A systematic review and reformulation of outcome evaluation in clinical supervision: Applying the fidelity framework.

Although a strikingly diverse range of outcomes have been measured within clinical supervision research, a dominant perspective is that clinical outcomes remain the “acid test” of its effectiveness (Ellis & Ladany, 1997). We question the wisdom of this acid test logic in 2 ways. First, we summarize alternative conceptualizations of outcome from within the supervision field, highlighting several important reasons for considering clinical benefit as but one of several equally valid, stepwise outcomes. The fidelity framework (Borrelli et al., 2005) is drawn upon to show how these complementary outcomes may be logically and advantageously combined. This framework’s dimensions are the design, training, delivery, receipt, and enactment of an intervention. Second, a sample of 12 interpretable studies of the clinical outcomes of supervision is evaluated in terms of the studies’ attention to these 5 dimensions. From this conceptual and empirical review, it is concluded that an overemphasis on clinical outcomes carries unnecessary risks (e.g., weak causal reasoning and a failure to identify mechanisms of change), while underemphasizing the several benefits of a more inclusive approach (e.g., increasing outcome research and improving supervision).