Clinical Supervision Experiences and Needs of Mental Health Professionals Working with Refugees and Asylum Seekers: A Systematic Review

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Method: A comprehensive search across the PubMed, Web of Science, and Scopus databases identified 27 studies (2000–2026) that met the criteria for inclusion and exclusion, which were subsequently included in the review. These studies span research from 15 different countries and contexts, utilizing qualitative, quantitative, and mixed-methods designs, with data analyzed through a descriptive and interpretive thematic synthesis approach. Findings: The thematic synthesis revealed four primary themes: (1) Psychological Burdens and Supervision: Mental health professionals working with refugees face unique psychological burdens, such as secondary traumatic stress, vicarious trauma, and burnout, which place them at a higher risk compared to those in other fields, highlighting the necessity of supervision support; (2) Supervision Experiences and Access: Factors such as geographic distance, limited resources, and institutional neglect of supervision hinder access to supervision; (3) Cultural and Contextual Factors: The success of supervision is heavily reliant on context-sensitive approaches that consider the cultural, linguistic, and political aspects of refugees; (4) Supervision Models and Practices: Innovative frameworks like PEACE, BECCS, and data-driven remote supervision models present feasible alternatives in resource-limited humanitarian settings. Conclusion: The review's findings suggest that structured, high-quality, and context-sensitive supervision for mental health professionals and social workers dealing with refugees and asylum seekers is vital not only for maintaining professional quality but also for ensuring professional sustainability. Based on the study's findings, it is advised that policymakers, institutional leaders, and clinical practitioners focus on assessing the adaptation of cultural competence training specifically for supervision, technology-supported remote online supervision models, and peer supervision in settings requiring humanitarian aid, such as those serving refugees. clinical supervision refugee mental health secondary traumatic stress vicarious trauma systematic review Figures Figure 1 Introduction Forced displacement is one of the most significant humanitarian crises of the 21st century. According to the United Nations High Commissioner for Refugees (UNHCR, 2025 ), the number of forcibly displaced individuals has reached 123.2 million, marking an increase of approximately 7 million (6%) from the previous year. According to the data, more than 123 million people worldwide have been forcibly displaced; of these, approximately 43 million have refugee status, while 68 million have been internally displaced within their own countries. Displacement resulting from the Ukraine-Russia war has significantly contributed to this figure, with Ukraine becoming one of the world’s largest sources of refugees, hosting approximately 6.9 million refugees (UNHCR, 2025 ). Turkey, meanwhile, is the country hosting the largest number of refugees globally, with approximately 3.2 million Syrian refugees. (UNHCR, 2025 ). Refugees and asylum seekers are exposed to multiple traumatic experiences—ranging from war to torture, sexual violence, the sudden loss of loved ones, and forced displacement—in a cumulative manner (Silove et al., 2017 ). In addition to these experiences, stress levels are exacerbated by post-migration challenges such as uncertainty, discrimination, language barriers, and concerns about legal status in the host country (Porter & Haslam, 2005 ). Indeed, research shows that the prevalence of post-traumatic stress disorder (PTSD), depression, and anxiety disorders among refugees and asylum seekers is significantly higher than in the general population (Steel et al., 2009 ; Fazel et al., 2005 ). In this context, the importance of mental health professionals, social workers, and mental health and psychosocial support (MHPSS) services cannot be overstated. However, technical expertise alone is insufficient for providing mental health services to refugees; cultural competence—the ability to work effectively with clients from diverse cultural backgrounds — and trauma sensitivity—the capacity to understand the impact of traumatic experiences on an individual’s functioning and narrative—cannot be sustained without systematic professional support in the form of clinical supervision and knowledge and experience in these areas (WHO, 2025; Inter-Agency Standing Committee [IASC], 2007). Mental health professionals working with refugees and asylum seekers face particularly severe and challenging professional difficulties specific to this context. A review of the literature highlights that these professionals are at risk of three primary psychological risks: secondary traumatic stress, vicarious trauma, and burnout. Secondary traumatic stress is a condition arising from indirect exposure to clients’ traumatic experiences while working with them, leading to symptoms similar to those of PTSD—such as avoidance, hyperarousal, and intrusive thoughts (Figley, 1995 ). Indirect trauma, on the other hand, is a more enduring process resulting from constant exposure to traumatic content, formed through empathy, and leading to changes in the individual’s self-perception, worldview, and systems of meaning. (McCann and Pearlman, 1990 ; Pearlman and Saakvitne, 1995 ). Burnout, on the other hand, is defined as emotional exhaustion, depersonalization, and a diminished sense of accomplishment associated with intense and persistent work-related stress (Maslach & Leiter, 2016 ). In addition to these risks, professionals working with refugee and asylum-seeker populations also face the following unique challenges: the triadic therapeutic relationship (therapist–interpreter–client) and the complexity of this relationship (Miller et al., 2005 ), the reality of sharing the same cultural identity with clients and having experienced shared traumatic events (Hamid et al., 2020 ), insufficient institutional support and scarcity of resources (limitations in mental health infrastructure, trained personnel, and funding) (Ghafoori et al., 2024 ), and professional isolation (Butt et al., 2025 ). Taking all these elements into account, it becomes evident that professionals in this field require structured and systematic clinical supervision support. This necessity is distinct from that of those in general mental health services because of the unique challenges posed by the refugee context, such as repeated trauma exposure, cultural intricacies, and structural vulnerabilities. Therefore, a more comprehensive and context-specific supervision framework is essential. (Denkinger et al., 2018 ; Butt et al., 2025 ). Supervision involves a systematic support process where a seasoned professional (supervisor) regularly engages with a less experienced colleague (supervisee) to evaluate clinical practice, foster professional growth, and safeguard the client’s well-being (Bernard & Goodyear, 1998 ; Hawkins & Shohet, 2012 ). Three primary functions of clinical supervision are highlighted in the literature: the normative function (monitoring the alignment of work with ethical standards), the formative function (developing the professional knowledge and skills of the supervisee or prospective supervisor), and the supportive/restorative function (support related to coping with professional challenges and processing emotional burdens) (Proctor, 1987 ; Inskipp & Proctor, 2001 ). For mental health professionals working specifically in the field of trauma, supervision is essential for the prevention, early identification, and management of secondary traumatic stress and vicarious trauma (Pearlman & Saakvitne, 1995 ), maintaining the quality of the therapeutic relationship (Safran & Muran, 2000), and ensuring the healthy continuation of professional sustainability in the long term (Figley, 1995 ). Cohen and Collens ( 2013 ) note that supervisors working with professionals who provide psychological assistance to refugees must possess sociopolitical awareness in addition to these functions and adapt this awareness to the supervision process. Current Study Contrary to what was mentioned above, it is noteworthy that the vast majority of mental health professionals working with refugees do not have access to adequate supervision support. Professionals in low- and middle-income countries (LMICs) face significant challenges in obtaining supervision due to inadequate mental health infrastructure, a shortage of trained personnel, and limited funding (Denkinger et al., 2018 ; Jahan et al., 2025 ). The situation becomes even more complicated when factors like cultural differences, resource limitations, and geographical distances are considered, further heightening the demand for supervision (Hamid et al., 2020 ; Denkinger et al., 2018 ; Jahan et al., 2025 ). Although there has been an increase in research on supervision, systematic studies specifically examining the experiences and needs of mental health professionals working with refugees and asylum seekers are still scarce. A review of the current literature shows that existing studies either concentrate on the broader trauma field (Sprang et al., 2007 ) or are confined to specific geographic areas (Apostolidou & Schweitzer, 2017 ; Guhan and Liebling-Kalifani, 2011 ). No comprehensive study has been conducted that addresses elements unique to the refugee context. This systematic review aims to thoroughly explore the supervision experiences and needs of mental health professionals working with refugees and asylum seekers, highlighting the importance of this issue. The review seeks to answer the primary question: “What characterizes the clinical supervision experiences of mental health professionals working with refugees and asylum seekers, and what are their supervision needs?” Additional questions include how supervision addresses psychological challenges, the models used in the field, barriers to accessing supervision, and other contextual factors. By examining studies from various regions, especially Turkey, this review intends to provide an evidence-based resource for policymakers and practitioners. The framework outlined in this study will not only guide supervisors and institutions offering supervision to mental health professionals working with this population but will also help clarify the current situation. It will also serve as a foundation for supervisors and researchers aiming to develop needs-based supervision models. Method This research is a systematic review aligned with the PRISMA 2020 guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) aimed at exploring the experiences and requirements of mental health professionals who provide clinical supervision to refugees and asylum seekers (Page et al., 2021). Search Strategy A literature review was carried out using the PubMed, Web of Science, and Scopus databases. The search focused on studies published in English and Turkish from 2000 to 2026. Keywords and MeSH terms such as clinical supervision, mental health professionals, refugees, asylum seekers, vicarious trauma, secondary traumatic stress, burnout, humanitarian settings, supervision needs, and supervision were utilized. These terms were combined using AND/OR logical operators for the search. Besides searching the databases, the citation chains of the selected studies were manually examined, but this approach did not yield any additional studies. Inclusion and Exclusion Criteria The criteria for including studies in the review were as follows: (1) the study must involve mental health professionals such as psychologists, psychiatrists, social workers, or psychological counselors who directly engage with refugees and/or asylum seekers as participants; (2) it should focus on clinical supervision experiences, needs, models, or access conditions as a main or significant secondary topic; (3) it must be original research employing qualitative, quantitative, or mixed-methods approaches; (4) it should be published in a peer-reviewed journal. The review excludes review articles, meta-analyses, editorials, opinion pieces, studies with student or trainee samples, research where supervision is only a secondary variable, studies not explicitly set in a refugee context, and publications where the full text is unavailable. Screening and Selection Process A total of 178 records were identified through database searches (PubMed: 52, Web of Science: 97, Scopus: 29). After removing duplicate records, 112 studies remained. In the screening conducted at the title and abstract level, 71 studies were excluded; the primary reasons for exclusion were irrelevant context, lack of a refugee focus, and review/synthesis type. Full texts of the remaining 41 studies were retrieved and evaluated against the established inclusion criteria. At this stage, 14 studies were excluded: student/intern sample (n = 5), supervision being a secondary topic (n = 4), absence of a refugee context (n = 2), inability to access the full text (n = 2), and having a program description/report nature (n = 1). As a result, 27 studies were included in the systematic review. The screening and selection process is presented in Fig. 1 as a PRISMA 2020 flow diagram. Quality Assessment The methodological quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT; Hong et al., 2018 ). The MMAT was selected because it allows for the evaluation of qualitative, quantitative, and mixed-methods studies within a single framework. The quality assessment was conducted independently by two researchers with experience in clinical supervision and refugee mental health; any disagreements were resolved through discussion. The quality assessment findings were used not to exclude studies but to provide context for interpreting them. Data Extraction and Synthesis Data extraction from the included studies was conducted systematically; for each study, the author(s), year of publication, country/context, study design, sample characteristics, data collection method, intervention/supervision model, measurement tools, key findings related to supervision experience and needs were recorded. Data synthesis was conducted at the descriptive and interpretive levels using Thomas and Harden’s ( 2008 ) thematic synthesis approach. Given the methodological diversity of the included studies, a statistical meta-analysis was not performed. Results Detailed information on the 27 studies included in the systematic review is presented in Table 1 : Table 1 Analysis Table of Studies Included in the Systematic Review (n = 27) No Authors Year Title Country Study Design n Sample Characteristics Data Collection Intervention / Supervision Model Scales / Analysis Key Findings Supervision Experience and Need 1 Guhan, R. & Liebling-Kalifani, H. 2011 The experiences of staff working with refugees and asylum seekers in the UK: A grounded theory exploration United Kingdom Qualitative / Grounded Theory — Mental health and social work professionals working with refugees and asylum seekers Semi-structured interviews Not specified Grounded Theory / Thematic Analysis EXPERIENCE: Unable to find supervisors familiar with the refugee context. NEED: Specialized, accessible supervision infrastructure. EXPERIENCE: Unable to find supervisors familiar with the refugee context. NEED: Specialized, accessible supervision infrastructure. 2 Barrington, A.J. & Shakespeare-Finch, J. 2013 Working with refugee survivors of torture and trauma: An opportunity for vicarious post-traumatic growth Australia Qualitative / IPA 17 Clinical and administrative staff (torture and trauma field) Semi-structured interviews Not specified IPA / Thematic Analysis Vicarious trauma (VT) and vicarious posttraumatic growth (VPTG) can co-occur. Supervision supports meaning-making and VPTG development. EXPERIENCE: Supervision is protective; it facilitates meaning-making. NEED: Supervision supporting posttraumatic growth. 3 Puvimanasinghe, T. et al. 2015 Vicarious resilience and vicarious traumatization: Experiences of working with refugees and asylum seekers in South Australia Australia Qualitative / Thematic Analysis — Mental health professionals working with refugees and asylum seekers Semi-structured interviews Not specified Thematic Analysis Vicarious trauma (VT) and vicarious resilience (VR) co-occur. Supervision and mentorship are decisive in processing these experiences. EXPERIENCE: Both VT and VR must be processed in supervision. NEED: Structured supervision supporting resilience. 4 Schweitzer, R. et al. 2015 Therapeutic practice with refugee clients: A qualitative study of therapist experience Australia Qualitative / Thematic Analysis 12 Therapists working with refugee clients Semi-structured interviews Not specified Thematic Analysis Complex trauma and systemic challenges are inadequately addressed in supervision. Access to a specialist supervisor is difficult. EXPERIENCE: Refugee-specific challenges not met in supervision. NEED: Access to a specialist supervisor in this field. 5 Apostolidou, Z. & Schweitzer, R.D. 2017 Refugee experiences of resettlement and supervision in mental health services Australia Qualitative / Thematic Analysis 9 Therapists serving refugees with temporary protection status Semi-structured interviews Cross-cultural supervision Thematic Analysis Current supervision does not focus on refugee context-specific challenges. EXPERIENCE: Supervision deficit and inadequacy. NEED: Reflective supervision space specific to the refugee context. 