7The Role of Deliberate and Reflective Practice in Fostering Responsible Caring in Supervision

Jon Amundson, Marc Ross, Dalal Shaheen

Introduction—Jon

Jean Pettifor and I worked together for over 20 years in a variety of areas. Supervision, the preparation of students, interns, or supervises for entrance into the profession was one such area. To honour Jean, who was always there to open doors for her students, and for a current perspective on supervision and the development of deliberate and reflective practice, I asked two of my former junior colleagues or supervisees to contribute to this project. Marc is in independent practice in Calgary and writes a regular column for Psymposium, the official publication of the Psychologists Association of Alberta, on early-career issues for psychologists. Dalal is finishing post-graduate and licensure work in the U.K.

We were asked to select one of the ethical principles in the Canadian Code of Ethics for Psychologists of the Canadian Psychological Association (CPA) (CPA, 2017), and to apply it to supervision. We selected Principle II (Responsible Caring) and have connected it to deliberate and reflective practice (Brookfield, 1998), an essential skill related to ethics in general, and to responsible caring in particular. Each of us reflects upon the methods, means, and modes employed in fostering responsible caring through deliberate and reflective practice as an acculturative exercise (Bashe et al., 2007), as the internalization of the ego ideal or inner heroic imagination (Franco et al., 2009), as fostering mindfulness (Campbell et al., 2012), and finally, as the development of contextual know-how (Flax, 1990).

Responsible Caring in Supervision—Jon

At the time of my preparation and entrance into the profession, supervision was initially less than well-structured and defined (Amundson, 2008a). My early supervision was a top-down affair, where the supervisor knew best, and the supervisee was to conform to the supervisor’s personal definitions of practice. In my initial work as a supervisor in the 1980s, the experience would be more akin to what I today would call training—almost exclusively, assistance in mastering a model of treatment or assessment. Attention to ethics, generic human relation skills, administrative responsibilities, and socio-cultural considerations were all but absent. Due to salient landmarks in the professionalization of supervision, this is not the case today.

Several articles have addressed the matter of supervision in Alberta (Amundson, 2008a, 2008b, 2009a, 2009c; Van Mastrigt et al., 2008). Into the 21st century, the majority of supervisors had virtually no specific training in supervision nor access to guidance (Amundson, 2008a). As a corrective measure, two actions were taken: (a) the Psychologists Association of Alberta in partnership with the University of Calgary designed an online course (Amundson, 2008b); and (b) two senior psychologists (Dr. Walter Goos and me) were appointed as supervision consultants for the College of Alberta Psychologists. The purpose of the first action was to offer a training opportunity to individuals interested in becoming more competent and confident as supervisors; the second action was to provide consultation to both supervisors and supervisees on supervision issues. Dr. Goos and I referred to these actions as “repairing the ship at sea” because, like most jurisdictions in North America at the time, there were more students, interns, and supervisees than available supervisors (Amundson, 2008a). Hence, to impose a higher standard (i.e., specific preparation or standards for supervisors) too quickly ran the risk of running actual and potential supervisors out of the business.

Supervision also began receiving greater attention in other parts of North America. In 2004, Falender and Shafranske published their first text on competency-based supervision. In 2006, the American Psychological Association began publishing the Journal of Training and Education in Professional Psychology, and the competency approach to supervision grew (Fouad et al., 2009; Hatcher & Lassiter, 2007). The competency approach spoke to specific skills, their development, and measurement of their progress during the process of supervision. It was a move away from a top-down and supervisor-dominated approach to one based on mutually identifiable goals and objectives, and it established structure regarding content and evaluation in supervision (Hatcher et al., 2013). The focus on what works and how to measure it in supervision paralleled the movement in professional psychology toward the empirical criterion for clinical practice. Supervisors began to structure supervision around the concept of functional and foundational principles (Rodolfa et al., 2005).

In my work with both supervisors and supervisees, I emphasize what is referred to as the (basic) competency cube (Rodolfa et al., 2005). For individual psychologists in training, the question is what each of them will be; that is, what functional skills each wishes to acquire. I speak of functional skills, then, as part of professional identity, particular to each psychologist within the broad scope of practice psychologists enjoy. Functional skills include treatment and intervention, assessment and evaluation, consultation, and teaching and training (including skills in supervision, research, and administration). These are concrete aspects of responsible caring. They are elective; that is, specific to whatever supervisees seek to define as their particular scope of practice. However, of equal, and perhaps even greater, importance are foundational skills.

