Unveiling Effectiveness: A Qualitative Exploration of Existential Psychotherapy Supervision through Supervisors’ Lenses

Unveiling Effectiveness: A Qualitative Exploration of Existential Psychotherapy Supervision through Supervisors’ Lenses | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unveiling Effectiveness: A Qualitative Exploration of Existential Psychotherapy Supervision through Supervisors’ Lenses Marija Vaštakė This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9284410/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Psychotherapy supervision plays a central role in therapists’ professional development, yet empirical research on its effectiveness remains limited, particularly within the existential tradition. This qualitative study examines factors influencing the effectiveness of existential psychotherapy supervision from supervisors’ perspectives. Seven existentially oriented supervisors participated in semi-structured interviews, and thematic analysis identified key facilitators and barriers. Facilitators included the quality of the supervisory relationship, supervisor attributes and interventions, and supervisee characteristics. Barriers involved lack of time and regularity, overly pedagogical approaches, unclear supervision questions, and supervisee anxiety or limited experience. The findings highlight underexplored relational and experiential dimensions, including humor, intentional slowing, and the process of “making the invisible visible,” with implications for supervision practice and training. Psychology Existential psychotherapy supervision supervision effectiveness Thematic analysis Figures Figure 1 Definition of Psychotherapy Supervision Goodyear ( 2014 ) posits, “A litmus test for evaluating the effectiveness of supervision is this: what is the supervisee doing differently now than before supervision?” Supervision is generally conceptualized as a relational and professionally sanctioned process wherein a qualified supervisor offers support, oversight, and developmental guidance to a less experienced practitioner (Milne, 2007 ). Within psychotherapy and counseling contexts, supervision is instrumental in enhancing professional competence, fostering reflective practice, and promoting both ethical and effective clinical work. Distinct theoretical models of supervision emphasize different facets of the supervisory process. Cognitive–behavioral and other structured approaches foreground goal-setting, skill acquisition, and feedback, whereas psychodynamic and existential models highlight relational depth, emotional attunement, and meaning-making. Despite these theoretical distinctions, there is consensus that a core aim across all models is to facilitate professional growth through relationship, reflection, and ethical responsibility (Bambling et al., 2006 ; Gilbert & Evans, 2000 ; Milne & Watkins, 2014 ; Pelling et al., 2017 ; Rousmaniere et al., 2016 ; Schweitzer & Witham, 2018 ; Tugendrajch, 2021; Vaštakė & Kočiūnas, 2017 ; Vaštakė, 2022 ). However, there remains a notable paucity of empirical research directly comparing the effectiveness of different supervisory models (Bernard & Goodyear, 2019 ; Ladany, 2013; Norberg et al., 2016 ; Watkins, 2017 ; Silva & Sousa, 2022 ; Stiwne, 2023 ). Several scholars underscore the field’s need for research elucidating both universal relational processes in supervision and model-specific mechanisms contributing to its effectiveness (Silva & Sousa, 2022 ; Stiwne, 2023 ; Watkins, 2017 ). Existential Supervision: Conceptualization and Research Context Although supervision has been examined for multiple decades, consensus regarding the definition of effective supervision remains elusive (Milne et al., 2007). Within this broader context, existential supervision is especially under-researched: du Plock ( 2009 ) highlights that existential supervision has primarily been discussed in reflective and philosophical terms, with scant empirical investigation. Similarly, van Deurzen and Young (2009) and Krug and Schneider ( 2016 ) note that while existential supervision is rooted in foundational philosophical principles—such as personal freedom, responsibility, meaning, and relational embeddedness—the literature remains largely conceptual rather than empirical. Two phenomenological studies (du Plock, 2009 ; Vaštakė & Kočiūnas, 2017 ) help delineate the structure of existential supervision. Drawing on these works, existential supervision is understood as encompassing four interrelated dimensions: 1. The supervision process – characterized by a slow, exploratory, and reflective inquiry rather than directive instruction; the primary aim is to illuminate meaning, not provide prescriptive solutions (Vaštakė & Kočiūnas, 2017 ; du Plock, 2009 ). 2. The supervisory relationship – founded on dialogical equality and shared exploration; the supervisor is positioned not as an expert but as a co-inquirer (du Plock, 2009 ). Spinelli ( 2015 ) has even suggested substituting the term “supervision” with “seeing-over,” to underscore mutual presence and perspective broadening. 3. The supervisor’s way of being – marked by openness, authenticity, and a phenomenological “not-knowing” stance; the supervisor suspends assumptions (epoché) to allow meanings to emerge from lived experience (Kočiūnas, 2018 ; Pagdin, 2013 ). 4. The interventions commonly employed in existential supervision reflect the foundational principles of the approach: attention to the “here and now,” mirroring of nonverbal reactions, analysis of parallel processes, and the formulation of open questions that foster exploration without imposing limits (Vaštakė & Kočiūnas, 2017 ). du Plock ( 2009 ) emphasizes the importance of assisting supervisees in learning to tolerate uncertainty, accept existential paradoxes, and resist the urge to confine client experience to diagnostic frameworks. Krug and Schneider ( 2016 ) similarly highlight the supervisor’s personal qualities—empathy, authenticity, congruence, and integrity—as essential to effective existential supervision. Ultimately, a core tenet of existential supervision is phenomenological openness, grounded in the principle of epoché—that is, the temporary suspension of judgments and assumptions to allow full acceptance of whatever emerges in the supervisory process (Kočiūnas, 2005 , 2018 ; Pett, 1995 ; Pagdin, 2013 ). This attitude creates space for genuine dialogue and an exploratory partnership. Assumptions Regarding the Effectiveness of Supervision in Existential Therapy Most scientific research to date has examined specific aspects of supervision indirectly, with very few systematic analyses isolating the factors that determine its effectiveness. The majority of researchers (Alfonsson et al., 2018 , 2020 ; Hill & Knox, 2013 ) address two principal questions: (1) which factors in supervision contribute to supervisees’ professional development, and (2) which variables influence the well-being of psychotherapy clients. Although it has been empirically established that supervision fosters reflexivity, professional skills, and job satisfaction (Hill & Knox, 2013 ), there remains a significant gap in understanding the precise mechanisms by which such change occurs. The second question—regarding supervision’s impact on client outcomes—remains almost entirely unexplored (Alfonsson et al., 2020 ; Kühne et al., 2019 ). Research also highlights that psychotherapy experience alone does not guarantee one’s ability to offer effective supervision; specialized training in supervision is essential (du Plock, 2009 ; Majcher & Daniluk, 2009 ; Watkins, 2012 ). Furthermore, supervisor competencies are distinct from those of a psychotherapist: effective supervision requires not only clinical expertise but also the ability to reflect on the process from a meta-perspective (the ability to reflect on the supervisory process itself, including the relational, emotional, and institutional dynamics operating across therapeutic and supervisory levels), to foster a learning-conducive relationship, and to support the supervisee’s ongoing professional growth. Nevertheless, the very boundaries of the concept of effective supervision remain ambiguous. Some scholars propose defining effective supervision as an interactive process in which the supervisee demonstrates the capacity to integrate knowledge and experience, and continues to develop professional competencies and ethical sensitivity (Graham et al., 2014 ). According to Ladany et al. ( 2013 ), effective supervision stimulates professional growth, while its absence stifles such development. Gonsalvez et al. (2017) further argue that effectiveness should be distinguished from supervisee satisfaction, as the latter is shaped by individual and contextual factors. With respect to existential therapy supervision, no studies have explicitly examined its effectiveness to date. The only empirical evidence is indirect. For example, Vaštakė’s ( 2022 ) doctoral dissertation revealed that the development of reflexivity may constitute one of the “active ingredients” in existential supervision. Reflexivity is cultivated within a long-term, equal, and dialogical relationship between supervisor and supervisee, with a strong focus on “here and now” emotions, a stance of “not-knowing,” and a careful negotiation of the boundaries between therapy and supervision. By contrast, reflexivity is impeded by factors such as a supervisor’s lack of preparation, physical and emotional distance, or an overly didactic supervision style. In their study of existentially oriented supervisors, Silva and Sousa ( 2022 ) emphasized that successful supervision is primarily determined by a safe, dialogical relationship that addresses the supervisee’s evolving needs. They also highlighted the importance of personal supervisor qualities—humility, authenticity, consistency, and the ability to tolerate uncertainty. In summary, the evidence base for the effectiveness of existential therapy supervision remains largely theoretical and fragmented. This underscores the relevance of empirically informed inquiry in this area. Previous work has described how reflexivity develops during existential supervision and highlighted the emergence of an “internal supervisor” as a key outcome of the supervisory process (Vaštakė, Skruibis, & Kočiūnas, 2021 ). Building on these findings, the present study shifts the focus from what changes in supervisees to how existential supervisors themselves understand and cultivate supervision effectiveness, including the relational and temporal processes that enable such reflexive change. Accordingly, the present study seeks to elucidate the factors that, from the perspective of existential supervisors, contribute to supervision effectiveness. Methods Participants and Qualitative Framework Since the aim of this study was to explore and describe existential psychotherapy supervisors’ experiences of supervision effectiveness, and because this phenomenon has not been directly examined in the context of existential supervision either in Lithuania or internationally, a qualitative research design was adopted. This approach is particularly appropriate for underexplored research areas in which existing findings are fragmented or insufficient to support hypothesis testing, and where the goal is to understand how participants experience and make sense of a phenomenon through detailed, nuanced accounts (Barker et al., 2002; Smith & Osborn, 2015). The study included seven existential psychotherapy supervisors currently practicing in Lithuania at the Humanistic and Existential Psychotherapy Institute (HEPI). The sample comprised six women and one man, aged between 43 and 54 years (M = 43.3). All participants were psychologists and certified existential psychotherapists with formal training in supervision. Participants were recruited using purposive sampling based on their formal training in existential psychotherapy supervision and active involvement in supervising trainees within the HEPI program. Sampling continued until thematic saturation was reached, defined as the point at which no substantively new themes or analytic insights emerged from subsequent interviews, indicating sufficient information power for the study’s qualitative aims. Participants’ experience of being supervised ranged from 11 to 30 years (M = 17.7), while their experience in providing supervision ranged from 3 to 20 years (M = 7.7). The number of supervisees they worked with per week varied from 4 to 15 (M = 6). At the time of the study, all supervisors were working with supervisees enrolled in the HEPI existential therapy program, each of whom had participated in no more than ten supervision sessions at the time of the interview. To preserve confidentiality, all participant names were replaced with pseudonyms. Data collection procedures The study was conducted between September 2023 and July 2024. Potential participants were contacted via email. All interviews were conducted in person; the researchers traveled to locations convenient for the participants, which in most cases were the participants’ psychotherapy offices. Prior to beginning the interview, each participant completed a demographic questionnaire, after which the semi-structured interview was initiated. Participants were invited to reflect on their experiences through open-ended questions. Participants were invited to reflect on their experiences through the following semi-structured interview questions: 1. How would you describe supervision effectiveness? Alternatively: What does effective supervision mean to you? 2. I would like to talk with you about your current work with your supervisee. To what extent do you experience this supervisory work as effective or ineffective? 