6 Denkinger, J.K. et al. 2018 Secondary Traumatization in Caregivers Working With Women and Children Who Suffered Violence and War Germany Cross-Sectional Analytic 84 Social workers, therapists, interpreters Quantitative anketler Not specified (HAP institutional context) FST, RQ Scales / Regression 22.9% of workers showed secondary traumatization. Personal trauma and avoidant attachment are risk factors. EXPERIENCE: 71.6% reported a high need for supervision; only 64.1% had access. NEED: Group and case-focused supervision; collective trauma processing. 7 Echeverri, C. et al. 2018 Facilitating and impeding factors for scaling up mental health care in LMICs (mhGAP-HIG assessment) Sub-Saharan Africa Assessment / Quantitative 619 Health workers (primary care, community) mhGAP-HIG assessment tool mhGAP-HIG Protocol (including tele-supervision) mhGAP-HIG / Quantitative assessment Supervision improved clinical competency by 44–53%. Remote access via phone/SMS played a critical role. EXPERIENCE: Tele-supervision implemented in remote areas. NEED: Sustainable remote supervision models in low-resource settings. 8 Brooks, M. 2019 The importance of using reflective practice when working with refugees, asylum seekers, and survivors of torture within IAPT United Kingdom Qualitative / Case Analysis — Therapists (torture/asylum seeker cases) Clinical observation and case notes Cross-cultural supervision Case Analysis / Psychoanalytic Perspective Management of the triadic relationship (therapist–interpreter–client) in supervision is critical. EXPERIENCE: Complexity of triadic relationship with interpreter. NEED: Specialized supervision covering cross-cultural dynamics. 9 Tarannum, S. et al. 2019 Integrating mental health into primary health care in the Rohingya refugee response in Bangladesh Bangladesh Quantitative 62 Health workers serving Rohingya refugees Practical skills observation form mhGAP-based supervision Practical Skills Assessment Form Only 15 of 62 workers received regular supervision. Significant deficits in psychosocial support skills. EXPERIENCE: A heavy workload impeded participation in supervision. NEED: Structured and regular supervision; psychosocial skill development. 10 Wirth, T. et al. 2019 Working conditions in the caring professions: A qualitative study of workers' experiences Germany Mixed / Scoping — Social workers with refugees and homeless individuals Literature synthesis + interviews Not specified Scoping Review / Thematic Analysis Inadequate supervision and institutional support are common themes. Chronic deprivation and emotional burden are prominent. EXPERIENCE: Institutional support insufficient; supervision critical. NEED: Structured supervision incorporating emotional burden management. 11 Binder, A. et al. 2020 Working with refugees: How do social workers experience work-related stress? Germany Mixed / Cross-Sectional 54 Social workers with women and children exposed to ISIS violence Quantitative survey + qualitative interview Not specified (institutional context) PSQ / Mixed-Methods analysis Supervision is the most important support resource. 64.1% access, but mostly administrative, not meeting emotional support needs. EXPERIENCE: Administrative supervision does not meet emotional needs. NEED: Emotionally supportive, trauma-focused supervision. 12 Hamid, A. et al. 2020 Qualitative accounts from Syrian mental health professionals: Shared realities of working with fellow Syrians Turkey Qualitative / Thematic Analysis 16 Syrian mental health professionals (also displaced) In-depth interviews Self-disclosure Thematic Analysis / NVivo Shared culture facilitates bonding; however, it creates emotional vulnerability. STS and burnout are prevalent. EXPERIENCE: High workload and insufficient number of supervisors. NEED: Supervision ensuring confidentiality and discussion of difficult cases. 13 Long, S. 2020 Supervisors' Perception of Vicarious Trauma and Growth in Australian Refugee Trauma Counselors Australia Qualitative / IPA 11 Clinical supervisors affiliated with FASSTT Semi-structured interviews Cohen & Collens Modeli analizi IPA / NVivo Supervisors facilitate meaning-making processes. Existing models leave the sociopolitical context underaddressed. EXPERIENCE: Supervision may neglect VT. NEED: Integration of the sociopolitical context into supervision. 14 Posselt, M. et al. 2020 Fostering mental health and well-being among workers who support refugees and asylum seekers Australia Mixed-Methods / Cross-Sectional 41 Refugee support personnel (social work, psychology, etc.) Online survey (DASS-21, ProQOL) Clinically focused supervision SWAI / Regression Supervisory alliance is protective against STS and depression. Workers receiving weekly supervision show lower anxiety. EXPERIENCE: Strong alliance with emotional support. NEED: Weekly regular supervision and a strong supervisory alliance. 15 Augusterfer, E.F. et al. 2020 A review of telepsychiatry as a tool for reintegrating displaced persons and refugees LMIC / Conceptual Theoretical Model — Professionals in low-resource crisis settings Literature synthesis Tele-supervision model Theoretical Analysis Tele-supervision reduces isolation in remote settings. Remote clinical guidance is proposed as a sustainable model, particularly in LMIC contexts. EXPERIENCE: Isolation and lack of immediate support. NEED: Technology-assisted remote supervision protocols. 16 Robelski, S. et al. 2020 Burnout in social work with refugees: A qualitative study Germany Qualitative / Interview 26 Social workers serving refugees and homeless persons Semi-structured interviews Group supervision Thematic Analysis Group supervision remains superficial under heavy caseloads. Demand for immediate individual support is prominent. EXPERIENCE: Inadequacy of the group format. NEED: Individual supervision and immediate professional support during crises. 17 Perera, C. et al. 2021 Towards an integrated model for supervision for MHPSS in humanitarian emergencies: A qualitative study Global / Humanitarian Qualitative / Thematic Analysis 26 Global MHPSS professionals Semi-structured interviews Integrated Model for Supervision (IMS) development Thematic Analysis / NVivo IMS provides a four-component flexible framework. Active listening and supervisors' access to their own support are critical. EXPERIENCE: Supervision is not prioritized in humanitarian settings. NEED: Standardized, adaptable IMS framework. 18 Potter, C. et al. 2023 Mental health supervision for psychotherapists working with refugees: The Fearless project Germany Qualitative / Thematic Analysis 13 Psychotherapists working with refugees (Fearless project) Semi-structured interviews Fearless project supervision model Thematic Analysis Structured supervision reduces reluctance to take on refugee cases and strengthens the development of self-confidence. EXPERIENCE: Supervision increases therapist motivation. NEED: Capacity building specifically to the refugee field through supervision. 19 O'Sullivan, E. et al. 2023 Gender considerations for supportive supervision in humanitarian contexts: A qualitative study Global / Humanitarian Qualitative 12 MHPSS workers (various humanitarian contexts) Semi-structured interviews IMS framework (gender-focused) Thematic Analysis Gender roles shape supervisory relationships. A one-size-fits-all approach is insufficient; flexibility sensitive to cultural norms is necessary. EXPERIENCE: Cultural norms affect supervision dynamics. NEED: Flexible supervision arrangements sensitive to gender and culture. 20 Ghafoori, B. et al. 2024 Psychological adaptation among health care workers who work with trauma-exposed refugees in Greece Greece Qualitative / Thematic Analysis 20 Healthcare workers in NGOs (psychologists, doctors, nurses) Semi-structured interviews Not specified (clinical adaptation-focused) Thematic Analysis (Braun & Clarke) Secondary trauma, expectation mismatch, and coping difficulties. Institutional instability increases burnout. EXPERIENCE: Inadequate training and supervision. NEED: Supervision supporting self-care and protecting professional health. 21 Greene, M.C. et al. 2024 Comparing implementation strategies for training and supervising nonspecialists in Group Problem Management Plus: A hybrid effectiveness-implementation trial in Colombia Colombia Quantitative / Mixed 127 Psychosocial intervention facilitators Fidelity tools (ENACT, GroupACT) Peer supervision (ENACT/GroupACT) ENACT / GroupACT / Quantitative comparison Peer supervision yielded outcomes comparable to those of expert supervision. Scalable model in LMIC contexts. EXPERIENCE: Peer supervision achieved fidelity rates comparable to expert supervision, demonstrating feasibility in low-resource settings. NEED: Scalable, accessible, and culturally appropriate supervision models in LMIC contexts. 22 Jahan, S. et al. 2025 Clinical mental health supervision in a humanitarian context in LMICs: PEACE model for community engagement Bangladesh / Turkey / Syria CBPR / Qualitative 6 Rohingya Advisory Committee members FGD, IDI, and RAC meetings PEACE Model (supervision-focused) Thematic Analysis / Constructivist The PEACE model increases community trust. Rohingya perspectives are directly integrated into supervision materials. EXPERIENCE: Online group supervision. NEED: Culturally aligned supervision that incorporates community voice. 23 Kurt, G. et al. 2025 Online group supervision for Syrian refugee mental health workers in Turkey: A longitudinal mixed-methods study Turkey / Syria Longitudinal / Mixed-Methods 55 Syrian mental health professionals (C4C program) Kessler-6, ProQOL; interviews C4C Online Group Supervision Bayesian Hierarchical Analysis / Mixed C4C online group supervision significantly reduced psychological stress (b = − 0.18). The effect sustained even after the 2023 earthquake. EXPERIENCE: Online supervision is functional even in extraordinary conditions. NEED: Sustainable remote supervision during crisis periods. 24 Küçüknane, A. et al. 2025 Secondary traumatic stress experiences and coping strategies of humanitarian aid workers Turkey Qualitative / Thematic Analysis 13 Humanitarian aid workers Semi-structured interviews Not specified (lived experience-focused) Thematic Analysis STS and absence of supervision are primary themes. Participants rely on informal peer networks; these are insufficient. EXPERIENCE: Absence of supervision; informal coping. NEED: Structured, institutionally supported clinical supervision. 25 van den Broek, M. et al. 2025 Data-driven supervision in humanitarian settings: Experiences from Uganda Uganda Qualitative 38 Community mental health gatekeepers and supervisors Semi-structured interviews Data-driven supervision (Dashboard) Dashboard Metrics / Thematic Analysis Real-time data dashboard increased motivation and confidence in case identification. Supervisor feedback is an important need. EXPERIENCE: Data-driven real-time supervision. NEED: Technology-assisted supervision in low-resource humanitarian settings. 26 Pillay, Y. & Civan, K. 2025 The BECCS Model: A Novel Approach to Clinical Supervision in Culturally Diverse Settings USA Conceptual Model Development — Clinical supervisors and counselors Literature synthesis BECCS Model (7 vectors) Theoretical Analiz / PPCT Entegrasyonu The BECCS model provides a humanistic, trauma-focused, and social justice-oriented framework for professionals working with refugees. EXPERIENCE: Not specified. NEED: A new supervision model that enhances cultural competency. 27 Butt, M.K. et al. 2026 Secondary traumatic stress among mental health professionals working with war refugees in Pakistan: A qualitative exploration Pakistan Qualitative / Reflexive Thematic Analysis 6 Psychologists, psychiatrists, social workers Semi-structured interviews Not specified (lived experience-focused) STSS / Reflexive Thematic Analysis Mental health professionals in Pakistan experience high STS. Professional isolation and institutional support deficit are core issues. EXPERIENCE: Professional isolation and inadequate supervision. NEED: Culturally appropriate supervision and institutional support. The findings of the 27 studies examined as part of the systematic review were synthesized under four main themes that align with the research questions: (1) the psychological implications of the work for the refugee population, (2) supervision experiences, the role of supervision, and access conditions, (3) cultural and contextual factors, and (4) supervision models and practices. Each theme is addressed in detail, taking into account the overlaps and differences among the findings of the studies included. Theme 1: Psychological Implications of Working with Refugee Populations Most studies reviewed consistently show that mental health professionals working with refugee populations face a unique and significant psychological burden. This burden is characterized by secondary traumatic stress (STS), vicarious trauma, and burnout, which are qualitatively different from general clinical practice. These experiences are closely tied to the availability or lack of structured supervision support. Secondary traumatic stress is frequently observed among professionals working with refugees, as evidenced by multiple studies. In a cross-sectional study of 84 professionals assisting Syrian refugees in Germany, 22.9% exhibited clinical-level secondary traumatization; while 71.6% expressed a strong need for supervision, only 64.1% reported having regular access to it (Denkinger et al., 2018 ). A personal history of trauma and shared experiences of flight with clients were identified as primary risk factors, whereas a secure attachment style was a protective factor. Similar results were found in a qualitative study in Pakistan, where participants linked high levels of STS to professional isolation and a lack of structured supervision (Butt et al., 2025 ). Ghafoori and colleagues ( 2024 ), who studied healthcare workers in refugee camps in Greece, also noted psychological adjustment difficulties, expectation mismatches, and symptoms of secondary trauma, identifying inadequate training and lack of supervision as major institutional challenges for professionals. Conversely, some studies suggest that working with refugees can be both traumatic and empowering. Puvimanasinghe et al. ( 2015 ) observed that professionals experience both vicarious trauma (VT) and vicarious resilience (VR), with supervision and guidance playing a crucial role in processing these complex experiences. Similarly, Barrington and Shakespeare-Finch ( 2013 ) found that vicarious trauma and vicarious post-traumatic growth (VPTG) can occur simultaneously, demonstrating that structured supervision can aid in professional meaning-making and growth. Long’s ( 2020 ) study, which looks at the issue from the supervisor’s perspective, emphasizes the significant role supervisors play in counselors’ meaning-making processes, but notes that current approaches do not adequately address vicarious trauma and the socio-political context. Burnout and the quality of supervision are significant themes in the literature. Binder et al. ( 2020 ) conducted a mixed-methods study revealing that 64.1% of professionals had access to supervision, yet most of it was inadequate, focusing mainly on administrative tasks and lacking emotional support. Similarly, Robelski et al. ( 2020 ) discovered that group supervision often remained surface-level due to heavy workloads, highlighting the need for immediate professional support during crises. Augustfer et al. (2015) emphasized the potential of tele-supervision to alleviate the isolation of specialists in remote areas and provide clinical guidance, suggesting it could be a sustainable solution, especially in LMICs. In line with this, Wirth et al. ( 2019 ) conducted a screening study in Germany, which showed that the emotional strain of working with clients facing chronic deprivation, combined with insufficient institutional support, is particularly severe in the refugee context. This underscores the importance of incorporating emotional management into supervision agendas alongside technical skills. Research in Turkey adds another layer to these patterns. Küçüknane et al. ( 2025 ) conducted a qualitative study with humanitarian aid workers, focusing on informal coping mechanisms. Participants reported relying on spontaneously formed peer networks for support, which, however, did not replace structured supervision. The lack of supervision and institutional support were identified as primary causes of burnout, indicating an urgent need to strengthen the supervision infrastructure in Turkey's humanitarian aid sector. Theme 2: Supervision Experiences, the Role of Supervision, and Access Conditions The studies included indicate that mental health professionals working with refugees face notable deficiencies in their supervision experiences, both qualitatively and quantitatively. This theme encompasses issues such as limited access to supervision, the quality of the supervision provided, and challenges specific to their work environment. 