Over the course of psychotherapy supervision history, the supervisor-supervisee alliance has increasingly emerged as a variable of preeminent importance in the conceptualization and conduct of the supervision experience: It has come to be embraced as the very heart and soul of supervision. But after a half century, what evidence do we actually have to justify that highly favorable outlook afforded to the alliance? What do we really know about the supervisory alliance? What do we need to know about it?
As we mark the first 50 years of supervisory alliance and look toward its future, I thought it might be useful to examine those questions and provide a current status report about the construct itself. In what follows, I (a) describe the two supervisory alliance visions that have been (and remain) dominant in the supervision literature and (b) provide a review of 20 plus years of supervision alliance research. While the supervisory alliance has accumulated solid clinical support, its empirical support appears to be more tentative and less robust. I consider why that is so, identify some missing elements in the alliance research conducted thus far and propose possible remedies to move inquiry in this area forward.
The relationship between psychotherapy supervisor and supervisee has long been a matter of concern in the supervision literature (Bernard & Goodyear, 2014; Falender & Shafranske, 2012). Even in some of the earliest writings about supervision, the importance of the supervisory connection, if not explicitly emphasized, appears to have been implicitly conveyed (e.g., Eitingon, 1923, 1926; Watkins, 2013a). In contemporary practice, the supervisor-supervisee relationship continues to be assigned a place of nuclear significance; as now conceptualized, it encompasses a host of substantive variables, including supervisory style, real relationship, transference-countertransference configuration, supervisee anxiety, and issues of difference and diversity (Beinart, 2012; Crook Lyon & Potkar, 2010; Rodenhauser, 1997; Toldson & Utsey, 2008; Watkins, 2011b). But of the various elements that compose the supervision relationship, none seems to exert more power and influence on supervisor and supervisee than their jointly-forged supervisory alliance.
Over the course of the last half century, the supervisory alliance—which tends to be thought of as the supervision equivalent of the psychotherapeutic alliance—has emerged as supremely significant in the conceptualization and conduct of the supervision experience (Bordin, 1983; Falender & Shafranske, 2004; Fleming & Benedek, 1964; Teitelbaum, 1995, 2001). The alliance has been increasingly embraced as the very heart and soul of supervision, and its potential impact on the supervisee change process and supervision outcome has generally come to be regarded as affecting and far reaching (Inman & Ladany, 2008; Ladany & Inman, 2012). Across psychology competency frameworks, the formation and management of the supervisory alliance has been made a core competency internationally (Falender, Cornish, Goodyear, Hatcher, Kaslow, Leventhal, & Grus, 2004; Fleming, 2012; Gonsalvez & Milne, 2010; Psychology Board of Australia, 2011; Roth & Pilling, 2008; Turpin & Wheeler, 2011). Regardless of the supervision model employed (e.g., psychotherapy-focused, social role models), form of treatment being supervised (e.g., individual, family), or type of population served, the alliance tends now to be recognized as pivotal in making the work of supervision possible (Falender & Shafranske, 2008; Hess, Hess, & Hess, 2008; Stoltenberg & McNeil, 2010; Watkins, 2012). Some supervision approaches may weigh the role of alliance more heavily than others (cf. Beck, Sarnat, & Baranstein, 2008), but its place in supervision appears to be uniformly acknowledged and accepted across varied models of conceptual understanding.
In this paper, I would like to shine a critical light on the supervisory alliance and to consider its current status and future directions. With the supervisory alliance having reached the half century mark, and being regarded as such a pivotal, transtheoretical construct in guiding supervision practice, I thought it might be a good time to “take stock” and examine two basic questions:
What have we learned about the supervisory alliance thus far?What do we need to know about it for our alliance knowledge and understanding to most fruitfully advance?
I will address those questions by (a) defining and describing the two alliance perspectives that dominate supervision theory, practice, and research; (b) reviewing the supervision research that has emerged over the past generation; and (c) developing an integrative picture of the present status and future needs of the supervisory alliance.
To best understand the supervisory alliance in a contemporary perspective, it is important to first look back, examine how the construct began to take form in psychological thought, and reflect on how it came to inform our views about “good” supervision. As with so much in psychotherapy’s origin and evolution, the alliance is typically viewed as having begun with Freud; that beginning also appears to have laid the groundwork for the eventual emergence of alliance considerations in supervision.
Although Freud did not specifically use the term “alliance” until his 1937 paper on analysis terminable or interminable, there is little question that his ongoing clinical work consistently revolved around matters of alliance. As Hatcher (2010) has nicely summarized: “Freud encountered alliance issues as soon as he began to use psychological methods with his patients.… we can identify as alliance issues his struggles to engage and keep his patients in treatment” (p. 8). In his writings, Freud (1913/1958, 1937/1964) made mention of the supreme importance of “a well-developed rapport”, pact, or compact between analyst and analysand for treatment advance. As his thinking evolved, the element of collaboration came to figure far more prominently into his vision of psychoanalysis (Hatcher, 2010). Building on those seminal concepts, other notable analysts such as Sterba (1934), Zetzel (1956), and Greenson (1965, 1967) introduced the terms of alliance, therapeutic alliance, or working alliance into the psychoanalytic lexicon, and the treatment relationship became increasingly conceptualized as a type of joint relational effort or therapeutic partnership. As the idea of a treatment alliance gained traction and acceptance in psychoanalytic thought, a related question soon emerged: How might the construct of alliance also apply to the psychoanalytic supervision relationship?
In the mid-1960s, Fleming and Benedek (1964, 1966) first proposed the concept of a learning alliance for psychoanalytic supervision, though they readily acknowledged Freud’s contributions in stimulating their own supervision alliance formulations.
The structure of both the analytic and supervisory situations is determined primarily by the goal which each participant expects to accomplish in their work together. These ultimate expectations, whether therapeutic or educational, orient the behavior of each member and guide their interactions through many vicissitudes. Expectations of giving and receiving help initiate a bond of trust and confidence between analyst and patient without which analytic work cannot proceed.… In supervision there exists the same necessity for acceptance of a mutually shared educational goal and the same need for confidence that the expectations of teacher and learner can be satisfied. The term learning alliance describes the essential characteristic of this relationship (pp. 52-53).
For Fleming and Benedek, the learning alliance—a supervision partnership, pact, or compact—was sine qua non for supervisor and supervisee to work profitably together.