3. Naturally, some supervision sessions are experienced as more effective than others. Please think of supervision sessions that felt effective. Could you describe specific moments or episodes that you experienced as effective? o How did you recognize that this particular session or moment was effective? o What, in your view, was most meaningful or impactful for your supervisee? 4. How would you describe your relationship with your supervisee? o What aspects of this relationship feel most important to you? o What feels lacking or challenging? o In what ways does this relationship contribute to (or hinder) the effectiveness of supervision? 5. If it were entirely up to you, what would you change in the supervision process with this supervisee? 6. Is there anything we have not discussed, but that you feel is important when talking about supervision effectiveness or the supervisory relationship? All interviews were audio-recorded and later transcribed verbatim, with attention to significant non-verbal expressions and relational nuances. Data analysis The data were analyzed using inductive reflexive thematic analysis as outlined by Braun and Clarke (2022, 2023). This approach allows for identifying, interpreting, and organizing patterns of meaning within the data without applying predefined theoretical frameworks or testing prior hypotheses. Reflexive thematic analysis emphasizes the researchers’ active role in constructing themes while remaining grounded in participants’ lived experiences. This method was chosen because it enables the exploration of how participants make sense of the phenomenon, allowing both anticipated and unexpected insights to emerge from the data. The data analysis followed the six phases proposed by Braun and Clarke: 1. Familiarization with the data. All interview transcripts were read multiple times to develop an immersive understanding of the participants’ experiences. Initial notes and impressions related to supervision effectiveness were recorded. 2. Generating initial codes. Each interview was coded line-by-line. Codes captured both semantic features (explicitly stated meanings) and latent meanings (underlying assumptions or emotional and relational nuances). Some excerpts were assigned multiple codes when relevant. 3. Searching for themes. The initial codes were organized into preliminary clusters based on conceptual similarity. These clusters informed the development of early candidate themes and subthemes. 4. Reviewing themes. Candidate themes and subthemes were compared back to the full dataset to ensure coherence and distinctiveness. During this process, some themes were refined, combined, or separated to more accurately reflect the data. 5. Defining and naming themes. Each theme and subtheme was clearly articulated to capture its core meaning and the essence of participants’ experiences. Theme names were selected to be both conceptually precise and grounded in the language participants used. 6. Writing the analysis. The themes and subthemes were described in detail and illustrated using representative quotations from the interviews. The analytic narrative aimed to show how participants understood and made sense of supervision effectiveness. Truthworthiness In line with contemporary standards of qualitative research, diversity within the research team—in terms of disciplinary background and professional experience—enhances the validity and trustworthiness of data interpretation by reducing the dominance of any single epistemological position and strengthening triangulation and reflexivity (Ahmed, 2024; Jansen, 2025; Timonen et al., 2024). Our research team was both methodologically and therapeutically diverse, which enabled the analysis to be approached from multiple conceptual perspectives and reduced the likelihood that any single theoretical orientation would shape the interpretation. The team consisted of five researchers. The first, second, third, and sixth researchers had prior experience working with qualitative methodologies, with the first three having received formal training in thematic and phenomenological analysis. The fourth and fifth researchers were graduate students in clinical psychology who were beginning to apply qualitative research methods. The first author is an existential psychotherapist and supervisor; the second author is an existential psychotherapist; the third and sixth authors are psychodynamic psychotherapists. All authors participated in every stage of the research process, including conducting interviews, transcribing data, and carrying out the analysis. Each researcher individually coded the interviews they conducted, after which codes were compared and discussed collaboratively to reach shared understandings. Each researcher created a hierarchical table of themes and subthemes for their transcript. These tables were then combined and collectively refined to develop consistent theme labels and thematic structure. The study adopted a phenomenological epistemological position, which shaped both the conduct and interpretation of the research by orienting the analysis toward participants’ lived experiences of supervision effectiveness, rather than toward the evaluation of predefined theoretical constructs or outcomes. This epistemological stance informed the researchers’ commitment to openness, reflexivity, and attentiveness to meaning as it emerged from the data. The interdisciplinary composition of the research team—drawing on existential, psychodynamic, and psychoanalytic theoretical backgrounds—further contributed to the analytic process. Engaging multiple clinical and conceptual perspectives enabled a dialogical examination of the data, supported reflexive awareness of theoretical assumptions, and reduced the risk of privileging a single interpretative lens. This plurality of perspectives enriched the analysis while remaining grounded in participants’ accounts.Because the effectiveness of existential supervision is a relatively unexplored topic, the analysis was approached from a “naïve listening” position, with an intentional effort to bracket presumptions and avoid premature theoretical closure. To support reflexivity, all researchers kept reflective journals throughout the analytic process, documenting their emotional and cognitive responses to the data. This practice assisted in recognizing personal assumptions and contributed to the overall trustworthiness of the interpretation. Findings The analysis revealed four overarching themes and seventeen subthemes that describe how existential supervisors understand and experience supervision effectiveness (see Fig. 1 ). These themes reflect both the relational and processual nature of existential supervision, highlighting the importance of interpersonal presence, reflective depth, supervisory stance, and the supervisee’s engagement with their own therapeutic work. Theme 1. Relationship Quality All research participants associate the effectiveness of supervision with the quality of the relationship between the supervisor and the supervisee. One participant, Nijolė, notes: The relationship is the main thing, in my view, for that effectiveness to develop. Subtheme 1. Support Participants indicate that support is one of the factors of effective supervision. Nijolė shares: …openness and being able to notice and, sort of, say some critical remarks, I also always try to build that relationship, kind of collegial, supportive, I know from my own experience how important it used to be for me that I am taken seriously, that I am considered, that I am supported, that the supervisor is on my side. Subtheme 2. Equality Participants observe that fostering an egalitarian relationship in the supervision process is also an important factor in effective supervision. Several excerpts from participant interviews: “So that real, kind of collegial equality, and here I feel how she works through those supervisions, she really shows that kind of way of working, it is not hard to feel that.” (Jonė) “He is collegial. So that is a very important aspect. He is, well, usually it is such an important part with beginning therapists, for whom it is kind of difficult to look at things in a collegial way, they really, kind of, look at it as at an authority, as at a teacher. I usually tend to put in effort to reduce this effect. So with my supervisor, it seems to me, there is that aspect that our relationship is really quite collegial. So that also helps. I think it takes away the tension.” (Roma) Subtheme 3. Trust and Openness Most participants emphasize the importance of trust and openness. Roma shares: A very good working contact, a lot of openness, and this really comes from the supervisee’s preparation and her motivation, so this kind of readiness to trust and to take the risk of trusting, and to speak very openly about all the nuances of the work, you know, so, um… such very good starting positions, really quite productive right from the first meeting, and this kind of readiness to go not only wide, but also into depth, that mutual trust between us, it is strongly growing, I mean, it is alive in all kinds of new ways of talking about things, well… Rimas observes: …she talks about her complicated feelings in the relationship with the client, about herself in the relationship with the client, so for me that is an indicator of both openness and trust in me. As a rule, as a rule, people who are afraid of the supervisor, like… or trust less, during supervision they talk more about the clients, and not about themselves, not about themselves and their own difficulties at work. Subtheme 4. Humor Four participants mention that humor is an important component of effective supervision. Roma notes: So, one of the forms, for example, that seems to me, well, well, how to say it, well, really very effective [emphasizes the word, laughs] – humor, so here with my supervisor this is really such a very unique, strong place. It creates distance, allows you to see the situation, and yourself, and to accept more easily those not-so-nice things that sometimes seem not very nice to see (?), in ourselves, you know, that kind of… especially at the beginning. Subtheme 5. Taking Time Participants note that it is important not to rush in supervision: “…for that you also need time, time, meetings, and that kind of shared, well, common thing, so in that sense I doubt that anyone could speed it up, like, I don’t know, a child being born, well, no one will make his processes develop faster (laughs), the ones that are developing there.” (Paula) “And then she had this long pause, and then everything kind of rearranged, she says, ‘well, it didn’t look like that at all’… so it lit up the situation in a completely different way.” (Jonė) Subtheme 6. Professional–Personal Boundaries Another important aspect of an effective supervisory relationship is maintaining the boundary between supervision and personal therapy. Rimas shares: As