2.1. Barriers to Accessing Supervision Numerous studies have documented the precise dimensions of these barriers. In a comprehensive evaluation by Echeverri et al. ( 2018 ) involving 619 healthcare professionals in Sub-Saharan Africa, it was discovered that supervision guided by the mhGAP-HIG protocol significantly enhanced clinical skills, showing a 44–53% improvement. Notably, in environments characterized by a lack of specialists, remote supervision through phone and SMS has proven to be a feasible alternative. Similarly, Tarannum and colleagues ( 2019 ) observed 62 healthcare workers in Rohingya camps in Bangladesh and found that only 15 participants received consistent supervision. Structural obstacles such as heavy workloads and insufficient infrastructure were identified as hindrances to participating in supervision. These findings underscore the geographical and institutional aspects of the supervision access issue. Comparable challenges were noted in Ghafoori et al.'s ( 2024 ) study in Greece, where participants, including psychologists, doctors, and nurses within a civil society organization, reported that frequent staff turnover, vague job roles, and inadequate supervision contributed to severe burnout. Additionally, the significant gap between expected and actual support led to a pronounced mismatch between expectations and reality. Apostolidou and Schweitzer’s ( 2017 ) qualitative research, conducted with nine therapists offering psychological services to refugees under temporary protection in Australia, is crucial in demonstrating that supervision experiences remained consistent despite temporal changes. While therapists deemed supervision essential for bridging cultural gaps and managing the helplessness stemming from shared trauma and legal uncertainties, they noted that current supervision does not adequately address these issues. This study is significant in that it demonstrates that the need for supervision specific to the refugee field was articulated in the same way nearly a decade ago and that structural transformation is still awaited. Schweitzer et al. ( 2015 ) also identified a similar pattern in their qualitative study with 12 therapists in Australia: The vast majority reported that existing supervision did not adequately address the challenges specific to working with refugees, and they faced significant difficulties accessing supervisors specialized in this field. This finding is significant because it demonstrates that the aforementioned access issue persists even in contexts such as Australia, which are not considered resource-constrained. The study conducted by Guhan and Liebling-Kalifani ( 2011 ) with mental health and social service professionals working with refugees and asylum seekers in the UK points to a historical continuity in that it clearly demonstrated, as early as fifteen years ago, just how widespread and systemic the lack of supervision is. The professionals participating in the study reported facing serious difficulties in accessing expert supervisors who understand the unique challenges of refugee clients and can adapt this experience to the supervision process. Burnout and professional isolation were found to be directly linked to the lack of structural supervision (regular, planned, and institutionally supported supervision). This study points to a historical continuity in that it demonstrates that this need was articulated in the same way approximately fifteen years ago and has yet to be resolved through a structural solution. In their 2020 qualitative study, Hamid et al. explored the experiences of 16 Syrian mental health professionals who were forcibly displaced to Turkey, documenting barriers to access such as heavy workloads, scarce supervision opportunities, and concerns over professional confidentiality, which align with findings from other research. However, this study uniquely emphasizes the dual nature of shared cultural and linguistic identity with refugees: it facilitates the formation of therapeutic connections but also poses the risk of emotional boundary issues. Some therapists pointed out ethical challenges when working with clients who are also colleagues or acquaintances' clients, highlighting the necessity for supervision. The study's results suggest that supervision by culturally similar professionals in Turkey requires particular attention and structured methods. 2.2. The Nature of Supervision The central theme emerging from the studies reviewed is the nature of the working relationship and therapeutic alliance within the supervisory context. Posselt et al. ( 2020 ) quantitatively showed that a robust supervisory alliance serves as a protective shield against secondary traumatic stress and depression, suggesting that the quality of supervision is as crucial as its frequency. Additionally, cultural sensitivity, countertransference management, and the supervisor's readiness for the refugee context are essential aspects of this theme. The mixed-methods study by Posselt et al. ( 2020 ) in Australia stands out as one of the most methodologically sound in this area. This study, which included 50 therapists working in refugee support services, revealed that a strong therapeutic alliance between supervisor and supervisee significantly protected against secondary traumatic stress and depression. It was found that anxiety levels were notably lower among staff receiving weekly supervision, with the supervisory alliance being the strongest predictor of this protective effect. This underscores the vital importance of not only conducting regular supervision but also establishing it on a foundation of trust and a strong relational bond. In 2019, Brooks conducted a case study within the framework of the United Kingdom's IAPT (Improving Access to Psychological Therapies) program, focusing on the therapeutic interaction between a therapist and a refugee client. In this study, supervision is defined as a space that serves a reflective function, facilitating the therapist’s awareness of and processing of their implicit assumptions, cultural biases, and countertransference reactions. In particular, managing the triadic therapeutic relationship (therapist–interpreter–client) poses a challenge that requires intensive supervision. This study indicates that focusing solely on the case is insufficient in supervision and that the therapist must examine their own attitudes and cultural position. In a qualitative study conducted by Van den Broek et al. ( 2025 ) in refugee settlements in Uganda, the authors examined the impact of a data-driven supervision approach that integrates real-time data provided via digital dashboards into the supervision process. In this approach, performance data for community mental health workers—such as case identification, intervention frequency, and follow-up rates—are visually tracked via a software interface (dashboard) and transmitted to the supervisor in real time. In this data-driven approach, data such as intervention frequency, case identification, and follow-up rates are displayed in real time on digital dashboards; the supervisor uses this data as a reference to provide feedback. Research findings have shown that this method significantly increases both therapist motivation and confidence in case detection (van den Broek et al., 2025 ). It has been observed that real-time feedback from supervisors is critical for correcting potential errors early. This study provides strong evidence regarding the feasibility of technology-supported, data-driven supervision models in low-resource humanitarian aid contexts. Finally, a qualitative study conducted by Potter et al. ( 2023 ) in Germany documented the direct impact of supervision on therapist motivation. Interviews with 13 therapists who began working with refugees as part of the Fearless project revealed that structured supervision reduced therapists’ reluctance to accept refugee cases and strengthened their self-confidence and the development of their professional identities. This discovery underscores the effectiveness of supervision in not only boosting mental health capabilities for refugees but also in the areas of hiring and maintaining employment. Although the Fearless project does not introduce a novel supervision model, it offers important insights into how structured supervision contributes to retaining therapists. Theme 3: Cultural and Contextual Factors When considering cultural and contextual elements, supervision in refugee settings diverges from typical supervision practices. The studies examined indicate that factors such as cultural identity, shared migration experiences, political context, and conditions in the host country significantly influence the supervision process. Hamid et al. ( 2020 ) discovered that professionals who share national, cultural, and linguistic identities with their clients find it easier to build therapeutic relationships. Therapists have observed that when identities align, it facilitates gaining clients' trust and understanding their experiences. However, this alignment can blur professional boundaries between therapists and clients, making therapists more emotionally vulnerable to the trauma their clients have endured. As one participant expressed, “Sometimes I forget that this pain is my own.” This insight underscores the importance of carefully monitoring the boundary between personal trauma and professional roles during supervision sessions with therapists who share a common identity with their clients. Jahan et al. ( 2025 ) explored the PEACE model (Participation, Respect for Community Expertise, Encouraging Action, Building Authentic Connections, and Empowerment), providing strong ethical and practical reasons for involving refugee communities actively in supervision processes. This study was part of the 16-month online group supervision program Caring for Carers (C4C), aimed at Rohingya refugees in Bangladesh and Syrian internally displaced persons in Turkey/Northern Syria. It involved adapting supervision materials based on input from the Rohingya Advisory Committee (RAC). The cultural insights shared by community members during supervision offered crucial contextual information on how mental health is perceived in the local language and culture, which was directly applied to adapt the supervision content. This study clearly illustrates that supervision should be developed within a collaborative framework that includes the knowledge and experience of refugee communities, rather than being conducted through a top-down, one-way approach dictated solely by experts (supervisor-consultant-client). In a qualitative study by O’Sullivan et al. ( 2023 ) conducted in humanitarian aid contexts, the gender aspect of supervision practices was explored. Interviews with 12 MHPSS workers revealed that gender roles influenced supervisory relationships, feedback dynamics, and emotional safety in ways intertwined with the cultural context. It was found that in some settings, male supervisees faced challenges receiving support and feedback from female supervisors due to cultural norms. These findings emphasize that a one-size-fits-all approach to gender in supervision models is inadequate and that flexible arrangements sensitive to cultural, religious, and social norms are crucial. The study also highlights that current humanitarian aid guidelines do not sufficiently address this aspect and calls for further research in this area. Theme 4: Supervision Models and Practices Research indicates that supervision models tailored to the refugee context are not only few in number but also still evolving. Nonetheless, it is important to highlight that innovative and promising models are emerging in this area. These models typically strive to incorporate cultural competence, community involvement, and social justice principles into the supervision framework. The PEACE model, introduced by Jahan et al. ( 2025 ), is a groundbreaking study that employs a community-based participatory research (CBPR) approach to clinical supervision within humanitarian aid settings. The model comprises five components: Participation, Expertise, Agency, Connection, and Empowerment. It provides a structured supervision curriculum that addresses topics such as human rights, diversity and power dynamics, the client-counselor relationship, MHPSS skills, case discussion, and reflective practice. In this model, community participation is viewed not just as a tool but as an ethical obligation that honors the knowledge and experiences of refugee communities. The PEACE model sets itself apart from existing models by integrating local cultural insights, awareness of power disparities, and a rights-based approach into the supervision agenda. The Bio-Ecological Cross-Cultural Clinical Supervision (BECCS) Model, created by Pillay and Civan ( 2025 ), uniquely adapts Bronfenbrenner’s bioecological theory of development (PPCT: Process-Person-Context-Time) to clinical supervision. This seven-dimensional conceptual framework addresses supervision content at various levels: micro (individual and therapeutic relationship), meso (team and organizational relationships within the supervision context), exo (organizational policy and funding structures), macro (social norms, culture, and legal framework), and chronosystem (experiences that change over time). A notable aspect of this framework is its emphasis on developing cultural competence and a social justice-oriented approach to supervision, tailored to the complex nature of refugee experiences. The temporal dimension is another distinctive feature of the model; it highlights the importance of incorporating the processing of the refugee experience within a temporal continuum into the supervision agenda. In essence, BECCS positions the supervisor not just as a clinical guide, but as a cultural mediator, an advocate for social justice, and a collaborative partner who comprehends the client’s multi-layered context. The qualitative study by Perera and colleagues ( 2021 ) with mental health and psychosocial support specialists in humanitarian contexts marks the initial phase of developing the Integrated Model for Supervision (IMS). Semi-structured interviews with 26 global mental health experts provided a comprehensive view of the components of effective supervision in humanitarian contexts. Participants concurred on the significance of active listening skills and supervisors having access to their own supervision support. The model comprises four main sections: (1) fundamental supervision principles, (2) organizational integration, (3) supervisor competency development, and (4) the participation of the supervisee. IMS offers a flexible framework that organizations of various sizes and different humanitarian aid contexts can adapt. The Turkey/C4C study by Kurt et al. ( 2025 ), which is based on IMS, confirms the model’s practical applicability in Turkish and regional contexts. Greene et al. ( 2024 ) conducted a study in Colombia to evaluate the impact of supervision in environments where essential resources, such as qualified supervisors, training facilities, and financial support, are scarce. The research, involving 127 facilitators, utilized tools to measure ENACT (adherence to individual interventions) and GroupACT (adherence to group interventions). The findings indicated that groups receiving peer supervision performed just as well in case follow-up and intervention adherence as those with expert supervision (Greene et al., 2024 ). This underscores the significance of creating culturally relevant and cost-efficient supervision methods, especially in countries with limited resources. It also implies that peer supervision could be a viable alternative in situations where expert supervision is not readily available. Discussion This systematic review consolidates current understanding of the supervision experiences and requirements of mental health professionals working with refugees and asylum seekers, highlighting these main conclusions: (1) professionals in this area face a significant and unique psychological burden; (2) there is a lack of adequate and evenly distributed access to structured, high-quality supervision; (3) cultural and contextual elements specific to the refugee environment greatly influence the supervision process; and (4) new models being developed in this field often emphasize cultural competency, community involvement, and social justice principles. The review indicates that supervision is not just a tool for professional growth; it plays a vital protective role for practitioners working with refugees. Posselt et al. ( 2020 ) quantitatively showed that a strong supervisory relationship can mitigate secondary traumatic stress and depression. Data from Denkinger et al. ( 2018 ) highlight the widespread and pressing need for this support. Echeverri et al. ( 2018 ) demonstrate that supervision concretely and measurably improves clinical skills. The qualitative findings of Butt et al. ( 2025 ) show that the quality of supervision matters more than its mere presence; a trauma-informed and individually tailored approach is essential in this context. These findings are consistent with the trauma supervision literature (Pearlman & Saakvitne, 1995 ; Figley, 1995 ) and demonstrate that supervision needs in the refugee context differ from those in general mental health practice in both scope and content. These findings raise important questions regarding the applicability of general supervision models in the refugee context. The majority of existing models are built on a Western, individualistic, and clinically focused framework; collective trauma, intergenerational effects, and sociopolitical dimensions are generally overlooked (Long, 2020 ). This demonstrates that developing supervision frameworks that are refugee context-sensitive, holistic, and culturally adapted is not an option but a necessity for practitioners working in this field. The included studies also reveal serious disparities in access to supervision across geographies and contexts. Even in relatively well-resourced settings such as Australia and the United Kingdom, practitioners reported inability to access adequate, quality supervision (Brooks, 2019 ; Posselt et al., 2020 ), demonstrating that this problem cannot be explained by resource constraints alone. This points to the necessity of addressing structural, cultural, and institutional dimensions to achieve quality access to supervision, and also reflects the extent to which the refugee population's needs and mental health service quality remain institutionally deprioritized. In LMIC contexts—countries