief therapy for psychologists and psychiatrists

• 3-year training program in supervision for psychologists and psychiatrists who have already completed a 2-year specialization in psychotherapy

• 1-year certificate program for strategic coaching for a variety of professionals

• Various free-standing single-course offerings and work- shops

• Low-cost psychotherapy services to the community—

provided by trainees in the systemic brief therapy program and supervised by trainees in the supervision program

The supervision training program accepts approximately 9–10 trainees per year and is staffed by 5 CONAPC-certified supervisors. The training comprises 1100 training hours over 3 years, allocated as follows:

• 200 theoretical hours. Trainees participate in monthly group discussions of topical readings and are responsible for reading, writing, leading discussions, and making presentations about this material. Reading topics include types and models of supervision, ethical issues and risk of harm in supervision, evidence of supervision effectiveness and evidence-based practice, the supervisory relationship, effective communication including coaching skills for difficult conversations, and therapist development.

• 300 supervision observation hours. Trainees first observe (shadow) and then advance to co-lead a large supervision group of 10–14 therapist trainees, under the lead of two supervisors-of-supervisors.

• 200 supervision practice hours. This includes leading didactic instruction of therapeutic skills, conducting indi- vidual or small-group administrative supervision, as well as eventually leading the large group of therapist trainees.

• 300 metasupervision hours. Trainees receive supervision of their supervision cases from the supervision program staff and the head of the program. Format includes monthly case presentations and review of audio or video session excerpts.

• 100 final monograph hours. Trainees prepare a capstone work of scholarship related to their supervisory experiences.

During all 3 years, supervision trainees participate in the same reading discussion group and receive supervision-of- supervision (metasupervision). Over the course of the program, trainees advance in their exposure to and level of responsibility for the clinical supervision of psychotherapy trainees.

The first year is spent learning and practicing the didactic and administrative responsibilities of the supervisor, and observ- ing the clinical supervision process of senior supervision staff.

In the second, supervision trainees begin to teach aspects of the brief therapy model, conduct administrative supervision (caseload disposition and documentation), and co-supervise the large supervision group with program staff. Finally, the third year features trainees leading the large supervision group and taking leadership on several psychotherapy trainees’ cases under the watch of the senior supervisors.

The Centro MIP Model of Supervision

It is worthwhile to note that the following description of Centro MIP’s model of supervision is principally derived from practice rather than theory. That is, although the

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practice was guided by some recognizable theoretical principles, the development of Centro MIP’s way of doing supervision proceeded through trial-and-error, frequent feedback from trainees and supervisors, and the gradual accrual of practical expertise—all the while striving to preserve the magic of inspirational moments in the work.

In the sections that follow, the assumptions underlying the model are articulated, the practice of the model is described, a pair of examples are provided, and the model is then compared to other models.

The thread that unites all of the other disparate strands of the Centro MIP model is the understanding that supervision is a service tailored to the needs of the supervisee. In a superficial sense, this means giving a quality response to the concerns of the supervisee. Although the supervisor does not typically give a direct, face-value answer to the supervisee’s question right away, the intent is to focus the session in such a way that the supervisee is able to gain clarity on their issue and develop their own answer.

In a deeper sense, service means providing a meaningful, empowering experience that promotes the supervisee’s autonomy and professional development. This includes respecting the personal style of each supervisee, rather than attempting to mold them to the style and beliefs of the supervisor. The supervisor strives to achieve a delicate balance between caring and demanding so that the supervisee feels supported as well as challenged and is at once more aware of their resources and empowered enough to dare to try new possibilities in their clinical work. Although a balance between supporting and challenging the supervisee has become something of a commonplace in the supervision literature (Borders, 2014), we note that this balance is easier achieved on paper than it is in the actual, ongoing interaction with the supervisee.

The overarching service orientation gives rise to four values that guide the work:

1. Being useful The interventions, contents or actions of the supervision are useful when they allow the supervisee to fulfill their own subjective requirements of the supervision.

2. Caring for the supervisee The experience should be a safe space of respect, listening, validation, and openness to trying new things, making mistakes, and learning from them.

3. Trusting in the supervisee’s resources The supervisee is conceptualized as someone who has the strengths and skills that are necessary to solve their problems and achieve positive client outcomes.

4. Fostering enjoyment and inspiration in the work At peak moments, supervision will awaken in both supervisor and supervisee a positive spirit of openness to being the best version of whom they can become.

