Abstract
Clinical supervision is fundamental to the training and development of professional psychologists; however, no clear supervision methods have been developed, and the ideal competencies for psychologists and supervisors are yet to be defined. This lack of consensus is aggravated in the field of clinical neuropsychology supervision due to the dearth of literature available, which has an impact not only in the supervisory activities and the training of new professionals, but also ultimately in the quality of service provided to people that in many cases could be considered to be a vulnerable population. The theoretical background provided in this review covers conceptual developments and debates in relation to clinical supervision. Specifically, it reflects on the definition of supervision in the context of neuropsychology, as well as competencies and practices required in order to render supervision. A brief review of supervision in the field of clinical neuropsychology is included. Additionally, some insights are offered into the dearth of research and theoretical developments in this area. Finally, some comments are included in relation to the professional progress of clinical neuropsychology in developing countries, with particular reference to South Africa.
Clinical supervision
Conceptualisation
Clinical supervision (and supervised practice) is considered to be the pillar of the education and training of mental health practitioners (Falender & Shafranske, 2010). In fact, supervision has been identified as the core element in psychology training programmes (The Association of State and Provincial Psychology Boards [ASPPB], Task Force on Supervision Guidelines, 2003), promoting effective intervention and ethical practices (Wheeler & Richards, 2007).
According to Bernard and Goodyear (2009), clinical supervision is an intervention that takes place in the context of an evaluative and hierarchical relationship with the aim of improving the professional functioning of a junior practitioner and protecting the client’s welfare, by monitoring the service that is provided.
An empirical definition designed to be precise, specific, operationalised, and subject to corroboration is offered by Milne (2007), who states that supervision should be a ‘formal’ service provided by ‘senior/qualified health practitioners’ (p. 440). The author adds that this relationship should be time intensive and based on the principles of alliance, collaboration, confidentiality, and shared decision-making. He adds that the relationship should have a therapeutic quality, being emphatic and warm, and should not only have the aim of developing competencies, but also of enhancing the problem-solving abilities of the supervisee. All of this training takes places under the umbrella of professional and organisational management.
Milne (2007) systematises the functions of supervision in three aspects: quality control; facilitation and preservation of the supervisees’ competences and skills; and development of effective work practices. He emphasises that quality control includes a gatekeeping function, while the development of effective work practices includes the promotion of ethical standards, preservation of client safety, fostering of independent work and responsibility, development of professional identity, and enhancement of personal qualities (such as coping skills, resilience, self-awareness, learning skills, and critical thinking).
Todd and O’Connor (2005) state that most of the time, this collaborative relationship is conducted between a more experienced practitioner and a less experienced practitioner, but it can also be carried out between practitioners of equal seniority. Wheeler and Richards (2007) note that some organisations require their members to have supervision throughout their careers, while others encourage their members to seek supervision on a voluntary basis. These authors add that it is common for trainees to participate in supervision consistently. It is important to keep in mind that trainees are not necessarily students in the process of obtaining a qualification, but can include anyone who is seeking to gain skills and competence in a new area of the professional field.
Bernard and Goodyear (2009) explain that the main purposes of supervision are to offer support and education to the trainee to foster professional development and to monitor the clients’ welfare, which involves a gatekeeping function. Due to the nature of mental health professions, the supervisor needs to prepare the professional to work with a high degree of independence and autonomy, in order to make decisions based on highly specialised knowledge under conditions filled with uncertainty (Bernard & Goodyear, 2009). Todd and O’Connor (2005) give priority to the educational and supportive goals of supervision, subordinating the considerations of the clients’ wellbeing. They propose that clinical supervision should improve the quality of clinical practice, enhance the supervisee’s skills and capacity to meet professional and organisational standards, as well as to provide support and encouragement to the supervisee.
