Training and Education in Professional Psychology

© 2019 American Psychological Association 2019, Vol. 13, No. 3, 194 –199
1931-3918/19/$12.00 http://dx.doi.org/10.1037/tep0000240

Supervisory Experiences of Trainees With Disabilities: The Good, the Bad,

and the Realistic
Jennifer G. Pearlstein and Peter D. Soyster
University of California, Berkeley

Clinical trainees with disabilities often have unique training needs. These can include requiring adequate
supervision in navigating disability disclosure with clients, responding to disability-related stigma and
discrimination in professional contexts, and developing an identity as a therapist that respects potential
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

disability-related limitations and maximizes the trainee’s strengths. The ability of supervisors to address
This document is copyrighted by the American Psychological Association or one of its allied publishers.

these needs can greatly impact the professional development of trainees with disabilities. The present
article offers 3 de-identified supervision experiences encountered by trainees with disabilities in the
context of a clinical psychology PhD program. We share both positive and negative supervision
experiences, highlighting the effect these interactions have on trainee development, and offer suggestions
for improved supervision of trainees with disabilities.

Public Significance Statement

People with disabilities are underrepresented in clinical training programs, and this may be in part
because clinical trainees with disabilities may have unique training needs. Supervision has the
potential to improve or interfere with the professional development of trainees with disabilities,
depending on how well the supervisor addresses these training needs. This article discusses three
examples of trainee experiences with supervisors and provides suggestions for improving supervision
of trainees with disabilities.

Keywords: disability, trainees with disabilities, trainee experience, supervision, professional development

Supervisory relationships are formative for the professional especially influential in the development of a trainee’s confidence
development of clinical trainees. Clinical trainees with physical and clinical skills (Inman, 2006; Jacobsen & Tanggaard, 2009).
disabilities often have unique training needs, including adaptations Addressing the needs of trainees with differences in ability is of
in clinical assessment, intervention, and professional development critical importance. Given the focus of this paper, the term dis-
practices. Given the unique experiences and needs faced by clin- ability is restricted in its use, describing differences in physical or
ical trainees with differences in ability, supervisors’ receptiveness, neurological functioning that are recognized under the Americans
sensitivity, and flexibility when working with these students can be with Disabilities Act (1990). We refer to students receiving clinical
training who experience differences in physical ability as trainees
with disabilities. We acknowledge some disability advocates pre-
fer identity-first language (e.g., disabled trainees); however, the
JENNIFER G. PEARLSTEIN received BS degrees in Psychology and Cog- American Psychological Association (APA) encourages the use of
nitive science at Truman State University and MA from the University of person-first language. The best available data estimates that about
California, Berkeley. She is currently a doctoral student in the Clinical 3% of graduate-level psychology trainees report having a disability
Science program at the University of California, Berkeley. Jennifer’s (Andrews & Lund, 2015), compared with 10.5% of people aged
research focuses on the transdiagnostic trait-based tendency to respond
18 – 64 living in the United States with a disability (Kraus, 2015),
impulsively to emotion. Specifically, she is testing models of neurocogni-
tive mechanisms of poor self-control and psychopathology. which indicates that people with disabilities are underrepresented
PETER D. SOYSTER received his BA in Psychology from the University of in psychology graduate programs. Barriers for trainees with dis-
California, Berkeley. He is currently a graduate student in the Clinical abilities may include power differentials and the lack of reciprocity
Science Ph.D. program at the University of California, Berkeley. Peter’s (i.e., imbalance in relationship needs) in clinical training (Vande
research employs idiographic methods to understand substance use dynam- Kemp, Shiomi Chen, Nagel Erickson, & Friesen, 2003).
ics and predict future use at an individual level. Specifically, he is inter- Beyond structural and systematic barriers faced by trainees with
ested in understanding how biological, psychological, and social factors
disabilities, we focus our article on supervision needs. There are
contribute to momentary decisions to use tobacco and alcohol.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to
common areas for which trainees with disabilities may need addi-
Jennifer G. Pearlstein, Department of Psychology, University of Cali- tional or augmented supervision. Specifically, trainees with dis-
fornia, Berkeley, 2121 Berkeley Way, CA 94720. E-mail: jenpearlstein@ abilities need adequate supervision in the following areas: (a)
berkeley.edu navigating disability disclosure with clients, (b) responding to