Foundational skills are common and necessary for all psychologists: They are expressive or normative aspects of responsible caring. This is reflected in questions I always ask myself regarding any potential supervisee: “Can this student or supervisee be trusted to be in a position of authority and influence with a potentially vulnerable patient? What is his or her capacity for responsible caring?” Whether working as a therapist or organizational consultant, foundational skills are primary and shared by all. In my work with supervisors, I speak of functional skills as more conceptual in nature (e.g., mastery of manual-based treatment, testing protocols, or particular statistical methods). Of foundational skills, I speak of a more dynamic emphasis, because competency here pertains to human relation skills, self-knowledge and awareness, appreciation of ethics and public policy, and the embracing of empiricism and even skepticism, as well as cultural and larger systemic considerations.

I emphasize the importance of foundational skills such as engagement, appreciation of socio-economic and cultural differences, motivational concerns, and treatment receptivity. It is with foundational skills that clinicians truly approach responsible caring, and where responsible caring emerges in deliberate and reflective practice (DeAngelis, 2018; Rousmaniere, 2016; Rousmaniere et al., 2017). Before discussing responsible caring and its development in supervision, however, it is important to speak to responsible caring on the part of the supervisor. Responsible caring is not a one-way street and, with the statement attributed alternatively to Rumi or Gandhi, I admonish supervisors to “be the change here you want there.” This means that the supervisor needs to model responsible caring and be deliberate and reflective in this regard. One method for internalization of ethics is social learning, consisting of modelling and observation, behavioural rehearsal, imitation and, finally, enactment (Bandura, 2017; Bandura & Walters, 1963). Supervisees are watching supervisors to see what they practice and what a psychologist looks like. For this reason, the central place of the supervisee in supervision cannot be overemphasized. Each student, intern, or supervisee is an N of 1—possessing a unique set of instrumental, normative, and expressive skills. Hence, appreciative inquiry by the supervisor is one way to demonstrate responsible caring.

Supervisors often call me and ask, “What is it I ought to do, prioritize, or put in place to make supervision work?” In response, I have found that it is helpful to provide the following four deliberate and reflective perspectives (Amundson, 2008a). First, understand and attend to both the administrative and process aspects of supervision. This involves: having in place a well-thought-out supervision plan and making clear the contractual responsibilities of both the supervisee and supervisor; being attentive to the process as it unfolds and making modifications accordingly; and seeking feedback on the relevance of the supervision to the goals of the supervisee, essentially being aware of what both the supervisor and supervisee are doing and why.

Second, provide feedback progressively (Amundson, 2009b). Nothing should take a supervisee by surprise. Supervisors often speak to me about their concerns regarding a supervisee who is approaching the end of a supervisory relationship with them. I ask how and in what manner they have communicated any of their concerns to the supervisee, and whether they have entered their concerns into the supervision record. Timely and useful feedback, though at times awkward for each party, is important.

Third, be creative in providing opportunities to incorporate not only foundational skills and experience into supervision, but also functional skills (Amundson, 2008b) For example, I often write (as with this chapter) with my younger colleagues and supervisees, so they are exposed to research as a functional skill area. Regarding foundational skill exploration, it is important not to simply wait for opportunities to discuss ethics, or systemic appreciation, or self-care, or cultural issues in supervision; rather, the supervisor needs to create such opportunities.

Finally, as with treatment, it is important to meet supervisees where they are (Prochaska & DiClemente, 2003), and to work in a collaborative, co-operative sense (Amundson, 2008b). Though the supervisor must exercise authority and responsibility, the hierarchy involved ought not be emphasized. The authority of supervisors is best exercised as editors, assisting supervisees to develop their own personal way of being in the profession (Parry & Doan, 1994).

