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Dyadic, triadic, and group models of peer supervision/consultation: What are

their components, and is there evidence of their effectiveness?

Article in Clinical Psychologist · July 2012

DOI: 10.1111/j.1742-9552.2012.00046.x

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Clinical Psychologist 16 (2012) 59–71

Dyadic, triadic, and group models of peer supervision/

consultation: What are their components, and is there
evidence of their effectiveness? cp_46 59..71

L. DiAnne BORDERS
Department of Counseling and Educational Development, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA

Key words Abstract

group supervision, peer consultation, peer
supervision, triadic supervision. Models that meet the Psychology Board of Australia’s definition of peer
consultation include dyadic, triadic, and group formats. Components of these
Correspondence models (e.g., goals, theoretical basis, role of leader, members’ roles, structure,
L. DiAnne Borders, Department of Counseling and steps in procedure, stages in group development) are presented, and
and Educational Development, PO Box 26170,
evidence of their effectiveness is reviewed. Psychologists are encouraged to
The University of North Carolina at Greensboro,
identify the model components and goals that match their own learning goals
Greensboro, NC 27402, USA.
Email: borders@uncg.edu for continuing professional development.

Received 31 January 2012; accepted 4 May

2012.

doi:10.1111/j.1742-9552.2012.00046.x

The Psychology Board of Australia recently enacted a practice. The peer groups varied widely in their compo-
new requirement of a minimum of 10 h of peer con- sition, structure, and activities. Townend, Iannetta, and
sultation a year as part of psychologists’ mandatory Freeston (2002) found similar results for accredited cog-
continuing professional development to maintain their nitive behavioural psychotherapists in the UK participat-
registration. The Board defined peer consultation as ing in supervision required for their accreditation. Over
“supervision and consultation in individual or group 75% of the respondents were either “very satisfied”
format, for the purposes of professional development and or “satisfied” with their supervision, and often were
support in the practice of psychology and includes a criti- attending supervision for more hours than required for
cally reflective focus on the practitioner’s own practice” accreditation. In peer groups (41%) or dyads (20%), the
(Psychology Board of Australia, 2010, p. 2; see also, Aus- psychotherapists typically discussed cases within a cogni-
tralian Psychological Society, 2011, p. 7). tive behavioural framework (“formulation development,
A reading of the relevant literature suggests the use of problem solving, and technical application of therapeutic
peer supervision/consultation is widely practised and strategies,” p. 489) as well as cognitive analysis of thera-
highly valued by counselling and psychology practitio- pist affect or behaviour.
ners. Over 20 years ago, Lewis, Greenburg, and Hatch More recently, Kassan (2010) interviewed 34 psycho-
(1988) found that almost 50% of psychologists in private therapists (24 women, 10 men) who represented 20 dif-
practice in the USA belonged or had belonged to peer ferent peer groups. Participants, primarily psychoanalysts
consultation groups. More than half not currently in in the New York area, had been in their groups from 1 to
groups expressed a desire to join a group. Members of over 30 years. Peer groups varied in size, composition
these voluntary groups reported high levels of satisfac- (e.g., one or both genders, one or more theoretical
tion with their experiences, and said the groups met backgrounds/orientations), and identified focus (e.g.,
their individual goals, particularly those around gaining group process, countertransference). Most involved case
suggestions for problem cases, discussing ethical and pro- presentations on a rotating or spontaneous basis. Only
fessional issues, and countering the isolation of private one used videotapes of therapy sessions. Presenters

© 2012 The Australian Psychological Society 59

Borders

primarily brought issues of countertransference, feeling leader-led or leaderless group, as well as degree of struc-
stuck, or personal feelings about the patient (e.g., frus- ture in procedure and members’ roles and feedback
trated, angry) to the group. Most reported feeling safe to focus. Below, the models’ similarities and differences are
present their work to the group, although they often felt summarised, and empirical evidence for their effective-
nervous or even shame about having made a mistake or ness is presented. Finally, key considerations for choosing
not knowing what to do. Few had an explicit contract; a model, based in the literature, are highlighted.
typically, the only explicit agreement was confidentiality.
Participants reported they gained community, colle-
giality, and connection to other professionals from their Dyadic Peer Models
groups; most could not imagine not being in a group even Models for peer dyads are listed in Table 1. Although
if they were considering leaving their current group. three models are listed, all are based in the Remley,
Their complaints included a lack of focus and structure. Benshoff, and Mowbray (1987) format. This is a true
In addition, without a leader, they reported they had to consultation model, with peers taking turns being super-
take more responsibility and work harder to stay on task. visor and supervisee without any oversight by others,
Nevertheless, they appreciated the freedom and equality although an orientation and training session was pro-
in the peer group. The peer groups varied in their ability vided to participants in one study (Benshoff & Paisley,
to deal with inevitable tensions and conflicts between 1996).
members, as well as whether they socialised with each
other outside of group (and whether this was seen as
helpful or hindering group dynamics). Kassan observed Empirical Studies of Dyadic Peer Models
that satisfaction with the group experience was lower
when members avoided discussing group process, which Benshoff (1993) adapted the model for counselling
he described as “the scariest, and the most difficult, aspect practicum students (n = 81) who, responding to seven
of group functioning” (p. 191), and yet the most crucial. open-ended questions, reported the sessions were very
Across the three studies, then, there is, anecdotally, helpful in providing support, encouragement, and prac-
high enthusiasm for peer groups. As indicated in the tical ideas. In a follow-up study, practicum and internship
following sections, participants who have described their students (n = 87) were randomly assigned to the experi-
models of peer supervision/consultation typically also mental peer model or control groups; all also received
have reported highly positive experiences, again mostly traditional supervision. Benshoff found no significant dif-
anecdotal. Thus, potential gains from the new peer ferences between the two groups’ post-test self-ratings
consultation requirement seem promising based on of counselling effectiveness. Benshoff and Paisley (1996)
participants’ reports. To make the best use of their peer employed the model with school counsellors (n = 20)
consultations, psychologists might benefit from a system- who, in a pilot study, completed 16 evaluation items.
atic overview of peer supervision/consultation models Participants gave very positive ratings of their experience
and the empirical evidence for them. The purpose of this overall and reported that the model had helped them
article is to provide such an overview. develop their counselling and consulting skills. They
Using several sources (e.g., databases, table of contents were highly satisfied with the amount of support they
of supervision-oriented journals), published models pur- received, but less satisfied with the peer’s ability to chal-
porting to offer some form of peer consultation and peer lenge them. Almost all participants said the review of
supervision that fell within the definition and guidelines counselling tapes was an important part of the model.
provided by the Psychology Board of Australia were iden- They requested a training to help them focus more on the
tified. Although distinctions between peer supervision counsellor’s performance rather than the client. Thus,
and peer consultation have been emphasised (e.g. Aus- although participants in several investigations were very
tralian Psychological Society, 2008; Ettin, 1995; Milne, positive about their experiences in the model, no studies
2009), examples of both were included since the Board have included objective measures of relevant outcome
used both terms in its definition. Models for peer dyads, variables for counsellors or clients.
triads, and groups were located, although it is not pre-
sumed that this is an exhaustive overview. To facilitative
Triadic and Group Peer Models
psychologists’ review, comparison, and evaluation of the
models, key components for each are provided in Models for peer triadic and group supervision/
Tables 1, 2, and 3. Psychologists can search for models consultation are listed in Tables 2 and 3. Triadic
that match their professional development plan based on supervision, an emerging modality in the USA, was for-
the models’ goals or theoretical basis, their desire for a mally endorsed by the counselling accreditation body

