IJSP Number 5, 2023

48 At the time, we argued that the competencies movement was necessitated by the urgent need to bring greater accountability to the profession. That call reflected a mounting groundswell of interest and innovation in competency-based education and training that challenged the assumption that competence was normatively achieved during the usual course of doctoral education and clinical training. Instead, we and others, such as Kaslow [3] and Roberts and colleagues [4] advocated for a paradigm shift that required the explicit demonstration of competence. It seemed a logical step to advance training in psychology, paralleling efforts in medicine and other healthcare professions [5], [6]. Further, establishing competence as the standard of practice fulfilled the profession’s social responsibility to protect and serve the public [7]. We concluded our text [1], with the call for further investigation “to ensure the development of effective methods . . . leading to benchmarks of competency” and asserting, “An empirical, evidence-based, theoretical foundation is required” (p. 232). Although necessary, we knew such a charge would not be easily fulfilled. So, what has happened over the past two decades? Competency-based approaches to education (CBE) and training have continued to be at the forefront in the development of healthcare professionals, particularly in medicine. Based on a PubMed search, almost 5000 articles on competency-based education were published between 2000 and 2022, with significant increases in the number of publications over time (e.g., 23 citations in 2000 to 445 in 2022). The inclusion of CBE in counseling and clinical psychology is significantly less robust. Although more than 6000, articles and books were published between 2004 and 2021 on clinical supervision, few works focused explicitly on clinical competence. In the past 20 years (2003-2022) only 300 citations were identified in psycINFO pairing “competency-based education and psychology” and 150 citations were identified using the terms “competency-based” and “clinical supervision.” Although the medical articles far exceed those in psychology, the trends in citations suggest that medicine has far exceeded psychology in embracing CBE as an educational and training approach. The establishment of Guidelines for Clinical Supervision in Health Service Psychology [8], [9] in the U. S. was pivotally important in placing emphasis on competencies and informing supervision practice. Guidelines in themselves are not sufficient to shape behavior and an abundance of evidence has accrued highlighting the current state of the field indicating both the critical necessity for supervisor competence and the fact that we have not achieved the goal of ensuring competence for supervisors. Research has addressed specific components of supervision practice—relationship, multicultural competence, strains—but not on the means of achieving competence or the intentional and systematic process entailed. A distinct lack of clarity or specific parameters or components, and minimal attention has been directed to outcomes of clients or supervisees as a function of supervision. Simply put, we do not know the impact of clinical supervision on client outcomes [10]. Further, inquiry has not extended to the settings in which supervision occurs, the power of administrative structure, the host organization [11] and the myriad aspects of worldview, hiring, economic realities, and priorities that determine all aspects of practice and supervision.