a supervisor, I don’t go into any of the therapist’s personal contexts, it’s only about the therapeutic relationship that the talk is. Theme 2. Supervisor’s Characteristics and Interventions The effectiveness of supervision is associated with supervisors’ characteristics and the interventions used within the supervision process. Subtheme 1. Making the Invisible Visible Participants note that when supervisees gain clarity—when what was invisible becomes visible—this is an indicator of effective supervision: “When the invisible becomes visible, that is effectiveness, well…” (Agata) “It’s just about understanding my question better, looking at it from different sides, expanding the context. Because when I bring a question, I bring this kind of ‘tunnelled’ moment. And when I manage to look at it from different aspects, then that tunnel kind of ‘thaws’.” (Jonė) Subtheme 2. Responsiveness to supervisee Participants note that formulating a request for supervision and responding to it is an important factor in effective supervision. Here are several excerpts from participant interviews: “…effective supervision is when, when a request is formulated that you can already respond to in a purposeful way.” (Nijolė) “…I understand that the goal of supervision is, supervision is meant to help a colleague. And that help is according to the need, the request, and if that help happens, or it starts to happen in the course of supervision, then supervision is effective.” (Roma) Subtheme 3. Facilitating Skills All participants mention that effective supervision involves support directed toward the development of supervisees’ new skills. Nijolė notes: Well, in a general sense, well, so that his competences would grow, really, that a person has all the necessary, I don’t know, abilities, data, this kind of informational base, now what remains is, well, to carry that into practice, to master certain processes, to understand how the consulting processes work, so that kind of, well, that they would strengthen, grow, I don’t know, the abilities, the skills of a young person. Subtheme 4. Supervisors’ Maturity Participants note that the supervisor’s personal maturity is an important factor in effective supervision. This is most clearly reflected in Paula’s interview: Here it’s about the maturity of my personal path, how far I have managed to go, how much I am able to be with that, so for now, at this moment, those are the kinds of answers about my contribution to effectiveness. Subtheme 5. Parallel Process Reflection Participants note that noticing and reflecting parallel processes in supervision is particularly important. This was most clearly evident in Jonė’s interview: And I showed the parallel between his life, how he does things there, and between her and that, and what really surprised the supervisee, well, it really seems like her eyes opened… Theme 3. Supervisee’s Characteristics Participants mention that the effectiveness of supervision also depends on the supervisee’s characteristics. Subtheme 1. Motivation The supervisee’s motivation emerged as a factor in the effectiveness of supervision. Rimas shares: And here it really comes from the preparation and her motivation, this kind of readiness to trust and to take the risk of trusting, and to speak very openly about all the nuances of the work, I mean, um… such very good starting positions, really quite productive right from the first meeting, and this kind of readiness to go not only wide, but also into depth. Subtheme 2. Self-Confidence Participants note that during effective supervision, supervisees are empowered and begin to trust themselves more. Agata notes: Well, in her case, effective supervision is when she really separates some of her own little tangles from those professional interventions and trusts them more, and relies more on those professional insights, and gets less mixed up with her personal context. And then I would say she really feels braver, well, more confident and able to continue working with that person, without going into some kind of emotional backstage. Theme 4. Factors Limiting the supervision effectiveness This theme reveals what reduces the effectiveness of supervision. Subtheme 1. Time, Regularity, and Live Contact Participants note that supervision is less effective when there is a lack of time or regularity, or when it takes place remotely. “That is probably also because it is not that frequent, you need time then to integrate… …” (Jonė) “For me, distance is still a different kind of physical presence, the fact that I don’t even see half, God willing a quarter. Another thing, well, from my experience of working, whether in therapy or in supervision remotely, and then when there is a chance to meet live, that three-dimensional image, I mean, it is different, well, that impression of a person, the image when I see them on the screen is more flat, and then when I meet live it seems different, and afterwards I can already work remotely, I already have that experience, my memory of it, and then even remotely I see differently.” (Paula) Subtheme 2. Didactic focus of supervision Participants note that supervision of an educational or didactic nature reduces the effectiveness of supervision. This is best illustrated by an excerpt from Agata’s interview: I thought that educational supervision comes more from insecurity, except for where there was a need to ventilate, not from striving for effectiveness, but it is a complete dead end. Subtheme 3. Unaddressed Topics Participants note that what remains unaddressed in supervision reduces its effectiveness. Agata shares: Maybe the obstacle is more in my head, we have not talked about it. We have not talked about our contract. Our contract is still more based on need. I think that the contract needs to be talked through. Subtheme 4. Supervisee’s Inexperience and Anxiety The supervisee’s inexperience and anxiety inhibit the effectiveness of supervision. This is reflected in Paula’s interview: Sometimes I feel that the anxiety, the tension is already there, and maybe, I mean, she has enough courage and strength to bring it up and show it, but then in some part it kind of, well, sometimes it makes it harder to go more calmly into it, or to stay more calmly with it, because simply that, that reaction is there, and here over time, I think, it can change, well, it can change. So maybe about her there are these kinds of nuances. Discussion This study revealed existential supervisors’ understanding of the factors that enhance and constrain the effectiveness of supervision. The primary “active” components identified were: (1) the quality of the relationship between the supervisor and the supervisee, (2) the supervisor’s characteristics and the interventions used, and (3) the supervisee’s characteristics. The effectiveness of supervision is constrained by a lack of time and regularity, an overly pedagogical orientation, unaddressed topics, and the supervisee’s inexperience and anxiety. Relationship quality, as the central axis of existential supervision, is widely discussed in the literature (du Plock, 2009 ; Kočiūnas, 2018 ; Spinelli, 2015 ; Silva & Sousa, 2022 ; Vaštakė, 2022 ). du Plock ( 2009 ) emphasizes the importance of attending to the encounter and the co-construction of meaning within the supervisory relationship. In the present study, participants highlighted that openness and trust foster supervisees’ professional growth. This is supported by Bhola et al. ( 2017 ), while Vaštakė, Skruibis, and Kočiūnas ( 2021 ) underscore that the supervisor’s openness encourages supervisees to share their vulnerability. Equality within the supervisory relationship reduces anxiety and promotes effectiveness (Spinelli, 2015 ; Kočiūnas, 2018 ; McMahon et al., 2022 ). Although humor is not frequently identified as a component of supervision, in this study it emerged as a resource for reflection and for sustaining relational ease (Vaštakė, 2022 ). The value of non-hastiness also became salient. Vaštakė and Kočiūnas ( 2017 ) describe existential supervision as a “slow-paced process of inquiry,” in which the relationship and the supervisor’s way of being are of fundamental importance. Maintaining clear boundaries between supervision and personal therapy, as suggested by Heru et al. ( 2004 ), Barnett ( 2009 ), and Stiwne ( 2023 ), supports a coherent working alliance. These boundaries create a safe context for reflection and strengthen the impact of supervision. The study also highlighted the significance of the supervisor’s characteristics and the interventions employed. One of the central findings was the process of making the invisible visible—understood as the supervisor’s capacity to help the supervisee move beyond “tunnelled” perception. While the literature emphasizes the role of feedback (Borders et al., 2014; Ladany et al., 2013 ), this specific experiential expansion of perception represents a novel contribution. Responsiveness to the supervisee’s request provides direction to the supervision process. This aligns with existing insights in the literature regarding the importance of goal orientation in supervision (Vaštakė & Kočiūnas, 2017 ). The supervisor’s support in the development of new skills was interpreted not as technical instruction, but as assistance in sensing when and how to apply particular actions. This resonates with du Plock ( 2009 ) and Vaštakė ( 2022 ), who argue that existential supervision relies more on experiential and affective change than on purely rational solutions. The supervisor’s maturity, authenticity, and capacity to be authentically present with others were associated with the development of supervisees’ reflexivity (Mangione et al., 2011; Watkins, 2012 ). The reflection of parallel processes was also considered significant, as it expands the supervisee’s perceptual field and enhances awareness (Kočiūnas, 2018 ). Supervisees’ motivation and self-confidence likewise contribute to the effectiveness of supervision. Motivation was linked to a willingness to engage at greater depth, while the growth of self-confidence supports the supervisee’s ability to differentiate personal feelings from professional insights. This finding is consistent with Vaštakė’s ( 2022 ) concept of the “internal supervisor.” Factors limiting the effectiveness of supervision include infrequent meetings, remote formats, an overly pedagogical orientation, unaddressed topics, and supervisee anxiety. Vaštakė ( 2022 ) and Stella et al. (2020) emphasize that nonverbal aspects are most effectively accessed in face-to-face encounters. Unarticulated contracts and requests also pose a risk of the process becoming ineffective (Stiwne, 2023 ). As reflected in participants’ accounts, a didactic style of supervision is not only ineffective but also contrary to the spirit of existential supervision (Krug & Schneider, 2016 ). Anxiety, particularly when supervisees feel evaluated, inhibits engagement. The literature (Falender & Shafranske, 2009 ; McMahon, 2022) suggests that fostering egalitarian relationships helps mitigate the impact of anxiety. In summary, this study is the first to systematically examine the effectiveness of supervision from the perspective of supervisors within the context of existential therapy. While many findings converge with existing research, several—particularly those concerning humor, the expansion of perception, and the conceptualization of motivation—represent novel contributions. These insights provide a foundation for further research and for the development of practice-based models of supervisor training. Limitations and Directions for Future Research Building on the preceding discussion of relational, temporal, and experiential mechanisms in existential supervision, this study contributes to the analysis of a previously underexplored phenomenon—the effectiveness of existential psychotherapy supervision—by systematically identifying factors that, from supervisors’ perspectives, enhance or constrain supervision processes. The findings may enrich the field of empirical supervision research and inform the training and professional development of supervisors within existential and related relational traditions. Several limitations should be acknowledged. First, the study focused exclusively on supervisors’ perspectives; incorporating supervisees’ accounts in