60 © 2012 The Australian Psychological Society

 Peer consultation models

Table 1 Dyadic peer supervision/consultation models

Citation, Professional field, and Country: Remley et al., 1987; peer consultation model for practitioners (counselling, USA)
Goals: Monitor practice, improve skills, and provide mutual support and affirmation
Theoretical basis: Not specified
Leader: No
Members’ roles: Consultants to each other in review of tapes and case studies
Steps in procedure: 10 sessions that include introductions and goal setting, then alternating oral case presentations (2 sessions), tape reviews
(4 sessions), discussion of journal articles (1 session), mid-point and final evaluation
Stages in dyad development: Not specified
Evidence: Not specified
Citation, Professional field, and Country: Benshoff, 1993 (adapted from Remley et al., 1987) (counselling, USA)
Goals: Provide clear, detailed structure for peer supervision process; keep peers focused on task of supervision
Theoretical basis: Not specified
Leader: No
Members’ roles: Supervisor and supervisee (take turns)
Steps in procedure: Seven sessions that include introductions and goal setting, discussion of journal articles, case presentations, tape reviews,
evaluation and termination
Stages in dyad development: Not specified
Evidence: Includes results of qualitative and quantitative studies with counselling students
Citation, Professional field, and Country: Benshoff & Paisley, 1996 (adapted from Remley et al., 1987) (school counselling, USA)
Goals: Provide organised structure for peer consultation for school counsellors
Theoretical basis: Not specified
Leader: No, but orientation and training meeting included
Members’ roles: Supervisor and supervisee (take turns)
Steps in procedure: Nine sessions that include background information and goal setting, discussion of school counselling programme, case
presentations, tape reviews, evaluation and termination
Stages in dyad development: Not specified
Evidence: Includes results of pilot study with 20 school counsellors; see also, Crutchfield & Borders, 1997

(Council for Accreditation of Counseling and Related formal supervisor leader, rotate the supervisor/leader
Educational Programs, 2009) in 2001. Triadic supervision role among the members, are leaderless, or gradually
is defined as one supervisor working simultaneously with move towards being leaderless as the group matures.
two supervisees, although one published model has three There are advantages and disadvantages for each
members and no supervisor (Spice & Spice, 1976). Only approach, with the experience level of group members
a few triadic models (see Table 2) have been published often being an important decision point around the
(Lawson, Hein, & Getz, 2009; Spice & Spice, 1976; need for a leader (see also, Counselman & Gumpert,
Stinchfield, Hill, & Kleist, 2007), but researchers have 1993; Counselman & Weber, 2004). Leaders, whether
found unique benefits and dynamics (e.g., Borders et al., formal supervisors or rotating members, typically keep
in press; see below). All of the models involve supervi- the group on task and attend to group dynamics.
sees taking turns presenting and giving feedback, often Several authors suggested that groups, especially lead-
assuming roles (e.g., commentator, giving feedback from erless groups, would benefit from periodic reviews of
a particular perspective). Although the triadic supervi- their functioning, perhaps even an evaluation by an
sion models were proposed for students, it is a potential outside consultant (see also, Goldberg, 1981). Group
modality for peer consultation, and so included here. models also vary in the type of and amount of struc-
Peer group supervision models (see Table 3) are more tured approaches (members’ roles, steps in procedure)
prolific and varied. Several group models that were suggested. Authors of more structured models designed
designed for students are included because they have them to achieve explicit goals, such as ensuring that all
been investigated empirically and have been suggested as group members participate, gaining multiple perspec-
appropriate for practitioners also. tives, learning to give constructive feedback, avoiding
Peer triadic and group models differ along several judging statements, and decreasing resistance to feed-
dimensions that can be considered as psychologists back. For some, segments of a taped counselling session
determine which components may be the best match are a required part of the case presentation.
for their learning needs. A distinguishing factor among Peer group models also vary in their focus, especially
the triad and group models is whether they include a around the extent to which personal issues and growth