The principal focus in these values is on the supervisee’s well-being and development. This stands in contrast to the diverse goals articulated in mainstream Western literature on supervision: supervisee development, client welfare, monitoring supervisee performance, fostering supervisee self-supervision (Corey et al., 2010). Client welfare is undoubtedly important in the Centro MIP model, but the supervisee’s welfare is placed right alongside it. Also note that the summative evaluation and gatekeeping functions implied by “monitoring supervisee performance” are given relatively less emphasis than in the U.S. literature, where these are defining aspects of supervision (Bernard & Good- year, 2019).

The Center strives to provide a safe space for the psychotherapist to develop within a community of professional growth. The Centro MIP model holds that supervision should be desired and not feared. It has been our finding that if a supervisee is worried about the potential negative con- sequences of what they disclose to the supervisor, they are likely to shut down or present a false persona. Therefore, all summative evaluations, critical judgments about the supervisee’s progress, etc. are kept out of the supervisory session.

By contrast, the model promotes the active use of formative feedback—from both the supervisor and the other supervision group members—as essential input for the supervisee’s development.

The Centro MIP model is predicated on three fundamen- tal principles of practice:

1. Unwavering leadership (Liderazgo Irrenunciable) The Centro MIP model recognizes that the supervisor

holds the ultimate responsibility for the success of the supervision. The supervisor is responsible for the well- being and development of the supervisee, and the quality of the professional service being offered to the client. By the end of the supervision, the supervisor must ensure that the objective of the supervision has been achieved and that the supervisee feels satisfied and empowered.

The supervisor ever strives to embrace the full responsibility of that leadership. Simply put, the supervisor vows: ‘I will not let my supervisee go unless I know they can do it—in their own words, in their own style, and on their own!’ This means that if the supervision is not going well, the supervisor resists the temptation to blame it on the failures or inadequacies (i.e. resist- ance) of the supervisee, but rather re-examine their own role in becoming disconnected from the supervisee. In other words, the supervisor cannot hide from or shirk their ever-present leadership, but must readjust their own stance to re-serve the needs of the supervisee.

2. Pursuing Excellence (Excelencia)

The supervision is oriented to instill the supervisee’s pursuit of excellence. Here, excelencia takes on a par-

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ticular meaning—it is not “perfectism,” the aspiration to reach a state of perfect behavior without mistakes or weak points. Rather, excelencia connotes a conscious and active striving toward continual improvement via self-evaluation (Miller, Hubble, & Chow, 2017) and supervision (Swift et al., 2015). The key inputs in this process for the supervisee are session and outcome rating forms completed by the client (Duncan et al., 2003;

Miller, Duncan, Brown, Sparks, & Claud, 2003) and active in-session feedback from their colleagues, and supervisor. In a parallel respect, the supervisor also strives toward excellence in their provision of supervision by opening themselves to active feedback from the supervisee.

3. Intervision (Intervisión)

Consistent with an overall constructivist view, it is assumed that neither the perspective of the supervisor nor that of the supervisee is privileged above that of the other. The concept of “intervision” was developed by Montado et al. (2010) to imply a dialogue “between visions” of professionals around a clinical issue. Thus, this concept underlines the importance placed on the co-construction or rapprochement between the views of supervisor and supervisee rather than elevating the expertise of the supervisor over the supervisee (Ceruti

& Ibaceta, 2014).

Taken together, these principles and the overarching attitude of service highlight a potentially confusing aspect of the supervisory model, which nevertheless must be accepted if one is to understand the whole system. Namely, the power relationship between the supervisor and the supervisee is manifested in paradoxical fashion. It is understood that due to their institutional role and greater expertise, the supervisor exercises more power in the relationship; indeed the model mandates that the supervisor unflinchingly accept the mantle of responsibility over the direction and outcomes of the supervision. At the same time, the supervision is directed to the supervisee’s needs, which presupposes that the supervisee is more important than the supervisor. This is perhaps an everyday paradox typical of many benevolent asymmetrical relationships, for example between parent and child. The supervision, however, layers an additional paradox of symmetry within the asymmetry owing to its belief in constructivism. For communication to be truly successful between two people, the meaning, of the interaction must be co-constructed equally by both parties. That is, both parties must acknowledge that they hold only a partial truth or vison of reality and both must give a little and open themselves to the other. Otherwise, one party is in the business of discounting the other’s reality and forcing them to accept theirs; this can produce compliance, but rarely learning or growth. This essential paradox, of symmetrical interactivity

within a framework of benevolent asymmetry, is at the core of understanding the subtlety of the supervisory work.