and regions such as Pakistan, Ethiopia, Bangladesh, and Northern Syria, where serious resource constraints exist in mental health services, supervision infrastructure, and qualified specialists—challenges are far more pronounced and multi-layered. The Pakistan study by Butt et al. ( 2025 ) documents the near-total absence of structured supervision systems; the study by Jahan et al. ( 2025 ) is valuable for demonstrating how online group supervision can be implemented in remote and hard-to-reach geographies. In the study conducted by Tarannum et al. ( 2019 ) in Bangladesh, it was found that a mere 15 out of 62 workers received consistent supervision, highlighting significant structural barriers to access. Conversely, research by van den Broek et al. ( 2025 ) in Uganda suggests that digital, real-time, data-driven supervision can help mitigate these challenges. These findings suggest that technology-based solutions could effectively address issues of access and inequality. Tele-supervision and online group supervision emerge as viable options to alleviate supervision resource limitations, though it remains crucial to adapt supervision content to cultural contexts. The situation in Turkey, which hosts the largest refugee population globally, deserves special consideration. Hamid et al. ( 2020 ) report that Syrian mental health professionals in Turkey face secondary traumatic stress and professional isolation while continuing to provide services, compounded by significant challenges in obtaining adequate supervisory support. This is corroborated by a longitudinal mixed-methods study by Kurt et al. ( 2025 ) involving 55 Syrian mental health professionals in Turkey and Northern Syria. The Caring for Carers (C4C) program's online group supervision was shown to significantly alleviate psychological stress (Bayesian hierarchical analysis: b = − 0.18), with this effect persisting even during the 2023 earthquake. This underscores the need for structural reinforcement of Turkey's refugee mental health system and the establishment of systematic supervision mechanisms to ensure the sustainability of practitioners in the field. A notable insight from this review is that cultural identity and context act as a dual factor—both aiding and complicating the supervision process. While a shared cultural identity with clients can enhance therapeutic rapport (Hamid et al., 2020 ), it also introduces risks such as boundary erosion, increased countertransference, and challenges in maintaining professional neutrality. This intricate dynamic suggests that supervision for practitioners sharing clients' cultural identity requires careful attention and structure, further supporting the need for supervision support. Limitations and Future Research Directions This review has several methodological limitations that need to be recognized. Firstly, the relatively small number of studies included (n = 27) restricts the generalizability of the results. The variation in samples, contexts, and methods among the studies complicates direct comparisons and prevents systematic statistical synthesis. The search did not encompass gray literature, such as reports, theses, conference proceedings, and institutional publications that are not found in peer-reviewed journals. Additionally, the focus on English and Turkish publications means that significant studies in languages like Arabic and French might have been overlooked. For future research, it is important to prioritize randomized controlled trials and longitudinal studies that assess the effectiveness of supervision interventions. The implementation processes and outcomes of culturally adapted supervision models in low- and middle-income country (LMIC) contexts, especially in Turkey, should be thoroughly documented. There is a need to develop psychometrically sound and culturally validated measurement tools for professionals working with refugees, explore the feasibility of technology-assisted supervision models in various contexts, and encourage participatory designs that involve refugee community members as research partners. It is also important to note that many of the reviewed studies did not provide basic information on supervision frequency, duration, and model (see Table 1 ). Comprehensive reporting of this information will significantly benefit future comparative research. Conclusion This systematic review thoroughly examines the supervision experiences and requirements of mental health professionals who work with refugees and asylum seekers. The results clearly indicate that structured, high-quality, and culturally sensitive supervision is essential for both individual practitioners and the overall quality of services in this area. As global focus on refugee mental health continues to grow, highlighting the psychological challenges and structural obstacles faced by practitioners in this field is crucial. Innovative models like PEACE and BECCS offer a glimpse into the future by integrating cultural competence, community involvement, and social justice principles into the supervision framework. It is vital to recognize that supervision is not merely a luxury or optional support but a fundamental professional right for mental health practitioners in any setting, and this understanding must be reflected in policy and practice. The findings of this review have significant implications for policymakers, institutional leaders, and clinical practitioners in the mental health sector. Primarily, ensuring regular, structured, and quality supervision for all mental health professionals working with refugees should be seen not as a privilege but as an essential ethical duty. Supervision models should evolve from one-size-fits-all approaches to become culturally sensitive, trauma-informed, and adaptable; supervisors should be equipped with comprehensive training on the historical, political, and cultural aspects of refugee communities. Especially in low- and middle-income countries, technology-assisted online supervision options should be carefully assessed for cultural suitability, and research should employ participatory methods that directly involve the voices of refugee communities in the process. 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This isn’t just about things, it’s about people and their future: A qualitative analysis of the working conditions and strains of social workers in refugee and homeless aid. International Journal of Environmental Research and Public Health , 16 (20), 3858. https://doi.org/10.3390/ijerph16203858 World Health Organization (2025). Refugee and migrant mental health. https://www.who.int/news-room/fact-sheets/detail/mental-health-and-forced-displacement Additional Declarations No competing interests reported. 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. 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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-9383040","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":626034708,"identity":"6ade506c-3bc0-42f0-8d6a-747e001e9ec0","order_by":0,"name":"Makbule DURAN MUCUK","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Makbule","middleName":"DURAN","lastName":"MUCUK","suffix":""},{"id":626034709,"identity":"85bf95b2-095e-41d3-b65f-995da77257c1","order_by":1,"name":"Melike KOÇYİĞİT","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYDACdjYQKcHAxsB8AMSQIayFGaaFjS0BxOAhVgsQsPEYgCjCWnSb2RIf/GyzsOuT7/n86kaNBQ8D++GjG/BpMTvMdtiwt00iuY2Nd5t1zjGgw3jS0m7g18LeJs0I1MIG1GKcwwbUIsFjRqwWnmfGOf+I0sJ2DKTFDqiF+XFuG3Fakg17zkkksLGlmTHn9knwsBH0y/E2wwc/yurs5ZsPP/6c861Ojp/98DG8WsCAkY0hsQEYMxIgDhsBxVDwh8EeSDJ/IE71KBgFo2AUjDQAAKhzPa4puH7dAAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Melike","middleName":"","lastName":"KOÇYİĞİT","suffix":""}],"badges":[],"createdAt":"2026-04-10 21:08:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9383040/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9383040/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107540604,"identity":"ccea632f-45b9-4737-9208-b9e2a58a3394","added_by":"auto","created_at":"2026-04-22 12:15:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":389453,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePRISMA 2020 flow diagram: supervision experiences of mental health professionals working with refugees/asylum seekers\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9383040/v1/d5ef4dcc5ce1634787c4b874.png"},{"id":107705524,"identity":"2f4f0cc1-af57-4583-82ac-056f2f319239","added_by":"auto","created_at":"2026-04-24 09:13:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":791878,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9383040/v1/e4d28bd0-924b-4980-be59-f5d479dce96c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Supervision Experiences and Needs of Mental Health Professionals Working with Refugees and Asylum Seekers: A Systematic Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eForced displacement is one of the most significant humanitarian crises of the 21st century. According to the United Nations High Commissioner for Refugees (UNHCR, \u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e), the number of forcibly displaced individuals has reached 123.2\u0026nbsp;million, marking an increase of approximately 7\u0026nbsp;million (6%) from the previous year.\u003c/p\u003e \u003cp\u003eAccording to the data, more than 123\u0026nbsp;million people worldwide have been forcibly displaced; of these, approximately 43\u0026nbsp;million have refugee status, while 68\u0026nbsp;million have been internally displaced within their own countries. Displacement resulting from the Ukraine-Russia war has significantly contributed to this figure, with Ukraine becoming one of the world’s largest sources of refugees, hosting approximately 6.9\u0026nbsp;million refugees (UNHCR, \u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e). Turkey, meanwhile, is the country hosting the largest number of refugees globally, with approximately 3.2\u0026nbsp;million Syrian refugees. (UNHCR, \u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e). Refugees and asylum seekers are exposed to multiple traumatic experiences—ranging from war to torture, sexual violence, the sudden loss of loved ones, and forced displacement—in a cumulative manner (Silove et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). In addition to these experiences, stress levels are exacerbated by post-migration challenges such as uncertainty, discrimination, language barriers, and concerns about legal status in the host country (Porter \u0026amp; Haslam, \u003cspan class=\"CitationRef\"\u003e2005\u003c/span\u003e). Indeed, research shows that the prevalence of post-traumatic stress disorder (PTSD), depression, and anxiety disorders among refugees and asylum seekers is significantly higher than in the general population (Steel et al., \u003cspan class=\"CitationRef\"\u003e2009\u003c/span\u003e; Fazel et al., \u003cspan class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this context, the importance of mental health professionals, social workers, and mental health and psychosocial support (MHPSS) services cannot be overstated. However, technical expertise alone is insufficient for providing mental health services to refugees; cultural competence—the ability to work effectively with clients from diverse cultural backgrounds — and trauma sensitivity—the capacity to understand the impact of traumatic experiences on an individual’s functioning and narrative—cannot be sustained without systematic professional support in the form of clinical supervision and knowledge and experience in these areas (WHO, 2025; Inter-Agency Standing Committee [IASC], 2007).\u003c/p\u003e \u003cp\u003eMental health professionals working with refugees and asylum seekers face particularly severe and challenging professional difficulties specific to this context. A review of the literature highlights that these professionals are at risk of three primary psychological risks: secondary traumatic stress, vicarious trauma, and burnout. Secondary traumatic stress is a condition arising from indirect exposure to clients’ traumatic experiences while working with them, leading to symptoms similar to those of PTSD—such as avoidance, hyperarousal, and intrusive thoughts (Figley, \u003cspan class=\"CitationRef\"\u003e1995\u003c/span\u003e). Indirect trauma, on the other hand, is a more enduring process resulting from constant exposure to traumatic content, formed through empathy, and leading to changes in the individual’s self-perception, worldview, and systems of meaning. (McCann and Pearlman, \u003cspan class=\"CitationRef\"\u003e1990\u003c/span\u003e; Pearlman and Saakvitne, \u003cspan class=\"CitationRef\"\u003e1995\u003c/span\u003e). Burnout, on the other hand, is defined as emotional exhaustion, depersonalization, and a diminished sense of accomplishment associated with intense and persistent work-related stress (Maslach \u0026amp; Leiter, \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition to these risks, professionals working with refugee and asylum-seeker populations also face the following unique challenges: the triadic therapeutic relationship (therapist–interpreter–client) and the complexity of this relationship (Miller et al., \u003cspan class=\"CitationRef\"\u003e2005\u003c/span\u003e), the reality of sharing the same cultural identity with clients and having experienced shared traumatic events (Hamid et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e), insufficient institutional support and scarcity of resources (limitations in mental health infrastructure, trained personnel, and funding) (Ghafoori et al., \u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e), and professional isolation (Butt et al., \u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e). Taking all these elements into account, it becomes evident that professionals in this field require structured and systematic clinical supervision support. This necessity is distinct from that of those in general mental health services because of the unique challenges posed by the refugee context, such as repeated trauma exposure, cultural intricacies, and structural vulnerabilities. Therefore, a more comprehensive and context-specific supervision framework is essential. (Denkinger et al., \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e; Butt et al., \u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSupervision involves a systematic support process where a seasoned professional (supervisor) regularly engages with a less experienced colleague (supervisee) to evaluate clinical practice, foster professional growth, and safeguard the client’s well-being (Bernard \u0026amp; Goodyear, \u003cspan class=\"CitationRef\"\u003e1998\u003c/span\u003e; Hawkins \u0026amp; Shohet, \u003cspan class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThree primary functions of clinical supervision are highlighted in the literature: the normative function (monitoring the alignment of work with ethical standards), the formative function (developing the professional knowledge and skills of the supervisee or prospective supervisor), and the supportive/restorative function (support related to coping with professional challenges and processing emotional burdens) (Proctor, \u003cspan class=\"CitationRef\"\u003e1987\u003c/span\u003e; Inskipp \u0026amp; Proctor, \u003cspan class=\"CitationRef\"\u003e2001\u003c/span\u003e). For mental health professionals working specifically in the field of trauma, supervision is essential for the prevention, early identification, and management of secondary traumatic stress and vicarious trauma (Pearlman \u0026amp; Saakvitne, \u003cspan class=\"CitationRef\"\u003e1995\u003c/span\u003e), maintaining the quality of the therapeutic relationship (Safran \u0026amp; Muran, 2000), and ensuring the healthy continuation of professional sustainability in the long term (Figley, \u003cspan class=\"CitationRef\"\u003e1995\u003c/span\u003e). Cohen and Collens (\u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e) note that supervisors working with professionals who provide psychological assistance to refugees must possess sociopolitical awareness in addition to these functions and adapt this awareness to the supervision process.\u003c/p\u003e\n\u003ch3\u003eCurrent Study\u003c/h3\u003e\n\u003cp\u003eContrary to what was mentioned above, it is noteworthy that the vast majority of mental health professionals working with refugees do not have access to adequate supervision support. Professionals in low- and middle-income countries (LMICs) face significant challenges in obtaining supervision due to inadequate mental health infrastructure, a shortage of trained personnel, and limited funding (Denkinger et al., \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e; Jahan et al., \u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e). The situation becomes even more complicated when factors like cultural differences, resource limitations, and geographical distances are considered, further heightening the demand for supervision (Hamid et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e; Denkinger et al., \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e; Jahan et al., \u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough there has been an increase in research on supervision, systematic studies specifically examining the experiences and needs of mental health professionals working with refugees and asylum seekers are still scarce. A review of the current literature shows that existing studies either concentrate on the broader trauma field (Sprang et al., \u003cspan class=\"CitationRef\"\u003e2007\u003c/span\u003e) or are confined to specific geographic areas (Apostolidou \u0026amp; Schweitzer, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e; Guhan and Liebling-Kalifani, \u003cspan class=\"CitationRef\"\u003e2011\u003c/span\u003e). No comprehensive study has been conducted that addresses elements unique to the refugee context.