Responsible Caring as Deliberate and Reflective Practice—Marc and Dalal

In our own training, we found that the creation of opportunity in supervision includes not only deliberate effort to develop functional skills but also opportunity regarding the foundational. In what follows, we discuss vehicles for bringing foundational skills to life—fostering more deliberate and reflective practice as a path to responsible caring. People have to walk before they can dance. The goal, however, in deliberate and reflective practice is to move beyond basic pedestrian application of clinical skills to greater and more creative professional judgement and execution.

Supervisees and students, in the process of learning to become professionals, have many opportunities to practice and learn the art of deliberate practice. One of the most important aspects of our growth as psychologists was the time we spent in conversation with supervisors on the theme of what it means to care responsibly. This occurred in various ways and included writing or using other creative ways of expressing insights, curiosities, and struggles.

Ideally, such self-reflection occurs throughout one’s career. However, it should be afforded special attention in one’s early career, so that one has a solid foundation for reflecting upon foundational skills. For instance, during supervision and consultation, Jon would occasionally provide space for us to share a challenging life event unrelated to the process of learning therapy; that is, our personal struggles related to our exceptional status as disabled or culturally distinct persons. Feedback on these reflections would be done kindly and respectfully, but directly, and would often be accompanied by an explanation of how supervision is different from therapy. This process of reflection was done in such an artful and mindfully non-judgemental way that we learned not just from the practical detail that was shared, but also from the way it was communicated, providing opportunity to see the process from several new vantage points (Paré & Larner, 2014).

To master our craft, however, such reflection also was supported by deliberate practice with each client. Case review is not unlike athletic training, involving a repetition of actions aimed at progressive improvement (Dreyfus & Dreyfus, 1980). We found that this progression goes from the safety of structure, routine, and automatic response to what is called contextual know-how (Flax, 1990). This development in supervision involves thinking, and then thinking about thinking—the ability to understand the minimal skills required for the practice of psychology, and then being able, when required, to think outside the box and execute at a more optimal level.

There are several ways to acquire deliberate and reflective competency, and the responsible caring it sponsors. Below, we present some of these options; namely, seeing supervision as acculturation (Bashe et al., 2007), internalized ideals (Zimbardo, 2007), mindfulness (Campbell & Christopher, 2012) and, finally, the contextual know-how associated with proficiency (Dreyfus & Dreyfus, 1980; Flax, 1990).

Professional Acculturation and Responsible Caring—Jon, Marc, and Dalal

In becoming a professional, there are “some thinks only a psychologist can believe” (Amundson, 2018, p. 1) and must do. These include learning the codes, standards, and guidelines defining conduct, and the habits and behaviours a psychologist must acquire on the way to independent practice. Navigating this process can be thought of as acculturation—the assimilation of a new culture (Handelsman et al., 2005).

When visiting a new culture, people often are exposed to beliefs, behaviours, and practices that are different from their habitual worldview. Sometimes they perceive deviance in those differences. As with any new cultural experience, there are four possible responses (Handelsman et al., 2005, pp. 60-61):

1. Rejection of the psychological ethos and adherence more exclusively to one’s own beliefs and experiences: “What I believe is more important than what they believe.”
2. Over-assimilation of the culture of psychology such that one’s own values, experiences, and beliefs are discounted: “What they believe is more important that what I believe.”
3. A third but rare response, where neither personal values nor the values of psychology are significant: “What do I need to believe to rationalize, justify, or defend my actions, situation to situation?”
4. Finally, and the preferable expression of deliberate and reflective process, assimilation of the culture of psychology and its accommodation to one’s own experience, beliefs, and values: “How do I balance what they believe with what I believe?”

Marc and Dalal found supervision and consultation to be an intriguing, if not inspiring, exposure to the culture of psychology, and a means of examining their values. Supervision is, as well, exposure to the demands associated with and required for professional identity and practice. Demands refer to the ethical and behavioural expectations placed upon the psychologist that are different from those placed on members of society in general. Supervision is not, however, a conversion experience. Supervision is an opportunity for the supervisor to honour what each of us brings as supervisees and to use our inner resources in our development. Parry and Doan (1994) compared this process to editing—supervisors creatively interacting with supervisees to assist them in the realization of their own personal and professional means of expression.