194
 SUPERVISION OF TRAINEES WITH DISABILITIES 195

disability-related stigma and discrimination in professional con- Case Examples

texts, and (c) developing an identity as a therapist that respects
potential disability-related limitations and maximizes the trainee’s The Good: Transparency Around Self-Disclosure
strengths. Both visible and invisible disabilities may impact clin-
ical work and necessitate the trainee to navigate effective self- Before seeing her first client, the trainee asked her supervisor to
disclosure to clients and develop skills to adapt the assessment and discuss the topic of self-disclosure. The trainee has low vision,
therapy format. For example, a trainee with hearing loss may need which impacts clinical work because of her inability to see stan-
to adapt the delivery of interventions and assessments through the dard print materials, make eye contact, and perceive others’ emo-
use of an interpreter, and the client may need to be informed about tional expressions. While most trainees experience anxiety before
confidentiality, as well as appropriate etiquette when using an beginning clinical work, the trainee with vision loss experienced
interpreter. The trainee with hearing loss may benefit from super- anxiety specific to disclosure of her disability. The trainee worried
vision that helps the trainee communicate about their hearing loss about how sharing her disability status would impact clients’
perceptions of her abilities and competence. The trainee wanted to
in professional contexts, advocate for their needs, and confidently
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

maintain focus on the client, while also providing an explanation

use reasonable accommodations to effectively engage in clinical
This document is copyrighted by the American Psychological Association or one of its allied publishers.

for the ways her disability impacts her social interactions. The
work.
trainee also experienced fears about self-disclosure to her super-
Clinical training presents unique challenges to trainees with
visor; similar to her fears with clients, the trainee worried about
disabilities because such training often includes a focus on enhanc-
how the supervisor would perceive her abilities and competence,
ing interpersonal effectiveness to improve the delivery of inter- especially given her supervisor was in a position of power, eval-
ventions. Supervision of this type can include feedback aimed at uating her clinical skills and progress.
shaping the trainee’s nonverbal and verbal communication skills, The trainee’s supervisor approached the conversation with cu-
including patterns of speech, body posture and movement, and eye riosity, asking questions to better understand the possible clinical
contact. The inherent challenge for students with disabilities is that impacts of the trainee’s disability on treatment. The supervisor also
disability could interfere with rapport. For example, a trainee with inquired about the trainee’s ideas and opinions about possible
cerebral palsy may demonstrate irregular muscle movements and options for self-disclosure. The supervisor expressed humility,
atypical gaze direction. These behaviors, outside the context of acknowledging he had no direct experience with disclosure of a
physical disability, are targets to hone in clinical training for the disability to clients. The supervisor empowered the trainee to share
purposes of developing effective rapport with clients. However, her experience and perspective. Whereas the trainee may indeed be
for trainees with disabilities, supervision focused on these invol- an expert on her own lived experience with disability, she none-
untary nonverbal and verbal communication patterns would be theless had very limited experience in the context of clinical
inappropriate because it calls immutable aspects of the trainee’s service provision. Hence, collaboration between the trainee and
ability and identity into question in a professional context. Instead, supervisor was crucial. The trainee benefitted from a safe and
we argue that supervision focused on enhancing trainee’s strengths supportive space to fully explore these questions in supervision. In
may be more effective. All trainees present with particular this case, the supervisor expressed nonjudgmental understanding
strengths, and, anecdotally, it is common for trainees with disabil- of the clinician’s concerns and encouraged that this question be
ities to possess strengths related to resilience, compassion, humil- readdressed regularly over the course of supervision.
ity, and openness. The skilled supervisor will work with the trainee The supervisor encouraged the trainee to evaluate the function
with disabilities to identify and harness their strengths and mitigate of self-disclosure (e.g., Henretty & Levitt, 2010). Why would the
the potential disruptions their disability could cause. trainee self-disclose? Why not? What would the consequences be?
This artily described three deidentified, composite supervision If the trainee chose to self-disclose, when was the appropriate
experiences encountered by two trainees with disabilities in a time? Should self-disclosure depend on the client? The supervisor
worked collaboratively with the trainee to view ways in which
clinical science PhD program. While we do not aim to provide a
self-disclosure of her disability could function to aid the client.
comprehensive list of scenarios in which self-disclosure or accom-
After assessing the function of self-disclosure, the supervisor
modations would be warranted, we offer specific examples to
encouraged the trainee to consider diverse responses from clients.
illustrate the role of supervisory experiences for trainees with
The supervisor-initiated role-plays with the trainee to practice
disabilities that we believe generalize to other forms of disability.
responding to various scenarios. How would the trainee respond if
The first vignette exemplifies how supervisors can work collab- the client questioned her competence and qualifications? What
oratively with trainees with disabilities to improve clinical skills would the trainee do if her client asked her to read something?
related to self-disclosure with clients. Because trainees with dis- They videotaped diverse examples, reviewed the videotapes to-
abilities often navigate self-disclosure of vulnerable health infor- gether, and iterated to improve the trainee’s communication and
mation, this presents an especially important aspect of professional confidence. The supervisor reviewed the trainee’s videotaped ses-
development. The second example portrays how well-intentioned sions to provide feedback about her interactions with clients about
supervisors can articulate stigma and bias that negatively shapes a her disability. Together, the supervisor and trainee harnessed the
trainee’s professional development and also illustrates the benefits trainee’s strengths in communication to engage in effective self-
of additional consultation and identifying reasonable accommoda- disclosure.
tions. The third example points to the detrimental consequences of This collaborative and nonjudgmental approach alleviated the
supervisors’ assumptions about ability, as well as the potential for trainee’s concerns and fostered her sense of self-efficacy. By
repair in the supervisory relationship. practicing self-disclosure, the trainee developed confidence and
 196 PEARLSTEIN AND SOYSTER