The Model in Practice

Practical realities are the supervisor’s first consideration. No successful supervisory process can begin until the supervisor takes stock of several factors: the safety of the client, the developmental level of the supervisee, and the community resources available to assist in the case. The safety of the client is paramount—if the client follows through on clear signs that they are a danger to themselves or others, then the supervision (and the therapy) has failed, regardless of anything else that happens in the session. During the supervisee’s presentation of the case, the supervisor gauges the level of client risk, and if high, the supervisor may be quite directive in instructing the supervisee what needs to be done.

This dovetails with the second practical consideration, the developmental level and effectiveness of the supervisee.

The supervisor is expected to be more directive with novice supervisees; whereas experienced supervisees are expected to formulate their own plan of action with more limited sup- port and direction from the supervisor. Finally, the supervisor must take stock of the relevant community resources present in the specific situation. If the client is seen in a clinic or agency setting, what are their relevant regulations? How thinly stretched are the available services? What other community organizations or government agencies can help the client meet their basic needs? What social supports (family/

friends/community leaders) can the client count on? All of these practical contingencies necessarily shape the contours of what can be done in this particular case and give implicit direction to the supervision.

Toward the beginning of the session, after reviewing data from any feedback measures completed by the client, the supervisee is asked to present the client case, which they have prepared beforehand using a templatized format. The supervisee’s case presentation concludes with their formula- tion of a problem or concern they have with the case¹ and a goal they would like to attain during the supervisory session.

The supervisor spends the next few minutes of supervision gaining specific understanding of the supervisee’s needs.

For example, the supervisor might ask any or all of the following questions:

• What would you like to obtain from this supervision?

1 Alternately, the supervisee could choose to discuss a problem in working with the clinical team or a general issue for themselves per- sonally, to similar effect.

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• How will I realize that this supervision has been useful for you?

• Is there anything special that I should be aware of?

• What do you not want for this supervision?

The supervisor might then ask the supervisee to share more of their thoughts and feelings about what concerns them about the problem they are having with the client.

Thus, this initial conversation, prompted by the supervisee’s presentation and guided by the supervisor, co-con- structs a specific goal (or target) for the present supervision session that will guide the whole encounter. The supervisor recognizes that this shared goal is paramount, as the therapeutic bond needs to be re-forged every session and the trust of the supervisee re-earned.

Once the supervisor has an intuitive sense of the contours of the problem or concern, their task is to influence the supervisee, within a relationship of trust and safety, to expand their awareness of their own part in the problem and to develop new courses of action they can take to address it. This process of influence proceeds via three main modes of interaction:

1. Supervisor Adjustment (Ajuste del supervisor)—The supervisor continually adjusts to what the supervisee brings to session, including their goals, conceptualiza- tion, skill level, etc. The supervisor remains alert to the supervisee’s verbal and non-verbal responses, which constitute important feedback regarding the effectiveness of the interventions carried out.

2. Co-construction of Meanings (Co-construcción de sig- nificados)—Since supervision is a dialogue between dif- ferent perspectives, the supervisor’s work is grounded in the world of the supervisee’s vision and needs. The supervisor then looks for meeting points between their own view and that of the supervisee and introduces opportunities for them to create new interpretations together.

3. Active Feedback (Retroalimentación Activa)—Within the session, both parties have an ongoing conversation about the supervisory process, with active feedback flowing in both directions. The supervisor gives feedback to increase the supervisee’s awareness and skills. In order to be effective, feedback should be specific, either in terms of making the supervisee’s resources (strengths) explicit or making a clear suggestion about behaviors that need improvement (Miller et al., 2017). At the same time, the supervisor is alert for both verbal and nonver- bal feedback coming from the supervisee in order to monitor the quality of supervision and to be mindful of potential damage to the more vulnerable supervisee.

At the conclusion of the session, the supervisor can specifically ask the supervisee, “Was this supervision useful to you? If I supervise you again, would you need something different from me next time?” Alternately, the supervisor can ask the supervisee for specific feedback regarding the supervisor´s interventions and/or check the learning that transpired: “Did you learn something new that helps you with your case/problem? What was it?”

Examples of the Model in Action

Example 1

The first case example (adapted and translated from Pesque- ira et al., 2019, pp. 36–38) concerns meta-supervision, in which the supervisee is, in turn, supervising a student therapist trainee.

