Standard II.C.3.b-c of the Standards of Accreditation (SoA) for internship program states that:
Interns receive at least 4 hours of supervision per week.
One or more doctoral level psychologists, who are appropriately training and licensed, are involved in ongoing supervisory relationships with an intern and have primary professional responsibility for the cases on which supervision is provided. The supervisor(s) must conduct a total of at least 2 hours per week of individual supervision with the intern during the course of the year.
The American Psychological Association (APA) uses the Bernard and Goodyear (2009) definition of supervision, which states that it is:
“…an interactive educational experience between the intern and the supervisor. This relationship: a) is evaluative and hierarchical, b) extends over time, and c) has the simultaneous purposes of enhancing the professional functioning of the more junior person(s); monitoring the quality of professional services offered to the clients that she, he, or they see; and serving as a gatekeeper for those who are to enter the particular profession.”
Intern supervision should make up 10% of the intern’s total hours each week. More details regarding the two types of supervision are provided below.
Primary Supervision #
Primary supervision is defined as individual, face-to-face supervision with a licensed psychologist who is involved in an ongoing supervisory relationship with the intern. Interns are assigned two primary supervisors and primary supervision is solely done by licensed psychologists on staff. The training director and primary supervisors are responsible for intern training and supervision, and have primary professional clinical responsibility as appropriate for the cases on which they provide supervision. When an intern splits time between site rotations, each primary supervisor maintains full order and control over the services provided while supervising at their assigned rotation. In the event that one primary supervisor is absent, the second primary supervisor maintains all clinical and legal responsibility for the psychology intern’s work. Two hours of individual face-to-face intensive supervision are required each week. Interns at some sites may receive more than the required 2 hours of individual supervision in order to meet the 4-hour supervision requirement.
The following activities are considered Primary Supervision:
Individual face-to-face supervision with a licensed Psychologist
Telesupervision
Must be conducted by one of the intern’s Primary supervisors.
Must follow the NPTC Telesupervision Policy.
Supervision focuses on profession-wide competencies, relationship building, clinical interview and intervention skills, application of theory to practice, and integration of the aforementioned functions with the intern’s developing professional style. It is expected that supervisors will spend time in the supervision session to review the intern’s goals and objectives for the year as set out in the ILTP, and use the questions on the Quarterly Evaluation as discussion points in supervision to elicit more information on the intern’s progression in the APA Profession-Wide Competencies. In order to enhance their ability to evaluate the intern in the supervision competency, all supervisors should especially make a point to discuss in regular supervision the intern’s knowledge of supervision models and the development of their identity as a potential future supervisor. Interns and supervisors should also be prepared to discuss what the intern is learning through the 2 hours of weekly journal review time.
The topics covered in supervision depends on the particular intern’s supervision needs in the moment—supervision can and will change throughout the year as the intern’s needs change. While supervision remains intense throughout the internship year, interns are afforded more autonomy as their skills progress.
Although interns are strongly encouraged to self-evaluate and to share that information with their supervisor when they find it helpful or necessary (i.e., when discussing counter-transference issues); disclosure of personal information is only required when the information is deemed to be pertinent to the intern’s ability to render services, is deemed to be interfering with patient interactions, or is thought to pose a threat to the intern or others.
Secondary Supervision #
Secondary supervision follows the definition of supervision listed above and is provided by both Primary supervisors (licensed psychologists) and Secondary supervisors (non-psychological personnel) to help foster interprofessional education and collaboration. All Secondary supervisors are required to be appropriately credentialed for their role/contribution to the program. Secondary supervision is provided to supplement the 2 hours of required Primary supervision to meet the 4-hour weekly supervision requirement. Interns may receive more of both supervision types provided that the first 4 weekly hours have at least 2 hours of Primary supervision.
The following activities are considered Secondary supervision:
Individual supervision with a Secondary supervisor
Telesupervision
Would need to be group supervision or conducted by a Secondary supervisor.
Would need to follow the NPTC Telesupervision Policy.
Group Supervision
Grand Rounds/Treatment Team Meetings
Supervisor who is a part of the NPTC system must be identified as the evaluator.
That individual is responsible for evaluating the intern’s participation in the meetings as well as providing additional feedback afterwards.