We all agree that it also is helpful to explore personal values and the habits of thought and behaviour associated with professional psychology, discussing the impact of the supervisee’s exposure to how the discipline is practiced (Amundson, 2015), with such questions as:

• What have you found in the profession that has surprised you?
• What are things you found in the profession that you did not expect, or expected to find but did not?
• What moral or ethical dilemmas can you recall in your life or in others’ lives?
• What has been the most useful, interesting, or unusual learning experience so far in your training?
• If you were speaking to someone who was interested in the psychology profession, what would you want the person to know?
• What life experiences have you had that you think will be useful in the future in your work with other people?
• What sorts of lapses or failures in ethical reasoning or conduct have you seen or experienced? (Fifty percent of supervisees describe negative experiences in supervision as well as observed lapses in ethics in psychologists to whom they are exposed; Amundson, 2008a).

As clinicians, the three of us found that these sorts of questions, when they are explored within a secure supervisor–supervisee or consultant relationship, demonstrate responsible caring by the supervisor who, in seeking such input, may then be prompted to guide or react in greater deliberate and reflective ways (Knapp et al., 2017). For example, in Jon’s experience, psychologists-in-training often are surprised that colleagues and older psychologists sometimes fail to practice outside the consulting room what the supervisees observed them practice with patients in the consulting room. Sometimes supervisees find experienced psychologists to be opinionated, abrupt, dogmatic, overbearing, less than supportive, and even condescending with each other; or, as one young psychologist-to-be who wishes to remain anonymous reported, “I thought psychologists would be different.” Supervisees’ idealized images of psychology as a means of rising above the interpersonal conflicts associated with everyday life become dashed upon the reality of business as usual (Amundson, 1995).

In conclusion, the three of us believe that effective supervision, as reflected in professional acculturation, celebrates what each party brings to the table. Within supervision, professionalization should be viewed as a complex, dynamic, and ongoing accommodation, serving as a means for the development of deliberate and reflective practice.

The Turn Inward: Guidance from the Internalized Hero—Jon, Marc, and Dalal

Zimbardo (2007), in his professional career, sought to understand the contextual nature of good and evil, and purports that ethical concerns often begin and end with situational forces. The Canadian Code of Ethics for Psychologists (CPA, 2017) in general, and particularly in Principle II (Responsible Caring), espouses the view that ethics must be more than simply a risk management strategy. The directions, both aspirational and prescriptive, found in the Code serve their best purpose when internalized; that is, when they truly serve as habits of thought, leading to and reflected in day-to-day behaviour. The reason such internalization becomes so important is because of the potential external pressure to behave unethically that may be embedded in some situations, and the capacity of internalization to override such pressures and serve psychologists’ best judgement (Zimbardo, 2007). In his role as ethics investigator, Jon often finds that, in a lapse of conduct or care, the excuse is that “It is what everyone does,” or “Well, the lawyer (or parent, or co-worker) wanted me to do it,” or “It was just a business decision.” The external forces associated with day-to-day practice related to expediency, finances, the need to maintain a patient referral base, opportunity, personal stress, organizational culture, crisis or emergency, and other demands, can overpower the internal forces associated with ethical consideration and better judgement. However, for Zimbardo, ethics codes and guidelines are not enough to overcome such forces. Franco and Zimbardo (2006), in the Heroic Imagination Project, state that thoughtful attentiveness can override contextual pressures and result in small but significant differences in psychologists’ day-to-day experience. They advocate for deliberate and reflective attention to daily circumstances and to the morality associated with virtuous and heroic stances (Franco et al., 2009).

In pursuit of deliberate and reflective thinking, psychologists need to acquire an inner ideal (Cornwell & Higgins, 2015), or “hero,” with values that can be linked to an ego ideal (e.g., “What would Dr. Pettifor do?”). These introjects—people who live in our head—can be sources of inspiration that drive a moral intensity that calls forth our better selves and may override contextual pressures. Regardless of whether the virtue being pursued is in the personification of a particular individual, elevating ethics from an external structure for circumstantial regulation to an inner dynamic for self-regulation is a goal in supervision as well as in practice (Handelsman et al., 2009).