Their vision of the learning alliance brought into focus the necessity of key features such as supervisor empathic perceptiveness and responsiveness, creation of a state of rapport in supervision, determination of a supervision goal or goals in common, and placement of learning tasks that stimulate goal accomplishment. The primary goals that provided guidance for supervision were: (a) insuring patient care; (b) enhancing the analyst’s knowledge; and (c) developing and enhancing the use of self as analytic instrument during the treatment process. Some of the learning tasks involved were: (a) the analyst/student’s working up case material for presentation in supervision; (b) the supervisor’s educational diagnosis of student’s learning needs for remediation; and (c) the supervisor’s sharing of instructive and corrective feedback. The Fleming/Benedek conceptualization accentuated, as never before, the ideas that supervision was itself a type of collaboration and the nature of that collaboration could be expected to substantially affect the entirety of the supervisory process and its eventual outcome (Watkins, 2011b). The concept of learning alliance has since heartily endured, proven quite durable down through the decades, and continues to be widely regarded as being of pivotal, nuclear significance for psychoanalytic supervision practice today (see Dewald, 1987, 1997; Frawley-O’Dea & Sarnat, 2001; Gill, 2001; Hyman, 2008; Kernberg, 2010; Oberman, 1990; Rock, 1997; Sarnat, 2012; Teitelbaum, 1990b, 2001; Watkins, 2013b).
As prelude to and model for his supervision working alliance conceptualization, Bordin (1979)—building on the work of Greenson (1967), Menninger (1958), Sterba (1934), and Zetzel (1956)—first proposed a highly heuristic, pan-theoretical vision of the treatment working alliance that hinged on three crucial components: The therapist-patient bond, the collaboratively established goals that guide the treatment process, and the collaboratively agreed-upon tasks that facilitate pursuit of goal attainment. In his presidential address to the Society for Psychotherapy Research, Bordin (1980) incorporated the importance of rupture and repair events into his alliance formulations (a substantive elaboration upon his earlier proposal). While the working alliance has long been a variable of preeminent concern in contemporary psychotherapy research, Bordin’s tripartite reconceptualization is credited with opening up untold possibilities for taking the alliance agenda into new and unexplored directions (Horvath, 2001); psychotherapy research across the last few decades has clearly borne strong testament to that reality (Lambert, 2013; Orlinsky, Ronnestad, & Willutzki, 2004).
Drawing on his treatment working alliance model, Bordin (1983) proposed a similar pan-theoretical vision of the supervision working alliance, which accordingly was composed of three core elements: The supervisor-supervisee bond, the collaboratively established goals that guide the supervision process, and the collaboratively agreed-upon tasks that facilitate pursuit of supervision goal attainment. As with the therapeutic working alliance, Bordin also envisioned rupture and repair events as playing a significant role in the development and maintenance of the supervision working alliance. The supervisor and supervisee bond was considered to involve their shared “feelings of liking, caring, and trusting” (Bordin, 1983, p. 36) and to “typically fall somewhere between… teacher to class members and therapist to patient” (p. 38). Bordin (1983) identified eight possible goals that could be used to guide supervision process:
mastery of specific skills; enlarging one’s understanding of clients; enlarging one’s awareness of process issues; increasing awareness of self and impact on process; overcoming personal and intellectual obstacles toward learning and mastery; deepening one’s understanding of concepts and theory; providing a stimulus to research; and maintaining standards of service (pp. 37-38).He also identified three tasks by which those goals could be pursued in supervision: (a) report (oral or written) prepared by the therapist of the hour or hours to be reviewed; (b) treatment session observation through audio-recordings, video-recordings, or live viewing; and (c) presentation of problems or issues in supervision selected by the supervisee (p. 38).
Like Fleming and Benedek’s conception of the learning alliance, Bordin’s conception of the supervision working alliance has proven highly durable, is embraced as being of pivotal, nuclear significance in much psychotherapy supervision practice, and is increasingly heuristic in stimulating supervision research (Inman & Ladany, 2008; Ladany, 2004; Ladany & Inman, 2012).
Fleming and Benedek focused their alliance attention on psychoanalytic supervision exclusively, whereas Bordin (while psychodynamically influenced) proposed a pan-theoretical alliance perspective. But as is clear from a reading of these two supervision alliance descriptions, both visions are highly similar in content—invoking a shared bond or rapport as requisite, shared goals as critical, and learning tasks as mandatory. While Bordin may have identified more goals overall, the goals across both visions are alike, as are the tasks involved in their pursuit. The essence of the Fleming/Benedek and Bordin supervision alliance proposals is much the same if not identical. In my reading, I have found that Fleming/Benedek’s learning alliance understandably appears far more apt to be familiar to and used by mental health professionals—particularly psychoanalysts and psychiatrists—who readily identify themselves as psychoanalytic, whereas Bordin’s supervision working alliance appears far more apt to be familiar to and used by mental health professionals—particularly psychologists, social workers, and counselors—who reflect a host of varied theoretical leanings. Exceptions can certainly be found, but if examined across disciplines, those differences appear to hold up quite well.
What then are the operational specifics that seem to cut across these two alliance perspectives in supervision? And how might those specifics be captured in a succinct but meaningful way? Based on my reading of the Fleming/Benedek and Bordin visions, some core features (after Rogers, 1957) that appear requisite for early alliance formation in supervision might best be formulated as follows:
Supervisor and supervisee are in psychoeducational contact (i.e., they are bound together by a matter of educational and psychological importance).
The supervisee, being in a state of educational incongruence, experiences both (a) vulnerability and anxiety about the process of learning psychotherapy and (b) openness and readiness to engage in that process with the supervisor. Educational incongruence can be defined as the perceived and actual dissimilarity between what learners know (real) and what they want or need to know (ideal).
The supervisor, being in a state of educational congruence, experiences openness and readiness to enter into the supervisory relationship with the supervisee. Educational congruence can be defined as the perceived and actual similarity between what supervisors know (real) and what they need to know (ideal).
The supervisor experiences the necessary psychological conditions (e.g., liking supervision, empathic attunement) and performs the necessary behaviors (e.g., verbal support, being fully present and available) that make alliance formation increasingly possible and communicates those conditions/behaviors to the supervisee.
The supervisee is receptive to and perceives the psychological conditions/behaviors offered by the supervisor.
The supervisee experiences the necessary psychological conditions (e.g., respect, desire to be supervised) and performs the necessary behaviors (e.g., verbal engagement) that make alliance formation increasingly possible and accordingly communicates those conditions/behaviors to the supervisor.