Clinical supervision also plays a role as a regulatory mechanism, providing skills and education in values and ethical principles to novice psychologists and assessing their readiness for independent practice (Bernard & Goodyear, 2009). Regulatory boards are in charge of regulating supervision practices. Although clinical supervision can also take place between registered or independent professionals, regulation from professional boards has been mostly directed to the period of formal training (such as practicums and internships). This regulation can be implemented in three ways: (a) delineating the qualifications of those who supervise; (b) establishing the amount of supervised practice that candidates must complete in order to become psychologists; and (c) stating the conditions under which the supervision should occur (Bernard & Goodyear, 2009).
A closer look at the local legislation reveals that only the first and third criteria are considered by the Professional Board for Psychology of the Health Professions Council of South Africa (HPCSA). HPCSA Form 104, referring to the ‘Criteria for the Training and for the Accreditation of Institutions Offering Training of Intern Clinical Psychologists’, section A, subsection 2, states that
Proper supervision of the intern’s work is essential and must be exercised by at least one full-time clinical psychologist with at least 3 years’ experience. [Note: for Clinical Psychologists Community Service may be counted as experience]. Such supervising clinical psychologist should accept the primary responsibility for the professional moulding of the interns. Under such guidance the interns must gradually be allowed to assume progressively greater responsibility. The supervising clinical psychologists must ensure that the candidate is registered as an intern clinical psychologist with the HPCSA. (HPCSA, 2009, p. 1)
This ‘moulding’ function is also highlighted by Tebes et al. (2011), who add that the supervisor has responsibility for the quality of the work and work life of the supervisee. They explain that this relationship should have a supportive quality, but that one party also holds authority over the work of the other. This is an important aspect because it addresses the organisational accountability that underlies the supervision process. This aspect of the relationship is addressed by annexure 12 of the ‘Rules of Conduct Pertaining Specifically to the Profession of Psychology’ from the Professional Board for Psychology of the HPCSA. The intrinsic responsibility of the supervision process is legislated by this document in two sections: ‘Delegation and supervision of psychological services’ (p. 23) and ‘Teaching, Training and Supervision’ (pp. 40–41), specifically in relation to the accuracy and objectivity in teaching, disclosure, and intimate relationships.
Beyond the educational and supportive functions of clinical supervision, there are also evaluative and administrative goals, through which the supervisor also fulfils a regulatory role within the organisation, helping it to achieve its goals and assess whether the candidate has the competencies to offer high-quality service. This has been called by the Association for Counselor Education and Supervision (ACES), Task Force on Best Practice in Clinical Supervision (2011) ‘administrative supervision’ (p. 1).
Administrative supervision sees the supervisee as an employee in an organisation (Hart, 1982 in Tromski-Klingshirn & Davis, 2007); hence, the supervisor acts as a manager who oversees case records, implements procedures and policies, participates in human resources activities such as hiring, firing, and performance evaluation; in short, the supervisor serves as the ‘boss’ in a clinical setting (Tromski-Klingshirn & Davis, 2007) and engages with the coordination of clinical services and evaluation systems (Kenfield, 1993, in Tromski-Klingshirn & Davis, 2007).
The administrative role of supervision has been debated and criticised. According to the Center for Substance Abuse Treatment (CSAT; 2008), many health centres direct most of their resources to client care, to the detriment of clinical supervision, which is basic to ensure a quality service. The supervisor’s role in many institutions is more administrative than clinical and even less part of staff development programmes. Furthermore, Tromski-Klingshirn (2007) asserts that clinical supervision provided by the administrative supervisor might elicit major ethical issues. According to this author, having the same person exercise clinical and administrative supervision creates space for conflicting roles and becomes an obstacle to conceptualise and operationalise clinical supervision per se and also to develop empirical research. Furthermore, Tromski-Klingshirn and Davis (2007) add that this dual role might mean that the clinical supervisor could be providing supervision in areas outside their scope and expertise.
Stucky, Bush, and Donders (2010) include another element with the potential for complicating the supervision relationship, which is the case of seeing the supervisee as a patient or doing supervisee psychotherapy. This can occur within approaches to supervision that aim to address personal issues of the supervisee in order to enhance self-awareness and understanding of their case dynamics.