In pursuit of an internal antidote to contextual pressures, we learned that the following questions are useful:

• How do we negotiate differences and conflicts in our lives?
• Are we more risk averse or more risk accommodating in our work?
• Who do we admire, not only in our profession but also in history?
• What stories do we have of ethical struggles and choices we made, as clinicians or otherwise?
• What made us proud of ourselves in our lives or in our profession?
• How can we pass on these moments to those we train when it is our turn to train or supervise?

The Turn Toward the East: Mindfulness and Its Role in Fostering Intrapersonal Responsible Caring—Jon, Marc, and Dalal

Through our experiences with supervision, the three of us have found that responsible caring, like Principle III (Integrity in Relationships) in the Code (CPA, 2017), is predominantly related to interpersonal issues. These issues encompass primary attention to recipients of professional services and deference to their interests, vulnerabilities, competencies, and right to receive effective psychological service. In the intrapersonal domain, psychologists are reminded not only to continue to remain competent and practice skillfully, but to pursue self-reflective and critical (i.e., deliberate and reflective) thinking regarding their “own values, attitudes, experiences and social context” (CPA, 2017, p. 18). The Code encourages self-care as well (Amundson, 2009b). This intrapersonal dimension of responsible caring pertains to one’s own well-being, and it is in this light that mindfulness becomes relevant to supervision.

Mindfulness, like the theory of mind in philosophy and mentalization in psychodynamic psychology, is essentially thinking, knowing that one thinks, knowing that others think too, and then thinking about that (Noone et al., 2016). Mindfulness has been associated with benefits to clients when practiced by their mental health practitioners, making it a skill for new psychologists that would be beneficial to responsible caring for others (Campbell & Christopher, 2012; Goldberg et al., 2013; Knowles, 2008). Specific to the context of supervision, Follette and Batten (2000) speak of supervisor and supervisee attunement, and the modelling of a non-judgemental stance. Mindfulness also has been associated with the working alliance in supervision, and with increased self-efficacy in the student (Keil, 2016). Finally, Davis (2014) found that mindfulness led to the cultivation of attitudinal, cognitive, and social skills. His research supports the role of mindfulness in personal and professional development.

Beyond the practical benefits of mindfulness to treatment and training is an argument that mindfulness can sponsor greater ethical commitment and conduct (Purser & Milillo, 2015; Ruedy & Schweitzer, 2010; Shapiro et al., 2012). Mindfulness seems to integrate the foundational skills and to support deliberate and reflective practice, which are active components of responsible caring (Jacobowitz & Rogers, 2014; Shapiro et al., 2012).

Marc and Dalal speak of mindfulness as being threefold: (a) interpersonal, in the sense that it benefits the therapeutic and supervisory relationship; (b) intrapersonal, in the sense of it providing exercise in developing more critical, clinical, and ethical perspectives; and (c) in a more immediate intrapersonal sense, as means of self-regulation. For the most part, mindfulness in clinical practice is associated with management of emotional distress. However, as a self-care skill for the psychologist, it can assist with managing clinical tension. By clinical tension, we think of the demands associated with case formulation, engagement, intervention, and deliberate attention to process and outcome. Cognitive exertion is required and needs to be developed. Responsible caring as self-care can become more than admonitions by supervisors and teachers to eat well, exercise physically, and cultivate a social support system. Responsible caring as self-care can become essential to clinical practice in and of itself.

In a recent article (Amundson & Ross, 2016), Jon and Marc advocate for a distinction between doing (i.e., functional skills) and being (i.e., the refinement of foundational skills). As noted above, much of supervision is dedicated to doing—namely, how to carry out treatments and interventions or assessments and evaluations. We have tried in this chapter, under the banner of responsible caring, to emphasize the aspect of being. “Being” refers to the person a psychologist is, shall be, or aspires to be. Responsible caring as self-care goes beyond care for the patient and reminds the intern, student, supervisee—or any psychologist—to undertake self-care, exercise self-awareness, and be aware of personal well-being. These considerations are all part of our Code and our standards and guidelines. Responsible caring for oneself is important because distress, burnout, or brownout (loss of professional enthusiasm) can negatively impact one’s clinical work and well-being on so many levels (APA Practice Organization, 2018). If taken seriously, self-care goes beyond the question of “What kind of psychologist do you want to be?” to “What kind of person do you want to be?”