© 2012 The Australian Psychological Society 61

Borders

Table 2 Triadic peer supervision/consultation models

Citation, Professional field, and Country: Lawson, Hein, & Getz, 2009; single-focused triadic supervision (counselling, USA)
Goals: Not specified
Theoretical basis: Not specified
Leader: Supervisor or supervisor-in-training
Members’ roles: Take roles or perspectives based on Borders (1991), Wilbur et al. (1991), and other action techniques
Steps in procedure: Orientation session, then one supervisee presents case, with videotape of counselling session during each session while other
provides feedback
Stages in triad development: Not specified
Evidence: Results from several studies summarised; see also, Hein & Lawson, 2008, 2009; Hein, Lawson, & Rodriguez, 2011, Lawson et al., 2009, 2010
Citation, Professional field, and Country: Spice & Spice, 1976; triadic method of supervision (counselling, USA)
Goals: Refine skills in presenting one’s work, art of critical commentary, engagement in meaningful dialogue, and deepening of here-and-now process
Theoretical basis: Not specified
Leader: Leader only when working with students; teaches the model to them
Members’ roles: Three members and three roles of supervisor, commentator, facilitator
Steps in procedure: Members rotate roles of supervisor, commentator, and facilitator. Presenter describes sample of practice (may include tape of
counselling session) which commentator has reviewed before session, commentator shares observations and encourages dialogue about those
points viewed as most important, facilitator focuses on present, here-and-now dialogue to deepen the impact of dialogue
Stages in triad development: Not specified
Evidence: Anecdotal
Citation, Professional field, and Country: Stinchfield, Hill, & Kleist, 2007; reflective model of triadic supervision (RMTS) (counselling, USA)
Goals: Encourage “inner” and “outer” dialogues
Theoretical basis: Reflecting process and reflecting teams
Leader: Leader instructs members regarding RMTS process, then facilitates the process/model
Members’ roles: Three roles (rotate): supervisee role, reflective role, observer-reflector role
Steps in procedure: Supervisee presents tape of session and discusses with supervisor, peer is in observer-reflector role; peer and supervisor discuss
session and supervision thus far while supervisee listens silently in reflective role; supervisor processes reflective role with supervisee while peer
observes
Stages in triad development: Not specified
Evidence: Reports preliminary results from qualitative interviews with students. See also, Stinchfield, Hill, and Kleist, 2010

are discussed. For some, attention is focused on skill students said the reflective role gave them freedom to just
development or case conceptualisation only, while others listen, not get defensive, and gain multiple perspectives,
are primarily focused on countertransference and similar while the observer role enhanced their conceptual skills
dynamics within the group. A few groups are designed and feedback skills. Later, in a phenomenological study
around learning a specific counselling orientation in (2010), the researchers identified five transcendent
depth, while most suggest a small range of diverse orien- themes from semi-structured interviews with students.
tations to enhance learning. Initial apprehensions about the experience included con-
Peer groups are groups, and so explicit attention to the cerns about the power differential between supervisor
issues that are central to the functioning of all groups is (faculty) and students and whether the model would
needed. The initial contract and agreement about the allow adequate time for both students during the session.
purpose and functioning of the group is highlighted. Simi- Shared developmental process described the normalisation
larly, careful attention to criteria for membership, and for that occurred during sessions. Vicarious learning happened
adding new members later, is emphasised. Fairly typical in both the reflective role and the observer role. Multiple
stages of group development (e.g., forming, storming, perspectives provided by the model were valued, and the
norming, and performing; Tuckman, 1965) are described trust and safety in relationships that developed over time
by those reporting experiences from their own groups. allowed for discussion of parallel processes.
In an investigation of their triadic supervision model,
Lawson and colleagues (Hein & Lawson, 2008, 2009;
Empirical Studies of Triadic and Group
Hein, Lawson, & Rodriguez, 2011; Lawson, Hein, &
Peer Models
Stuart, 2009, 2010) interviewed six supervisees (practi-
Stinchfield et al. (2007), and Stinchfield, Hill, and Kleist cum students) and six supervisors (doctoral students) in
(2010) reported preliminary results for their reflective one counsellor education programme. Supervisee peer
model of triadic supervision (RMTS). In pilot data (2007), matching (e.g., similar skill level) was emphasised by