future research would enable a more comprehensive understanding of the reciprocal dynamics of the supervisory relationship. Second, the sample size was small and drawn from a single institutional context, with a gender imbalance (six women and one man), which may have shaped the range of experiences and viewpoints represented. Comparative studies across different training institutions, theoretical orientations, and cultural contexts would further clarify the scope and applicability of the present findings. The findings are grounded in a specific cultural and institutional context (existential supervision at HEPI in Lithuania) and are not intended to be statistically generalizable. Instead, they offer analytic and theoretical transferability by highlighting relational and experiential processes that may inform supervision practices across diverse cultural and training settings. Future research may extend this work by examining supervision effectiveness from supervisees’ perspectives and by exploring how the identified relational and temporal processes unfold longitudinally across different stages of professional development. Conclusion This article extends supervision theory by articulating an existential, phenomenologically grounded account of supervision effectiveness that foregrounds the ontological status of the supervisory relationship rather than its technical or procedural components. It introduces three novel conceptual contributions: first, the process of making the invisible visible as a distinct experiential intervention that expands supervisees’ perceptual and reflective fields beyond feedback and skills acquisition; second, non-hastiness as a temporal–ethical condition of supervision that enables depth, trust, and the emergence of meaning over time; and third, humor as a relational and reflexive resource that facilitates distance, perspective-taking, and emotional containment within supervisory encounters. By centering supervisors’ lived experience, the study reframes supervision effectiveness as a co-constructed, relational phenomenon rooted in presence, mutuality, and phenomenological inquiry. At the same time, the study does not seek to offer an objective or universal definition of effective existential supervision; rather, it functions as a “panoramic map” that provides an initial orientation for further empirical and theoretical exploration, to be refined and deepened through future research. Declarations Ethical Approval and Funding This study forms part of the research project “The Effectiveness of Psychotherapy Supervision and the Dynamics of Relationships in the Supervision Process (SUPER)” , conducted at the Institute of Psychology, Vilnius University. The project is funded by the Research Council of Lithuania (Grant No. S-MIP-23-13) and received approval from the Vilnius University Committee on the Ethics of Psychological Research (No. 20 / (1.13 E) 250000-KT-161). Declaration of Interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article. 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REETA, pp 97–108 Kočiūnas R (2018) Ekzistencial’naya superviziya: Ot ekspertnosti k sovmestnosti. Existentia: Psikhologiya i psikhoterapiya , 11 Krug OT, Schneider KJ (2016) Research and support for the existential-humanistic training approach: APA supervision essentials for existential-humanistic therapy. American Psychological Association Kühne F, Maas J, Wiesenthal S (2019) Empirical research in clinical supervision: A systematic review and suggestions for future studies. BMC Psychol 7., Article 54. https://doi.org/10.1186/s40359-019-0327-7 Ladany N, Mori Y, Mehr K (2013) Effective and ineffective supervision. Couns Psychol 41:28–47. https://doi.org/10.1177/0011000012442648 Majcher J, Daniluk J (2009) The process of becoming a supervisor for students in a doctoral supervision training course. Train Educ Prof Psychol 3:63–71 Mangione L, Nadkarni L (2010) Relationship competency: Broadening and deepening. In M. B. Kenkel & R. L. Peterson (Eds.), Competency-based education for professional psychology (pp. 643–658). American Psychological Association. https://doi.org/10.1037/12068-004 McMahon A, Jennings C, O’Brien G (2022) A naturalistic, observational study of the seven-eyed model of supervision. Clin Supervisor 41(1):47–69. https://doi.org/10.1080/07325223.2021.2022060 Milne D (2007) An empirical definition of supervision. Br J Clin Psychol 46:437–438. https://doi.org/10.1348/014466507X197415 Milne D, Watkins CE (2014) Defining and understanding clinical supervision: A functional approach. In: Watkins CE, Milne DL (eds) The Wiley international handbook of clinical supervision. Wiley, pp 3–10 Norberg J, Axelsson H, Barkman N, Hamrin M, Carlsson J (2016) What psychodynamic supervisors say about supervision: Freedom within limits. Clin Supervisor 36(2):268–286. https://doi.org/10.1080/07325223.2016.1219896 Pagdin S (2013) An existential phenomenological model of supervision. Existential Anal 24:142–152 Pelling N, Abbott D, Lack CW (2017) Clinical supervision: An applied activity and research focus. The practice of counselling & clinical supervision, 2nd edn. Australian Academic, pp 109–112 Pett J (1995) A personal approach to existential supervision. J Soc Existential Anal 6(2):117–125 Rousmaniere T, Swift JK, Babins-Wagner R, Whipple JL, Berzins S (2016) Supervisor variance in psychotherapy outcome in routine practice. Psychother Res 26(2):196–205. https://doi.org/10.1080/10503307.2014.963730 Schweitzer R, Witham M (2018) The supervisory alliance: Comparison implications for a supervision toolkit. Counselling Psychother Res 38(1):71–78. https://doi.org/10.1002/capr.12143 Silva S, Sousa D (2022) Existential psychotherapy supervision: The supervisor’s perspective. J Humanistic Psychol 62(3):397–417 Smith JA, Osborn M (2015) Interpretative phenomenological analysis as a useful methodology for research on the lived experience of pain. Br J Pain 9:41–42 Spinelli E (2015) On existential supervision. Existential Anal 26:168–178 Stiwne D (2023) Dilemmas in existential therapy supervision. Existential Analysis: J Soc Existential Anal, 34 (2) Timonen V, Foley G, Conlon C (2024) Quality in qualitative research: A relational process. Qualitative Res J. https://doi.org/10.1108/QRJ-07-2024-0153 Tugendrajch S, Sheerin K, Andrews J, Reimers R, Marriott B, Cho E, Hawley KM (2021) What is the evidence for supervision best practices? Clin Supervisor 40(1):68–87. https://doi.org/10.1080/07325223.2021.1887785 van Deurzen E (2009) Aims of existential supervision: Truth as a guiding light. In: van Deurzen E, van Young S (eds) Existential perspectives on supervision: Widening the horizon of psychotherapy and counselling. Palgrave Macmillan, pp 535–545 Vaštakė M (2022) Vyrų ir moterų refleksyvumo patirtys egzistencinės terapijos supervizijoje [Doctoral dissertation, Vilnius University]. https://doi.org/10.15388/vu.thesis.332 Vaštakė M, Kočiūnas R (2017) Fenomenologinis egzistencinės supervizijos tyrimas. Psichologija 55:72–87 Vaštakė M, Skruibis P (2021) Refleksyvumo fenomenas psichoterapinėje supervizijoje: Sistematinė literatūros analizė. Psichologija 65:22–39. https://doi.org/10.15388/Psichol.2021.35 Vaštakė M, Skruibis P, Kočiūnas R (2021) Changes in reflexivity during existential supervision. Clin Supervisor 40(2):263–281. https://doi.org/10.1080/07325223.2021.1966692 Watkins EC (2012) Educating psychotherapy supervisors. Am J Psychother 66:279–307 Watkins EC (2017) Convergence in psychotherapy supervision: A common factors, common processes, common practices perspective. J Psychother Integr 27(2):140–152. https://doi.org/10.1037/int0000040 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9284410","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":615527040,"identity":"2f4857e1-61d6-4569-8188-6492115c0875","order_by":0,"name":"Marija Vaštakė","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYJCCAxJQBmMDgw0/A/MBENuCGC3MIC1pkg1sCSCehAQ+LVAA1nKYsBbd9rMPD1jUMCT2958/+HFGxXkJ+TYGNmkeBok6XFrMzqQbHJA4xpA440Yys+SGM7clDI5BtOC0xexAGtAvbAzGDDeYGSQftt2uM5BvYDbGq+X8M6CWfwzG8ucPM/98+O8cyGEEtNwA2iLZxiBncCCZTXJjAzD0jjEwPsavBWiLZJ+EnOGNZDPLGceSgX5hbHw4x0BCsgGnw9KYP0t8s+GRO3/w8c2eGjugw5gPHHhTAYxTPIBZggHFFcDoYTDApwGo5AN++VEwCkbBKBjpAACTvE/8aAmhGQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-8975-7832","institution":"Vilnius University","correspondingAuthor":true,"prefix":"","firstName":"Marija","middleName":"","lastName":"Vaštakė","suffix":""}],"badges":[],"createdAt":"2026-03-31 21:37:53","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9284410/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9284410/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105975010,"identity":"619e654c-aefb-411d-bf8b-6aef5be50ca0","added_by":"auto","created_at":"2026-04-02 05:01:35","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":110258,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eFactors Influencing the Effectiveness of Existential Therapy Supervision\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9284410/v1/48ce5b1dbb3478d2d5386f06.jpg"},{"id":106093511,"identity":"e2773a07-ad83-45da-b27e-a0503530dafe","added_by":"auto","created_at":"2026-04-03 11:37:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1001012,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9284410/v1/e4ba18c1-cbe3-4b31-bc8e-772287261bc3.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eUnveiling Effectiveness: A Qualitative Exploration of Existential Psychotherapy Supervision through Supervisors’ Lenses\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Definition of Psychotherapy Supervision","content":"\u003cp\u003eGoodyear (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) posits, \u0026ldquo;A litmus test for evaluating the effectiveness of supervision is this: what is the supervisee doing differently now than before supervision?\u0026rdquo; Supervision is generally conceptualized as a relational and professionally sanctioned process wherein a qualified supervisor offers support, oversight, and developmental guidance to a less experienced practitioner (Milne, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Within psychotherapy and counseling contexts, supervision is instrumental in enhancing professional competence, fostering reflective practice, and promoting both ethical and effective clinical work.\u003c/p\u003e \u003cp\u003eDistinct theoretical models of supervision emphasize different facets of the supervisory process. Cognitive\u0026ndash;behavioral and other structured approaches foreground goal-setting, skill acquisition, and feedback, whereas psychodynamic and existential models highlight relational depth, emotional attunement, and meaning-making. Despite these theoretical distinctions, there is consensus that a core aim across all models is to facilitate professional growth through relationship, reflection, and ethical responsibility (Bambling et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Gilbert \u0026amp; Evans, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Milne \u0026amp; Watkins, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Pelling et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Rousmaniere et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Schweitzer \u0026amp; Witham, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Tugendrajch, 2021; Vaštakė \u0026amp; Kočiūnas, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Vaštakė, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, there remains a notable paucity of empirical research directly comparing the effectiveness of different supervisory models (Bernard \u0026amp; Goodyear, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Ladany, 2013; Norberg et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Watkins, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Silva \u0026amp; Sousa, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Stiwne, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Several scholars underscore the field\u0026rsquo;s need for research elucidating both universal relational processes in supervision and model-specific mechanisms contributing to its effectiveness (Silva \u0026amp; Sousa, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Stiwne, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Watkins, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eExistential Supervision: Conceptualization and Research Context\u003c/h3\u003e\n\u003cp\u003eAlthough supervision has been examined for multiple decades, consensus regarding the definition of effective supervision remains elusive (Milne et al., 2007). Within this broader context, existential supervision is especially under-researched: du Plock (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) highlights that existential supervision has primarily been discussed in reflective and philosophical terms, with scant empirical investigation. Similarly, van Deurzen and Young (2009) and Krug and Schneider (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) note that while existential supervision is rooted in foundational philosophical principles\u0026mdash;such as personal freedom, responsibility, meaning, and relational embeddedness\u0026mdash;the literature remains largely conceptual rather than empirical.