Responsible Caring as Contextual Know-How—Jon, Marc, and Dalal

The three of us have elected to end this chapter with a discussion of contextual know-how—a term coined by Flax (1990), a feminist clinician. We view contextual know-how as both a means and end to effective supervision, and the best way to talk about responsible caring.

Jon has been involved in Hawaiian culture and canoe racing for many years. In Hawaiian Indigenous wisdom, the Hawaiians speak of Lokahi. Lokahi refers to balance, harmony, coherence, and integration of competing, or even contradictory, perspectives (McGregor et al., 2003). Colloquially it means to be the right person, for the right reason(s), for the right people, in the right way, and at the right time. Lokahi, the Hawaiian definition of responsible caring, would be equivalent to the Greek philosophical concept of phronesis, or practical wisdom (Dunne & Pendlebury, 2002; Gaete-Silva et al., 2017).

Phronesis is the integration of the technical, the systematic, and the virtuous. It focuses upon the particulars of how to act in specific situations—for psychologists to reflect upon and determine the best purposes and ends consistent with the well-being of our patients. Phronesis emphasizes that there is never only one way to approach a challenge or solve a problem in clinical work, given the realities of integrative complexity (Suedfeld & Bluck, 1988), relational responsibility (Crocket, 2004), critical or reflective practice (Larner, 2001), and not knowing (Anderson, 1997).

When ethics is seen as only a risk management exercise, psychologists limit themselves in their ability to approach the discipline. All three of us have come to understand contextual know-how as the sine qua non of responsible caring: The ability to merge ethics and risk management with best clinical practice (Behnke, 2005) leading perhaps to arete—the cultivation of virtuous being.

Imagine a swimming pool. The staging of supervision, and supervisee development, requires entry at the shallow end (Žorga, 2003). This means that supervisees are protected from deep water—their feet are touching the bottom, a side of the pool is close by, and a rope is separating the deep end from the shallow end. In the shallow end, there is a greater emphasis upon technique, systemization, and ethics, and the early stages of supervision are often initially seen as risk management: What is expected of me? What do I do, or not do, to not get in trouble? (Barnett et al., 2007). Nonetheless, although many psychologists remain in the relative security of the shallows (Meichenbaum & Lilienfeld, 2018), deliberate and reflective practice invites the psychologist to move beyond the security of shallow water. Schön (1983) has described this movement in his book The reflective practitioner:

When someone reflects in action, he becomes a researcher in the practice context. He is not dependent upon categories of established theory and technique but constructs a new theory of the unique case. His enquiry is not limited to a deliberation about means, which depends upon prior agreement about ends. He does not keep end and means separate but defines them interactively as he frames a problematic situation. . . . Many practitioners, however, locked into a view of themselves as technical experts, find nothing in the world of practice to occasion reflection (pp. 68–69).

Meichenbaum and Lilienfeld (2018) noted that, to be reflective, psychologists ought to embrace skepticism and practice with healthy self-doubt. For clinicians, this means having to swim in deeper waters; to be self-sustaining and refrain from reducing ethics to rules and clinical practice to purely manual-based applications (Amundson & Gill, 2001; Lilienfeld, et al., 2017). Deep water, although a goal for effective supervision, and true responsible caring, is not to be taken for granted (Knapp et al., 2013; Remez, 2016). In his role as consultant for his association regarding ethics and supervision, Jon often is contacted with requests for consults. Frequent in such consultation is a simple request for specific direction: What to do or not to do; a psychologist seeking an answer—“the” answer—to an ethical and practice-related problem. Few such inquiries can be resolved so easily. Instead there is a discussion regarding the often two or more options that exist. In doing this, the goal is to increase reflection on both sides of the dialogue:

• How do the psychologists frame the problem? Do they seem more risk tolerant or risk avoidant? To what extent do they seem interested, capable, or motivated to explore the process?
• How might they frame a response one way or another? What kinds of clinical considerations do they see that they would account for? How many ways might they address the concern, and what contextual matters would require consideration?
• Finally, if they did or did not do one thing or another, how would they responsibly and ethically frame the action or inaction?