62 © 2012 The Australian Psychological Society

 Peer consultation models

Table 3 Group peer supervision/consultation models

Citation, Professional field, and Country: Baruch, 2009; generic model of group supervision of private practitioners (counselling,
Australia)
Goals: Forum to explore integrative and eclectic models of working; learn from practitioners from different theoretical traditions, training, and modes
of practice
Theoretical basis: Integrates models of Proctor (2004) and Page and Wosket (2001)
Leader: Leader supervises and facilitates co-supervision by members
Members’ roles: Three to six members suggested in closed group; at least 2 years of clinical experience; self-selected to achieve mixed gender and
reasonable homogeneity in theoretical orientations
Steps in procedure: First session involves written contract and establishing norms, responsibilities, and session agenda. Member presents, members
provide “felt responses,” bridge to give presenter time to reflect and to share how will apply feedback. Ends with supervisor leading review of
group functioning, verbal, and written feedback of supervisor’s performance. Formal review of group after 6 months.
Stages in group development: Not specified
Evidence: Not specified
Citation, Professional field, and Country: Borders, 1991; structured peer group supervision approach (see also, Borders & Brown, 2005, chapter 4)
(counselling, USA)
Goals: Ensure all members are involved; help members give focused, objective feedback; highlight development of cognitive skills; be adaptable for
novice and experienced counsellors; be adaptable for various counselling formats; encourage self-monitoring; encourage self-growth; encourage
awareness of group dynamics; be useful for novice and experienced supervisors
Theoretical basis: Developmental models of counsellor development, especially the promotion of cognitive complexity
Leader: Trained supervisor or supervisor-in-training; takes roles of moderator (keeps group on task) and process observer (comments on group
dynamics). (Multicultural competency infuser added by Lassiter, Napolitano, Culbreth, & Ng, 2008)
Members’ roles: Three to six members suggested. Presenter; members provide feedback via roles (e.g., client, counsellor, significant person in client’s
life) and perspectives (e.g., focused observations of particular skills, apply theoretical approaches, metaphors). (Multicultural-intensive role added
by Lassiter et al., 2008. Roles based on Bernard’s (1997) discrimination model added by Christensen & Kline, 2001)
Steps in procedure: Presenter states request for feedback and shows portion of taped session; roles assigned for watching tape; peers give feedback
from roles and perspectives (first-person language); supervisor facilitates discussion; supervisor summarises, and presenter indicates whether
needs met
Stages in group development: Not specified, but attention to developmental levels of counsellors included
Evidence: Anecdotal in Borders, 1991. See also, Christensen & Kline, 2001; Crutchfield & Borders, 1997; Starling & Baker, 2000
Citation, Professional field, and Country: Chaiklin & Munson, 1983; peer consultation group (social work, USA)
Goals: Support life-long learning
Theoretical basis: Control session procedure from psychoanalysis; principles of willing to take risks, believing members have something to teach,
trust that feedback will be given with dignity
Leader: Leader (paid or unpaid) needed for at least 1 year. Keeps group on task, relates case to own practice, keeps members from blaming
bureaucracy, and keeps members from talking about theory. After learning approach, members take turns leading
Members’ roles: 6–12 members suggested. Questions for discussion are client focused (What does the client want? What are the real problems that
face the client? What are the patterns of relating the client demonstrates?)
Steps in procedure: Members take turns presenting cases or topic (e.g., client resistance). Focus is not on what the presenter should do. Each
member brainstorms without interruption, then comments on own learning and application to own work, leader integrates and summarises
Stages in group development: Not specified
Evidence: Not specified
Citation, Professional field, and Country: Ettin, 1995; group consultation for group psychotherapy (psychiatry, USA)
Goals: Achieve formulation that may suggest action plan to address the presenter’s question
Theoretical basis: Countertransference consultation
Leader: Leader most directive in dynamic formulation and intervention strategy phase: integrates members’ associations about presenter and
question about therapy group into a formulation
Members’ roles: Number not specified. Role is to freely associate to the presenter and the presented (i.e., What feelings, images, sensations, or
memories did you have during the presentation?)
Steps in procedure: Four phases; presenter gives structured description phase of the group (protocol for what information to share) and consultation
question, primary process enhancement phase where members respond freely without offering advice, reassociation phase where the presenter
reacts to the input, dynamic formation and intervention strategy phase (see leader), and shared formulation is negotiated
Stages in group development: Not specified
Evidence: Anecdotal through vignettes
Citation, Professional field, and Country: Granello et al., 2008; peer consultation model (counselling, USA)
Goals: Enhance supervisor development towards self-determined goals through multiple perspectives; purpose is not to solve case but encourage
different perspectives and understanding of complexities of supervision
Theoretical basis: Cognitive complexity