The supervisor is receptive to and perceives the psychological conditions/behaviors offered by the supervisee.
Supervisor and supervisee collaboratively discuss and identify possible goals for guiding the supervisory experience.
Supervisor and supervisee collaboratively agree upon and establish supervision goals to be achieved.Supervisor and supervisee collaboratively discuss and identify possible tasks by which supervisory goals can be pursued.
Supervisor and supervisee collaboratively agree upon and establish tasks by which goals will be pursued.
Supervisor and supervisee remain open to discussing their relationship and renegotiating the supervisory contract as needed.
While not exhaustive, those 12 postulates—which are explicitly stated within or suggested by the Fleming/Benedek (1964, 1966) and Bordin (1983) visions—paint a portrait of some essentials needed for supervision alliance formation to occur. Where compromise occurs at any point (e.g., a lack of openness or receptivity), alliance formation will be negatively affected and, in turn, can be slowed in its development and rendered less likely to occur. Approaches to considering supervision goals and tasks can conceivably be quite varied in scope, ranging from the more formalized and contractual to the relatively informal (see Alonso, 2000; Bordin, 1983; Gordan, 1996; Jacobs, David, & Meyer, 1995; Teitlebaum, 1990a). What appears most important is having a mutually clarifying discussion and reaching a mutually clarifying agreement.
The Fleming/Benedek and Bordin visions provide us with two highly similar ways by which to understand the supervision alliance and its development. Although having psychoanalytic provenance, the supervisory alliance has since been embraced as a construct of transtheoretical import (cf. Carroll, 2009, 2010; Farber, 2012; Hawkins & Shohet, 2012; Ladany, Friedlander, & Nelson, 2005; Levenson & Ladany, 2012; Reiser & Milne, 2012; Sarnat, 2012; Scaturo, 2012; Stoltenberg & McNeil, 2010; Watkins, 2012; Watkins & Milne, 2014). As now conceptualized in psychotherapy supervision, the supervision alliance has come to be viewed as the very heart and soul of the supervision endeavor itself. Extrapolating Bordin’s (1979, p. 253) propostions about the therapeutic working alliance to supervision, the following statements appear to capture current thinking about the transtheoretical applicability of the supervisory alliance:
All approaches to psychotherapy supervision involve embedded working alliances;Each supervision approach (e.g., psychoanalytic-focused versus cognitive-focused) involves its own type of alliance—possessing some unique features and characteristics that serve to differentiate and define it;
Supervision effectiveness appears to largely be a function of the strength of the working alliance between supervisor and supervisee; and
The strength of the supervisory working alliance is a function of closeness of fit between two intersecting sets of variables: (a) the inherent demands and requirements of the type of working alliance being implemented; and (b) the personal characteristics that supervisor and supervisee bring to and make manifest in the supervision situation.
In complementing the theoretical/practical material considered thus far, I would like to next examine the research that has been done on the supervisory alliance. The primary questions that I will address are: Across the last 20 plus years, what have we learned empirically about the supervisory alliance? What do we not know? What do we need to know? My specific focus will be on the supervisory alliance as studied in psychological treatment supervision (i.e., the supervision of psychotherapy or counseling)—as opposed to other forms of clinical supervision, such as occupational therapy or speech pathology, where psychological treatment is not the primary subject of concern. Psychological treatment supervision will be defined as: A “distinct professional activity” (Falender & Shafranske, 2004, p. 3) or “intervention” (Bernard & Goodyear, 2014) in which a senior professional (supervisor) serves as mentor or guide to a junior professional (supervisee) who is in the process of learning and practicing psychological treatment; its primary objective is enhancement of the supervisee’s professional functioning, it involves evaluation of that professional functioning by the supervisor, and it is a hierarchical monitoring process (supervisor to supervisee) that serves a protective function for both patients and profession (Milne, 2007; Thomas, 2010).
In a broad-based review of psychoanalytic constructs in psychotherapy supervision, I (Watkins, 2010) examined the features of 17 supervisory alliance studies (along with parallel process and countertransference research) appearing up through the early part of 2010. The focus, with one study excepted, was on the individual therapy supervision relationship (as opposed to group and marital/family therapy supervision). As part of this half-century retrospective, and in order to provide a more complete picture of where alliance research stands now, I would like to build on and render the alliance portion of the earlier review current. Although the primary alliance conclusions were recently made (and will be referenced in my discussion), the alliance portion of the review could benefit from updating for two reasons: (a) several important alliance studies that merit scrutiny were not included; and (b) in the last several years supervision alliance studies have shown a considerable comparative increase. In the earlier review, studies were not included for three reasons: (a) investigations were published at or shortly before the review’s close date; (b) investigations did not focus on the supervisory alliance as the primary variable of interest; and (c) investigations were missed due to oversight. I have attempted here to cast my net as widely as possible and include all studies where the supervisory alliance was a variable of interest in any way. As with the earlier review, my focus will be on individual supervision; it remains the most prevalently-used form of supervision learning—what Bernard and Goodyear (2014) have referred to as “the cornerstone of professional development.” Thus, to get the most contemporary, informed, and comprehensive picture of supervision alliance research, I subsequently consider the entirety of such studies done so far; to make that possible, I have taken material from Watkins (2010; with permission), identified missed and new research studies, and accordingly combined the two sources of research information for review purposes.
To identify those new and missed articles, four steps were taken: (a) PsycInfo, MedLine, Education Research Complete, and Google Scholar database searches were conducted using “supervisory alliance” or “supervision alliance” as the key search words; (b) reference sections of identified studies were examined to further identify other appropriate articles for inclusion that might have been missed (“ancestry approach”; Cooper, 1989); (c) supervision journals or journals that publish some supervision material were examined for any recent articles that might have appeared; and (d) recent supervision texts (e.g., Ladany & Bradley, 2010) were also examined to further find any other possible missed work. Based on those steps, a total of 24 new or missed studies was identified for inclusion, which were then combined with 16 of the earlier-identified studies (Watkins, 2010; the one study from that review on marital/family supervision [Inman, 2006] was not included here). The review time period spanned from 1/1990 through the early part of 2013. Each article was reviewed to determine: Setting/sample characteristics, measures used, procedure, analyses, findings/conclusions, and limitations/strengths. Table 1 provides a summary of those seven features for each study. Table 2 provides a more focused snapshot of study similarities across several selected variables of empirical import.