Despite all the complexities described above, clinical supervision is very much appreciated by health care professionals, such as psychologists (Lucock, Hall, & Noble, 2006). Although valued, little is known about which characteristics of supervision are effective and, as a consequence, not many clear supervision methods have been developed (Kavanagh et al., 2003). The lack of standard guiding principles (both nationally and internationally) is problematic. Being a complex task and crucial in the training of professionals and the protection of the public, regulating bodies should stipulate some level of training in the particular psychological activity and prescribe more than simplistic guidelines for their practice (ASPPB, Task Force on Supervision Guidelines, 2003).
Due to the lack of global standards delineating what makes a good supervisor, as well as difficulties accessing training in clinical supervision skills, it is common practice that supervisors assume their roles based on seniority and/or professional abilities, which are basic aspects of this role. However, being a clinical supervisor entails a different professional role that requires a new set of skills and knowledge that are not normally formally provided to the clinicians taking on that responsibility (CSAT, 2008).
Supervisory competencies
Epstein and Hundert (2002) provide a widely used definition of professional competency: ‘the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community served’ (p. 226). Thus, professional competency not only includes clinical skills and scientific knowledge, but many other dimensions such as cognitive abilities to solve complex problems, integrative abilities to incorporate models and theories, relational abilities to communicate effectively, and affective and moral abilities (patience, emotional awareness).
Supervision, having its own theoretical framework and methodology, integrates a variety of personal and professional competencies that are specific to this activity (Falender & Shafranske, 2010). In Bernard and Goodyear’s (2009) words, ‘Having been a supervisee is itself insufficient preparation to be a supervisor’ (p. 5) and ‘to be an effective therapist is an insufficient prerequisite to being a good supervisor’ (p. 5).
Many efforts have been made to operationalise these competencies in the helping professions, often focused in particular areas of psychology practice, rather than necessarily in supervision. However, the relevance of these developments in the supervisory practice is critical since it informs and almost directs the supervision space in terms of its training aims. In particular, the American Academy of Clinical Neuropsychology (ACCN) has recently published a set of comprehensive guidelines for the practicum stage of professional training (Nelson et al., 2016), which are considered the first of their kind to delineate competency expectations for the initial levels of training in professional neuropsychology. The definitions for competency expectations presented by the ACCN are categorised into six levels (novice, basic, intermediate, advanced, proficient, and expert), which are operationalised based on supervision intensity. Novice practitioners require intensive supervision and expert practitioners would be the ideal providers of clinical supervision. These guidelines are pioneering the conversation on what the ideal competencies of the neuropsychologist are, and also what the level of professional expertise is required for supervisors in this field.
The CSAT (2008) identified three main objectives of clinical supervision: clinical, administrative, and evaluative. With these as guidance, this institution developed a model for supervision in the particular field of addiction that includes two different types of abilities: foundation areas and performance domain. According to this model, a foundation area includes the basic knowledge and concepts in supervision, such as theories, roles, modalities, leadership, supervisory alliance, critical thinking, and organisational management and administration. The performance domain is skill specific and incorporates essential abilities to protect the client’s welfare, improve clinical services, reach the organisation’s goals, as well as to provide professional development for staff. Counsellor development, professional and ethical standards, programmes development and quality assurance, performance evaluation, and administration are among the skills that form part of the professional domain. In this competency-based model, the supervisor is expected to achieve these competencies to master the supervision role.
However, the CSAT (2008) explains that supervisors working in particular settings must be knowledgeable and proficient in particular skills related to each health field. Nevertheless, accessing this training on a particular field is not always possible, forcing health professionals to search for related training among other fields.
