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 principal supervisors and primary supervision is solely done by licensed psychologists on staff. The training director and principal 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 principal supervisor maintains full order and control over the services provided while supervising at their assigned rotation. In the event that one principal supervisor is absent, the second principal 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 Principal 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.
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.
Principal Supervisor #
A principal supervisor is a licensed psychologist who is formally assigned to an intern(s) or who regularly interacts with the intern(s) in a meaningful long-term way (i.e., Assessment Supervisor, Group Supervisor).
Responsibilities:
Provides regular supervision
Completes the Quarterly Intern Evaluations, ILTPs, Mock Supervision, Critical Analysis, and/or approves timesheets
Shares knowledge from their field and their experience with the intern(s) as applicable
Complete yearly CV update
Training Requirements:
Must attend Supervisor Orientation and complete Supervision Training Courses as necessary. They will have 60 days to complete the Supervisor Orientation Homestudy if they cannot attend orientation on the scheduled day.
Typically, the CE trainings from NPTC will be free.
Secondary Supervision #
Secondary supervision follows the definition of supervision listed above and is provided by both Principal supervisors (licensed psychologists) and Ancillary supervisors (everyone else) to help foster interprofessional education and collaboration. All Ancillary 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 an Ancillary supervisor
Telesupervision
Would need to be group supervision or conducted by a Ancillary 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 Principal supervisor maintains overall responsibility for all supervision that happens on site. This includes oversight and integration of supervision provided by other Principal and Ancillary supervisors with psychological research and practice.
For more information regarding Principal and Ancillary supervisors and Primary and Secondary supervision, please see the Supervision Cheat Sheet resource.
Ancillary Supervisor #
Responsibilities:
Provides shadowing opportunities for interns
Provides secondary supervision (not including Group Supervision)
Shares knowledge from their field and their experience with the intern(s) as applicable
Complete yearly CV update
Training Requirements:
Not required to attend Supervisor Orientation or complete additional Supervision Training Courses.
NPTC reserves the right to assign training courses as needed if a licensed psychologist.
The CE trainings from NPTC will be offered at a discounted rate (25%).
If called to Principal Supervisor status, we will need a 30-day notice before the change is official so that training requirements can be assigned.
Making Up Missed Supervision #
It is the responsibility of the Principal 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 principal 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-15 I as “supervision of psychological services through a synchronous audio and video format where the supervisor is not in the same physical location as the trainee.” It is NPTC’s policy to use telesupervision at member sites provided they follow the guidelines listed below:
Specify how many of the 4 hours of required supervision may be provided via telesupervision and via in-person supervision;
Telesupervision may be provided up to 100% of required weekly supervision provided by any supervisors.
At least two times per month the intern must receive in-person check-ins/individual supervision by a principal supervisor.
Sites may provide any level of telesupervision that is above and beyond the required four hours of supervision each week.
Specify how many hours of individual and group supervision may be provided via telesupervision and via in-person supervision;
Individual supervision may be provided up to 100% telesupervision weekly provided that at least two times per month the intern is receiving in-person individual supervision.
Group supervision may be provided up to 100% telesupervision weekly.
An explicit rationale for using telesupervision;
Telesupervision may be used to ensure intern access to a broader range of supervisors and increase expertise.
Telesupervision may be used to mitigate intern travel requirements while maintaining maximum quality supervision.
How telesupervision is consistent with their 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.
How the program engages in self-assessment of trainee outcomes and satisfaction with use of telesupervision versus in-person supervision;
At the end of each quarter, interns will provide feedback regarding supervisor accessibility and support which the Site Training Director and Regional Training Director will review.
The Site Training Director will initiate quarterly meetings with interns receiving telesupervision to assess their overall satisfaction with their supervision experience.
How and when telesupervision is utilized in clinical training;
For any site providing more than 50% tele-supervision (for total supervision OR individual supervision), written plans need to be approved in advance by the Sr. VP of Clinical Operations. Requests need to include the following:
Rationale
Frequency of telesupervision
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
How they plan to assess intern satisfaction with the telesupervision process
On-site support for the intern.
Sr. VP of Clinical Operations maintains the right to review and adjust telesupervision practice and implementation at sites in order to ensure maximum compliance and training integrity.
How it is determined which trainees can participate in telesupervision;
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.
How the program ensures that relationships between supervisors and trainees are established at the onset of the supervisory experience;
At the outset of any supervisor relationship there will a planned connection time between supervisor and supervisee(s). This can be conducted virtually or in-person. The purpose of this time is not for supervision specifically, but to have an additional planned time (1-2 hours) to establish a connection prior to supervision.
The same applies for group supervision, but the connection time would be between the supervisor(s) and all members of the group rather than individual meetings.
How the supervision relationship is facilitated, maintained, and monitored for ruptures;
Telesupervision will continue to follow the same process for relationship development and monitoring as all other face-to-face supervision provided at member sites.
For all telesupervision requests that are more than 50% of intern supervision time, there will be regularly scheduled (at least quarterly) meetings that focus on relationship building/connection/engagement for individual supervision as well as group supervision.
In the event of any relationship rupture or conflict, NPTC reserves the right to request an increase of in-person supervision either temporarily or permanently.
How an off-site supervisor maintains full professional responsibility for clinical cases;
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 will be coordinated between the site and supervisor prior to any supervision time.
How non-scheduled consultation and crisis coverage are managed;
Sites are required to always provide access to other on-site supervisors (primary or secondary) for any consultation or crisis coverage that should arise.
How privacy and confidentiality of the client and trainees are assured;
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.).
The technology and quality requirements and any education in the use of this technology that is required by either trainee or supervisor;
Prior to starting telesupervision appropriate training and testing of required technology must be provided/initiated by both parties.
How it ensures that supervisors are competent to provide telesupervision
For any supervisor who is providing more than 50% tele-supervision, the site Training Director must attest to the supervisor having tele-supervision training and/or skills within the first 60 days of the supervisory relationship.
What circumstances would lead to changing between telesupervision and in-person supervision; and
Sites may choose to offer telesupervision for any reason noted previously in this policy and as approved by NPTC, including but not limited to, intern travel concerns, providing access to a broader range of supervisors, a requested change in supervisor, etc.
Sites may also be requested to increase in part or entirely to in-person supervision should NPTC note any concerns with the intern support or ruptures in the supervisory relationship that are not able to be adequately addressed through telesupervision.
How are diversity, equity, inclusion, and accessibility issues considered and addressed.
Prior to initiating a telesupervision relationship, the site Training Director will ensure that the appropriate technology to succeed in telesupervision is provided to both the intern and the supervisor that would meet all accessibility concerns.
As noted in the technology education section, all parties would be responsible for testing the technology and attending the appropriate trainings on how to use the available technology.
Accommodations and considerations will be made for interns with disabilities which could result in tele-supervision being inappropriate or inaccessible (i.e. hard of hearing). In these instances NPTC would work with the site to find alternative solutions that allow for appropriate supervision and support.
Sites and supervisors would follow the same DEI considerations through telesupervision as with all other face-to-face supervision provided at the member site.