\u003c/p\u003e \u003cp\u003eTwo phenomenological studies (du Plock, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Vaštakė \u0026amp; Kočiūnas, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) help delineate the structure of existential supervision. Drawing on these works, existential supervision is understood as encompassing four interrelated dimensions:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e1. \u003cem\u003eThe supervision process\u003c/em\u003e \u0026ndash; characterized by a slow, exploratory, and reflective inquiry rather than directive instruction; the primary aim is to illuminate meaning, not provide prescriptive solutions (Vaštakė \u0026amp; Kočiūnas, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; du Plock, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e2. \u003cem\u003eThe supervisory relationship\u003c/em\u003e \u0026ndash; founded on dialogical equality and shared exploration; the supervisor is positioned not as an expert but as a co-inquirer (du Plock, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Spinelli (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) has even suggested substituting the term \u0026ldquo;supervision\u0026rdquo; with \u0026ldquo;seeing-over,\u0026rdquo; to underscore mutual presence and perspective broadening.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e3. \u003cem\u003eThe supervisor\u0026rsquo;s way of being\u003c/em\u003e \u0026ndash; marked by openness, authenticity, and a phenomenological \u0026ldquo;not-knowing\u0026rdquo; stance; the supervisor suspends assumptions (epoch\u0026eacute;) to allow meanings to emerge from lived experience (Kočiūnas, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Pagdin, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e4. \u003cem\u003eThe interventions\u003c/em\u003e commonly employed in existential supervision reflect the foundational principles of the approach: attention to the \u0026ldquo;here and now,\u0026rdquo; mirroring of nonverbal reactions, analysis of parallel processes, and the formulation of open questions that foster exploration without imposing limits (Vaštakė \u0026amp; Kočiūnas, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). du Plock (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) emphasizes the importance of assisting supervisees in learning to tolerate uncertainty, accept existential paradoxes, and resist the urge to confine client experience to diagnostic frameworks. Krug and Schneider (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) similarly highlight the supervisor\u0026rsquo;s personal qualities\u0026mdash;empathy, authenticity, congruence, and integrity\u0026mdash;as essential to effective existential supervision.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eUltimately, a core tenet of existential supervision is phenomenological openness, grounded in the principle of epoch\u0026eacute;\u0026mdash;that is, the temporary suspension of judgments and assumptions to allow full acceptance of whatever emerges in the supervisory process (Kočiūnas, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2005\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Pett, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e1995\u003c/span\u003e; Pagdin, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). This attitude creates space for genuine dialogue and an exploratory partnership.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAssumptions Regarding the Effectiveness of Supervision in Existential Therapy\u003c/h2\u003e \u003cp\u003eMost scientific research to date has examined specific aspects of supervision indirectly, with very few systematic analyses isolating the factors that determine its effectiveness. The majority of researchers (Alfonsson et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Hill \u0026amp; Knox, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) address two principal questions: (1) which factors in supervision contribute to supervisees\u0026rsquo; professional development, and (2) which variables influence the well-being of psychotherapy clients. Although it has been empirically established that supervision fosters reflexivity, professional skills, and job satisfaction (Hill \u0026amp; Knox, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), there remains a significant gap in understanding the precise mechanisms by which such change occurs. The second question\u0026mdash;regarding supervision\u0026rsquo;s impact on client outcomes\u0026mdash;remains almost entirely unexplored (Alfonsson et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; K\u0026uuml;hne et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResearch also highlights that psychotherapy experience alone does not guarantee one\u0026rsquo;s ability to offer effective supervision; specialized training in supervision is essential (du Plock, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Majcher \u0026amp; Daniluk, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Watkins, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Furthermore, supervisor competencies are distinct from those of a psychotherapist: effective supervision requires not only clinical expertise but also the ability to reflect on the process from a meta-perspective (the ability to reflect on the supervisory process itself, including the relational, emotional, and institutional dynamics operating across therapeutic and supervisory levels), to foster a learning-conducive relationship, and to support the supervisee\u0026rsquo;s ongoing professional growth.\u003c/p\u003e \u003cp\u003eNevertheless, the very boundaries of the concept of effective supervision remain ambiguous. Some scholars propose defining effective supervision as an interactive process in which the supervisee demonstrates the capacity to integrate knowledge and experience, and continues to develop professional competencies and ethical sensitivity (Graham et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). According to Ladany et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), effective supervision stimulates professional growth, while its absence stifles such development. Gonsalvez et al. (2017) further argue that effectiveness should be distinguished from supervisee satisfaction, as the latter is shaped by individual and contextual factors.\u003c/p\u003e \u003cp\u003eWith respect to existential therapy supervision, no studies have explicitly examined its effectiveness to date. The only empirical evidence is indirect. For example, Vaštakė\u0026rsquo;s (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) doctoral dissertation revealed that the development of reflexivity may constitute one of the \u0026ldquo;active ingredients\u0026rdquo; in existential supervision. Reflexivity is cultivated within a long-term, equal, and dialogical relationship between supervisor and supervisee, with a strong focus on \u0026ldquo;here and now\u0026rdquo; emotions, a stance of \u0026ldquo;not-knowing,\u0026rdquo; and a careful negotiation of the boundaries between therapy and supervision. By contrast, reflexivity is impeded by factors such as a supervisor\u0026rsquo;s lack of preparation, physical and emotional distance, or an overly didactic supervision style.\u003c/p\u003e \u003cp\u003eIn their study of existentially oriented supervisors, Silva and Sousa (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) emphasized that successful supervision is primarily determined by a safe, dialogical relationship that addresses the supervisee\u0026rsquo;s evolving needs. They also highlighted the importance of personal supervisor qualities\u0026mdash;humility, authenticity, consistency, and the ability to tolerate uncertainty.\u003c/p\u003e \u003cp\u003eIn summary, the evidence base for the effectiveness of existential therapy supervision remains largely theoretical and fragmented. This underscores the relevance of empirically informed inquiry in this area. Previous work has described how reflexivity develops during existential supervision and highlighted the emergence of an \u0026ldquo;internal supervisor\u0026rdquo; as a key outcome of the supervisory process (Vaštakė, Skruibis, \u0026amp; Kočiūnas, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Building on these findings, the present study shifts the focus from what changes in supervisees to how existential supervisors themselves understand and cultivate supervision effectiveness, including the relational and temporal processes that enable such reflexive change. Accordingly, the present study seeks to elucidate the factors that, from the perspective of existential supervisors, contribute to supervision effectiveness.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eParticipants and Qualitative Framework\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSince the aim of this study was to explore and describe existential psychotherapy supervisors’ experiences of supervision effectiveness, and because this phenomenon has not been directly examined in the context of existential supervision either in Lithuania or internationally, a qualitative research design was adopted. This approach is particularly appropriate for underexplored research areas in which existing findings are fragmented or insufficient to support hypothesis testing, and where the goal is to understand how participants experience and make sense of a phenomenon through detailed, nuanced accounts (Barker et al., 2002; Smith \u0026amp; Osborn, 2015).\u003c/p\u003e\n\u003cp\u003eThe study included seven existential psychotherapy supervisors currently practicing in Lithuania at the Humanistic and Existential Psychotherapy Institute (HEPI). The sample comprised six women and one man, aged between 43 and 54 years (M = 43.3). All participants were psychologists and certified existential psychotherapists with formal training in supervision.\u003c/p\u003e\n\u003cp\u003eParticipants were recruited using purposive sampling based on their formal training in existential psychotherapy supervision and active involvement in supervising trainees within the HEPI program. Sampling continued until thematic saturation was reached, defined as the point at which no substantively new themes or analytic insights emerged from subsequent interviews, indicating sufficient information power for the study’s qualitative aims.\u003c/p\u003e\n\u003cp\u003eParticipants’ experience of being supervised ranged from 11 to 30 years (M = 17.7), while their experience in providing supervision ranged from 3 to 20 years (M = 7.7). The number of supervisees they worked with per week varied from 4 to 15 (M = 6). At the time of the study, all supervisors were working with supervisees enrolled in the HEPI existential therapy program, each of whom had participated in no more than ten supervision sessions at the time of the interview.\u003c/p\u003e\n\u003cp\u003eTo preserve confidentiality, all participant names were replaced with pseudonyms.