This lack of training, plus the shortage of clinical supervisors in specialised fields, as well as the increasing emphasis on collaborative practice in social and health services can be considered as the main antecedents for cross-disciplinary practice. According to O’Donoghue (2004), this term is used to refer to the participation of practitioners from different disciplinary backgrounds (inside and outside the field of psychology) in clinical supervision of each other. This author asserts that these current practices are associated with political and ethical challenges. One challenge is associated with the issue of legitimisation, status, and the consequent construction of professional identity that cross-disciplinary supervision might shape. Although supervision during the internship is required to be carried out by professionals under the same category of registration (and such is the case with respect to South Africa and the HPCSA), those junior clinicians that practice in specialised areas (like clinical neuropsychology) sometimes seek post-qualification professional development with the assistance of senior professionals of different registration categories.
Particular reflections are made by Bogo, Paterson, Tufford, and King (2011) around inter-professional supervision for new practitioners, who revealed a desire to be more connected to their profession and with supervisors who can offer them career guidance and mentorship in the early stages of their career. Bernard and Goodyear (2009) highlight the socialisation function that supervision has. Thus, cross-disciplinary supervision has a particular impact on professional identities, especially those of independent psychologists.
In summary, two main issues are raised in the previous paragraphs: first, supervision as a particular professional domain requires particular training in specific competences. Second, the access to specialty-specific supervision is not always available; and in consequence there is an increase in cross-disciplinary supervision, which may be threatening the professional identity formation of novice practitioners and forming new professionals with competences that are not specific to their work field, which may be problematic when facing field-specific challenges.
Supervision in clinical neuropsychology
The topic of supervision has received increasing attention in many of the health providers’ professions, such as nursing, social work, counselling, and psychotherapy. Clinical neuropsychology has been an exception.
Undoubtedly, among the areas of teaching and learning of clinical neuropsychology, clinical supervision plays a fundamental role. It is an appropriate mechanism for ensuring the development of quality clinical competencies required for effective professional performance, cognisant of ethical principles, and relevant scientific and social relevance. Hence, it is a fundamental and privileged space, scientifically, professionally, and socially. Walsh (1992) highlighted several difficulties faced by neuropsychologists, which were affecting the development of the field in general. More than 20 years ago, he explained that professional development in this field can be best promoted by first-hand clinical experience that is accompanied by an experienced supervisor; however, he warned about the dearth of skilled supervisors in this area, especially in developing countries, a shortcoming that still remains.
Supervised practice is usually considered a mandatory aspect of clinical training. Roper (2009) suggested that the Houston Conference on Specialty Education and Training in Clinical Neuropsychology should be considered as guidelines that should be followed by programmes offering training in clinical neuropsychology. This document specified the skills and basic knowledge required for professional practice in clinical neuropsychology; supervised practice being only one aspect. The author warned that this document must be revised, emphasising the definition and development of competencies in clinical neuropsychology, which will have an impact on how supervisors should be trained, and what skills are particularly relevant for training neuropsychologists.
In a PubMed search, Stucky et al. (2010) revealed no publications that specifically addressed the training of neuropsychology supervisors. This highlights the dearth of available literature regarding teaching and supervising in clinical neuropsychology. Stucky and colleagues (2010) point out that neuropsychology supervisors have had to learn how to supervise without any additional training, due to the lack of specific programmes to develop supervisory competency for this branch of knowledge.
In this context, Stucky et al. (2010) established the following goals of supervision: ‘(a) the development of neuropsychological knowledge and skills, (b) critical thinking and decision making, (c) high-quality clinical care, (d) investment in career-long learning, (e) meaningful patient outcomes, and (f) development and fostering of essential attitudes for ethical practice’ (p. 740). Furthermore, they proposed a model for neuropsychological supervision based on a process approach in which the supervisor plays multiple roles (such as teacher, consultant, and administrator), all of them aimed at improving supervisee development and understanding of professional practice. The model is also based on a developmental approach that engages with the supervisee at their level of professional development and provides graded responsibility. The model also highlights the individual characteristics of each supervisee, in terms of strengths and weaknesses, for which the supervision must be individually tailored.