© 2012 The Australian Psychological Society 63

Borders

Table 3 Continued

Leader: Leader serves as convener and moderator to manage power differentials, enforce time limits, assure all treated with respect, and keep all
involved
Members’ roles: Five members. Convener intentionally invited doctoral student, faculty member/supervisor, on-site supervisor, and chair of state
ethics committee to achieve desired multiple perspectives
Steps in procedure: Members present cases in written format; members decide which to discuss; each presents own perspectives without
interruption, open dialogue (based on reflecting team guidelines)
Stages in group development: Not specified
Evidence: Anecdotal based on member feedback and reactions from participants in workshops on the approach
Citation, Professional field, and Country: Greenburg, Lewis, & Johnson, 1985; peer consultation group for private practitioners (psychology,
USA)
Goals: Provide mutual support and help in dealing with problematic cases and various sources of stress in private practice; provide a source of
objectivity in processing countertransference issues; share information regarding referral sources, therapeutic techniques, literary references, and
professional meetings and seminars
Theoretical basis: Not specified; group members have varied theoretical orientations
Leader: “Leadership is shared. Certain members tend to take on either task or maintenance functions more consistently, though all members share in
both” (p. 442)
Members’ roles: Flexible in terms of who presents when; roles “rotate naturally” (p. 442)
Steps in procedure: Not specified
Stages in group development: Five stages: focus on client and professional issues than personal ones; conflict and confrontation; cohesiveness with
suppressed negative feelings perhaps due to power differentials; productive stage with more openness and ability to handle conflict; termination
when member leaves with some temporary regressions in group development
Evidence: Anecdotal; members find it “professionally and emotionally beneficial” (p. 446)
Citation, Professional field, and Country: Lakeman & Glasgow, 2009; peer group clinical supervision (psychiatric nursing, Ireland and
Trinidad)
Goals: Contribute to role development, job satisfaction, and reduced burnout of psychiatric nurses in Trinidad
Theoretical basis: Concept of role, role development, reflecting on the intent of interactions, concept of pattern interaction and integration
Leader: Facilitator role rotated among members. One-day intensive training on peer group supervision, including practice of group facilitation skills.
Suggested supervisor for initial sessions may have increased fidelity to model and strengthened members’ facilitation skills
Members’ roles: Five members. At least 2 years experience working at the hospital
Steps in procedure: Interpersonal practice review process: Presenter describes person and interaction with person, members ask clarifying questions
in a round, members make critical comments of observations while presenter observes, members provide positive feedback, presenter reflects on
learning and what may do differently
Stages in group development: Not specified
Evidence: Developed out of action research project
Citation, Professional field, and Country: Lowe & Guy, 1999; reflecting team process (psychotherapy, Australia)
Goals: Offer more affordable option than ongoing groups, provide skills in supervision, and encourage autonomy and flexibility. Over time, move from
group led by consultant to group facilitated by peers (after training in format and consultant role), with original consultant serving as an
“occasional guest” or “outsider witness” to help with difficulties, drift way from solution-oriented principles, etc.
Theoretical basis: Solution-orientation approach
Leader: Consultant who facilitates the solution-oriented reflecting team format, models, and trains members to take on consultant role, and then
“occasional guest”
Members’ roles: Presenter and member of reflecting team
Steps in procedure: Three-stage process: individual solution-oriented interview between consultant and presenter, observed by team behind one-way
mirror; switch positions, reflecting team discussion with consultant and presenter watching from behind one-way mirror; switch positions,
consultant and presenter reflect on team’s discussion while team members observe. Provides example questions for the first-stage interview,
guidelines for reflecting team discussion
Stages in group development: State that little attention has been given to potential group development within a reflecting team; suggests
“group-on-group” reflections (small or subgroup discussions about typical group process, dynamics, and tensions)
Evidence: Anecdotal from authors’ experience leading reflecting teams and helping them move from group to peer supervision
Citation, Professional field, and Country: Markus et al., 2003; experiential model of peer consultation (psychiatry, USA)
Goals: Overcome countertransference dilemmas
Theoretical basis: Ego psychology, object relations, gestalt theory
Leader: Rotating leadership; group concluded this “inhibited the optimal functioning of the consultation group” (p. 34)
Members’ roles: Nine members. Range of disciplines and theoretical orientations. Best for advanced clinicians. Suggest contract for
12 months
Steps in procedure: Presenter, members share images, fantasies, feelings, associations, etc., they experience while listening to case material, stated
in here-and-now language

64 © 2012 The Australian Psychological Society

 Peer consultation models

Table 3 Continued

Stages in group development: In early sessions, members reluctant to serve as leader and share their clinical work; overly supportive and theoretical;
changed when all members had turn to lead
Evidence: Anecdotal based on members’ experiences
Citation, Professional field, and Country: McWilliams, 2004; supervision-consultation groups (psychology, USA)
Goals: Increase therapeutic skills of members with potential “fringe benefits” of networking and other professional development
Theoretical basis: Not specified
Leader: Leader serves dual functions: provide knowledge, resources, and insights; provide leadership in resolving problematic group dynamics
Members’ roles: Nine members maximum suggested
Steps in procedure: Presenter describes on patient in detail; members offer feedback that may include hypotheses about case, resistance,
transference, and countertransference; provide support, share emotional reactions, suggest interventions; may involve role play
Stages in group development: Not specified
Evidence: Anecdotal, based on McWilliams’ experiences as leader of groups that have met for few years up to 20 + years
Citation, Professional field, and Country: Salomonsson & Norman, 2005; “weaving thoughts” method for peer groups (psychoanalysis, Sweden)
Goals: Provide a “containment” of rules and procedures that facilitate a work-group climate, protect the presenter’s “integrity and self-reflection”
(p. 1287), keep group members from debating facts, diagnosis, and effectiveness of the analyst
Theoretical basis: Psychoanalysis, Bion’s theory of groups
Leader: Moderator is a group member, appointed before the group session, who opens and closes the session, introduces the presenter and “contains
the discussion” (p. 1289); makes sure members’ comments are related to the text provided by the presenter; when necessary, describes the silence
of the group and asks if it might be related to the case; makes sure questions are not answered but are treated as any other thought shared by group
member
Members’ roles: 10–15 members. Share associations to the material, such as thoughts, images, and feelings that are directly tied to the material shared
by the presenter
Steps in procedure: Presenter shares a typed, detailed overview of a case that includes information from one or two sessions. Without being inter-
rupted, presenter provides information about what analyst and analysand (patient) said and did, perhaps how presenter felt and made sense of the
session; setting, frequency of sessions, age and sex of the patient, but no further background information. Members signal moderator when he/she
wants to share a comment; moderator keeps list and invites comments in order. Members share comments (associations) while presenter is silent.
Creates a “web of comments on comments” (p. 1293). If presenter wants to describe second session, moderator decides when that will occur; same
procedure as above is followed. With few minutes left, moderator asks if presenter wants to comment about the experience of listening, and then
may invite members to reflect on how the group worked. There is no summary of what was shared; “the discussion is left unfinished and without con-
clusions” (p. 1296).
Stages in group development: Not specified
Evidence: Not specified
Citation, Professional field, and Country: Padesky, 1996; several examples of applying cognitive therapy principles to supervision of cognitive thera-
pists (cognitive therapy, USA)
Goals: Develop cognitive therapist competency through use of fundamental cognitive therapy processes of collaboration, guided discovery, and struc-
ture
Theoretical basis: Beck’s cognitive therapy
Leader: Yes, at least for those just beginning to learn cognitive therapy; more advanced therapists may help supervise each other
Members’ roles: Not specified, although it is emphasised that all members should participate in each session
Steps in procedure: Steps parallel cognitive therapy. At beginning, supervisor and supervisee(s) “establish a problem list, set goals, collaboratively con-
ceptualise roadblocks to attaining these goals, and strategise to overcome these problems. Within each supervision session an agenda is set, new
skills are taught, guided discovery is employed, and homework is assigned” (p. 281). Model depicted in “Supervision Options Grid” (p. 282) that
includes five focus areas presented in order addressed with beginning, intermediate, and advanced therapists: mastery of cognitive therapy
methods, case conceptualisation, client–therapist relationship, therapist reactions, and supervisory processes. These focus areas may be addressed
through five modes: case discussion, video/audio/live observation, role-play demonstration, supervisor–supervisee co-therapy, peer co-therapy. Five
supervision guidelines for guiding supervisory choices: “build on the supervisee’s strengths; choose modes and foci that help develop the next stage
of competence; build conceptualisation skills so supervisees learn to help themselves; when difficulties occur, use a supervisory road map to pin-
point the problem; and pay attention to what is not discussed in supervision” (p. 282). Use of direct observation of therapist/therapy sessions empha-
sised.
In “piggy-back” supervision model (p. 277) for peer group, the most experienced therapist conducts therapy session while members do live observa-
tion, followed by discussion and critique. After a few weeks, a second therapist begins therapy with a new client, followed by discussion and critique.
Group continues the rotation so that all group members are observed.
Stages in group development: Not specified
Evidence: Not specified; reports research on teaching and supervisory methods “in its infancy” (p. 289)
Citation, Professional field, and Country: Page & Wosket, 2001; cyclical model of counsellor supervision (counselling and psychotherapy, UK)
Goals: Provide framework for supervision process, for both novice and experienced practitioners, which can encompass process, function, aims,
and methodology