Table 1 . STUDIES OF THE SUPERVISORY ALLIANCE, 1990-2013| Study | Sample Characteristics | Measures/Assessment Used | Procedure | Analyses Used | Findings | Limitations |
|---|---|---|---|---|---|---|
| Bennett, BrintzenhofeSzoc, Mohr, & Saks (2008) | 72 MSW students in their field placements (26female, 5male; 80% White; mean age=32.5 years; demographics provided for only 30 individuals, not entire sample) | Working Alliance Inventory; Supervisory Styles Inventory; Relationship Scales Questionnaire; Relationship Structures Questionnaire (RSQ) | Survey packet containing questionnaires provided to trainees for completion | Multiple regression analyses | Supervision-specific attachments found to strongly predict supervision alliance perceptions; alliance rated least favorably by highly avoidant supervisees | Ex post facto design; focus on supervisees’ perspective only; self-report survey data;48% return rate |
| Bhat & Davis (2007) | 119 supervisors (80 female, 39 male; 108 White, 10 African-American, 1 Latino; x age = 50.5 years; 90 master’s degree, 21 doctoral degree, 8 other) | White Racial Identity Attitude Scale or People of Color Racial Identity Attitude Scale; Perceptions of Supervisee Racial Identity for White or Perceptions of Supervisee Racial Identity for POC; Working Alliance Inventory-Supervisor Version; demographic questionnaire | Survey packet containing questionnaires provided to all supervisors for completion | ANOVA | Racial identity status of supervisor and supervisee related to strength of supervision alliance (where identity status high for both, alliance rated more favorably; converse where identity status low for both) | Ex post facto design; self-report survey data; supervisors provided all ratings; no supervisee ratings included |
| Bilodeau & Lecomte (2010) | 31 supervisees (26 female, 5 male, x age=31.9 years), 13 supervisors (9 female, 4 male, x age=37.5); each student received five supervision sessions | Supervisory Working Alliance Inventory-T (SWAI-T; supervisee version); Supervisory Working Alliance Inventory-S (SWAI-S; supervisor version); Internalized Shame Scale (ISS) | At study’s outset, supervisees completed ISS and demographic questionnaire; supervisees again completed ISS after final supervision session; after each supervision session, supervisees and supervisors, respectively, completed SWAI-T and SWAI-S | Repeated measures ANOVAs | Supervisees rated alliance more favorably across all sessions compared to supervisors; supervisee shame-proneness had no effect on alliance ratings of either supervisee or supervisor | Only four individuals in high shame group; some supervisees shared same supervisor; one university sample; self-report survey data |
| Bilodeau & Lecomte (2012) | 43 supervisees (36 female, 7 male, x age=30.1 years); each student received five supervision sessions | Supervisory Working Alliance Inventory-T (SWAI-T; supervisee version); Internalized Shame Scale (ISS); Session Evaluation Questionnaire (SEQ) | At study’s outset, supervisees completed ISS and demographic questionnaire; supervisees again completed ISS after final supervision session; after each supervision session, supervisees completed SWAI-T and SEQ | Independent samples t tests; repeated measures analysis of covariance | Shame proneness affected supervisees’ alliance ratings across five sessions; highly shame prone supervisees rated alliance more favorably after first session but not after fifth | One university sample; self-report survey data |
| Bucky, Marques, Daly, Alley, & Karp (2010) | 87 clinical psychology doctoral students(74 female, 13 male; 72 White, 1 African-American, 5 Latino, 5 Asian-American; 64 students 20 to 30 years in age, remainder over 30; 26, 36, 16, and 9 students, respectively, identified as being in their second, third, fourth, and fifth year (or beyond) of training | Supervisee Evaluation of Supervisor Questionnaire | Students who had completed practicum or internship the previous year filled out online questionnaire | Frequencies determined | “The results of the study support the… importance of the supervisory relationship or working alliance…”(Bucky et al., 2010, p. 159). | Ex post facto design; frequencies only; self-report survey data from supervisees only |
| Burke, Goodyear, & Guzzardo (1998) | 10 supervisor-supervisee dyads (5 female, 5 male supervisors; 7 female, 3 male supervisees) from mental health center or counseling center settings; supervisees all pre-doctoral psychology interns | Working Alliance Inventory-Modified (WAI-M; parallel versions for supervisor and supervisee); Working Alliance Inventory-Modified Short Form (WAI-MSF; parallel versions for supervisor and supervisee); Session Evaluation Questionnaire (SEQ); outcome rating | Supervisor and supervisee completed their respective versions of WAI-M after first and last of ten audiotaped sessions; for sessions 2-9, supervisor and supervisee completed their respective versions of WAI-MSF and SEQ-M | ANOVA, t tests, audiotape coding | Supervisor ratings of alliance considered more stable and consistent than supervisee ratings; supervisee experience level appeared to affect alliance weakening and repair events | Still the only study to examine alliance rupture/repair events in process; multiple case study design |
| Chen & Bernstein (2000) 1 | 1 high-alliance and 1 low-alliance dyad selected from 10 supervision dyads overall (9 White female and 1 White male supervisees in first counseling practicum; x age=36; 6 White female and 1 white male doctoral student supervisors [in supervision course], x age = 33) | Supervisory Styles Inventory; Critical Incidents Questionnaire; Supervisory Working Alliance Inventory (Trainee and Supervisor Versions); Complementarity Indices | Questionnaires completed by supervisor/supervisee dyads prior to first supervision meetingand during the three supervision meetings held | Chi-square tests and correlational data | Higher degree of complementary interaction found in “high-rated alliance” dyad as opposed to “low-rated alliance” dyad | Relatively small sample pool Limited evidence to support validity of Complementarity Indices in supervision research Age and experience differences in high-alliance versus low-alliance dyads |
| Cooper & Ng (2009) | 64 supervisees (61 female, 3 male; 64% White, 28% African-Americans, 3% Latino, 2% Asian-Americans, 2% American Indian, 1% other; x age=33.8 years;) completing internship in community/agency-based sites; 64 supervisors (55 female, 9 male; 86% White, 9% African-Americans, 3% Latino, 2% Asian-Americans,; x age=46.7 years;) providing supervision to supervisee sample | Trait Emotional Intelligence Questionnaire-Short Form; Working Alliance Inventory-Modified (supervisee and supervisor versions) | Questionnaires packets provided to supervisor/supervisee dyads for completion | Hierarchical multiple regression analysis | Higher levels of emotional intelligence related to more favorable perceptions of supervisory alliance for both supervisee and supervisor, but no interaction effects found | Ex post facto design; self-report survey data; 36% and 26% response rate, respectively, for supervisees and supervisors; predominantly female convenience sample |