The model for neuropsychological supervision developed by these authors also outlines general supervisor expectations as well as the desirable qualities and the competencies of the supervisor and the supervisee. Although this model overlaps with the supervision models used in other branches of psychology, the authors emphasise the differences, in terms of process and content, between neuropsychology supervision and other specialties, such as the focus on the study of brain-behaviour relationship, and on standardised assessment and close (shoulder-to-shoulder) supervision in certain contexts. Stucky et al. (2010) conclude that neuropsychologists need to have special training in how to supervise other neuropsychologists, and this training should be included in educational programmes.
Clinical neuropsychology (and supervision) in a developing context: South Africa
The development of clinical neuropsychology as a speciality in the discipline of psychology has followed different timelines in various parts of the world. In developed countries, the progress of clinical neuropsychology as a profession has a long history that includes the creation of training programmes, research units, specialised scientific journals, professional organisations and registration, and professional meetings. As in other developing countries, such as South Africa, progress has been observed in research, but efforts to establish clinical neuropsychology as a distinct category of professional practice have met with challenges.
According to Watts (2008), the three main challenges that the neuropsychology discipline is facing in South Africa are ‘gaining specialist registration, making neuropsychology relevant for South Africa by developing appropriate assessment and intervention procedures as well as training neuropsychologists to provide these services and carving a niche for neuropsychologists in South Africa’s transformed health system’ (p. 373). These challenges are in addition to those shared with other scopes associated with the lack of resources common to the public health system.
In the past years, the training of neuropsychologists in South Africa has relied on an apprentice model, and only recently has a more formal education been introduced in the country. It could be argued that, at the moment, neuropsychological training is a contentious topic in South Africa.
The HPCSA (2008), in a document named ‘Practice Framework for Psychologists, Psychometrists, Registered Counsellors and Mental Health Practitioners’, recognised a new scope of practice for neuropsychologists: ‘Neuropsychologists assess, diagnose and intervene in psychological disorders of people experiencing neuropathology or compromised functioning of the central nervous system’ (p. 15). In 2011, a revised scope of practice for neuropsychologists was promulgated by the HPCSA (Government Notice No. R. 704, Government Gazette No. 34581; Government Notice, 2011).
Although this new scope of practice was promulgated initially in 2008 and more recently in 2011, before and since then, many health services (such as psychiatry, neurosurgery, and neurology) have been served mainly by clinical psychologists (and interns), some of them with strong neuropsychological foundations although this is not the case for all of them (Watts, 2008). Many psychologists with an interest in neuropsychology were practicing in this field, catered for under chapter 1, section 3, sub-rule 1 related to professional competence, in the Rules of Conduct Pertaining Specifically to the Profession of Psychology from the Professional Board for Psychology of the HPCSA. This section states ‘A psychologist shall limit his or her practice to areas within the boundaries of his or her competency based on his or her formal education, training, supervised experience and/or appropriate professional experience’ (p. 16); hence, the supervision space may be offering specialised training that is not otherwise available in the country.
No registration as neuropsychologist with the HPCSA has been available since the promulgation of the scope of practice. In August 2013, the HPCSA Newsletter announced ‘that after extensive consultation it was resolved at a meeting of the Executive Committee in February 2013, that neuropsychology and forensic psychology be recognised as separate registration categories for Psychologists’ (p. 2). According to this publication, a task team was constituted to revise some of the principles for registration as a clinical neuropsychologist. However, final resolution on this matter has not yet been reached. Furthermore, Government Notice No. R. 768 (Government Gazette No. 38048; Government Notice, 2014) published the intention to amend the regulations to the qualifications which entitles professional psychologists to register under the scope of practice of clinical neuropsychology, as per HPCSA’s recommendation.