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Table 3 Continued

Theoretical basis: Meant to be applied to a range of theoretical orientations

Leader: Supervisor with training and experience in supervision and group work; begins contract stage with what is predetermined and what is
negotiable; facilitates and mediates as needed through stages; ensures group work and activities serve the presenter’s work with the client; is
aware of unconscious processes that may be at work in group; intervenes as necessary to manage energy levels of group; serves as timekeeper
who keeps group on task and in line with contract regarding the chosen structure of the group; in peer groups, “tasks of both facilitation and
supervision are shared among the members” (p. 162) in a predetermined rotation or a fluid manner. More attention to developing therapeutic use
of self of groups of experienced practitioners
Members’ roles: Three roles of presenter, group member, co-supervisor. In discussing presented case, may take roles (e.g., for family session, roles
of family members; for confusing client, roles to speak aloud the various reactions of the counsellor to the client); presenter takes role of client
Steps in procedure: Five steps during session: contract and group rules for that session; identifying the focus of the presentation; working within the
supervision space to achieve insights; creating the bridge to give presenter time to reflect and then share how insights will be applied; reviewing
effectiveness of work and functioning of group itself at end of each session and more formally periodically (e.g., every 6 months). Structure needed
at least in early stages and at beginning of each group session.
Stages in group development: Not specified beyond the typical stages of group development
Evidence: Based on authors’ years of experience as counsellors, supervisors, and supervision trainers as well as review of the literature. Anecdotal
quotes from one research group
Citation, Professional field, and Country: Proctor, 2000; Proctor & Inskipp, 2009; group supervision alliance model (psychotherapy, UK)
Goals: Provide comprehensive map and frameworks to help supervisors structure, facilitate, and evaluate supervision groups
Theoretical basis: Not specified, but aspects of gestalt and transactional analysis mentioned
Leader: Leader role varies by type of group; in Type 4, peer group supervision, leadership is shared
Members’ roles: “Supervisor-full group” (Proctor, 2000, p. 56). Structured exercises and creative approaches highlighted (e.g., mini-psychodrama,
sculpting, metaphors)
Steps in procedure: Not specified for Type 4 peer group; variations of Durham model illustrated (e.g., dyadic during first half of meeting, group during
second half)
Stages in development: Not specified other than general group movement
Evidence: Anecdotal based on 25 + years as trainers, supervisors of counsellors, and supervisors
Citation, Professional field, and Country: Richard & Rodway, 1992; peer consultation group in a clinical social work family practice (social work,
Canada)
Goals: Make use of decision-making process used by peer consultation group clearer and more effective
Theoretical basis: Dewey’s model of problem solving
Leader: Supervisor active in first (clarify presenter’s purpose and goal) and last phases (help group reach consensus decision about what presenter
will do in subsequent sessions); points out conflict and encourages exploration and evaluation of these
Members’ roles: In response to presenter’s request for help, asks questions, speculates, suggests interventions, explicating assessment and
intervention around the family; reaches consensus. Pre-group preparation by presenter emphasised
Steps in procedure: Four phases: presenter makes request for help with family, presenter then provides exposition of case data, group reaction,
decision. Group decision-making described as spiral rather than linear in which an “anchored idea” resurfaces and becomes the basis for the
consensus decision
Stages in group development: Not specified
Evidence: Descriptions based on review of eight recorded peer consultation group (two groups) sessions
Citation, Professional field, and Country: Scaife, 2010 (psychology, UK)
Goals: Promote reflective practice
Theoretical basis: Various theories of reflective practice, critical thinking, experiential learning, and transformative learning
Leader: Varies by type or model of structure
Members’ roles: Several structures with varying roles are outlined; includes models from other fields such as education and management. Themes
include no “why” questions, collaborative learning, avoiding judgments, questioning to achieve multiple perspectives
Steps in procedure: Varies by model
Stages in group development: Not specified
Evidence: Not specified
Citation, Professional field, and Country: Schreiber & Frank, 1983; peer supervision group (social work, USA)
Goals: Help members continue to develop professionally
Theoretical basis: Not specified
Leader: Leaderless; host calls group to order and presents case
Members’ roles: Five to seven members. Members share similar concerns and cases; members chosen based on similar backgrounds as well as
variety of clinical approaches
Steps in procedure: Not specified
Stages in group development: Three stages described: introductions of selves and practices, tentative to give feedback and criticise, more direct
Evidence: Anecdotal based on members’ experiences