comfort. The supervisor validated the trainee’s concerns and en- sure.” The trainee was mortified. She questioned her choice to
couraged the trainee to speak openly and honestly to clients about pursue clinical psychology and wondered if the supervisor was
her disability when clinically appropriate. It is important that this right.
collaboration exemplifies parallel process, whereby dynamics in The trainee’s experience with a supervisor who viewed her
the supervisory relationship mirror dynamics in the therapy rela- disability as an insurmountable roadblock to clinical development
tionship (Tracey, Bludworth, & Glidden-Tracey, 2012). Specifi- was upsetting and unhelpful. The trainee’s experience coheres with
cally, this interaction illustrates the parallel experience of anxiety a growing body of literature on the attributes that characterizes
related to self -disclosure, encountered here by the trainee in effective and competent supervision, which include respect for
supervision and commonly encountered by clients in therapy. By diversity, encouragement of trainee autonomy, open communica-
role-playing strategies to cope with this anxiety, the trainee gains tion, and a strong relationship (e.g., Falender et al., 2004; Ladany,
additional empathy for clients and the anxiety they encounter Mori, & Mehr, 2013). Through invoking the trainee’s disability
during self-disclosure. In this way, the parallel process in super- status as proof that she could not be a competent clinician, the
vision provides valuable skills and experiences relevant for the supervisor disrespected diversity, damaged the supervisory rela-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

trainee when delivering therapy. tionship, and discouraged autonomy, all of which interfered with
This document is copyrighted by the American Psychological Association or one of its allied publishers.

During one therapy session, the trainee’s client professed ex- building the trainee’s assessment skills.
treme shame and self-stigma tied to his recent diagnosis. He In contrast to this stigmatizing and rigid response, several su-
questioned what his life would look like now that he “officially has pervisors, faculty, and psychologists with disabilities provided
a mental illness.” He doubted himself and his worth, asking “How actionable suggestions for accommodating the assessment process.
could anyone love me now?” The trainee chose to disclose her Many recommendations involved the use of assistive technology,
experiences with transformations in her identity related to the such as adapting materials by digitizing, magnifying, or converting
receipt of a diagnosis for chronic illness. The client cried and materials to Braille. Another recommended the use of a psycho-
expressed profound gratitude for the clinical trainee’s self- metrician or test administrator for neuropsychological tests. In
disclosure, articulating that knowing others have struggled with practice, the trainee with low vision has sought diverse accommo-
similar challenges helped normalize his experience and reduce his dations catered to each assessment. The trainee with low vision
feelings of shame. now conducts clinical interviewing using standardized instruments
by digitizing and enlarging, enabling her to use a tablet or laptop
The Bad: Stigma and Prejudice During Self-Disclosure for interview-based assessments. With support from her training
clinic and guidance from supervisors, the trainee with low vision
in Supervision
has recruited and supervised psychometricians to administer neu-
Trainees with disabilities often require accommodations to ropsychological tests that are particularly challenging to adapt.
adapt the structure and format of interventions and assessments. Each assessment has required an evaluation of the trainee’s ac-
The APA has documented one of the greatest barriers to clinical commodation needs and a collaborative plan with her supervisor to
psychology training is providing reasonable accommodations for meet those needs. This flexible, personalized, and collaborative
psychological testing and assessment, as it is often difficult to approach has benefited the trainee by providing a sense of efficacy
obtain accessible versions of materials and many disabilities in- and confidence. The trainee has also successfully obtained assess-
terfere with the clinician’s ability to administer and score assess- ment competence by delivering or observing all assessments,
ments according to standardized protocols (APA, 2011). working alongside the psychometrician to score and interpret
When the trainee with low vision began her assessment training, results in integrative reports.
she experienced these barriers firsthand. Given that reliability and
validity of assessments depend on their delivery using a standard- The Realistic: Making and Repairing Mistakes in Self-
ized protocol, the trainee saw little space for accommodating
Disclosure in Supervision
testing materials. The trainee therefore felt insecure about her
abilities to fulfill the training requirements of her program, and In a diverse training program, it seems inevitable that even
worried she would not be able to find ways to accommodate the well-intentioned supervisors will make errors during supervision.
assessment process. She worried she would be unable to gain These can include the use of stigmatizing or outdated language,
required competency in assessment. She sought mentorship from incorrect attributions about the cause of disability-related behav-
other psychologists with disabilities, supervisors, and faculty to iors, and prejudiced assumptions about the potential of trainees
understand how trainees with disabilities might accommodate the with disabilities. However, just as clinicians work to repair rup-
assessment process. tures in alliance with clients (Safran, Muran, & Eubanks-Carter,
While many of these consultations were informative, some 2011), the skilled supervisor can work to repair the working
people responded with rampant stigma, bias, and discrimination. In relationship with trainees with disabilities after an error has been
one such interaction, the trainee disclosed to the supervisor the made.
nature of her disability and how it impacted her ability to admin- A first-year graduate student has Tourette syndrome. The train-
ister assessments. The supervisor responded, “I just don’t know ee’s symptoms manifest as involuntary facial and motor tics and
how you could ever be a clinical psychologist if you can’t see to throat clearing of mild to moderate severity. The trainee was
do assessments.” The trainee attempted to advocate for herself, generally comfortable discussing his diagnosis and symptoms and
stating that she was aware of other psychologists with disabilities disclosed this in his graduate application materials and interviews.
modifying the assessment process. The supervisor maintained her While the trainee’s symptoms had never prevented him from
stance, repeating, “You’ll never be a neuropsychologist, that’s for succeeding in clinical experiences, he felt some concern when
 SUPERVISION OF TRAINEES WITH DISABILITIES 197