\u003c/p\u003e \u003cp\u003eThis systematic review aims to thoroughly explore the supervision experiences and needs of mental health professionals working with refugees and asylum seekers, highlighting the importance of this issue. The review seeks to answer the primary question: “What characterizes the clinical supervision experiences of mental health professionals working with refugees and asylum seekers, and what are their supervision needs?”\u003c/p\u003e \u003cp\u003eAdditional questions include how supervision addresses psychological challenges, the models used in the field, barriers to accessing supervision, and other contextual factors. By examining studies from various regions, especially Turkey, this review intends to provide an evidence-based resource for policymakers and practitioners. The framework outlined in this study will not only guide supervisors and institutions offering supervision to mental health professionals working with this population but will also help clarify the current situation. It will also serve as a foundation for supervisors and researchers aiming to develop needs-based supervision models.\u003c/p\u003e "},{"header":"Method","content":"\u003cp\u003eThis research is a systematic review aligned with the PRISMA 2020 guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) aimed at exploring the experiences and requirements of mental health professionals who provide clinical supervision to refugees and asylum seekers (Page et al., 2021).\u003c/p\u003e\n\u003ch3\u003eSearch Strategy\u003c/h3\u003e\n\u003cp\u003eA literature review was carried out using the PubMed, Web of Science, and Scopus databases. The search focused on studies published in English and Turkish from 2000 to 2026. Keywords and MeSH terms such as clinical supervision, mental health professionals, refugees, asylum seekers, vicarious trauma, secondary traumatic stress, burnout, humanitarian settings, supervision needs, and supervision were utilized. These terms were combined using AND/OR logical operators for the search. Besides searching the databases, the citation chains of the selected studies were manually examined, but this approach did not yield any additional studies.\u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eThe criteria for including studies in the review were as follows: (1) the study must involve mental health professionals such as psychologists, psychiatrists, social workers, or psychological counselors who directly engage with refugees and/or asylum seekers as participants; (2) it should focus on clinical supervision experiences, needs, models, or access conditions as a main or significant secondary topic; (3) it must be original research employing qualitative, quantitative, or mixed-methods approaches; (4) it should be published in a peer-reviewed journal. The review excludes review articles, meta-analyses, editorials, opinion pieces, studies with student or trainee samples, research where supervision is only a secondary variable, studies not explicitly set in a refugee context, and publications where the full text is unavailable.\u003c/p\u003e\n\u003ch3\u003eScreening and Selection Process\u003c/h3\u003e\n\u003cp\u003eA total of 178 records were identified through database searches (PubMed: 52, Web of Science: 97, Scopus: 29). After removing duplicate records, 112 studies remained. In the screening conducted at the title and abstract level, 71 studies were excluded; the primary reasons for exclusion were irrelevant context, lack of a refugee focus, and review/synthesis type. Full texts of the remaining 41 studies were retrieved and evaluated against the established inclusion criteria. At this stage, 14 studies were excluded: student/intern sample (n\u0026thinsp;=\u0026thinsp;5), supervision being a secondary topic (n\u0026thinsp;=\u0026thinsp;4), absence of a refugee context (n\u0026thinsp;=\u0026thinsp;2), inability to access the full text (n\u0026thinsp;=\u0026thinsp;2), and having a program description/report nature (n\u0026thinsp;=\u0026thinsp;1). As a result, 27 studies were included in the systematic review. The screening and selection process is presented in Fig.\u0026nbsp;1 as a PRISMA 2020 flow diagram.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch2\u003eQuality Assessment\u003c/h2\u003e\n\u003cp\u003eThe methodological quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT; Hong et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The MMAT was selected because it allows for the evaluation of qualitative, quantitative, and mixed-methods studies within a single framework. The quality assessment was conducted independently by two researchers with experience in clinical supervision and refugee mental health; any disagreements were resolved through discussion. The quality assessment findings were used not to exclude studies but to provide context for interpreting them.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eData Extraction and Synthesis\u003c/h3\u003e\n\u003cp\u003eData extraction from the included studies was conducted systematically; for each study, the author(s), year of publication, country/context, study design, sample characteristics, data collection method, intervention/supervision model, measurement tools, key findings related to supervision experience and needs were recorded. Data synthesis was conducted at the descriptive and interpretive levels using Thomas and Harden\u0026rsquo;s (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) thematic synthesis approach. Given the methodological diversity of the included studies, a statistical meta-analysis was not performed.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDetailed information on the 27 studies included in the systematic review is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eAnalysis Table of Studies Included in the Systematic Review (n\u0026thinsp;=\u0026thinsp;27)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuthors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTitle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSample Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eData Collection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIntervention / Supervision Model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eScales / Analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eKey Findings\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eSupervision Experience and Need\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGuhan, R. \u0026amp; Liebling-Kalifani, H.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe experiences of staff working with refugees and asylum seekers in the UK: A grounded theory exploration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnited Kingdom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative / Grounded Theory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMental health and social work professionals working with refugees and asylum seekers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSemi-structured interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGrounded Theory / Thematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eEXPERIENCE: Unable to find supervisors familiar with the refugee context. NEED: Specialized, accessible supervision infrastructure.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Unable to find supervisors familiar with the refugee context. NEED: Specialized, accessible supervision infrastructure.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBarrington, A.J. \u0026amp; Shakespeare-Finch, J.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWorking with refugee survivors of torture and trauma: An opportunity for vicarious post-traumatic growth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative / IPA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eClinical and administrative staff (torture and trauma field)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSemi-structured interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eIPA / Thematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eVicarious trauma (VT) and vicarious posttraumatic growth (VPTG) can co-occur. Supervision supports meaning-making and VPTG development.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Supervision is protective; it facilitates meaning-making. NEED: Supervision supporting posttraumatic growth.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePuvimanasinghe, T. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVicarious resilience and vicarious traumatization: Experiences of working with refugees and asylum seekers in South Australia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative / Thematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMental health professionals working with refugees and asylum seekers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSemi-structured interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eThematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eVicarious trauma (VT) and vicarious resilience (VR) co-occur. Supervision and mentorship are decisive in processing these experiences.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Both VT and VR must be processed in supervision. NEED: Structured supervision supporting resilience.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchweitzer, R. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTherapeutic practice with refugee clients: A qualitative study of therapist experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative / Thematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTherapists working with refugee clients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSemi-structured interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eThematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eComplex trauma and systemic challenges are inadequately addressed in supervision. Access to a specialist supervisor is difficult.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Refugee-specific challenges not met in supervision. NEED: Access to a specialist supervisor in this field.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApostolidou, Z. \u0026amp; Schweitzer, R.D.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRefugee experiences of resettlement and supervision in mental health services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative / Thematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTherapists serving refugees with temporary protection status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSemi-structured interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCross-cultural supervision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eThematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eCurrent supervision does not focus on refugee context-specific challenges.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Supervision deficit and inadequacy. NEED: Reflective supervision space specific to the refugee context.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDenkinger, J.K. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary Traumatization in Caregivers Working With Women and Children Who Suffered Violence and War\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGermany\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCross-Sectional Analytic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSocial workers, therapists, interpreters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQuantitative anketler\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNot specified (HAP institutional context)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFST, RQ Scales / Regression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e22.9% of workers showed secondary traumatization. Personal trauma and avoidant attachment are risk factors.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: 71.6% reported a high need for supervision; only 64.1% had access. NEED: Group and case-focused supervision; collective trauma processing.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEcheverri, C. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFacilitating and impeding factors for scaling up mental health care in LMICs (mhGAP-HIG assessment)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSub-Saharan Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAssessment / Quantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e619\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHealth workers (primary care, community)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003emhGAP-HIG assessment tool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003emhGAP-HIG Protocol (including tele-supervision)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003emhGAP-HIG / Quantitative assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eSupervision improved clinical competency by 44\u0026ndash;53%. Remote access via phone/SMS played a critical role.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Tele-supervision implemented in remote areas. NEED: Sustainable remote supervision models in low-resource settings.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrooks, M.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe importance of using reflective practice when working with refugees, asylum seekers, and survivors of torture within IAPT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnited Kingdom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative / Case Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTherapists (torture/asylum seeker cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eClinical observation and case notes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCross-cultural supervision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCase Analysis / Psychoanalytic Perspective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eManagement of the triadic relationship (therapist\u0026ndash;interpreter\u0026ndash;client) in supervision is critical.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Complexity of triadic relationship with interpreter. NEED: Specialized supervision covering cross-cultural dynamics.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTarannum, S. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntegrating mental health into primary health care in the Rohingya refugee response in Bangladesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBangladesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHealth workers serving Rohingya refugees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePractical skills observation form\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003emhGAP-based supervision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003ePractical Skills Assessment Form\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOnly 15 of 62 workers received regular supervision. Significant deficits in psychosocial support skills.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: A heavy workload impeded participation in supervision. NEED: Structured and regular supervision; psychosocial skill development.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWirth, T. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWorking conditions in the caring professions: A qualitative study of workers' experiences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGermany\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMixed / Scoping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSocial workers with refugees and homeless individuals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLiterature synthesis\u0026thinsp;+\u0026thinsp;interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eScoping Review / Thematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eInadequate supervision and institutional support are common themes. Chronic deprivation and emotional burden are prominent.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Institutional support insufficient; supervision critical. NEED: Structured supervision incorporating emotional burden management.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBinder, A. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWorking with refugees: How do social workers experience work-related stress?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGermany\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMixed / Cross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSocial workers with women and children exposed to ISIS violence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQuantitative survey\u0026thinsp;+\u0026thinsp;qualitative interview\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNot specified (institutional context)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003ePSQ / Mixed-Methods analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eSupervision is the most important support resource. 64.1% access, but mostly administrative, not meeting emotional support needs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Administrative supervision does not meet emotional needs. NEED: Emotionally supportive, trauma-focused supervision.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHamid, A. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQualitative accounts from Syrian mental health professionals: Shared realities of working with fellow Syrians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative / Thematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSyrian mental health professionals (also displaced)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIn-depth interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSelf-disclosure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eThematic Analysis / NVivo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eShared culture facilitates bonding; however, it creates emotional vulnerability. STS and burnout are prevalent.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: High workload and insufficient number of supervisors. NEED: Supervision ensuring confidentiality and discussion of difficult cases.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLong, S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSupervisors' Perception of Vicarious Trauma and Growth in Australian Refugee Trauma Counselors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative / IPA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eClinical supervisors affiliated with FASSTT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSemi-structured interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCohen \u0026amp; Collens Modeli analizi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eIPA / NVivo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eSupervisors facilitate meaning-making processes. Existing models leave the sociopolitical context underaddressed.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Supervision may neglect VT. NEED: Integration of the sociopolitical context into supervision.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePosselt, M. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFostering mental health and well-being among workers who support refugees and asylum seekers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMixed-Methods / Cross-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRefugee support personnel (social work, psychology, etc.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eOnline survey (DASS-21, ProQOL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eClinically focused supervision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSWAI / Regression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eSupervisory alliance is protective against STS and depression. Workers receiving weekly supervision show lower anxiety.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Strong alliance with emotional support. NEED: Weekly regular supervision and a strong supervisory alliance.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAugusterfer, E.F. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA review of telepsychiatry as a tool for reintegrating displaced persons and refugees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLMIC / Conceptual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTheoretical Model\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eProfessionals in low-resource crisis settings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLiterature synthesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eTele-supervision model\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eTheoretical Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTele-supervision reduces isolation in remote settings. Remote clinical guidance is proposed as a sustainable model, particularly in LMIC contexts.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Isolation and lack of immediate support. NEED: Technology-assisted remote supervision protocols.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRobelski, S. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBurnout in social work with refugees: A qualitative study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGermany\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative / Interview\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSocial workers serving refugees and homeless persons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSemi-structured interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eGroup supervision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eThematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eGroup supervision remains superficial under heavy caseloads. Demand for immediate individual support is prominent.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Inadequacy of the group format. NEED: Individual supervision and immediate professional support during crises.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerera, C. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTowards an integrated model for supervision for MHPSS in humanitarian emergencies: A qualitative study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGlobal / Humanitarian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative / Thematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eGlobal MHPSS professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSemi-structured interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIntegrated Model for Supervision (IMS) development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eThematic Analysis / NVivo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eIMS provides a four-component flexible framework. Active listening and supervisors' access to their own support are critical.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Supervision is not prioritized in humanitarian settings. NEED: Standardized, adaptable IMS framework.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePotter, C. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMental health supervision for psychotherapists working with refugees: The Fearless project\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGermany\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative / Thematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePsychotherapists working with refugees (Fearless project)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSemi-structured interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eFearless project supervision model\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eThematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eStructured supervision reduces reluctance to take on refugee cases and strengthens the development of self-confidence.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Supervision increases therapist motivation. NEED: Capacity building specifically to the refugee field through supervision.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eO'Sullivan, E. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGender considerations for supportive supervision in humanitarian contexts: A qualitative study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGlobal / Humanitarian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMHPSS workers (various humanitarian contexts)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSemi-structured interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIMS framework (gender-focused)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eThematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eGender roles shape supervisory relationships. A one-size-fits-all approach is insufficient; flexibility sensitive to cultural norms is necessary.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Cultural norms affect supervision dynamics. NEED: Flexible supervision arrangements sensitive to gender and culture.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGhafoori, B. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePsychological adaptation among health care workers who work with trauma-exposed refugees in Greece\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGreece\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative / Thematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHealthcare workers in NGOs (psychologists, doctors, nurses)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSemi-structured interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNot specified (clinical adaptation-focused)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eThematic Analysis (Braun \u0026amp; Clarke)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eSecondary trauma, expectation mismatch, and coping difficulties. Institutional instability increases burnout.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Inadequate training and supervision. NEED: Supervision supporting self-care and protecting professional health.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGreene, M.C. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eComparing implementation strategies for training and supervising nonspecialists in Group Problem Management Plus: A hybrid effectiveness-implementation trial in Colombia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eColombia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQuantitative / Mixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePsychosocial intervention facilitators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eFidelity tools (ENACT, GroupACT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePeer supervision (ENACT/GroupACT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eENACT / GroupACT / Quantitative comparison\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePeer supervision yielded outcomes comparable to those of expert supervision. Scalable model in LMIC contexts.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Peer supervision achieved fidelity rates comparable to expert supervision, demonstrating feasibility in low-resource settings. NEED: Scalable, accessible, and culturally appropriate supervision models in LMIC contexts.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJahan, S. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eClinical mental health supervision in a humanitarian context in LMICs: PEACE model for community engagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBangladesh / Turkey / Syria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCBPR / Qualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRohingya Advisory Committee members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eFGD, IDI, and RAC meetings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePEACE Model (supervision-focused)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eThematic Analysis / Constructivist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eThe PEACE model increases community trust. Rohingya perspectives are directly integrated into supervision materials.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Online group supervision. NEED: Culturally aligned supervision that incorporates community voice.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKurt, G. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOnline group supervision for Syrian refugee mental health workers in Turkey: A longitudinal mixed-methods study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTurkey / Syria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLongitudinal / Mixed-Methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSyrian mental health professionals (C4C program)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eKessler-6, ProQOL; interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eC4C Online Group Supervision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eBayesian Hierarchical Analysis / Mixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eC4C online group supervision significantly reduced psychological stress (b\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.18). The effect sustained even after the 2023 earthquake.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Online supervision is functional even in extraordinary conditions. NEED: Sustainable remote supervision during crisis periods.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eK\u0026uuml;\u0026ccedil;\u0026uuml;knane, A. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary traumatic stress experiences and coping strategies of humanitarian aid workers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative / Thematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHumanitarian aid workers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSemi-structured interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNot specified (lived experience-focused)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eThematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eSTS and absence of supervision are primary themes. Participants rely on informal peer networks; these are insufficient.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Absence of supervision; informal coping. NEED: Structured, institutionally supported clinical supervision.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003evan den Broek, M. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eData-driven supervision in humanitarian settings: Experiences from Uganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCommunity mental health gatekeepers and supervisors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSemi-structured interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eData-driven supervision (Dashboard)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eDashboard Metrics / Thematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eReal-time data dashboard increased motivation and confidence in case identification. Supervisor feedback is an important need.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Data-driven real-time supervision. NEED: Technology-assisted supervision in low-resource humanitarian settings.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePillay, Y. \u0026amp; Civan, K.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe BECCS Model: A Novel Approach to Clinical Supervision in Culturally Diverse Settings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eConceptual Model Development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eClinical supervisors and counselors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLiterature synthesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBECCS Model (7 vectors)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eTheoretical Analiz / PPCT Entegrasyonu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eThe BECCS model provides a humanistic, trauma-focused, and social justice-oriented framework for professionals working with refugees.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Not specified. NEED: A new supervision model that enhances cultural competency.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eButt, M.K. et al.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecondary traumatic stress among mental health professionals working with war refugees in Pakistan: A qualitative exploration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePakistan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQualitative / Reflexive Thematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePsychologists, psychiatrists, social workers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSemi-structured interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNot specified (lived experience-focused)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSTSS / Reflexive Thematic Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eMental health professionals in Pakistan experience high STS. Professional isolation and institutional support deficit are core issues.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eEXPERIENCE: Professional isolation and inadequate supervision. NEED: Culturally appropriate supervision and institutional support.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe findings of the 27 studies examined as part of the systematic review were synthesized under four main themes that align with the research questions: (1) the psychological implications of the work for the refugee population, (2) supervision experiences, the role of supervision, and access conditions, (3) cultural and contextual factors, and (4) supervision models and practices. Each theme is addressed in detail, taking into account the overlaps and differences among the findings of the studies included.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Psychological Implications of Working with Refugee Populations\u003c/h2\u003e \u003cp\u003eMost studies reviewed consistently show that mental health professionals working with refugee populations face a unique and significant psychological burden. This burden is characterized by secondary traumatic stress (STS), vicarious trauma, and burnout, which are qualitatively different from general clinical practice. These experiences are closely tied to the availability or lack of structured supervision support.\u003c/p\u003e \u003cp\u003eSecondary traumatic stress is frequently observed among professionals working with refugees, as evidenced by multiple studies. In a cross-sectional study of 84 professionals assisting Syrian refugees in Germany, 22.9% exhibited clinical-level secondary traumatization; while 71.6% expressed a strong need for supervision, only 64.1% reported having regular access to it (Denkinger et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). A personal history of trauma and shared experiences of flight with clients were identified as primary risk factors, whereas a secure attachment style was a protective factor. Similar results were found in a qualitative study in Pakistan, where participants linked high levels of STS to professional isolation and a lack of structured supervision (Butt et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Ghafoori and colleagues (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), who studied healthcare workers in refugee camps in Greece, also noted psychological adjustment difficulties, expectation mismatches, and symptoms of secondary trauma, identifying inadequate training and lack of supervision as major institutional challenges for professionals. Conversely, some studies suggest that working with refugees can be both traumatic and empowering. Puvimanasinghe et al. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) observed that professionals experience both vicarious trauma (VT) and vicarious resilience (VR), with supervision and guidance playing a crucial role in processing these complex experiences. Similarly, Barrington and Shakespeare-Finch (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) found that vicarious trauma and vicarious post-traumatic growth (VPTG) can occur simultaneously, demonstrating that structured supervision can aid in professional meaning-making and growth. Long\u0026rsquo;s (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) study, which looks at the issue from the supervisor\u0026rsquo;s perspective, emphasizes the significant role supervisors play in counselors\u0026rsquo; meaning-making processes, but notes that current approaches do not adequately address vicarious trauma and the socio-political context.\u003c/p\u003e \u003cp\u003eBurnout and the quality of supervision are significant themes in the literature. Binder et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) conducted a mixed-methods study revealing that 64.1% of professionals had access to supervision, yet most of it was inadequate, focusing mainly on administrative tasks and lacking emotional support. Similarly, Robelski et al. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) discovered that group supervision often remained surface-level due to heavy workloads, highlighting the need for immediate professional support during crises. Augustfer et al. (2015) emphasized the potential of tele-supervision to alleviate the isolation of specialists in remote areas and provide clinical guidance, suggesting it could be a sustainable solution, especially in LMICs. In line with this, Wirth et al. (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) conducted a screening study in Germany, which showed that the emotional strain of working with clients facing chronic deprivation, combined with insufficient institutional support, is particularly severe in the refugee context. This underscores the importance of incorporating emotional management into supervision agendas alongside technical skills. Research in Turkey adds another layer to these patterns. K\u0026uuml;\u0026ccedil;\u0026uuml;knane et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) conducted a qualitative study with humanitarian aid workers, focusing on informal coping mechanisms. Participants reported relying on spontaneously formed peer networks for support, which, however, did not replace structured supervision. The lack of supervision and institutional support were identified as primary causes of burnout, indicating an urgent need to strengthen the supervision infrastructure in Turkey's humanitarian aid sector.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Supervision Experiences, the Role of Supervision, and Access Conditions\u003c/h2\u003e \u003cp\u003eThe studies included indicate that mental health professionals working with refugees face notable deficiencies in their supervision experiences, both qualitatively and quantitatively. This theme encompasses issues such as limited access to supervision, the quality of the supervision provided, and challenges specific to their work environment.\u003c/p\u003e \u003cp\u003e \u003cb\u003e2.1. Barriers to Accessing Supervision\u003c/b\u003e \u003c/p\u003e \u003cp\u003eNumerous studies have documented the precise dimensions of these barriers. In a comprehensive evaluation by Echeverri et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) involving 619 healthcare professionals in Sub-Saharan Africa, it was discovered that supervision guided by the mhGAP-HIG protocol significantly enhanced clinical skills, showing a 44\u0026ndash;53% improvement. Notably, in environments characterized by a lack of specialists, remote supervision through phone and SMS has proven to be a feasible alternative.\u003c/p\u003e \u003cp\u003eSimilarly, Tarannum and colleagues (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) observed 62 healthcare workers in Rohingya camps in Bangladesh and found that only 15 participants received consistent supervision. Structural obstacles such as heavy workloads and insufficient infrastructure were identified as hindrances to participating in supervision. These findings underscore the geographical and institutional aspects of the supervision access issue. Comparable challenges were noted in Ghafoori et al.'s (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) study in Greece, where participants, including psychologists, doctors, and nurses within a civil society organization, reported that frequent staff turnover, vague job roles, and inadequate supervision contributed to severe burnout. Additionally, the significant gap between expected and actual support led to a pronounced mismatch between expectations and reality.\u003c/p\u003e \u003cp\u003eApostolidou and Schweitzer\u0026rsquo;s (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) qualitative research, conducted with nine therapists offering psychological services to refugees under temporary protection in Australia, is crucial in demonstrating that supervision experiences remained consistent despite temporal changes. While therapists deemed supervision essential for bridging cultural gaps and managing the helplessness stemming from shared trauma and legal uncertainties, they noted that current supervision does not adequately address these issues. This study is significant in that it demonstrates that the need for supervision specific to the refugee field was articulated in the same way nearly a decade ago and that structural transformation is still awaited.\u003c/p\u003e \u003cp\u003eSchweitzer et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) also identified a similar pattern in their qualitative study with 12 therapists in Australia: The vast majority reported that existing supervision did not adequately address the challenges specific to working with refugees, and they faced significant difficulties accessing supervisors specialized in this field. This finding is significant because it demonstrates that the aforementioned access issue persists even in contexts such as Australia, which are not considered resource-constrained.\u003c/p\u003e \u003cp\u003eThe study conducted by Guhan and Liebling-Kalifani (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) with mental health and social service professionals working with refugees and asylum seekers in the UK points to a historical continuity in that it clearly demonstrated, as early as fifteen years ago, just how widespread and systemic the lack of supervision is. The professionals participating in the study reported facing serious difficulties in accessing expert supervisors who understand the unique challenges of refugee clients and can adapt this experience to the supervision process. Burnout and professional isolation were found to be directly linked to the lack of structural supervision (regular, planned, and institutionally supported supervision). This study points to a historical continuity in that it demonstrates that this need was articulated in the same way approximately fifteen years ago and has yet to be resolved through a structural solution.\u003c/p\u003e \u003cp\u003eIn their 2020 qualitative study, Hamid et al. explored the experiences of 16 Syrian mental health professionals who were forcibly displaced to Turkey, documenting barriers to access such as heavy workloads, scarce supervision opportunities, and concerns over professional confidentiality, which align with findings from other research. However, this study uniquely emphasizes the dual nature of shared cultural and linguistic identity with refugees: it facilitates the formation of therapeutic connections but also poses the risk of emotional boundary issues. Some therapists pointed out ethical challenges when working with clients who are also colleagues or acquaintances' clients, highlighting the necessity for supervision. The study's results suggest that supervision by culturally similar professionals in Turkey requires particular attention and structured methods.\u003c/p\u003e \u003cp\u003e \u003cb\u003e2.2. The Nature of Supervision\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe central theme emerging from the studies reviewed is the nature of the working relationship and therapeutic alliance within the supervisory context. Posselt et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) quantitatively showed that a robust supervisory alliance serves as a protective shield against secondary traumatic stress and depression, suggesting that the quality of supervision is as crucial as its frequency. Additionally, cultural sensitivity, countertransference management, and the supervisor's readiness for the refugee context are essential aspects of this theme.\u003c/p\u003e \u003cp\u003eThe mixed-methods study by Posselt et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) in Australia stands out as one of the most methodologically sound in this area. This study, which included 50 therapists working in refugee support services, revealed that a strong therapeutic alliance between supervisor and supervisee significantly protected against secondary traumatic stress and depression. It was found that anxiety levels were notably lower among staff receiving weekly supervision, with the supervisory alliance being the strongest predictor of this protective effect. This underscores the vital importance of not only conducting regular supervision but also establishing it on a foundation of trust and a strong relational bond.\u003c/p\u003e \u003cp\u003eIn 2019, Brooks conducted a case study within the framework of the United Kingdom's IAPT (Improving Access to Psychological Therapies) program, focusing on the therapeutic interaction between a therapist and a refugee client. In this study, supervision is defined as a space that serves a reflective function, facilitating the therapist\u0026rsquo;s awareness of and processing of their implicit assumptions, cultural biases, and countertransference reactions. In particular, managing the triadic therapeutic relationship (therapist\u0026ndash;interpreter\u0026ndash;client) poses a challenge that requires intensive supervision. This study indicates that focusing solely on the case is insufficient in supervision and that the therapist must examine their own attitudes and cultural position.\u003c/p\u003e \u003cp\u003eIn a qualitative study conducted by Van den Broek et al. (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) in refugee settlements in Uganda, the authors examined the impact of a data-driven supervision approach that integrates real-time data provided via digital dashboards into the supervision process. In this approach, performance data for community mental health workers\u0026mdash;such as case identification, intervention frequency, and follow-up rates\u0026mdash;are visually tracked via a software interface (dashboard) and transmitted to the supervisor in real time. In this data-driven approach, data such as intervention frequency, case identification, and follow-up rates are displayed in real time on digital dashboards; the supervisor uses this data as a reference to provide feedback. Research findings have shown that this method significantly increases both therapist motivation and confidence in case detection (van den Broek et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). It has been observed that real-time feedback from supervisors is critical for correcting potential errors early. This study provides strong evidence regarding the feasibility of technology-supported, data-driven supervision models in low-resource humanitarian aid contexts.\u003c/p\u003e \u003cp\u003eFinally, a qualitative study conducted by Potter et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) in Germany documented the direct impact of supervision on therapist motivation. Interviews with 13 therapists who began working with refugees as part of the Fearless project revealed that structured supervision reduced therapists\u0026rsquo; reluctance to accept refugee cases and strengthened their self-confidence and the development of their professional identities. This discovery underscores the effectiveness of supervision in not only boosting mental health capabilities for refugees but also in the areas of hiring and maintaining employment. Although the Fearless project does not introduce a novel supervision model, it offers important insights into how structured supervision contributes to retaining therapists.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Cultural and Contextual Factors\u003c/h2\u003e \u003cp\u003eWhen considering cultural and contextual elements, supervision in refugee settings diverges from typical supervision practices. The studies examined indicate that factors such as cultural identity, shared migration experiences, political context, and conditions in the host country significantly influence the supervision process.\u003c/p\u003e \u003cp\u003eHamid et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) discovered that professionals who share national, cultural, and linguistic identities with their clients find it easier to build therapeutic relationships. Therapists have observed that when identities align, it facilitates gaining clients' trust and understanding their experiences. However, this alignment can blur professional boundaries between therapists and clients, making therapists more emotionally vulnerable to the trauma their clients have endured. As one participant expressed, \u0026ldquo;Sometimes I forget that this pain is my own.\u0026rdquo; This insight underscores the importance of carefully monitoring the boundary between personal trauma and professional roles during supervision sessions with therapists who share a common identity with their clients.\u003c/p\u003e \u003cp\u003eJahan et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) explored the PEACE model (Participation, Respect for Community Expertise, Encouraging Action, Building Authentic Connections, and Empowerment), providing strong ethical and practical reasons for involving refugee communities actively in supervision processes. This study was part of the 16-month online group supervision program Caring for Carers (C4C), aimed at Rohingya refugees in Bangladesh and Syrian internally displaced persons in Turkey/Northern Syria. It involved adapting supervision materials based on input from the Rohingya Advisory Committee (RAC). The cultural insights shared by community members during supervision offered crucial contextual information on how mental health is perceived in the local language and culture, which was directly applied to adapt the supervision content. This study clearly illustrates that supervision should be developed within a collaborative framework that includes the knowledge and experience of refugee communities, rather than being conducted through a top-down, one-way approach dictated solely by experts (supervisor-consultant-client).\u003c/p\u003e \u003cp\u003eIn a qualitative study by O\u0026rsquo;Sullivan et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) conducted in humanitarian aid contexts, the gender aspect of supervision practices was explored. Interviews with 12 MHPSS workers revealed that gender roles influenced supervisory relationships, feedback dynamics, and emotional safety in ways intertwined with the cultural context. It was found that in some settings, male supervisees faced challenges receiving support and feedback from female supervisors due to cultural norms. These findings emphasize that a one-size-fits-all approach to gender in supervision models is inadequate and that flexible arrangements sensitive to cultural, religious, and social norms are crucial. The study also highlights that current humanitarian aid guidelines do not sufficiently address this aspect and calls for further research in this area.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4: Supervision Models and Practices\u003c/h2\u003e \u003cp\u003eResearch indicates that supervision models tailored to the refugee context are not only few in number but also still evolving. Nonetheless, it is important to highlight that innovative and promising models are emerging in this area. These models typically strive to incorporate cultural competence, community involvement, and social justice principles into the supervision framework.\u003c/p\u003e \u003cp\u003eThe PEACE model, introduced by Jahan et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), is a groundbreaking study that employs a community-based participatory research (CBPR) approach to clinical supervision within humanitarian aid settings. The model comprises five components: Participation, Expertise, Agency, Connection, and Empowerment. It provides a structured supervision curriculum that addresses topics such as human rights, diversity and power dynamics, the client-counselor relationship, MHPSS skills, case discussion, and reflective practice. In this model, community participation is viewed not just as a tool but as an ethical obligation that honors the knowledge and experiences of refugee communities. The PEACE model sets itself apart from existing models by integrating local cultural insights, awareness of power disparities, and a rights-based approach into the supervision agenda.