As is typical, the supervisor (SVor) starts with a direct, structured question: What does the supervisee (SVee) want to achieve in the session?

SVee: I want to see an impasse that I had with a student, understand what happened and hopefully solve it.

The supervisor then askes the supervisee to elaborate...

SVee: I . . . I don’t like her, I find her super scattered and very difficult to understand . . . it is difficult to converse with her. I think she was resistant and probably needed a lot more validation from me to get what I was trying to say.

SVor: OK. I really appreciate the phrase "I don’t like her." I think saying that is very honest and it’s so good to be able to supervise from there, to help me to help you. Also, they are like those things that are unspeak- able. How are we going to dislike a patient? How can we dislike a pupil? . . . That is a super comment.

Note that the supervisor immediately praises and encour- ages the supervisees’ honesty, especially toward ostensibly negative or unacceptable feelings. Additionally, her negative feelings towards a client are normalized.

The supervisor then makes a rapid, intuitive decision about where to go at this point—whether to follow-up the personal emotional aspect (“I don’t like her”) or the interper- sonal aspect (“I think she was resistant”)—and then checks with the supervisee, both verbally and nonverbally—as to whether this direction seems profitable or not.

SVor: And tell me, what is difficult for you about her?

I go from the assumption that when one thinks ill of someone it is because it is difficult for them. . . . It’s not the only reason, but one of the reasons why we don’t like someone—because they are different and

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that gives us a lot of anxiety, because we don’t know what to do with that difference, then we don’t like it (...) What is difficult for you?

SVee: I believe that it is something right from the beginning, because from day one I was like, ‘She speaks, makes comments in the class where she begins to recount all of her cases and it must be stopped because it has no point.’ I don’t see the connection, no one sees the connection, no one in the group sees it. So, I see her making extremely little contribution.

At this point, the supervisor exerts influence in the session via intervision. At first the supervisor adjusts her intervention by adapting to the supervisee’s position and even exaggerating her view of the problem as located within the trainee, and from there to co-constructing new meanings that, by the end of the exchange, re-signify the “stupid”

actions as specific, contextual and interactional behavior.

SVor: So you find her super stupid.

SVee: But then I don’t find her so stupid all the time. I see that she does good reports . . . makes good clinical decisions.

SVor: Yes, yes, that’s good. And what does that tell you? That maybe it happens to her emotionally . . . What have you observed?

SVee: I don’t know, I imagine she gets anxious and it will make her very nervous in session.

Example 2

The second, previously unpublished, case example involves supervision of a therapist who has been getting discouraged with the lack of seeming progress with her client (in terms of the post-session outcome scores).

The supervisor makes an initial move to contextualize the scores to make them less threatening to the supervisee—to give the supervisee the space to discern their potential meaning for the client instead of getting consumed by what they may mean about her own performance:

SVor: The scores are not more important than what you are experiencing or assessing, learn to put them aside. It is difficult to tell you “use them” [the outcome measures] because they are a powerful tool, and then I’m telling you “put them aside”. Because the important thing in using them is not believing that they pos- sess the truth. They add information in the way that a projective test adds information, it is simpler as a num- ber, but what your patient can report is enormous. But you told me that it was difficult to obtain information from your patient about the measure. That when trying to inquire, the information was ambiguous.

SVee: Yes, very ambiguous. She gets pretty nervous and also, she is struggling with putting it into words . . . The first thing she told me is that she was a very demanding person and probably she scores poorly because she was a demanding person. In the outcome measures, she says she has always been feeling bad . . . and she tells me,

“This is the best I’ve ever been.”

SVor: The best therapy that she had ever had!!

SVee: No, not the therapy, this level of well-being.

SVor: So, this low score that I am marking—this is great for me, this is awesome. I see, because she’s been a lot worse before. And what does it tell you?

A bit later in the session, the supervisee returns to the interaction with the client over the outcome scores, which allows the supervisor to pick up on and highlight both the interactional meaning and the emotional problem for the supervisee:

SVee: She got that I was worried about not helping her well enough. I asked her what I’m not doing well and that I was really interested in helping her. And she was like this [makes impressed facial expression]. Well, let´s move to something else.

[ . . . ]

SVor: You’re trying to minimize what the patient told you and telling us, “OK, let’s go back to the focus”, no!

No, you need to stay there, and that is really hard for you.