| Culbreth & Borders (1999) | 370 supervised substance abuse counselors (202 female, 122 male, 36 no response; 282 White, 65 African-American, 13others; x age = 41 years; recovery status=235 non-recovering, 123 recovering, 2 no response; 40% held graduate degree) | Supervisory Styles Inventory; Supervisor Rating Form-SV; Working Alliance Inventory (where “supervision” substituted for “counseling” in all items); Barrett-Lennard Relationship Inventory; supervision satisfaction items | Survey packet containing questionnaires provided to all substance abuse counselors for completion | Series of MANOVAs | Counselor or supervisor recovery status had no effect on supervision relationship variables; supervision alliance bond rated highly by counselors | Ex post facto design; self-report survey data; supervisee perspective only; one state survey |
| Davidson (2011) | 184 social work students enrolled in field placement (164 female, 20 male; 142 White/Caucasian; x age=29 years; respndents evenly split between foundation and advanced year) | Working Alliance Inventory-Trainee Version; Supervisor Self-Disclosure Index | Online questionnaires completed by all participating students | Correlations; multiple regression | More frequent supervisor selfdisclosures related to stronger supervisory alliance; certain types of supervisor disclosures (e.g., normalizing) most strongly associated with positive alliance ratings | Ex post facto design; self-report survey data; supervisee perspective only; 23% response rate |
| Deal, Bennett, Mohr, & Hwang (2011) | 100 field instructors (FIs)/supervisors: (93 female, 7 male; 70% White, 21% African-Americans, 6% Latino/Hispanic, 1% Pacific Islander, 2% biracial or other; x age =41.2 years;) 48 received training in Developmental-Relational Approach to Field Supervision, 52 did not (control group); 64 supervisees (59 female, 5 male; 80% White, 9.4% African-Americans, 3% Latino/Hispanic, 3% Asian-Americans, 5% biracial or other; x age =31.1 years) enrolled in year-long practicum with with supervisors | Time 1 supervisor assessments: demographic questionnaire, Working Alliance Inventory-Supervisor Version (WAI-SVOR), Competency-Based Evaluation (CBE); time 2 and 3 supervisor assessments WAI-SVOR and CBE; Time 1 supervisee assessments: demographic questionnaire, Relationship Scales Questionnaire (RSQ), Positive and Negative Affect Scale (PANAS), Working Alliance Inventory-Supervisee Version WAI-SVEE), Supervisee Levels Questionnaire-Revised (SLQ-R); time 2 and 3 supervisee assessments WAI-SVEE, PANAS, and SLQ-R | Supervisors receiving training completed assessments time 1 at beginning of first training session, time 2 at end of last training session, and time 3 at end of academic year; control group supervisors received mailed questionnaires at same times; supervisees also received their questionnaires at same times | Hierarchical linear modeling | Training led to more favorable perceptions of supervisory alliance on the part of supervisors but not supervisees; “approach appeared to help FIs improve the supervisory alliance from their perspective” (Deal et al., 2011, p. 722); supervisee attachment style had no moderating effect | Intervention study; randomized controlled trial; increased likelihood of Type I errors; lack of statistical power possible with some student sample results; self-report data |
| Dickson, Moberly, Marshall, & Reilly (2011) | 259 clinical psychology trainees (229 female, 25 male, 5 unspecified; mean age=28.6 years; 71% White British; 104 1 st year trainees, 81 2 nd year, 70 3 rd year, 14 th year, and 3 unspecified | Working Alliance Inventory; Measure of Parental Style; Reciprocal Attachment Questionnaire; Relationship Questionnaire | Online data collected from trainees across 28 clinical doctoral programs in Britain | MANOVAs; structural equation modeling | Trainees’ ratings of supervisory working alliance related to their perceptions of supervisor attachment style; replication of Riggs & Bretz (2006) | Ex post facto design; focus on supervisee perceptions only; self-report survey data; return rate not reported |
| Efstation, Patton, & Kardash (1990) 1 | 185 supervisors (69 female, 114 male, 2 unspecified; x age= 42 years; 122 clinical and 45 counseling psychologists, 12 other; outpatient clinics 33%, university/college counseling centers 31%; VAs 13%, psychiatric hospitals 21%); 178 supervisees (103 female, 73 male; 2 not specified; x age = 30 years) | Supervisory Working Alliance Inventory; Supervisory Style Inventory; Self-Efficacy Inventory | Questionnaire packets mailed out | Principal components factor analysis; hierarchical regression | Positive relationship found between supervisee self-efficacy expectations and perceptions of supervisory working alliance | Advanced practicum and intern-level students only |
| Gatmon, Jackson, Koshkarian, Martos-Perry, Molina, Patel, & Rodolfa (2001) 1 | 289 predoctoral psychology interns (203 female, 86 male; 73.4% European-American, 6.6% African-American, 5.9% Asian-American, 5.2% Chicano/Latino, 8% other) | Working Alliance Inventory; Supervision Questionnaire—Revised; Cultural variables questions | Questionnaire packets distributed | Frequency and correlational analyses, ANOVAs and MANOVAs | Positive relationship found between discussions of cultural variables in supervision and supervisees’ reported satisfaction with supervision and supervisory working alliance | Ex post facto design; self-report data; focused exclusively on perceptions of supervisees |
| Gnilka, Chang, & Dew (2012) | 232 supervisees (200 female, 30 male, 2 transgender; 78% White, 11% African-American, 3% Latino, 3% Asian/Pacific Islander, 5% biracial; x age=32.8 years) participating in practicum/internship across varied settings | Demographic sheet; Working Alliance Inventory-Short Form (WAI-S); Supervisory Working Alliance Inventory-Trainee Version (SWAI-TV); Perceived Stress Scale (PSS); Coping Resources Inventory for Stress-Short Form (CRIS-SF) | Questionnaires answered via web link by supervisees | Stepwise multiple regression analyses | Supervisee stress (where rated more highly) found to negatively impact perceptions of the supervisory alliance; coping resources (where rated more highly) found to positively impact supervisory alliance perceptions | Ex post facto design; self-report survey data; focused exclusively on perceptions of supervisees |