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Table 3 Continued

Citation, Professional field, and Country: Simmonds, 2008; peer supervision group within a child and adolescent mental health service, using ideas
from narrative therapy (clinical psychology, UK)
Goals: Make space to “deconstruct take for granted ideas” (p. 52); empower members, value members’ experience and knowledge, put clients
(families and children) at centre of supervision sessions
Theoretical basis: Narrative therapy
Leader: Author facilitated until other group members learned the interviewing process
Members’ roles: Maximum of eight members. Members alternate in roles of interviewer and outsider witness group. Outsider witness group follows
questioning scaffold: think about images that come to mind, “resonances” or themes shared between the listener and the person at the centre of
the story, and “transport” or paying attention to what influence the story might have on the listener’s life
Steps in procedure: Presenter identifies an issue or dilemma, presenter is interviewed by one group member while other members observe, members
discuss their responses with the interviewer, interviewer talks with presenter about points made by the outsider witness group, general discussion
by entire group, including process of supervision group. Time outs allowed if interviewer is unsure what to ask next and needs help
Stages in group development: Not specified
Evidence: Anecdotal, based on author’s and members’ informal reports
Citation, Professional field, and Country: Truneckova, Viney, Maitland, & Seaborn, 2010; personal construct peer consultation (psychology,
Australia)
Goals: Understand therapy from personal construct framework and understand peer group consultation within context of working alliance
Theoretical basis: Personal construct theory
Leader: Shared leadership
Members’ roles: Members are “joint consultants”
Steps in procedure: Members have three roles: provide emotional and professional support, develop treatment skills, promote personal development
of members
Stages in group development: Three stages: presented “successful” cases; then cases with doubts and more open to feedback; then interactions that
were more open, close, and supportive
Evidence: Anecdotal based on three members’ experiences across 13 years together; complete formal self-rated evaluation of group processes after
each meeting
Citation, Professional field, and Country: Wilbur, Roberts-Wilbur, Morris, Betz, & Hart, 1991; structured group supervision (SGS) model
(counselling, USA)
Goals: Provide for orderly input and processing of feedback, minimise interactions that interfere with process, enhance group productivity, reduce
conflict and resistance to feedback, increase members’ ability to provide feedback
Theoretical basis: Conceptual models of supervision and typology of group modalities
Leader: Leader instructs members about the SGS model, then directs group through model until group members are able to direct on their own
Members’ roles: 8–12 members. Presenter; members provide feedback
Steps in procedure: Seven phases: presenter states request, members ask questions for clarification in round robin format, and supervisor helps
identify focus of request (e.g., skills, personal growth), members give feedback about how they would handle the issue in round robin format,
while presenter remains silent, short break/pause, presenter reports which statements were helpful or not helpful, while members remain silent,
supervisor may lead discussion of process and/or group dynamics
Stages in group development: Not specified, but states members quickly learn structure and need less direction from supervisor
Evidence: Anecdotal and pilot data in Wilbur et al., 1991. See also Wilbur & Roberts-Wilbur, 1994.

both groups; mismatches reportedly reduced productiv- reported). They rated themselves and their peers in a
ity, truncated feedback, and limited support. Supervisors pre-test–post-test design. The pre-test condition was not
reported triadic supervision, in comparison to individual, a statistically significant covariate; t-tests for dependent
was both less stressful and more stressful, especially samples (Bonferonni correction) were conducted by
around managing feedback and relationship dynamics. item on the post-test. Significant differences were found
Wilbur and colleagues (Wilbur & Roberts-Wilbur, between the post-test scores of the SGS and control
1994; Wilbur, Roberts-Wilbur, Morris, Betz, & Hart, groups on all 20 items and on the two subscales of
1991) investigated their structured group supervision personal growth and skill development. Similarly, signifi-
(SGS) with practicum students in a quasi-experimental cant increases from pre-test to post-test scores for the
study. Over 7 years, 194 students were assigned to treat- SGS group were found on all 20 items.
ment groups and 50 to a control group (unstructured case Borders’ (1991) structured peer group approach has
presentations and dyadic role plays). Participants com- been applied in several studies. In an experimental study,
pleted an author-developed measure of personal growth Crutchfield and Borders (1997) assigned school counsel-
and skill development (no reliability or validity data lors (n = 29) to the Borders’ group model, the Benshoff