I know that it’s very hard because they are giving you compliments. They are telling you, “It touches me that you are worried about me.” For you it seems much more comfortable to think that you are not doing well enough.

‘I am not helping her, this is not improving.’ That kind of therapist is easier for you. But the therapist that she is seeing is different that the therapist that you are seeing—

she is showing you that she is impressed that you worry about her and that not all professionals really do. That’s where you have to stop, that’s where you have to stay.

The direction for the remainder of the session is now set—the supervisor proceeds to challenge the supervisee to return to that moment of vulnerability with the client in the next session.

When the supervisee expresses being at a loss as to how to do that, the supervisor enlists the help of the supervision group to come up with possible ideas, but does not let the supervisee go until she has offered her own intervention in her own words.

Comparison to Other Supervisory Models

Bernard and Goodyear (2019) broadly outline three overarching categories of contemporary models of supervision: psychotherapy theory-based models, developmental models, and supervision process models. The Centro MIP model is definitely in the first category; its principles are

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theoretical assertions about what works in supervision that are grounded in various styles of psychotherapy. Although the supervisee’s developmental level is taken into account through the supervisor’s choice of behavioral tactics, the overall approach does not change; similarly, although a particular kind of supervisory process is integral to the Centro MIP model, it is not attention to the process itself that is the goal, but the supervisee’s therapeutic capabilities that are unlocked via this process. Within the universe of psychotherapy-based models, Centro MIP draws on a diverse set of theoretical orientations.

Certainly, the lines of influence from the Mental Research Institute’s (MRI) strategic and structural schools are clear- est to trace—to Hugo Hirsch and then to the first author.

However, resonances with other traditions can be discerned in the Centro MIP model, particularly in the valuing of the supervisee’s perspective shared by client-centered, strategic- eclectic, and constructivist approaches. It is important to realize that Centro MIP did not set out to adopt practices based on a study of theories of supervision; indeed the bur- geoning English-language literature on supervision had not yet penetrated the Chilean psychotherapy community by the time the Center began its work. Rather, Centro MIP came to its integration independently through force of circumstance.

It is only recently that the authors have attempted to sys- tematize what they have been doing. And, in so doing, they have been enlivened by reading of kindred spirits in other traditions who have arrived at many of the same conclusions.

As noted previously, Hirsch had a direct influence on the first author’s practice; in addition, he has continued to impart his ideas and practices to Centro MIP staff via consultations and supervision over the course of many years. His influence is more practical than theoretical; although he wove into his practice strands from Weakland and Fisch’s brief strategic therapy, Minuchin’s structural therapy, and especially de Shazer’s solution-focused therapy, he did not write exten- sively about these topics, nor was he particularly didactic in his supervision. In his own work, he exemplified an attitude of service, an orientation toward results, a trust in the supervisee’s resources, a willingness to challenge the supervisee to dare new possibilities, and an ability to redefine problems into opportunities.

From brief structural therapy, Hirsch borrowed a focus on results (Haley, 1974) and a close attentiveness to the interactional dynamics between supervisee and client (Weak- land, Johnson, & Morrissette, 1995). Notably, he did not share Weakland and Fisch’s supervisory style, which uti- lized teacher-student roles and was skill-focused rather than process-oriented (Fisch, 1988).

From structural therapy, he carried on the notion that the therapist needs to adapt to the client (and be influenced by them) in order to effect change and Minuchin’s encouragement of his supervisees to stretch themselves outside of their

comfort zones in order to be the kind of therapist a particular family needed (Reiter, 2017). In similar fashion to the Cen- tro MIP model, structural supervision holds that supervisors bear a deep sense of duty for their supervisee’s development and that the supervisor adapts to the supervisee in order to influence them (Tadros, 2020).

Finally, solution-focused therapy’s mark on Hirsch’s practice is evident in trusting in the client’s strengths, in redefining problems in a positive light, and in encouraging the client to take risks and do something different (de Shazer et al., 1986). These principles were then transferred to the supervisee in solution-focused supervision (Selekman &

Todd, 1995). Although a later development, it is interesting that some solution-focused supervision formulations share Centro MIP’s proscription against using explicit normative evaluations in supervision (Presbury, Echterling, & McKee, 1999). The Centro MIP and solution-focused models do diverge somewhat, in that Centro MIP’s supervision utilizes both problem-understanding and solution-generation rather than exclusively focusing on positive solutions.