The South African Clinical Neuropsychology Association (SACNA; n.d.) has played an important role in the promotion of clinical neuropsychology in South Africa, such as with training and fostering of professional cooperation and competencies in the area (according to its aims on: http://www.sacna.co.za/who.php). Although it does not play a regulatory role in the practice of the profession, those who wish to belong to this organisation are required to provide a formal account of their knowledge and experience in the area of neuropsychology. To apply for registration as a full member of SACNA, candidates must be registered with the Professional Board for Psychology of the HPCSA as psychologists and must have been registered continuously for at least 2 years, or have at least 5 years of supervised working experience in neuropsychological assessment and treatment. They must also be able to provide details about their competence in the field and prove such by passing SACNA’s knowledge examination. Candidates must also provide three comprehensive neuropsychological reports for examination. If these initial criteria are met, the candidate must then work under clinical supervision by a SACNA member for a period of 12 weeks. Having completed all of these requirements prior to registration, the candidate must pass an oral examination.
This list of requirements highlights two main elements. First, candidates must be training and practicing in the neuropsychology field in a country with reduced (or unavailable) training accredited by universities and the HPCSA. Second, clinical supervision is recognised as a basic training space for neuropsychologists, both before and after their registration with SACNA.
Training in professional clinical neuropsychology at Master’s degree level is scarce in South Africa, mainly as a consequence of regulatory delays. In 2012, two Master’s degree programmes were developed, by the University of The Witwatersrand (Wits) and The University of Cape Town, respectively, to train neuropsychologists to provide services and address the challenges described above. These programmes were approved by the Department of Education and accredited by HPCSA (Maraba, E., 2011, Maraba to M. Lucas, 1 March 2011; Maraba, E., 2011, Maraba to D. Foster, 7 June 2011); however, the HPCSA has not thus far provided a specific registration category for neuropsychologists, as was expected before the creation of the master degrees. As a consequence, students who were registered for the Wits programme had to adjust their training midway through the programme in order to be able to register as clinical psychologists in the interim until the new clinical neuropsychologist registration category becomes available (Sodi, T., 2012, Sodi to M. Lucas, 20 April 2012). Currently, due to this registration issue, the MA degree in Clinical Neuropsychology at Wits has been held in abeyance until further notice.
One could argue that the topic of clinical neuropsychology is included in other training programmes at the Master’s degree level, especially considering that before the Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-V) and now even more so, neuropsychology is a core feature of most of mental health training programmes. However, the lack of intensive training in neuroanatomy, cognitive psychology, and neurological and neuropsychological pathologies in the available programmes, and the fact that they do not require these subjects as a pre-requisite for application, strongly support the argument for considering the available education in neuropsychology rather scarce.
Additionally, no formal training in clinical neuropsychology supervision is available at present, which is a common situation in many countries that, in some cases, do not have clear regulations regarding different scopes of professional practice in psychology.
This situation contrasts highly with the current debates around neuropsychological competency in developed countries. Denney (2010) highlights the need for clinical neuropsychologists to pursue authentic professional competence instead of settling for basic levels of expertise. He explains that following a well-designed training programme in the particular field, as well as board certification carried out by expert peers will have a positive impact not only on the quality of service, but also in the credibility of the profession. Such is the case in the guidelines provided by the ACCN (Nelson et al., 2016), which facilitate the evaluation of the training programmes of supervisors and the training environment. Although it constitutes a foreign set of guidelines, it represents the first available step in the direction of systematisation of training in neuropsychology.
As shown in the previous paragraphs, the current training for clinical neuropsychologists in South Africa may be a very particular and interesting example of how in academia, research and professional practice, and clinical supervision should figure prominently in the discussion of this professional field. It stands to reason that the specific skills and competencies for neuropsychologists should somehow answer to an international standard, adapted to the local nuances. However, there are no detailed South African guidelines available, and almost no research in this area has been produced. Research regarding competencies in the area of clinical neuropsychology, and more specifically in supervision, is thus called for. Specially, there is a need for the study of skills that can be operationalised and hence subjected to measurement, critique, improvement, reinforcement, and communication between all stakeholders. This dearth has previously been raised as a concern (e.g., Watts, 2008). The availability of the registration category (along with the associated criteria) for clinical neuropsychologists could mark the beginning of this much needed line of research.