\u003c/p\u003e \u003cp\u003eThe Bio-Ecological Cross-Cultural Clinical Supervision (BECCS) Model, created by Pillay and Civan (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), uniquely adapts Bronfenbrenner\u0026rsquo;s bioecological theory of development (PPCT: Process-Person-Context-Time) to clinical supervision. This seven-dimensional conceptual framework addresses supervision content at various levels: micro (individual and therapeutic relationship), meso (team and organizational relationships within the supervision context), exo (organizational policy and funding structures), macro (social norms, culture, and legal framework), and chronosystem (experiences that change over time). A notable aspect of this framework is its emphasis on developing cultural competence and a social justice-oriented approach to supervision, tailored to the complex nature of refugee experiences. The temporal dimension is another distinctive feature of the model; it highlights the importance of incorporating the processing of the refugee experience within a temporal continuum into the supervision agenda. In essence, BECCS positions the supervisor not just as a clinical guide, but as a cultural mediator, an advocate for social justice, and a collaborative partner who comprehends the client\u0026rsquo;s multi-layered context.\u003c/p\u003e \u003cp\u003eThe qualitative study by Perera and colleagues (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) with mental health and psychosocial support specialists in humanitarian contexts marks the initial phase of developing the Integrated Model for Supervision (IMS). Semi-structured interviews with 26 global mental health experts provided a comprehensive view of the components of effective supervision in humanitarian contexts. Participants concurred on the significance of active listening skills and supervisors having access to their own supervision support. The model comprises four main sections: (1) fundamental supervision principles, (2) organizational integration, (3) supervisor competency development, and (4) the participation of the supervisee. IMS offers a flexible framework that organizations of various sizes and different humanitarian aid contexts can adapt. The Turkey/C4C study by Kurt et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), which is based on IMS, confirms the model\u0026rsquo;s practical applicability in Turkish and regional contexts.\u003c/p\u003e \u003cp\u003eGreene et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) conducted a study in Colombia to evaluate the impact of supervision in environments where essential resources, such as qualified supervisors, training facilities, and financial support, are scarce. The research, involving 127 facilitators, utilized tools to measure ENACT (adherence to individual interventions) and GroupACT (adherence to group interventions). The findings indicated that groups receiving peer supervision performed just as well in case follow-up and intervention adherence as those with expert supervision (Greene et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This underscores the significance of creating culturally relevant and cost-efficient supervision methods, especially in countries with limited resources. It also implies that peer supervision could be a viable alternative in situations where expert supervision is not readily available.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis systematic review consolidates current understanding of the supervision experiences and requirements of mental health professionals working with refugees and asylum seekers, highlighting these main conclusions: (1) professionals in this area face a significant and unique psychological burden; (2) there is a lack of adequate and evenly distributed access to structured, high-quality supervision; (3) cultural and contextual elements specific to the refugee environment greatly influence the supervision process; and (4) new models being developed in this field often emphasize cultural competency, community involvement, and social justice principles.\u003c/p\u003e \u003cp\u003eThe review indicates that supervision is not just a tool for professional growth; it plays a vital protective role for practitioners working with refugees. Posselt et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) quantitatively showed that a strong supervisory relationship can mitigate secondary traumatic stress and depression. Data from Denkinger et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) highlight the widespread and pressing need for this support. Echeverri et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) demonstrate that supervision concretely and measurably improves clinical skills. The qualitative findings of Butt et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) show that the quality of supervision matters more than its mere presence; a trauma-informed and individually tailored approach is essential in this context. These findings are consistent with the trauma supervision literature (Pearlman \u0026amp; Saakvitne, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e1995\u003c/span\u003e; Figley, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1995\u003c/span\u003e) and demonstrate that supervision needs in the refugee context differ from those in general mental health practice in both scope and content.\u003c/p\u003e \u003cp\u003eThese findings raise important questions regarding the applicability of general supervision models in the refugee context. The majority of existing models are built on a Western, individualistic, and clinically focused framework; collective trauma, intergenerational effects, and sociopolitical dimensions are generally overlooked (Long, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This demonstrates that developing supervision frameworks that are refugee context-sensitive, holistic, and culturally adapted is not an option but a necessity for practitioners working in this field.\u003c/p\u003e \u003cp\u003eThe included studies also reveal serious disparities in access to supervision across geographies and contexts. Even in relatively well-resourced settings such as Australia and the United Kingdom, practitioners reported inability to access adequate, quality supervision (Brooks, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Posselt et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), demonstrating that this problem cannot be explained by resource constraints alone. This points to the necessity of addressing structural, cultural, and institutional dimensions to achieve quality access to supervision, and also reflects the extent to which the refugee population's needs and mental health service quality remain institutionally deprioritized.\u003c/p\u003e \u003cp\u003eIn LMIC contexts\u0026mdash;countries and regions such as Pakistan, Ethiopia, Bangladesh, and Northern Syria, where serious resource constraints exist in mental health services, supervision infrastructure, and qualified specialists\u0026mdash;challenges are far more pronounced and multi-layered. The Pakistan study by Butt et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) documents the near-total absence of structured supervision systems; the study by Jahan et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) is valuable for demonstrating how online group supervision can be implemented in remote and hard-to-reach geographies.\u003c/p\u003e \u003cp\u003eIn the study conducted by Tarannum et al. (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) in Bangladesh, it was found that a mere 15 out of 62 workers received consistent supervision, highlighting significant structural barriers to access. Conversely, research by van den Broek et al. (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) in Uganda suggests that digital, real-time, data-driven supervision can help mitigate these challenges. These findings suggest that technology-based solutions could effectively address issues of access and inequality. Tele-supervision and online group supervision emerge as viable options to alleviate supervision resource limitations, though it remains crucial to adapt supervision content to cultural contexts.\u003c/p\u003e \u003cp\u003eThe situation in Turkey, which hosts the largest refugee population globally, deserves special consideration. Hamid et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) report that Syrian mental health professionals in Turkey face secondary traumatic stress and professional isolation while continuing to provide services, compounded by significant challenges in obtaining adequate supervisory support. This is corroborated by a longitudinal mixed-methods study by Kurt et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) involving 55 Syrian mental health professionals in Turkey and Northern Syria. The Caring for Carers (C4C) program's online group supervision was shown to significantly alleviate psychological stress (Bayesian hierarchical analysis: b\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.18), with this effect persisting even during the 2023 earthquake. This underscores the need for structural reinforcement of Turkey's refugee mental health system and the establishment of systematic supervision mechanisms to ensure the sustainability of practitioners in the field.\u003c/p\u003e \u003cp\u003eA notable insight from this review is that cultural identity and context act as a dual factor\u0026mdash;both aiding and complicating the supervision process. While a shared cultural identity with clients can enhance therapeutic rapport (Hamid et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), it also introduces risks such as boundary erosion, increased countertransference, and challenges in maintaining professional neutrality. This intricate dynamic suggests that supervision for practitioners sharing clients' cultural identity requires careful attention and structure, further supporting the need for supervision support.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Future Research Directions\u003c/h2\u003e \u003cp\u003eThis review has several methodological limitations that need to be recognized. Firstly, the relatively small number of studies included (n\u0026thinsp;=\u0026thinsp;27) restricts the generalizability of the results. The variation in samples, contexts, and methods among the studies complicates direct comparisons and prevents systematic statistical synthesis. The search did not encompass gray literature, such as reports, theses, conference proceedings, and institutional publications that are not found in peer-reviewed journals. Additionally, the focus on English and Turkish publications means that significant studies in languages like Arabic and French might have been overlooked.\u003c/p\u003e \u003cp\u003eFor future research, it is important to prioritize randomized controlled trials and longitudinal studies that assess the effectiveness of supervision interventions. The implementation processes and outcomes of culturally adapted supervision models in low- and middle-income country (LMIC) contexts, especially in Turkey, should be thoroughly documented. There is a need to develop psychometrically sound and culturally validated measurement tools for professionals working with refugees, explore the feasibility of technology-assisted supervision models in various contexts, and encourage participatory designs that involve refugee community members as research partners. It is also important to note that many of the reviewed studies did not provide basic information on supervision frequency, duration, and model (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Comprehensive reporting of this information will significantly benefit future comparative research.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis systematic review thoroughly examines the supervision experiences and requirements of mental health professionals who work with refugees and asylum seekers. The results clearly indicate that structured, high-quality, and culturally sensitive supervision is essential for both individual practitioners and the overall quality of services in this area. As global focus on refugee mental health continues to grow, highlighting the psychological challenges and structural obstacles faced by practitioners in this field is crucial. Innovative models like PEACE and BECCS offer a glimpse into the future by integrating cultural competence, community involvement, and social justice principles into the supervision framework. It is vital to recognize that supervision is not merely a luxury or optional support but a fundamental professional right for mental health practitioners in any setting, and this understanding must be reflected in policy and practice.\u003c/p\u003e \u003cp\u003eThe findings of this review have significant implications for policymakers, institutional leaders, and clinical practitioners in the mental health sector. Primarily, ensuring regular, structured, and quality supervision for all mental health professionals working with refugees should be seen not as a privilege but as an essential ethical duty. Supervision models should evolve from one-size-fits-all approaches to become culturally sensitive, trauma-informed, and adaptable; supervisors should be equipped with comprehensive training on the historical, political, and cultural aspects of refugee communities. Especially in low- and middle-income countries, technology-assisted online supervision options should be carefully assessed for cultural suitability, and research should employ participatory methods that directly involve the voices of refugee communities in the process.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMDM: Conceptualization, literature search and screening, data extraction, thematic synthesis, writing \u0026ndash; original draft, writing.MK: Conceptualization, supervision, methodology oversight, writing \u0026ndash; review and editing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eApostolidou, Z., \u0026amp; Schweitzer, R. (2017). 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Refugee and migrant mental health. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/mental-health-and-forced-displacement\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/mental-health-and-forced-displacement\" targettype=\"URL\" 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":false,"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":"clinical supervision, refugee mental health, secondary traumatic stress, vicarious trauma, systematic review","lastPublishedDoi":"10.21203/rs.3.rs-9383040/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9383040/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: This systematic review aims to thoroughly explore the supervision experiences, needs, and challenges encountered by mental health professionals and social workers engaged with refugees and asylum seekers.\u003c/p\u003e\n\u003cp\u003eMethod: A comprehensive search across the PubMed, Web of Science, and Scopus databases identified 27 studies (2000–2026) that met the criteria for inclusion and exclusion, which were subsequently included in the review. These studies span research from 15 different countries and contexts, utilizing qualitative, quantitative, and mixed-methods designs, with data analyzed through a descriptive and interpretive thematic synthesis approach.\u003c/p\u003e\n\u003cp\u003eFindings: The thematic synthesis revealed four primary themes: (1) Psychological Burdens and Supervision: Mental health professionals working with refugees face unique psychological burdens, such as secondary traumatic stress, vicarious trauma, and burnout, which place them at a higher risk compared to those in other fields, highlighting the necessity of supervision support; (2) Supervision Experiences and Access: Factors such as geographic distance, limited resources, and institutional neglect of supervision hinder access to supervision; (3) Cultural and Contextual Factors: The success of supervision is heavily reliant on context-sensitive approaches that consider the cultural, linguistic, and political aspects of refugees; (4) Supervision Models and Practices: Innovative frameworks like PEACE, BECCS, and data-driven remote supervision models present feasible alternatives in resource-limited humanitarian settings.\u003c/p\u003e\n\u003cp\u003eConclusion: The review's findings suggest that structured, high-quality, and context-sensitive supervision for mental health professionals and social workers dealing with refugees and asylum seekers is vital not only for maintaining professional quality but also for ensuring professional sustainability. Based on the study's findings, it is advised that policymakers, institutional leaders, and clinical practitioners focus on assessing the adaptation of cultural competence training specifically for supervision, technology-supported remote online supervision models, and peer supervision in settings requiring humanitarian aid, such as those serving refugees.\u003c/p\u003e","manuscriptTitle":"Clinical Supervision Experiences and Needs of Mental Health Professionals Working with Refugees and Asylum Seekers: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-22 12:15:20","doi":"10.21203/rs.3.rs-9383040/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":"9c4e6377-34b4-444f-9299-4aa0f6b2adb8","owner":[],"postedDate":"April 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T12:15:20+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-22 12:15:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9383040","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9383040","identity":"rs-9383040","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}