| Gunn & Pistole (2012) | 480 supervisees (393 female, 80 male, 83% Caucasian, 3,5% African-American, 2% Asian-American; x age=30 years; from master’s and doctoral counseling and clinical programs | Demographis questionnaire; Experiences in Supervision Scale; Supervisory Working Alliance Inventory-Trainee Version; Disclosure in Supervision Scale | Questionnaires distributed to graduate students via the Web | Structural equation modeling | Higher supervisory alliance ratings and higher disclosure in supervision related to higher supervisee attachment security to supervisor | Ex post facto design; self-report survey data; focused exclusively on perceptions of supervisees |
| Ladany, Brittan-Powell, & Pannu (1997) | 105 supervisees (81 female, 23 male; 1 unspecified; 71% White, 11% African-American, 5% Asian-American, 11% Latino, 3% other; x age = 29.9 years; clinical psychology 17%; counseling psychology/counselor education 71%;doctoral 43%, master’s 50%; university/college counseling center 38%, mental health center 22%, schools 27%) | Cultural Identity Attitude Scale; White Racial Identity Attitude Scale; Perceptions of Supervisor Racial Identity; Working Alliance Inventory-Trainee Version; Cross-Cultural Counseling Inventory—Revised | Questionnaire packets distributed to graduate training programs | Factorial MANOVA | Expected relations found between supervisees’ perceptions of racial identity interaction and supervisory working alliance | Ex post facto design; self-report survey data; focused exclusively on perceptions of supervisees |
| Ladany, Ellis, & Friedlander (1999) 1 | 107 supervisees (72 female, 35 male; 86% White, 7% African-Americans, 3% Latino, 2% Asian-Americans, 3% unspecified; x age =29.9 years; clinical psychology 36%, counseling psychology/counselor education 59%; doctoral 71%, master’s 29%; university/college counseling center 40%, mental health center 25%, VA 22%) | Working Alliance Inventory-Trainee Version; Self-Efficacy Inventory; Trainee Personal Reaction Scale—Revised | Questionnaire packets distributed | Multivariate multiple regression analysis | Emotional bond component of alliance significantly related to supervisee satisfaction with supervision | Ex post facto design; self-report survey data; focused exclusively on perceptions of supervisees |
| Ladany & Friedlander (1995) 1 | 123 supervisees (81 female, 42 male; 85% White, 8% African-American, 2.4% Latino, 1.6 Asian-American, 2.4% unspecified; x age = 30 years; 54% counseling psychology, 37% clinical psychology; 68% doctoral 27% masters; university/college counseling center 41%, mental health center 23%, VA 20%) | Working Alliance Inventory-Trainee Version; Role Conflict and Role Ambiguity Inventory | Questionnaire packets distributed | Multivariate multiple regression analysis | Expected relations found between supervisory working alliance and supervisees’ perceptions of role conflict and role ambiguity | Ex post facto design; self-report survey data; focused exclusively on perceptions of supervisees; advanced sample of supervisees |
| Ladany & Lehrman-Waterman (1999) 1 | 105 supervisees (82 female, 23 male; 84 White, 12 African-American, 5 Hispanic, 1 unspecified; x age = 30.4 years; clinical psychology 30%, counseling psychology/counselor education 67%) | Supervisor Self-Disclosure Questionnaire; Supervisor Self-Disclosure Index; Supervisory Styles Inventory; Working Alliance Inventory-Trainee Version | Questionnaire packets distributed | Univariate and multivariate regression analyses | Positive relationship found between supervisor selfdisclosure frequency and supervisory working alliance components (goals, tasks, and bond) | Ex post facto design; self-report survey data; focused exclusively on perceptions of supervisee; used supervisee recall |
| Ladany, Lehrman-Waterman, Molinaro, & Wolgast (1999) 1 | 151 supervisees (114 females, 36 males, 1 unspecified; 121 White, 12 African-American, 4 Latino, 1 Native American, 4 unspecified; x age = 31.5 years; clinical psychology 26%; counseling psychology 68%; 58% doctoral, 36% master’s; university/college counseling center 41%, mental health center 18%; schools 9%; prisons 4%; private practice 2%) | Supervisor Ethical Practice Questionnaire; Supervisor Ethical Behavior Scale; Working Alliance Inventory-Trainee Version; Supervisee Satisfaction Questionnaire | Questionnaire packets distributed to graduate training programs and training sites | Multivariate multiple regression analysis | Expected relations found between supervisee perceptions of supervisors’ ethical behaviors and working alliance components | Ex post facto design; self-report survey data; focused exclusively on perceptions of supervisees |
| Ladany, Mori, & Mehr (2013) | 128 supervisees (100 females, 27 males, 1 unspecified; 109 White, 5 African-American, 8 Latino/Hispanic, 3 Asian-American/Pacific Islander, 2 other, 1 unspecified; x age = 35.4 years; doctoral programs represented 58% clinical psychology, 29% counseling psychology, 5% school psychology, 9% other) | Supervisee evaluation of supervisor form; Working Alliance Inventory/Supervision-Short Form; Supervisory Styles Inventory; Supervisor Self-Disclosure Index; Trainee Disclosure Scale; Evaluation Process Within Supervision Inventory | Participants responded to questionnaires via web link; asked to reflect upon a “best supervisor” and a “worst supervisor” in responding | Series of multivariate analyses | Behaviors of best and worst supervisors identified; results supported supervision relationship as “foundational competency”, “important influence on supervisee learning”; concluded that effective supervisors foremost work toward developing a strong supervisory alliance | Primarily ex post facto design; self-report survey data; focused exclusively on perceptions of supervisees |
| Ladany, Walker, & Melincoff (2001) 1 | 137 supervisors (80 female, 55 male, 1 other; 119 White, 6 African-American, 3 Latino, 1 other; x age = 45 years; clinical psychology 18%; counseling psychology/counselor education 68%; 110 doctoral, 27 master’s; university/college counseling center 33%, mental health center 15%; academic 15%) | Supervisory Styles Inventory; Working Alliance Inventory-Supervisor Version; Supervisor Self-Disclosure Inventory | Questionnaire packets mailed | Multivariate multiple regression analysis | Positive relationship found between supervisory style and working alliance components | Ex post facto design; self-report survey data; focused exclusively on perceptions of supervisors; could not determine return rate |