starting graduate school that his disability might be a problem, ness about learning from this experience, including not making
because he did not fit the traditional image of a therapist. The assumptions about ability status in trainees, paying more attention
trainee expressed this concern to his supervisor upon entry to the to ability status in general among trainees, and recognizing that the
training program. impact of a disability on actual clinical care depends on each
As part of an introductory intervention course, the trainee com- trainee and should be evaluated on a case-by-case basis. The
pleted a video-recorded mock clinical intake. The tape of the supervisor’s actions to repair the alliance with the trainee demon-
session was reviewed by a supervisor to provide feedback on the strate several empirically supported strategies for repairing rup-
trainee’s readiness to begin seeing clients. Although the supervisor tures in therapeutic alliance, including openly discussing and ex-
had been previously informed, she had not remembered the train- ploring the rupture, responding openly and nonjudgmentally, and
ee’s disability status. In written feedback to the trainee about the taking responsibility for the rupture (Safran et al., 2011).
mock session, the supervisor wrote that some of the trainee’s
symptoms were potentially therapy-interfering, and suggested an
Discussion
extinction schedule timeline for reducing these behaviors that were
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

directly related to his disability. In addition, the supervisor ex- The supervisory relationship is designed to shape the profes-
This document is copyrighted by the American Psychological Association or one of its allied publishers.

pressed concerns about these symptoms in a faculty meeting sional development of clinical psychology trainees. Trainees with
focused on the progress of clinical training of students. At the disabilities present with specific training needs related to self-
meeting, the supervisor was reminded of the trainee’s disability disclosure and the need for accommodations. In this paper, we
status by another faculty member, and was told that suggestions provided three examples illustrating how supervisors’ responses to
that the trainee attempt to reduce involuntary symptoms were the needs of trainees with disabilities can influence the trainee’s
inappropriate. professional development. Many of the supervisor attributes indi-
The trainee was embarrassed and upset by the written and verbal cated here are consistent with the consensus statement on compe-
feedback, as it seemed to confirm his concerns that his disability tent supervision (Falender et al., 2004), including transparent com-
made him unfit for clinical work. In addition, although he had munication, collaboration, humility, curiosity, respect, and
attempted to be open and transparent about his diagnosis, his flexibility. These examples illustrate ways in which supervisors
supervisor’s feedback appeared to confirm to the trainee that, can enhance the professional development of trainees with disabil-
occasionally, his disability would be included in evaluations of his ities (Table 1).
ability as a clinician. He sought consultation with peers and other The first example depicts the importance of collaboration be-
graduate students who suggested that he seek out other faculty tween the trainee and supervisor in implementing an effective
members to discuss this issue. clinical training plan, especially related to self-disclosure. The
It is important that after realizing her mistake, the supervisor supervisor expressed humility and respect for the trainee, and
made several efforts to correct her feedback and repair the rela- provided space for the trainee to share her experience and perspec-
tionship with the trainee. The supervisor had an in-person meeting tive. Through role-playing with the supervisor, the trainee became
with the trainee to listen to and understand how her feedback had equipped to handle various responses to her self-disclosure, bol-
affected the trainee and to apologize for forgetting this important stering her effectiveness and confidence. He also sought out con-
information. The supervisor expressed warmth and empathy, char- sultation with other supervisors. This supervisory experience em-
acteristics important for alliance and outcomes (Angus & Kagan, powered the trainee, which helped her to build confidence and
2007). Over the following months, the supervisor worked to pro- improve her clinical skills. The trainee learned not to hide from her
vide appropriate clinical feedback in a way that helped the trainee disability in clinical work, and instead developed the ability to use
to build clinical skills and to navigate disclosure in other clinical effective self-disclosure of her own experiences to alleviate her
and supervision experiences. The supervisor expressed an open- client’s pessimism and sense of shame. Self-disclosure is an im-