As noted previously, similarities can also be discerned with client-centered, strategic-eclectic, and constructivist models. Rogerian supervision shares with client-centered counseling a principled nondirectiveness, a deep caring for the well-being of the supervisee and an absence of critical evaluation (Hackney & Goodyear, 1984). Although the Cen- tro MIP supervisor embodies the client-centered facilitative conditions (empathy, genuineness, unconditional positive regard), the process is not nondirective. The Centro MIP supervisor never loses sight of the goal of the session and the time remaining, and may thus choose to cut the supervisee’s process short in the interest of expediency.²

The strategic eclecticism advocated by Duncan and Miller (2000) takes common factors research seriously and rec- ommends that the therapist adapt not only their language and interactional style, but also their explicit mechanism of therapy, to what the client expects will work (Duncan, Solovey, & Rusk, 1992). Although Duncan and Miller do not explicitly apply the same principle to the supervisory context, it is not farfetched to see echoes of this approach in Centro MIP’s notion of supervisor adjustment.

The constructivist model of supervision articulated by Feixas (1992) and Guiffrida (2015) shares the use of client- centered facilitative conditions to create the desired supervisory relationship. To this, constructivist approaches add a procedure similar to Centro MIP’s own: the supervisee selects the problem or issue to discuss and is encouraged to

2 It is worthwhile to note that even Rogers occasionally steps out of nondirectiveness in a supervisory context, sometimes giving advice about what he might do in the therapist’s position (Hackney & Good- year, 1984).

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explore their own perception of (and thinking and feeling about) the problem. Supervisors in both styles also help the supervisee see the implications and limitations of their own perspective through exploration of alternative perspectives, and inviting the supervisee to experiment with—and evalu- ate the success of—new approaches to working with their client (Feixas, 1992; Guiffrida, 2015). The main difference is that Centro MIP juxtaposes the co-equal ‘travel partner’

position of the constructivist supervisor (Guiffrida, 2015) with the supervisor’s greater power and responsibility for ensuring that the supervisee reaches their goal.

Conclusions

It is our wish to impart to a global audience some small part of the learning and wisdom we have accumulated over the past three decades of providing and training our own brand of supervision in Chile. The first message is that it is not necessary to know where you are going to end up before you start on the path. We have embraced an organic process of developing a supervisory practice model—we first did what enlivened us and energized the therapists we trained, and then had to analyze what we were doing that was working.

Through the collection of systematic feedback from trainees, we have successively refined our model of practice, pursuing but never reaching excellence. Perhaps somewhat ironi- cally, the lack of existing standards for supervision in Chile prompted the Centro MIP to create its own standards and process of program evaluation—and emerge with a uniquely integrative supervision model.

We view supervision as a holistic service to the supervisee, a place of safety and exploration, striking a balance between supporting and challenging the supervisee that is largely experiential, felt, and never finished. The supervisor takes on the charge of unwavering leadership, responsible for the outcome but never fully in control of the process, and enters an intervision of perspectives with the supervisee, the other supervisory group members, and (indirectly) the client—all for the purpose of guiding the supervisee to use their untapped resources to be the person they need to be for this client. In the midst of this, the supervisor must always be sensitive to whether or not the current direction is produc- tive and helpful for the supervisee—and adjust their actions accordingly. We share the belief that just as supervision can be a powerful asset to therapists (Orlinsky & Rønnestad, 2005), it can also cause harm when it fails to sustain the therapist’s well-being or when it becomes an abusive vehicle of the supervisor’s power (Ellis, Taylor, Corp, Hutman, &

Kangos, 2017).

In contrast to the predominant Western view that supervision necessarily involves a dual role, that of facilitation/

growth vs. evaluation/gatekeeping, we propose that the

facilitative role is best served by limiting evaluation to formative feedback targeted to the clinical actions at hand, while keeping summative evaluation out of the supervisory session. While recognizing that summative evaluation and gatekeeping functions are essential to the health of the profession, we would argue that those functions can be served through other means and structures besides clinical supervision—for example, through ongoing administrative supervision with another member of the staff, periodic status meet- ings with the collective program faculty, and comprehensive skills-based examinations.

Funding The development of this manuscript was not supported by external sources.

Declarations

Conflict of interest The first author (MIP) is the majority owner of Centro MIP and would potentially benefit from increased public interest in its supervision program. The second and third authors (IR & PC) are employees of Centro MIP but do not otherwise have a financial stake in its operations. The fourth author (JWC) has no financial interest related to this article.

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