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData collection procedures\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted between September 2023 and July 2024. Potential participants were contacted via email. All interviews were conducted in person; the researchers traveled to locations convenient for the participants, which in most cases were the participants’ psychotherapy offices. Prior to beginning the interview, each participant completed a demographic questionnaire, after which the semi-structured interview was initiated. Participants were invited to reflect on their experiences through open-ended questions. Participants were invited to reflect on their experiences through the following semi-structured interview questions:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;How would you describe supervision effectiveness?\u003cbr\u003eAlternatively: \u003cem\u003eWhat does effective supervision mean to you?\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;I would like to talk with you about your current work with your supervisee.\u003cbr\u003e\u0026nbsp;To what extent do you experience this supervisory work as effective or ineffective?\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp;Naturally, some supervision sessions are experienced as more effective than others.\u003cbr\u003e\u0026nbsp;Please think of supervision sessions that felt effective.\u003cbr\u003e\u0026nbsp;Could you describe specific moments or episodes that you experienced as effective?\u003c/p\u003e\n\u003cp\u003eo How did you recognize that this particular session or moment was effective?\u003c/p\u003e\n\u003cp\u003eo What, in your view, was most meaningful or impactful for your supervisee?\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp;How would you describe your relationship with your supervisee?\u003c/p\u003e\n\u003cp\u003eo What aspects of this relationship feel most important to you?\u003c/p\u003e\n\u003cp\u003eo What feels lacking or challenging?\u003c/p\u003e\n\u003cp\u003eo In what ways does this relationship contribute to (or hinder) the effectiveness of supervision?\u003c/p\u003e\n\u003cp\u003e5.\u0026nbsp; \u0026nbsp;If it were entirely up to you, what would you change in the supervision process with this supervisee?\u003c/p\u003e\n\u003cp\u003e6.\u0026nbsp; \u0026nbsp;Is there anything we have not discussed, but that you feel is important when talking about supervision effectiveness or the supervisory relationship?\u003c/p\u003e\n\u003cp\u003eAll interviews were audio-recorded and later transcribed verbatim, with attention to significant non-verbal expressions and relational nuances.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were analyzed using inductive reflexive thematic analysis as outlined by Braun and Clarke (2022, 2023). This approach allows for identifying, interpreting, and organizing patterns of meaning within the data without applying predefined theoretical frameworks or testing prior hypotheses. Reflexive thematic analysis emphasizes the researchers’ active role in constructing themes while remaining grounded in participants’ lived experiences. This method was chosen because it enables the exploration of how participants make sense of the phenomenon, allowing both anticipated and unexpected insights to emerge from the data.\u003c/p\u003e\n\u003cp\u003eThe data analysis followed the six phases proposed by Braun and Clarke:\u003c/p\u003e\n\u003cp\u003e1. \u003cem\u003eFamiliarization with the data.\u003c/em\u003e\u003cbr\u003e\u0026nbsp;All interview transcripts were read multiple times to develop an immersive understanding of the participants’ experiences. Initial notes and impressions related to supervision effectiveness were recorded.\u003c/p\u003e\n\u003cp\u003e2. \u003cem\u003eGenerating initial codes.\u003c/em\u003e\u003cbr\u003e\u0026nbsp;Each interview was coded line-by-line. Codes captured both semantic features (explicitly stated meanings) and latent meanings (underlying assumptions or emotional and relational nuances). Some excerpts were assigned multiple codes when relevant.\u003c/p\u003e\n\u003cp\u003e3. \u003cem\u003eSearching for themes.\u003cbr\u003e\u0026nbsp;\u003c/em\u003eThe initial codes were organized into preliminary clusters based on conceptual similarity. These clusters informed the development of early candidate themes and subthemes.\u003c/p\u003e\n\u003cp\u003e4. \u003cem\u003eReviewing themes.\u003c/em\u003e\u003cbr\u003e\u0026nbsp;Candidate themes and subthemes were compared back to the full dataset to ensure coherence and distinctiveness. During this process, some themes were refined, combined, or separated to more accurately reflect the data.\u003c/p\u003e\n\u003cp\u003e5. \u003cem\u003eDefining and naming themes.\u003cbr\u003e\u0026nbsp;\u003c/em\u003eEach theme and subtheme was clearly articulated to capture its core meaning and the essence of participants’ experiences. Theme names were selected to be both conceptually precise and grounded in the language participants used.\u003c/p\u003e\n\u003cp\u003e6. \u003cem\u003eWriting the analysis.\u003cbr\u003e\u0026nbsp;\u003c/em\u003eThe themes and subthemes were described in detail and illustrated using representative quotations from the interviews. The analytic narrative aimed to show how participants understood and made sense of supervision effectiveness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTruthworthiness\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn line with contemporary standards of qualitative research, diversity within the research team—in terms of disciplinary background and professional experience—enhances the validity and trustworthiness of data interpretation by reducing the dominance of any single epistemological position and strengthening triangulation and reflexivity (Ahmed, 2024; Jansen, 2025; Timonen et al., 2024).\u003c/p\u003e\n\u003cp\u003eOur research team was both methodologically and therapeutically diverse, which enabled the analysis to be approached from multiple conceptual perspectives and reduced the likelihood that any single theoretical orientation would shape the interpretation. The team consisted of five researchers. The first, second, third, and sixth researchers had prior experience working with qualitative methodologies, with the first three having received formal training in thematic and phenomenological analysis. The fourth and fifth researchers were graduate students in clinical psychology who were beginning to apply qualitative research methods. The first author is an existential psychotherapist and supervisor; the second author is an existential psychotherapist; the third and sixth authors are psychodynamic psychotherapists.\u003c/p\u003e\n\u003cp\u003eAll authors participated in every stage of the research process, including conducting interviews, transcribing data, and carrying out the analysis. Each researcher individually coded the interviews they conducted, after which codes were compared and discussed collaboratively to reach shared understandings. Each researcher created a hierarchical table of themes and subthemes for their transcript. These tables were then combined and collectively refined to develop consistent theme labels and thematic structure.\u003c/p\u003e\n\u003cp\u003eThe study adopted a phenomenological epistemological position, which shaped both the conduct and interpretation of the research by orienting the analysis toward participants’ lived experiences of supervision effectiveness, rather than toward the evaluation of predefined theoretical constructs or outcomes. This epistemological stance informed the researchers’ commitment to openness, reflexivity, and attentiveness to meaning as it emerged from the data. The interdisciplinary composition of the research team—drawing on existential, psychodynamic, and psychoanalytic theoretical backgrounds—further contributed to the analytic process. Engaging multiple clinical and conceptual perspectives enabled a dialogical examination of the data, supported reflexive awareness of theoretical assumptions, and reduced the risk of privileging a single interpretative lens. This plurality of perspectives enriched the analysis while remaining grounded in participants’ accounts.Because the effectiveness of existential supervision is a relatively unexplored topic, the analysis was approached from a “naïve listening” position, with an intentional effort to bracket presumptions and avoid premature theoretical closure. To support reflexivity, all researchers kept reflective journals throughout the analytic process, documenting their emotional and cognitive responses to the data. This practice assisted in recognizing personal assumptions and contributed to the overall trustworthiness of the interpretation.\u003c/p\u003e"},{"header":"Findings","content":"\u003cp\u003eThe analysis revealed four overarching themes and seventeen subthemes that describe how existential supervisors understand and experience supervision effectiveness (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). These themes reflect both the relational and processual nature of existential supervision, highlighting the importance of interpersonal presence, reflective depth, supervisory stance, and the supervisee\u0026rsquo;s engagement with their own therapeutic work.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eTheme 1. Relationship Quality\u003c/h3\u003e\n\u003cp\u003eAll research participants associate the effectiveness of supervision with the quality of the relationship between the supervisor and the supervisee. One participant, Nijolė, notes:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe relationship is the main thing, in my view, for that effectiveness to develop.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 1. Support\u003c/h2\u003e \u003cp\u003eParticipants indicate that support is one of the factors of effective supervision. Nijolė shares:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026hellip;openness and being able to notice and, sort of, say some critical remarks, I also always try to build that relationship, kind of collegial, supportive, I know from my own experience how important it used to be for me that I am taken seriously, that I am considered, that I am supported, that the supervisor is on my side.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 2. Equality\u003c/h2\u003e \u003cp\u003eParticipants observe that fostering an egalitarian relationship in the supervision process is also an important factor in effective supervision. Several excerpts from participant interviews:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;So that real, kind of collegial equality, and here I feel how she works through those supervisions, she really shows that kind of way of working, it is not hard to feel that.\u0026rdquo;\u003c/em\u003e (Jonė)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;He is collegial. So that is a very important aspect. He is, well, usually it is such an important part with beginning therapists, for whom it is kind of difficult to look at things in a collegial way, they really, kind of, look at it as at an authority, as at a teacher. I usually tend to put in effort to reduce this effect. So with my supervisor, it seems to me, there is that aspect that our relationship is really quite collegial. So that also helps. I think it takes away the tension.\u0026rdquo;\u003c/em\u003e (Roma)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 3. Trust and Openness\u003c/h2\u003e \u003cp\u003eMost participants emphasize the importance of trust and openness. Roma shares:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA very good working contact, a lot of openness, and this really comes from the supervisee\u0026rsquo;s preparation and her motivation, so this kind of readiness to trust and to take the risk of trusting, and to speak very openly about all the nuances of the work, you know, so, um\u0026hellip; such very good starting positions, really quite productive right from the first meeting, and this kind of readiness to go not only wide, but also into depth, that mutual trust between us, it is strongly growing, I mean, it is alive in all kinds of new ways of talking about things, well\u0026hellip;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eRimas observes:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026hellip;she talks about her complicated feelings in the relationship with the client, about herself in the relationship with the client, so for me that is an indicator of both openness and trust in me. As a rule, as a rule, people who are afraid of the supervisor, like\u0026hellip; or trust less, during supervision they talk more about the clients, and not about themselves, not about themselves and their own difficulties at work.