Final remarks
Stucky et al. (2010) state, ‘The value of a specialty is dependent on the provision of competent supervision to its trainees’ (p. 737). The power of this statement can be seen by its implications in professional training and quality of service. Supervisors are responsible for being aware of the relevant body of knowledge, skills, values, and personal attributes that they need to mould in their trainees. Furthermore, supervision is considered a speciality in its own right, which entails a variety of personal and professional competencies that are specific of this activity.
A supervisor is a highly skilled practitioner with substantial responsibility in the training of professionals and with a gatekeeping function. The ideal supervisor is aware of the desirable competences to be developed by novices and at the same time holds another set of competencies that makes him/her an effective supervisor. However, it is typical that seniority instead of formal training is the main criterion to become a supervisor. Furthermore, due to the lack of training in supervision and the shortage of supervisors in specialised fields (O’Donoghue, 2004) as well as financial limitations and complexities in accreditation processes (Stucky et al., 2010), there has been a slow development of training and supervision standards and a high proliferation of cross-disciplinary practice.
In clinical neuropsychology, cross-scope supervision is a common practice, especially in countries such as South Africa, where practitioners with clinical, counselling, and educational backgrounds have neuropsychology as a common field. This has a great impact not only on professional identity but also on the training process, which ultimately affects the quality of service. To achieve high-quality services in specialised areas (such as clinical neuropsychology), it is imperative that supervisors have a particular set of competencies adapted to the unique challenges of that profession (Stucky et al., 2010). This argument is particularly strong in South Africa where challenges and demands are nuanced due to the multicultural and multilinguistic landscape, the high incidence rates of traumatic brain injury (1.5–3.5 times that of the estimated global rate [Bryan-Hancock & Harrison, 2010]), the high percentage of people living with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS; UNAIDS, 2013), and the high incidence of alcohol and drug abuse (‘Substance Use and Abuse in South Africa. Central Drug Authority Briefing’, 2011). Hence, there is a great need for professionals with robust competence in dealing with compromised central nervous systems under these very special circumstances.
However complex and appreciated, little is known about which characteristics of supervision are effective or not and, in consequence, not many clear supervision methods have been developed (Lucock et al., 2006) although models have been proposed (Stucky et al., 2010). However, despite the relevance of this topic, not much has been written about supervision in clinical neuropsychology in comparison with supervision in clinical and counselling psychology (Stucky et al., 2010). One exception is the work by Dunbar-Krige and Fritz (2006), which, although in the area of supervision in counselling psychology in South Africa, recognises the contextual challenges and highlights the need for local reflections on the field of supervision. With particular reference to supervision in clinical neuropsychology, the dearth of literature demonstrates the unsettled nature of this discipline, and raises questions about professional training and knowledge bases of individuals providing neuropsychological services and supervision in some contexts, especially in those where formal training is not easily available.
It is therefore imperative to examine clinical neuropsychology supervision as well as to investigate how neuropsychological knowledge is conveyed between the boundaries of clinical neuropsychology and clinical psychology, especially in those contexts where the frontiers between these realms is not yet regulated, or even clear. Moreover, in many developed countries, special training is required to practice as a clinical supervisor. In developing countries, and particularly in South Africa, special training to become a clinical supervisor is not easily available and a great deal of the clinical training is gained in the supervisory space following an apprentice model (senior vs. novice practitioners). The apprentice model is one of the main historical contributions to clinical supervision and refers to a specific way of training where a student has the opportunity to learn from an expert by ‘observing, assisting, and receiving feedback from an accomplished member of the same field’ (Smith, 2009, para. 1). However, as mentioned earlier, being an accomplished clinician does not necessarily imply being a proficient supervisor.
Footnotes
Acknowledgements
Special thanks to Prof Kevin Whitehead (University of the Witwatersrand) for his contributions towards the conceptualisation of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.