Content of the Grand Rounds and/or Treatment Team Meeting must include discussion of a patient currently being seen by the intern.
Co-providing services
Anything that both the psychology intern and supervisor do together, which may include intervention, assessment, group facilitation, etc., as long as there is evaluation of a training activity.
Professional Consultation/Meetings
Consultation or meetings in which the intern and supervisor participate together. The meeting or professional consultation must include evaluation of a training experience.
The intern’s Training Director and/or Primary supervisor maintains overall responsibility for all supervision that happens on site. This includes oversight and integration of supervision provided by other Primary and Secondary supervisors with psychological research and practice.
For more information regarding Primary and Secondary supervisors and Primary and Secondary supervision, please see the Supervision Cheat Sheet resource.
Making Up Missed Supervision #
It is the responsibility of the Primary supervisor(s) to provide appropriate accommodations to ensure interns receive all required supervision so as to not cause undue stress on the intern over the course of the year. In the event that supervision time is missed due to the intern consistently cancelling and/or missing supervision time, then the responsibility for rescheduling supervision would fall to the intern. As interns are required to receive at least 2 hours of primary supervision per week, that means there are only 2 weeks in the training year that allow for missing supervision due to illness or vacation in order for the intern to meet graduation requirements. Supervision makeups can include extra time added to the existing supervision schedule, additional supervision time with either or both primary supervisors, and additional secondary supervision (either group or individual). The type of supervision missed will determine the type of makeup necessary. Additional primary supervision is always acceptable; however, secondary supervision can only be used to make up missed secondary supervision. Reschedule supervision in-person or via telesupervision within 30 days.
Telesupervision #
Telesupervision is defined by the APA CoA Implementing Regulation C-28 as “clinical supervision of psychological services through a synchronous audio and video format where the supervisor is not in the same physical facility as the trainee.” It is NPTC’s policy to use telesupervision at member sites provided they follow the guidelines listed below:
Rationale:
Telesupervision shall be used to ensure intern access to a broader range of supervisors and increase expertise.
Telesupervision shall be used to mitigate intern travel requirements while maintaining maximum quality supervision.
Consistency with overall aims and training outcomes:
Telesupervision shall continue to provide the same content, structure, and philosophy as all other face-to-face supervision provided at member sites.
Time and frequency:
Regular telesupervision shall make up no more than one (1) hour of the minimum weekly individual supervision and no more than two (2) hours of the minimum total weekly supervision. Supervision above and beyond the minimum requirements may follow whatever supervision modality needed.
Telesupervision plans need to be approved in advance by the President/CEO. Requests need to include the following:
Rationale
The benefits for the intern and/or training experience
How the intern/supervisor would build a relationship at the outset of supervision
How the supervisor would maintain primary responsibilities for the cases under supervision
Telesupervision shall not be used in lieu of appropriate onsite supervision, but rather used to complement existing in-person supervision and mitigate travel concerns.
President/CEO maintains right to review and adjust telesupervision practice and implementation at sites in order to ensure maximum compliance and training integrity.
Trainee participation:
Any intern is allowed to participate in telesupervision provided their site can provide the supervision in adherence to the guidelines set forth in this policy.
Supervisor and trainee relationship:
At the outset of any supervisor relationship at least one (1) face-to-face meeting at least 1-2 hours in length shall occur within the first month.
Off-site supervisor responsibility:
All off-site supervisors must retain digital access to clinical cases using appropriate digital means (VPN, de-identified data that can be shared, etc.). This shall be coordinated between the site and supervisor prior to any supervision time.
Non-scheduled consultation and crisis coverage:
Interns shall always have access to other on-site supervisors for any consultation or crisis coverage that should arise. Telesupervision shall be seen as complementary to other services and two (2) hours or more of interns’ total weekly supervision time will remain face-to-face.
Privacy and confidentiality:
In order to provide telesupervision, member sites must ensure sufficient privacy of the synchronous audio/video to be compliant with all applicable guidelines (HIPAA, local agencies, etc.).
Technology requirements and education:
Prior to the onset of telesupervision appropriate training and testing of required technology must be provided/initiated by both parties.