Table 1
Summary of Trainees With Disabilities’ Needs and Supervisory Practices That Address These Needs and Enhance
Professional Development

Training needs Supervisory practices

Navigating disability disclosure with clients Approach conversation with humility to assess needs for self-disclosure, determine the
function of self-disclosure, and collaborate with the trainee about the appropriate course
of action. With trainee consent, engage in role-plays to practice potential scenarios,
evaluate and iteratively improve.
Responding to disability-related stigma and Consider one’s own biases; engage in trainings to improve knowledge of disability culture,
discrimination in professional contexts disability rights, and accommodations; consult with colleagues; ask the trainee how to
best accommodate their needs, solicit feedback; work with the trainee to identify and
implement reasonable accommodations; approach supervision with flexibility; embrace
diversity in clinical work by accepting clinical training requires individualization.
Developing an identity as a therapist that respects Help the trainee gain confidence with clinical work, collaborate with the trainee to identify
potential disability-related limitations and their strengths, ask the trainee about their concerns, problem-solve with the trainee to
maximizes the trainee’s strengths mitigate effects of disability, model nonjudgmental acceptance of the limitations because
of the trainee’s disability, process and support client responses (e.g. bias, stigma,
discrimination), connect the trainee to other psychologists with disabilities.
 198 PEARLSTEIN AND SOYSTER

portant and valuable clinical skill (Knox & Hill, 2003), and this trainees about needs for accommodations, and by responding
supervisory experience helped the trainee develop and hone her with curiosity. As the previous examples illustrate, there can be
use of self-disclosure. personal and professional consequences to disclosing disability,
The second example highlights the strong stigma, bias, and and the choice to do so should be at the discretion of the trainee
discrimination that remains among some supervisors, and con- (Von Schrader, Malzer, & Bruyère, 2014). However, we also
tributes to a known need for greater training to increase com- encourage trainees with disabilities to consider the potential
petence and sensitivity related to disability (Andrews et al., consequences of nondisclosure. As with any discussion of per-
2013). Trainees with disabilities are protected under the Amer- sonal information in a clinical context, an important first step
icans with Disabilities Act and are equally deserving of clinical for supervisors is to recognize and respect the trainee’s auton-
opportunities and reasonable accommodations. The successful omy and personal boundaries.
accommodation of clinical work requires flexibility on the part While trainees with disabilities present with unique training
of the supervisor to see alternative ways of delivering assess- needs, it is important to acknowledge that supervisors are not, and
ments and interventions. In this supervisory interaction, the should not be, expected to be experts on all forms of disability.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

supervisor lacked the necessary humility and flexibility to con- Instead, these examples suggest a process by which supervisors
This document is copyrighted by the American Psychological Association or one of its allied publishers.

sider reasonable accommodations, which in turn halted the can provide supervision with sensitivity, humility, and respect for
trainee’s professional development. This example also illus- diversity. We hope these examples illustrate that supervisors need
trates the importance of consultation. Even in cases where not be perfect to enhance the growth of trainees with disabilities.
reasonable accommodations are not easily identifiable, super- Instead, a supervisor’s openness, flexibility, and willingness to
visors can play an important role in guiding the trainee through collaborate can build a trainee’s efficacy, confidence, and skills to
the experience and can work collaboratively to find an individ- improve their clinical work and overall professional development.
ualized solution that respects the trainee’s identity.
The third example reveals common misinterpretations and
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