SYSTEMATIC REVIEW article
Front. Psychiatry
Sec. Psychological Therapy and Psychosomatics
The Effects of Clinical Supervision on Supervisees and Patient Outcomes in Psychotherapy – A Systematic Review and Meta-Analysis
Provisionally accepted
- 1Catholic University of Eichstaett-Ingolstadt, Faculty of Philosophy and Education, Department of Clinical and Biological Psychology, Eichstätt, Germany
- 2LMU Munich, Faculty of Psychology and Educational Sciences, Department of Psychology, Clinical Psychology and Psychological Treatment, Munich, Germany
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Objective: Supervisions and case consultations are an essential and often required part of psychotherapeutic training. Despite its importance and ubiquitous use, research is limited, and no quantitative review is yet available. This systematic review and meta-analysis provides an overview of empirical literature on clinical supervision and investigates its effectiveness regarding various outcomes (PROSPERO CRD42024574318). Method: We conducted a comprehensive literature search up to June 16th, 2025, in the databases Epistemonikos, Cochrane Library, EMBASE, PubMed, PsycINFO and Web of Science. Eligible trials were controlled and uncontrolled trials evaluating the effectiveness of clinical supervision/case consultation with pre-and post-assessment points. Study quality was assessed using Cochrane's ROBINS-I V2 and RoB-2 tool. Where applicable, outcomes were analyzed using a random-effects model meta-analysis. Results: 32 studies met the inclusion criteria of which 13 studies could be included in meta-analyses for the outcomes on therapists' competence, therapeutic alliance and patients' symptoms. Supervision interventions yielded a significant small non-significant effect on patients' symptoms reduction favoring the respective supervision interventions. There was a small effect on therapists' competence and medium effect on therapeutic alliance, which both were non-significant, yet large and significant when compared with passive controls. Regarding the studies included in the review, supervision was mostly reported to have a beneficial effect on therapists' competence, alliance and patients' symptoms, while the effects on therapists' adherence were heterogeneous. Conclusion: These results highlight positive promising effects of supervision and the need for further investigation of different supervision models. Further research is needed to examine the effectiveness of supervision and investigate potential moderating factors.
Keywords: supervision, Psychotherapy, Therapists in training, Therapist competence, Therapeutic Alliance, Patient symptoms, Meta-analysis
Received: 15 Sep 2025; Accepted: 03 Nov 2025.
Copyright: © 2025 Schreyer, Leithner, Eilers, Gossmann and Rosner. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bianca Schreyer, bianca.schreyer@ku.de
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