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 4. Humor\u003c/h2\u003e \u003cp\u003eFour participants mention that humor is an important component of effective supervision. Roma notes:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSo, one of the forms, for example, that seems to me, well, well, how to say it, well, really very effective [emphasizes the word, laughs] \u0026ndash; humor, so here with my supervisor this is really such a very unique, strong place. It creates distance, allows you to see the situation, and yourself, and to accept more easily those not-so-nice things that sometimes seem not very nice to see (?), in ourselves, you know, that kind of\u0026hellip; especially at the beginning.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 5. Taking Time\u003c/h2\u003e \u003cp\u003eParticipants note that it is important not to rush in supervision:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;for that you also need time, time, meetings, and that kind of shared, well, common thing, so in that sense I doubt that anyone could speed it up, like, I don\u0026rsquo;t know, a child being born, well, no one will make his processes develop faster (laughs), the ones that are developing there.\u0026rdquo;\u003c/em\u003e (Paula)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;And then she had this long pause, and then everything kind of rearranged, she says, \u0026lsquo;well, it didn\u0026rsquo;t look like that at all\u0026rsquo;\u0026hellip; so it lit up the situation in a completely different way.\u0026rdquo;\u003c/em\u003e (Jonė)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 6. Professional\u0026ndash;Personal Boundaries\u003c/h2\u003e \u003cp\u003eAnother important aspect of an effective supervisory relationship is maintaining the boundary between supervision and personal therapy. Rimas shares:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAs a supervisor, I don\u0026rsquo;t go into any of the therapist\u0026rsquo;s personal contexts, it\u0026rsquo;s only about the therapeutic relationship that the talk is.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2. Supervisor\u0026rsquo;s Characteristics and Interventions\u003c/h2\u003e \u003cp\u003eThe effectiveness of supervision is associated with supervisors\u0026rsquo; characteristics and the interventions used within the supervision process.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 1. Making the Invisible Visible\u003c/h2\u003e \u003cp\u003eParticipants note that when supervisees gain clarity\u0026mdash;when what was invisible becomes visible\u0026mdash;this is an indicator of effective supervision:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When the invisible becomes visible, that is effectiveness, well\u0026hellip;\u0026rdquo;\u003c/em\u003e (Agata)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It\u0026rsquo;s just about understanding my question better, looking at it from different sides, expanding the context. Because when I bring a question, I bring this kind of \u0026lsquo;tunnelled\u0026rsquo; moment. And when I manage to look at it from different aspects, then that tunnel kind of \u0026lsquo;thaws\u0026rsquo;.\u0026rdquo;\u003c/em\u003e (Jonė)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 2. Responsiveness to supervisee\u003c/h2\u003e \u003cp\u003eParticipants note that formulating a request for supervision and responding to it is an important factor in effective supervision. Here are several excerpts from participant interviews:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;effective supervision is when, when a request is formulated that you can already respond to in a purposeful way.\u0026rdquo;\u003c/em\u003e (Nijolė)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;I understand that the goal of supervision is, supervision is meant to help a colleague. And that help is according to the need, the request, and if that help happens, or it starts to happen in the course of supervision, then supervision is effective.\u0026rdquo;\u003c/em\u003e (Roma)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 3. Facilitating Skills\u003c/h2\u003e \u003cp\u003eAll participants mention that effective supervision involves support directed toward the development of supervisees\u0026rsquo; new skills. Nijolė notes:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWell, in a general sense, well, so that his competences would grow, really, that a person has all the necessary, I don\u0026rsquo;t know, abilities, data, this kind of informational base, now what remains is, well, to carry that into practice, to master certain processes, to understand how the consulting processes work, so that kind of, well, that they would strengthen, grow, I don\u0026rsquo;t know, the abilities, the skills of a young person.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 4. Supervisors\u0026rsquo; Maturity\u003c/h2\u003e \u003cp\u003eParticipants note that the supervisor\u0026rsquo;s personal maturity is an important factor in effective supervision. This is most clearly reflected in Paula\u0026rsquo;s interview:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHere it\u0026rsquo;s about the maturity of my personal path, how far I have managed to go, how much I am able to be with that, so for now, at this moment, those are the kinds of answers about my contribution to effectiveness.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 5. Parallel Process Reflection\u003c/h2\u003e \u003cp\u003eParticipants note that noticing and reflecting parallel processes in supervision is particularly important. This was most clearly evident in Jonė\u0026rsquo;s interview:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAnd I showed the parallel between his life, how he does things there, and between her and that, and what really surprised the supervisee, well, it really seems like her eyes opened\u0026hellip;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eTheme 3. Supervisee\u0026rsquo;s Characteristics\u003c/h2\u003e \u003cp\u003eParticipants mention that the effectiveness of supervision also depends on the supervisee\u0026rsquo;s characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 1. Motivation\u003c/h2\u003e \u003cp\u003eThe supervisee\u0026rsquo;s motivation emerged as a factor in the effectiveness of supervision. Rimas shares:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAnd here it really comes from the preparation and her motivation, this kind of readiness to trust and to take the risk of trusting, and to speak very openly about all the nuances of the work, I mean, um\u0026hellip; such very good starting positions, really quite productive right from the first meeting, and this kind of readiness to go not only wide, but also into depth.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eSubtheme 2. Self-Confidence\u003c/h2\u003e \u003cp\u003eParticipants note that during effective supervision, supervisees are empowered and begin to trust themselves more. Agata notes:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWell, in her case, effective supervision is when she really separates some of her own little tangles from those professional interventions and trusts them more, and relies more on those professional insights, and gets less mixed up with her personal context. And then I would say she really feels braver, well, more confident and able to continue working with that person, without going into some kind of emotional backstage.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eTheme 4. Factors Limiting the supervision effectiveness\u003c/h2\u003e \u003cp\u003eThis theme reveals what reduces the effectiveness of supervision.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eSubtheme 1. Time, Regularity, and Live Contact\u003c/h2\u003e \u003cp\u003eParticipants note that supervision is less effective when there is a lack of time or regularity, or when it takes place remotely.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;That is probably also because it is not that frequent, you need time then to integrate\u0026hellip; \u0026lt;a month a person tries it, then another month maybe sees whether it worked or not, anyway that slowness is a problem\u0026gt;\u0026hellip;\u0026rdquo;\u003c/em\u003e (Jonė)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For me, distance is still a different kind of physical presence, the fact that I don\u0026rsquo;t even see half, God willing a quarter. Another thing, well, from my experience of working, whether in therapy or in supervision remotely, and then when there is a chance to meet live, that three-dimensional image, I mean, it is different, well, that impression of a person, the image when I see them on the screen is more flat, and then when I meet live it seems different, and afterwards I can already work remotely, I already have that experience, my memory of it, and then even remotely I see differently.\u0026rdquo;\u003c/em\u003e (Paula)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 2. Didactic focus of supervision\u003c/h2\u003e \u003cp\u003eParticipants note that supervision of an educational or didactic nature reduces the effectiveness of supervision. This is best illustrated by an excerpt from Agata\u0026rsquo;s interview:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI thought that educational supervision comes more from insecurity, except for where there was a need to ventilate, not from striving for effectiveness, but it is a complete dead end.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 3. Unaddressed Topics\u003c/h2\u003e \u003cp\u003eParticipants note that what remains unaddressed in supervision reduces its effectiveness. Agata shares:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMaybe the obstacle is more in my head, we have not talked about it. We have not talked about our contract. Our contract is still more based on need. I think that the contract needs to be talked through.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSubtheme 4. Supervisee’s Inexperience and Anxiety\u003c/h3\u003e\n\u003cp\u003eThe supervisee\u0026rsquo;s inexperience and anxiety inhibit the effectiveness of supervision. This is reflected in Paula\u0026rsquo;s interview:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSometimes I feel that the anxiety, the tension is already there, and maybe, I mean, she has enough courage and strength to bring it up and show it, but then in some part it kind of, well, sometimes it makes it harder to go more calmly into it, or to stay more calmly with it, because simply that, that reaction is there, and here over time, I think, it can change, well, it can change. So maybe about her there are these kinds of nuances.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study revealed existential supervisors\u0026rsquo; understanding of the factors that enhance and constrain the effectiveness of supervision. The primary \u0026ldquo;active\u0026rdquo; components identified were: (1) the quality of the relationship between the supervisor and the supervisee, (2) the supervisor\u0026rsquo;s characteristics and the interventions used, and (3) the supervisee\u0026rsquo;s characteristics. The effectiveness of supervision is constrained by a lack of time and regularity, an overly pedagogical orientation, unaddressed topics, and the supervisee\u0026rsquo;s inexperience and anxiety.