Clinical supervision of master and doctoral-level mental healthcare trainees has long been cited as a meaningful component of a student’s education, fostering competency in the multiple areas of clinical practice.

    Such competency is not only an ethical mandate for safe and evidence-informed care but also a licensure requirement. Processes allow a supervisor to identify a trainee's strengths and areas of improvement, promote self-reflection of the trainee’s abilities and practices, and assist in the trainee’s professional development. Although historically predominantly completed face-to-face (F2F), the rapid expansion of coronavirus 2019 (COVID-19) prompted an unexpected and rapid shift to distant training methods. As a result, telesupervision exploded in popularity, becoming a norm for trainee education. 

    Telesupervision provides individual or group distant supervision of face-to-face (F2F) or telehealth-based clinical services through telecommunication technologies (e.g., video, telephone, email, electronic health record). Research has highlighted that telesupervision often yields comparable rates of supervision satisfaction for both telesupervisors and trainees compared to F2F methods. More importantly, if proper adjustments are made, use has been demonstrated not to positively affect either the working alliance or supervision quality. 

    Although a viable option to encourage an ethical supervisory practice that aligns with the American Psychological Association’s guidelines (i.e., APA Guidelines for Clinical Supervision in Health Service Psychology, 2014), prospective telesupervisors should not only ensure competence with the new modalities but consider both the benefits and challenges associated with the use of telesupervision when compared to the more traditional F2F methods. 

    Although additional study is required to understand the many differences between F2F practices, telesupervision has been suggested as having multiple benefits compared to traditional methods. Perhaps the most crucial benefit is the ability to provide increased access to timely and evidence-informed feedback through the increased availability of specialized supervisors who may otherwise be unavailable to the trainee (e.g., not in the area, state, or country). The ability to connect telesupervisors and trainees also allows for reduced financial and time-related costs associated with travel, allows for greater scheduling flexibility (e.g., supervisor is unavailable when trainee is on-site), and fosters increased diversity of supervisory experiences through access to different providers. 

    Additionally, some have suggested reduced hierarchical effects that may occur in traditional F2F practices, leading trainees to be more comfortable and forthcoming with their thoughts and feelings when the supervisor is not in the same room. 

    Finally, if a trainee utilizes telehealth, it allows them to practice using the new technologies in a controlled and safe environment with guided expert feedback to optimize future telehealth services.

    Despite the numerous identified benefits, several challenges have also

been documented that warrant consideration for any prospective

telesupervisor. Common challenges can be broadly grouped into three

categories: technological challenges, supervisory process challenges,

and research-related challenges. 

     Regarding technology, internet connectivity issues can create lag or

disconnects for either party. Compounding this are the possible

program-related “down times” and updates leading to problems for 

computer programs such as electronic health records.

“Dead zones” can also create technological challenges, especially

for those using the internet or telephone in more remote locations (e.g., rural areas), limiting appropriate and continuous interactions. General compatibility issues can further prompt problems for those attempting to share materials across different operating systems and program versions. 

    Supplementing technology considerations, the supervision processes themselves require additional planning. For example, at the onset of the supervisory relationship, the telesupervisor should evaluate the trainee’s comfort and familiarity with the technology to ensure proper “fit.” As technology fosters a greater propensity toward distraction, the telesupervisor should establish methods of addressing a non-participatory trainee (especially in a group telesupervision format) as a preventive measure. To plan for technological issues, a “Plan B” (e.g., using the telephone) should be created for situations in which the primary telesupervision method (e.g., video) becomes unviable. 

    As patient care can be unpredictable, the telesupervisor and trainee should collaborate to create a safety plan for what the trainee should do if a crisis arises and the telesupervisor is unavailable. Similarly, the telesupervisor should clarify appropriate and inappropriate means of communication for routine challenges and emergencies (e.g., some telesupervisors may approve of text messaging, while others do not; only video or telephone should be used in emergencies). To ensure the telesupervisor has adequate records to review and receive such records via a HIPAA-compliant method, the telesupervisor should explain what materials should be sent and how (i.e., encrypted file-sharing methods). 

    Lastly, the telesupervisor should indicate appropriate and inappropriate settings for the telesupervision. This last point not only helps ensure a private and confidential workspace but also encourages professionalism due to a higher probability of what some have referred to as the disinhibition effect, leading to more relaxed communication styles and standards during the telesupervision (e.g., higher chances of inappropriate disclosure, higher chance of engaging in non-supervisory activities during the telesupervision). 

    Finally, the current state of the telesupervision literature can be viewed as a challenge to providing evidence-informed telesupervision. More specifically, although available works have broadly showcased positive outcomes for telesupervisory practices, large-scale evaluations clarifying optimal telesupervisor characteristics and potential differences between modalities (e.g., video vs telephone vs email) are still required. 

    Supervisors must evolve to meet the growing demand as technology continues to become more and more integrated into healthcare education. As such, prospective telesupervisors should seek competency in general supervision models and methods of adapting F2F supervision strategies for the new technological medium. Simply put, being an excellent F2F supervisor knowledgeable of clinical matters and good at technology does not necessarily prepare one for the many novel “what ifs” that can arise in a telesupervisory relationship.