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and Paisley (1996) dyadic model, or a control group. clinical supervision and then received training in the
Participants received training and a manual for the two selected model. They also received a manual outlining
experimental treatments. They completed pre- and post- the processes to be followed in group meetings (see
test standardised measures of job satisfaction; counsell- Table 2); the facilitator role rotated among the members.
ing self-efficacy; and counselling effectiveness, including While two peer groups meet (over 4 months), the
empathic responding, adaptability and flexibility in coun- researchers hosted monthly evaluation focus groups. The
sellor response, as well as client behaviour change (teach- nurses reported they were more mindful in their work,
ers rated problematic behaviours of students seen by the were more satisfied with their work, and believed they
counsellor and one control client). None of the analyses provided enhanced counselling with patients on the
of covariance examining treatment effects were signifi- acute ward (but not the chronic ward). Lakeman and
cant, although trends were in the preferred direction. Glasgow noted that it was “uncertain whether or not
Post-session ratings of helpfulness were high for both actual rather than perceived improvements in ‘patient
treatment groups. Participants in the peer dyads reported care’ occurred” (p. 208). They reported that during case
collegial support as the most helpful aspects of their presentations during group meetings, members more
sessions, while those in the peer group said specific, con- easily focused on the intent of their interactions with
crete feedback about counselling skills techniques was patients and had more difficulty with the model’s empha-
most helpful. sis on identifying patterns of interactions. They noted
Starling and Baker (2000) employed the structured that fidelity to the model depended on the members’
peer group model (Borders, 1991) with four school coun- strong facilitation skills and a commitment to follow the
selling interns, who also received individual supervision. model; they suggested that a supervisor-led group may
The interns participated in intensive retrospective inter- have been a more effective approach, at least initially.
views about their peer group experiences at the middle
and end of the semester. Four general themes were iden-
Summary, Conclusion, and
tified: decrease in confusion and anxiety, clearer goals,
Recommendations
increased confidence, and value of the peer feedback.
Christensen and Kline (2001) used an adaptation of A number of peer supervision/consultation models were
the model with interns in a grounded theory study. identified that differed along a number of components,
Two primary themes were identified. Peer engagement, or including number of participants, type and presence of a
degree of involvement in the group, enhanced develop- leader, amount of structure, and stated goals. Psycholo-
ment of self-awareness; participants perceived that they gists clearly have a range of options for meeting the
gained more self-awareness than they had in previous requirement of 10 h of peer consultation for continued
groups. They reported peer feedback was the most critical professional development. Beyond choice of model, one
aspect of peer engagement, and said the structure helped important decision is whether recordings of counselling/
them learn how to give and receive feedback. Supervisor therapy sessions will be used during peer supervision/
involvement was characterised along a continuum of direc- consultation. Townend et al. (2002) criticised “an over
tive and facilitative; participants said they learned more reliance on case discussion with insufficient attention
from the facilitative approach. Christensen and Kline also being given to direct review . . . in order to maintain
identified three group phases. Initially, there was “passive standards of practice” (p. 499). Similarly, Gonsalvez and
involvement” and dependence on the supervisor for Milne (2010) cited “compelling literature across disci-
direction. As the supervisors promoted peer interaction, plines” that suggests “systematic biases affect self-report
the groups moved to phase two of “learning responsibil- and self-assessment” (p. 235). If methods of direct obser-
ity” and independence. Supervisees initiated feedback vation are not used, another method to achieve “critically
and were more focused on their interactions. Finally, reflective focus” cited by the (Psychology Board of
phase three, “personal involvement,” was characterised Australia (2010, p. 2) would need to be identified.
by more interdependence and intimacy; supervisees Effectiveness of peer consultation also will be depen-
reported valuing increased confidence and greater self- dent on the level of supervision skills brought by the
awareness gained from their active involvement with participants and/or a formal leader (see also, Townend
each other. et al., 2002). Gonsalvez and Milne (2010) who provided
Lakeman and Glasgow (2009) described a model devel- an in-depth review of relevant issues, such as the flawed
oped as part of an action research project with 10 psy- assumption that “experience-begets-expertise” (p. 234)
chiatric nurses employed in a hospital in Trinidad. The and the perspective that untrained supervisors may be
peer group model was developed through initial focus practicing unethically, outside their competencies. Simi-
groups in which the nurses discussed their needs for larly, some models involved an orientation or training for

68 © 2012 The Australian Psychological Society

 Peer consultation models

participants as one way to ensure the group structure lian context or create new models may be needed.
or format was followed and its potential benefits were Ongoing data collection focused on outcome variables
achieved. Leaderless groups, in particular, can experience relevant to the model’s goals and the critical components
“task drift” (Counselman & Weber, 2004), and can be contributing to the model’s effectiveness would greatly
overly supportive and prone to advice giving (Borders, enhance the practice of peer supervision/consultation.
1991). Although decisions about these issues may require Key points to consider in choosing a peer supervision/
dealing with some discomfort and vulnerability, they also consultation model include the following:
seem critical for peer consultation to achieve a “rigorous • Some structure, particularly during the early stages of
evaluation of . . . professional activities” (Australian Psy- the peer process, is recommended.
chological Society, 2008, p. 2). • A mechanism for staying on task (as determined by
Although there is enthusiastic support for peer models the peers) and regularly attending to group process is
and high satisfaction anecdotally, few models have needed, which might include a designated supervisor,
been investigated empirically, and published studies rotating leadership, member training in the selected
provide weak support for the few models that have been approach to reviewing cases, or some similar option.
investigated, often due to study design. Qualitative studies • Methods of direct observation likely will enhance the
involved small numbers of supervisees, typically from one peers’ professional development.
programme; measures to achieve trustworthiness of find-
ings were sometimes limited. Limitations of quantitative
research to date include small sample sizes; samples com- Acknowledgements
posed of students more often than practitioners; heavy Nicole Adamson provided technical assistance in the
reliance on author-created measures with minimal psy- preparation of this manuscript.
chometric support; more attention to member satisfaction
than increases in effectiveness of performance, client out-
comes, or other stated goals of the models; reliance on References
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© 2012 The Australian Psychological Society 71

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