| Livni, Crowe, & Gonsalvez (2012) | 37 supervisees (22 female, 7 male, 8 no response; modal age=45; 16 nurses, 5 psychologists, 1 social worker, 3 case workers, 2 addictions counselors, 10 other/unidentified); 10 supervisors (5 female, 5 male; 5 psychologists, 2 managers, 1 nurse, 2 unspecified); all participants from Area Health Service in New South Wales, Australia | Demographic questionnaire; Supervisory Working Alliance Inventory (parallel forms for supervisor and supervisee); Supervision Evaluation Questionnaire; Maslach Burnout Inventory; Intrinsic Job satisfaction Scale; Scales of Psychological Well-Being; California Psychotherapy Alliance Scale-Group-Modified | Supervisors received either individual, group, or individual/group supervision training; supervisees randomly assigned to individual or group supervision conditions; supervisees completed measures at baseline, again right before the start of their supervision (with the trained supervisors), and six months later | Repeated measures within groups design | Stronger supervisory alliance correlated with greater perceived supervision effectiveness; stronger alliance negatively related to burnout and positively related to job satisfaction and well-being in individual supervision condition | Infrequency of supervision sessions; self-report survey data; focused exclusively on perceptions of supervisees; absence of independent control group |
| Mena & Bailey (2007) 1 | 51 supervisors (47 female, 4 male; 49 White, 1 African-American, 1 other); 80 workers (all female; 69 White, 7 African-American, 3 Hispanic, 1 other) | Supervisory Working Alliance Inventory (Supervisor and Worker Versions); Minnesota Satisfaction Questionnaire; Maslach Burnout Inventory | Questionnaire packets distributed | Hierarchical linear modeling | Positive relations between alliance rapport and workers’ job satisfaction; negative relations found between alliance rapport and workers’ emotional exhaustion and depersonalization | Ex post facto design; self-report survey data; one point in time sampled |
| Mehr, Ladany, & Caskie (2010) | 204 supervisees (172 females, 28 males, 4 unspecified; 181 White, 2 African-American, 5 Latino/Hispanic, 2 Native American/Alaskan Native, 7 Asian-American/Pacific Islander, 7 other/unspecified; x age=29.4 years; graduate programs represented 67% clinical psychology, 23% counseling psychology; practicum settings represented 28% university/college counseling center, 21% mental health center, 21% hospitals) | Demographic questionnaire; Supervisee Nondisclosure Survey; Trainee Disclosure Scale; Working Alliance Inventory/Supervision-Short (Trainee Version); Trainee Anxiety Scale | Participants responded to questionnaires via web link | Chi-square analyses; multivariate multiple regression analysis | “…strong supervisory working alliance was related to a lower amount of trainee nondisclosure and a higher overall willingness to disclose in a single supervision session” (p. 110). | Ex post facto design; self-report survey data; focused exclusively on perceptions of supervisees |
| Newgent, Davis, & Farley (2004) | 15 doctoral students enrolled in supervision course (8 female, 7 male; 11 White, 4 non-White); each student received a certain number of individual, group, and triadic supervision of supervision sessions | Working Alliance Inventory (WAI; for measuring supervision of supervision alliance); Supervisory Styles Inventory (SSI); Supervisory Working Alliance Inventory-Supervisee Form (SWAI); Supervision of Supervision Evaluation (SSE) | Measures completed on each type of supervision received (individual, group, triadic) | ANOVAs | No significant alliance differences found between triadic and individual models or triadic and group models | Ex post facto design; self-report survey data; focused exclusively on perceptions of supervisees; small sample size; supervisee exposure to individual and triadic supervision highly variable |
| Patton & Kivlighan (1997) 1 | 75 graduate-level pre-practicum supervisees (53 female, 22 male; 64 European-American, 11 African-American; x age=27.7 years); 77 clients (59 female, 16 male; 69 European-American, 8 African-American; x age=20 years; compensated undergraduate volunteers) | Working Alliance Inventory; Supervisor Working Alliance Inventory (Supervisee Form); Vanderbilt Therapeutic Strategies Scale | “Clients” seen by beginning graduate-level students for 4 50-minute sessions; “supervisees” then seen for supervision session after each client meeting; time-limited dynamic psychotherapy the treatment focus | Hierarchical linear modeling | Positive relationship found between supervisees’ perceptions of supervisory working alliance and clients’ perceptions of therapeutic working alliance | Focused on self-report perceptions of supervisees and clients; “clients” were compensated undergraduate volunteers who had not actually sought treatment; videotape session data also rated |
| Quarto (2002) 1 | 72 supervisees (78% female, 22% male; 86% White, 6% African-American, 4% Hispanic, 4% Other; x age=33.5 years; university counseling centers 28%, agencies 21%, psychology clinics 3%, other 15%); 74 supervisors (61% female, 39% male; x age=44.4 years; 73% professionals in counselor education, counseling psychology, or clinical psychology, 23% other) | Supervision Interaction Questionnaire; Supervisory Working Alliance Inventory (Trainee and Supervisor versions) | Questionnaire packets distributed | Exploratory factor analysis One-factor ANOVA | Negative relationship found between supervision conflict and supervision working alliance | Ex post facto design; self-report survey data; perceptions sampled at only one point in time |
| Ramos-Sanchez, Esnil, Goodwin, Riggs, Touster, Wright, Ratanasiripuns, & Radolfa (2002) 1 | 126 practicum students and interns (73% female, 27% male; 79% European-American, 21% Other; x age =30.7 years) | Relationship Questionnaire; Working Alliance Inventory; Supervisee Levels Questionnaire-Revised | Questionnaire packets distributed | Correlational, MANOVA, and qualitative analyses | Expected relations found between supervisee developmental level, negative supervisory events, and perceptions of supervisory working alliance | Ex post facto design; self-report survey data; focused exclusively on perceptions of supervisee |
| Renfro-Michel & Sheperis (2009) | 117 graduate students (102f); even distribution of entry, prac and internship levels; variety of programs (school, counseling, rehabilitation, community, mental health) | Supervisory Working Alliance Inventory; Relationship Questionnaire; measured at mid-semester and end of semsester | Survey questionnaires completed | ANOVAs | Supervisee attachment related to alliance, with secure reporting better alliance than insecure at both mid and end of semester; supervisee development and working alliance unrelated | Ex post facto design; self-report survey data; of email signups 67.3% return rate in first semester, 54% return rate in second semester of data collection |
| Riggs & Bretz (2006) | 87 psychology interns (66female, 20male; 78% Caucasian; mean age=32.6 years; 78% clinical psychology interns, 17% counseling psychology interns, 2% school psychology interns) | Working Alliance Inventory; Measure of Parental Style; Reciprocal Attachment Questionnaire; Relationship Questionnaire | Online data collection | MANOVAs; latent variable path analysis | Perceived supervisor attachment style had most direct impact on supervision alliance; supervisees who viewed supervisor as being securely attached viewed supervisory bond and task more positively | Ex post facto design; self-report survey data; focus on supervisee perceptions only; 50% return rate |