Elaborating upon this process of “if you did–if you did not” is beyond the scope of the discussion here (see Amundson, 2016); however, it reflects the contextual know-how of swimming in deeper waters. The consideration here is not simple do’s or don’ts, as one would imagine in the shallow end, but rather how good clinical practice, risk management, and ethical perspective could support decision making one way or another. Again, when responsible caring is equated with pure risk management and rote application of clinical methods, psychologists find themselves in the shallow end of the pool. To manage deeper-end water requires reflection and deliberation, and the associated cognitive exertion, promoting contextual know-how. These are specific habits of thought that support swimming in deeper water.

Initially, psychologists need to see ethics and standards as prosthetics to professional judgement, not as a substitute for such judgement. Codes, standards, and guidelines are not there to end struggle, but to invite struggle (King & Amundson, 1998). This emphasis upon the clinician’s reflective learning agility (De Meuse, 2017) opens up opportunity for creativity: not the right way, but the right way for patients and psychologists in the clinical moment. As with ethics, learning agility and reflection emphasize that there is probably more than one way to care responsibly (Amundson et al., 1993; Amundson, 1996).

Clinical openness and healthy skepticism are linked. However, skepticism does not imply cynicism. As Meichenbaum and Lilienfeld (2018) have stated, it is

a propensity to engage in thoughtful self-reflection regarding one’s bias and limitations. . . . Practitioners marked by healthy self-doubt are not diffident. To the contrary, they are confident, but not over-confident. Their confidence is properly calibrated to their level of knowledge and skills. (p. 23)

Enhancing confidence, therefore, is a goal in effective supervision. This confidence, however, also might be called engaged humility. Dalal and Marc have learned, and Jon perennially seeks, to ground clinical practice less in the pursuit of certainty through a particular theory and method, and more in openness to the potential of the moment (Amundson, 1996; Amundson, et al., 1993). By this we mean being contextually alert and responsive to the patients we serve. What do they bring to the treatment? What has their experience been? What issues related to age, ethnicity, development, gender, socio-economic circumstance, or other contexts may be relevant to the matter? One of Jon and Marc’s favourite clinicians, Milton H. Erikson, was once accused of developing a different therapy for each patient. Allegedly he replied, “Of course, or it would be boring otherwise” (as cited in Lankton, 2015, p. 54). Contextual know-how, then, is the capacity not to be bored, to find many ways to responsibly care, and to swim in deeper water throughout one’s career.

Conclusion

We have linked Principle II (Responsible Caring) (CPA, 2017) to many aspects of supervision. This included ways to think about effective supervision (i.e., contextual know-how), as well as ways to execute it effectively (i.e., deliberate and reflective practice). There is, however, one additional connection to be made regarding responsible caring, and that is professionalism. In the shallow end of the pool, there is an emphasis upon the technical or systematic. However, as a self-governing health care profession, psychology must offer more than technical knowledge. We concur with Kaslow et al. (2018) that professionalism is the capstone of successful training and supervision. It is “contextually and culturally based and includes accountability, ethical engagement, self-reflection, professional identification as a psychologist, striving for excellence, humanism, civility, collaboration, collegiality, and social responsibility” (Kaslow et al., p. 55).

Responsible caring starts with the supervisor modelling these dynamics in supervision and prioritizing accountability, engagement, reflection, civility, and responsibility in professional practice. Supervision, although heralded as the most important part of professional preparation, has existed as a stepchild in professional practice (Amundson, 2008a). Supervision often has been an add-on activity to a psychologist’s busy schedule in institutions and undertaken in other sectors with naiveté regarding expectations and priority (Barnett et al., 2007; Polychronis & Brown, 2016). Only through increased emphasis on supervision as a type of professional practice will responsible caring be actualized for supervisors, supervisees, and patients.

Questions for Reflection

1. Describe one or two situations in your own experience of being supervised where you felt that your supervisor was responsibly caring. What made you feel that way?
2. Describe one or two situations in your own experience of being supervised where you felt that your supervisor was not responsibly caring. What made you feel that way?
3. On a scale of one to ten, with ten being of highest importance and one being of no importance, how would you rate the importance of a supervisor modelling appropriate ethical behaviour and professionalism. Justify your answer.
4. As a supervisee, what role did deliberate and reflective practice play in your development? Would you have wanted more? Less? Why?

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