\u003c/p\u003e \u003cp\u003eRelationship quality, as the central axis of existential supervision, is widely discussed in the literature (du Plock, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Kočiūnas, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Spinelli, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Silva \u0026amp; Sousa, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Vaštakė, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). du Plock (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) emphasizes the importance of attending to the encounter and the co-construction of meaning within the supervisory relationship. In the present study, participants highlighted that openness and trust foster supervisees\u0026rsquo; professional growth. This is supported by Bhola et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), while Vaštakė, Skruibis, and Kočiūnas (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) underscore that the supervisor\u0026rsquo;s openness encourages supervisees to share their vulnerability. Equality within the supervisory relationship reduces anxiety and promotes effectiveness (Spinelli, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Kočiūnas, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; McMahon et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough humor is not frequently identified as a component of supervision, in this study it emerged as a resource for reflection and for sustaining relational ease (Vaštakė, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The value of non-hastiness also became salient. Vaštakė and Kočiūnas (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) describe existential supervision as a \u0026ldquo;slow-paced process of inquiry,\u0026rdquo; in which the relationship and the supervisor\u0026rsquo;s way of being are of fundamental importance.\u003c/p\u003e \u003cp\u003eMaintaining clear boundaries between supervision and personal therapy, as suggested by Heru et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2004\u003c/span\u003e), Barnett (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), and Stiwne (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), supports a coherent working alliance. These boundaries create a safe context for reflection and strengthen the impact of supervision.\u003c/p\u003e \u003cp\u003eThe study also highlighted the significance of the supervisor\u0026rsquo;s characteristics and the interventions employed. One of the central findings was the process of making the invisible visible\u0026mdash;understood as the supervisor\u0026rsquo;s capacity to help the supervisee move beyond \u0026ldquo;tunnelled\u0026rdquo; perception. While the literature emphasizes the role of feedback (Borders et al., 2014; Ladany et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), this specific experiential expansion of perception represents a novel contribution.\u003c/p\u003e \u003cp\u003eResponsiveness to the supervisee\u0026rsquo;s request provides direction to the supervision process. This aligns with existing insights in the literature regarding the importance of goal orientation in supervision (Vaštakė \u0026amp; Kočiūnas, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe supervisor\u0026rsquo;s support in the development of new skills was interpreted not as technical instruction, but as assistance in sensing when and how to apply particular actions. This resonates with du Plock (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) and Vaštakė (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), who argue that existential supervision relies more on experiential and affective change than on purely rational solutions.\u003c/p\u003e \u003cp\u003eThe supervisor\u0026rsquo;s maturity, authenticity, and capacity to be authentically present with others were associated with the development of supervisees\u0026rsquo; reflexivity (Mangione et al., 2011; Watkins, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). The reflection of parallel processes was also considered significant, as it expands the supervisee\u0026rsquo;s perceptual field and enhances awareness (Kočiūnas, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSupervisees\u0026rsquo; motivation and self-confidence likewise contribute to the effectiveness of supervision. Motivation was linked to a willingness to engage at greater depth, while the growth of self-confidence supports the supervisee\u0026rsquo;s ability to differentiate personal feelings from professional insights. This finding is consistent with Vaštakė\u0026rsquo;s (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) concept of the \u0026ldquo;internal supervisor.\u0026rdquo;\u003c/p\u003e \u003cp\u003eFactors limiting the effectiveness of supervision include infrequent meetings, remote formats, an overly pedagogical orientation, unaddressed topics, and supervisee anxiety. Vaštakė (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and Stella et al. (2020) emphasize that nonverbal aspects are most effectively accessed in face-to-face encounters. Unarticulated contracts and requests also pose a risk of the process becoming ineffective (Stiwne, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs reflected in participants\u0026rsquo; accounts, a didactic style of supervision is not only ineffective but also contrary to the spirit of existential supervision (Krug \u0026amp; Schneider, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Anxiety, particularly when supervisees feel evaluated, inhibits engagement. The literature (Falender \u0026amp; Shafranske, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; McMahon, 2022) suggests that fostering egalitarian relationships helps mitigate the impact of anxiety.\u003c/p\u003e \u003cp\u003eIn summary, this study is the first to systematically examine the effectiveness of supervision from the perspective of supervisors within the context of existential therapy. While many findings converge with existing research, several\u0026mdash;particularly those concerning humor, the expansion of perception, and the conceptualization of motivation\u0026mdash;represent novel contributions. These insights provide a foundation for further research and for the development of practice-based models of supervisor training.\u003c/p\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Directions for Future Research\u003c/h2\u003e \u003cp\u003eBuilding on the preceding discussion of relational, temporal, and experiential mechanisms in existential supervision, this study contributes to the analysis of a previously underexplored phenomenon\u0026mdash;the effectiveness of existential psychotherapy supervision\u0026mdash;by systematically identifying factors that, from supervisors\u0026rsquo; perspectives, enhance or constrain supervision processes. The findings may enrich the field of empirical supervision research and inform the training and professional development of supervisors within existential and related relational traditions.\u003c/p\u003e \u003cp\u003eSeveral limitations should be acknowledged. First, the study focused exclusively on supervisors\u0026rsquo; perspectives; incorporating supervisees\u0026rsquo; accounts in future research would enable a more comprehensive understanding of the reciprocal dynamics of the supervisory relationship. Second, the sample size was small and drawn from a single institutional context, with a gender imbalance (six women and one man), which may have shaped the range of experiences and viewpoints represented. Comparative studies across different training institutions, theoretical orientations, and cultural contexts would further clarify the scope and applicability of the present findings.\u003c/p\u003e \u003cp\u003eThe findings are grounded in a specific cultural and institutional context (existential supervision at HEPI in Lithuania) and are not intended to be statistically generalizable. Instead, they offer analytic and theoretical transferability by highlighting relational and experiential processes that may inform supervision practices across diverse cultural and training settings.\u003c/p\u003e \u003cp\u003eFuture research may extend this work by examining supervision effectiveness from supervisees\u0026rsquo; perspectives and by exploring how the identified relational and temporal processes unfold longitudinally across different stages of professional development.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis article extends supervision theory by articulating an existential, phenomenologically grounded account of supervision effectiveness that foregrounds the ontological status of the supervisory relationship rather than its technical or procedural components. It introduces three novel conceptual contributions: first, the process of making the invisible visible as a distinct experiential intervention that expands supervisees\u0026rsquo; perceptual and reflective fields beyond feedback and skills acquisition; second, non-hastiness as a temporal\u0026ndash;ethical condition of supervision that enables depth, trust, and the emergence of meaning over time; and third, humor as a relational and reflexive resource that facilitates distance, perspective-taking, and emotional containment within supervisory encounters. By centering supervisors\u0026rsquo; lived experience, the study reframes supervision effectiveness as a co-constructed, relational phenomenon rooted in presence, mutuality, and phenomenological inquiry. At the same time, the study does not seek to offer an objective or universal definition of effective existential supervision; rather, it functions as a \u0026ldquo;panoramic map\u0026rdquo; that provides an initial orientation for further empirical and theoretical exploration, to be refined and deepened through future research.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study forms part of the research project \u003cem\u003e\u0026ldquo;The Effectiveness of Psychotherapy Supervision and the Dynamics of Relationships in the Supervision Process (SUPER)\u0026rdquo;\u003c/em\u003e, conducted at the Institute of Psychology, Vilnius University. The project is funded by the Research Council of Lithuania (Grant No. S-MIP-23-13) and received approval from the Vilnius University Committee on the Ethics of Psychological Research (No. 20 / (1.13 E) 250000-KT-161).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAhmed SK (2024) The pillars of trustworthiness in qualitative research. J Med Surg Public Health\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlfonsson S, Parling T, Spannarg\u0026aring;rd \u0026Aring;, Andersson G, Lundgren T (2018) The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: A systematic review. 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Am J Psychother 66:279\u0026ndash;307\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatkins EC (2017) Convergence in psychotherapy supervision: A common factors, common processes, common practices perspective. J Psychother Integr 27(2):140\u0026ndash;152. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/int0000040\u003c/span\u003e\u003cspan address=\"10.1037/int0000040\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Existential psychotherapy supervision, supervision effectiveness, Thematic analysis","lastPublishedDoi":"10.21203/rs.3.rs-9284410/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9284410/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePsychotherapy supervision plays a central role in therapists\u0026rsquo; professional development, yet empirical research on its effectiveness remains limited, particularly within the existential tradition. This qualitative study examines factors influencing the effectiveness of existential psychotherapy supervision from supervisors\u0026rsquo; perspectives. Seven existentially oriented supervisors participated in semi-structured interviews, and thematic analysis identified key facilitators and barriers. Facilitators included the quality of the supervisory relationship, supervisor attributes and interventions, and supervisee characteristics. Barriers involved lack of time and regularity, overly pedagogical approaches, unclear supervision questions, and supervisee anxiety or limited experience. The findings highlight underexplored relational and experiential dimensions, including humor, intentional slowing, and the process of \u0026ldquo;making the invisible visible,\u0026rdquo; with implications for supervision practice and training.\u003c/p\u003e","manuscriptTitle":"Unveiling Effectiveness: A Qualitative Exploration of Existential Psychotherapy Supervision through Supervisors’ Lenses","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-02 05:01:31","doi":"10.21203/rs.3.rs-9284410/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"17d2f574-a89b-427c-9e20-65d3c6485fff","owner":[],"postedDate":"April 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":65496371,"name":"Psychology"}],"tags":[],"updatedAt":"2026-04-02T05:01:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-02 05:01:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9284410","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9284410","identity":"rs-9284410","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}