| Schultz, Ososkie, Fried, Nelson, & Bardos (2002) | 111 employed rehabilitation counselors in supervision (68 female, 43 male; 101 White, 5 Hispanic, 3 Native American, 2 Asian/Pacific Islander) | Demographic questionnaire; Supervisory Working Alliance Inventory-Trainee Form; Rahim Leader Power Inventory | Questionnaire packets mailed to counselor/super-visees in two western states | ANCOVA and MANCOVAs | More time spent in supervision related to stronger supervisory alliance; higher supervisor scores on Expert and Referent power bases related to stronger alliance ratings | Ex post facto design; self-report survey data; focused exclusively on perceptions of supervisees |
| Sterner (2009) 1 | 71 mental health counselors either now being supervised or having been supervised post degree (48 female, 22 male, 1 no response; 90% White, 4% Latino-American, 1% Native American; x age=51; 83% held master’s degree, 17% doctoral; 39% private practice, 27% mental health agency, 16% private, nonprofit agency, 4% hospital, 14% other) | Supervisory Working Alliance Inventory-Trainee Version; Minnesota Satisfaction Questionnaire-Short Form; Occupational Stress Inventory-Revised | Survey questionnaire completed on Internet website by American Mental Health Counseling Association members (AMHCA) | Correlational analyses and canonical correlational analysis | Positively perceived supervisory working alliance related to greater work satisfaction and less work-related stress | Ex post facto design; self-report survey data; focused exclusively on perceptions of AMHCA supervisees; unclear how many “supervisees” were not actually in supervision and how long they had not been |
| Sumerel & Borders (1996) | 40 graduate-level counseling students (26 female, 14 male; 20 beginning and 20 advanced trainees; 37 White) | Supervisory Working Alliance Inventory-Trainee Version (SWAI-T); Impact Message Inventory IMI); Session Evaluation Questionnaire | Trainees watched either a videotape of supervisor addressing interfering supervisee personal issues or of supervisor addressing supervisee skill deficits in supervision; participants then completed three measures | Correlations; ANOVA; MANOVA | Negative relationship between Rapport (SWAI-T) and Dominance (IMI) | Analogue study; ex post facto design; self-report survey data; focused exclusively on perceptions of supervisees |
| Walker, Ladany, & Pate-Carolan (2007) 1 | 111 female graduate student supervisees (91 White, 9 African-American, 4 Asian, 3 biracial, 3 Latina, 1 other; x age =31 years; 18% clinical psychology, 70% counseling psychology; university/college counseling centers 58%, mental health centers 18%, schools 6%; VAs 5%; state hospitals 5%) | Gender-Related Events Survey; Working Alliance Inventory-Trainee Version; Trainee Disclosure Scale | Questionnaire packets distributed | Multivariate multiple regression analyses | Supportive gen derrelated events found to be positively related to supervisory working alliance; converse found for non-supportive gender-related events | Ex post facto design; self-report survey data; focused exclusively on perceptions of supervisees; could not determine response rate |
| Webb & Wheeler (1998) | 96 counselors in supervision (75 females, 20 males, 1 unspecified; 44 in diploma or master’s training; all registered in British Association for Counselling) | Sensitivity to disclosing in supervision assessment tool; Supervisory Working Alliance Inventory (supervisee version) | Questionnaire packets mailed to counselors for completion | Correlations and factor analysis | Positive correlation found between supervisees’ ratings of alliance rapport and willingness to disclose in supervision | Ex post facto design; self-report survey data; focused exclusively on perceptions of counselor/supervisees; 44% return rate |
| Wester, Vogel, & Archer (2004) 1 | 103 male psychology interns (93 White, 9 Hispanic, 1 African-American; x age =33.3; 64 doctoral students 35 master’s) | Gender Role Conflict Scale; Supervisory Working Alliance Inventory-Trainee Version; Counseling Self-Estimate Inventory | Questionnaire packets distributed | t tests ANOVAs | Male supervisees working with male as opposed to female supervisors perceived supervisory working alliance less favorably, lending initial support to possible male socialization explanation | Ex post facto design; self-report survey data; focused exclusively on perceptions of supervisees |
| White & Queener (2003) | 67 supervision dyads: Supervisees–56female, 11male; 59 master’s students, 8 doctoral students; 80% first year of training through internship; Supervisors–47female, 20male; 55 licensed professionals, 12 doctoral students | Supervisory Working Alliance Inventory; Adult Attachments Scale; Social Provisions Scale | Supervisees and supervisors completed survey packet containing questionnaires | Simultaneous regression analyses | Supervisors’ ability to form close, healthy relationships predictive of supervisees’ and supervisors’ perceptions supervisory working alliance; weaker relational ability and unfavorable alliance perceptions related and vice versa | Ex post facto design; self-report survey data; 50% return rate |
| Williams, Helm, & Clemens (2012) | 131 mental health therapists employed full time in community mental health agencies (83 female, 48 male; 106 White, 19 Hispanic, 1 Native American, 2 multiethnic, 3 other; 50 social workers, 11 marriage and family therapists, 40 professional counselors; 7 psychologists, 17 unlicensed professionals); received at least one hour of supervision per month | Childhood Trauma Questionnaire; Five Factor Wellness Inventory-Form A; Supervisory Working Alliance Inventory-Supervisee Form; Job Satisfaction Survey; Quantitative Workload Inventory; Trauma and Attachment Belief Scale | Questionnaires administered (in random order) to participants’ at their work sites | Path analysis | Anticipated partial mediating effect of supervisory alliance on vicarious traumatization not significant | Ex post facto design; self-report survey data; limited range of scores on alliance measure may have negatively affected results; very limited amount of supervision upon which to base alliance ratings |
Note: ANOVA = analysis of variance; MANOVA = multivariate analysis of variance; ANCOVA = analysis of covariance; MANCOVA = multivariate analysis of covariance.
Reprinted and adapted with permission of the Association for the Advancement of Psychotherapy. Watkins (2010), Psychoanalytic constructs in psychotherapy supervision. American Journal of Psychotherapy, 64, 393-416.