Expecting Less and Getting It: The Role of Rejection Sensitivity in Feedback-Seeking and Supervisory Relationships

Abstract

While there is extensive literature on the strengths of different supervisory models, we have limited understanding of how the relational capacity of front-line staff may impact how they receive and seek feedback from their supervisor. This study examines how mental health providers’ and front-line staff’s own rejection sensitivity may be associated with the supervisory relationship and the ways in which job feedback is sought and received in community-based mental health settings. Cross-sectional survey data were collected from 156 front-line staff of three mental health agencies. Staff were administered an original survey using validated measures related to supervision, feedback, and relational capacities. We found staff with a higher rejection sensitivity (RS) were less likely to actively seek feedback about their performance; and, when feedback was received, were more likely to rate its quality as poor. Staff with a higher RS were more likely to perceive their supervisor and their relationship negatively. This is the first study to examine whether workers’ relational capacities, as expressed through a higher RS, influence their perceptions of supervision and quality of feedback and their feedback-seeking behaviors. These findings build theory related to the important role that staff relational capacities play in influencing organizational dynamics and support.

1. Introduction

Clinical supervision and the ability to seek and receive feedback have been widely recognized as important factors in the effective provision of community-based mental health services (Borders, 2014; Choy-Brown & Stanhope, 2018). The implementation of evidence-based mental health interventions emphasizes supervision as a mechanism by which providers learn new models and apply them with fidelity. Several studies highlight how the supervisory process may be even more critical than training itself because of the role that receiving feedback plays in developing and honing the practice skills of those who are supervised (hereafter, “front-line staff;” Salas et al., 2012; Schoenwald et al., 2013). Therefore, in conjunction with the diffusion and implementation of new evidence-based practices, increased attention has been given to the importance of supervision.

While there is extensive literature on the strengths of different supervisory models, we have relatively limited understanding of how the relational capacity of front-line staff (e.g., attachment security, rejection sensitivity) may impact how they receive and seek feedback from their supervisor. Recent research suggests that the relational capacity of front-line staff may be an overlooked component of community-based mental health agencies’ implementation of trauma-informed care (TIC) (Bosk et al., 2020), highlighting the need to better understand how staffs’ personal histories of loss and trauma influence organizational processes and practices such as supervision.

This line of research is particularly important as TIC becomes a widely diffused practice approach in community-based mental health services. TIC emphasizes the provider–client relationship and views repeated positive interactions as key to re-establishing a sense of both internal and external safety that is often disrupted in the context of traumatic experiences. This approach centers principles of relational safety, calling on mental health providers to manage clients’ emotional and behavioral dysregulation without becoming dysregulated themselves. Clients with histories of complex trauma are more likely to engage in relational challenges, rejecting or explicitly defying mental health providers with disruptive behaviors and affect that can be experienced as hostile or aggressive (Donisch et al., 2016; Sprang et al., 2011). To effectively provide TIC, mental health providers must be able to manage client relational challenges and maintain their own emotional equilibrium.

Mental health providers with a heightened rejection sensitivity (RS) may be less able to do so and may need more supervisory support to implement TIC (Baker et al., 2018; Hensel et al., 2015). Clinical supervision and seeking and receiving feedback are all necessary components of supporting mental health providers in navigating complex relationships with highly traumatized clients. Yet, we have very little knowledge of how mental health providers’ own relational capacities, such as their sensitivity to rejection, influence their ability to make use of supervision in general, and to seek and receive feedback in particular. This study examines whether mental health providers and front-line staff’s own rejection sensitivity are associated with the supervisory relationship and the ways in which job feedback is sought and received in community-based mental health settings. The goal of this work is to begin to build theory related to the intersection of organizational processes with staff relational capacities and expectations. To our knowledge, this is the first study to examine these relationships.

1.1. Rejection Sensitivity

Rejection sensitivity is a “cognitive-affective process” in which people expect and (mis)perceive rejection in interpersonal or group interactions (Downey & Feldman, 1996, p. 1328). Romero-Canyas and Downey (2005) describe rejection sensitivity as a defensive motivational system (DSM) designed to prevent the occurrence of rejection. While the goal of heightened rejection sensitivity is to avoid a situation in which rejection will occur, the expectation of rejection makes it more likely that neutral or ambiguous social interactions will be interpreted through this lens, triggering flight or fight responses. Perceived rejection then results in anxious withdrawal or inappropriate displays of anger, creating a self-fulfilling prophecy whereby the expectation of rejection results in behavior that invites it.

Expectations of rejection and their associated responses fall into two categories: anxious and angry. An anxious expectation is managed by withdrawing from social relationships to avoid its occurrence, while an angry expectation can prompt retributive, reactive, or aggressive responses when rejection is perceived (Zimmer-Gembeck & Nesdale, 2013). These transactional patterns of relational interactions build upon one another so that each new and successive experience of rejection acts as confirmation of the likelihood of future rejection, reinforcing a heightened sensitivity to it. For some, the desire to maintain connection while avoiding rejection might take the form of highly regulated accommodation efforts, sometimes at the expense of important personal goals, rather than presenting as anxious or angry (Zimmer-Gembeck & Nesdale, 2013).

A heightened rejection sensitivity likely results from adverse childhood experiences (ACES), particularly from impairments in relationships with early caregivers (Feldman & Downey, 1994). Briefly, the attachment system (for a review see Sroufe, 2005) comprises the dynamic pattern of transactions between an infant and their caregiver. The attachment system lays the foundation for emotional and behavioral regulation as well as schemas for the self and relationships (Sroufe, 2005). When a caregiver consistently avoids or inappropriately or inconsistently responds to a child’s distress, the child may then develop a template of relationships as unreliable or unsafe, leading to a heightened rejection sensitivity (Benoit, 2004; Lyons-Ruth et al., 2005).

These patterns of relating can be enduring. There is a strong association between internalized experiences of rejection in early childhood, child maltreatment, and insecure attachment styles in adulthood (Feldman & Downey, 1994). Anxiety, depression, borderline personality disorder, eating disorders, and loneliness in adulthood are all associated with a heightened rejection sensitivity (Gao et al., 2019). Further, rejection sensitivity is highly associated with an increased risk of victimization and more modestly associated with increased aggression over the life course (Gao et al., 2019).

1.2. Rejection Sensitivity as a Characteristic of Workplace Performance

Despite the numerous ways in which rejection sensitivity predicts individual and relational trajectories, we have a limited understanding of how this construct may be associated with workplace and organizational factors. Adults typically spend considerable amounts of their lives in the world of work, navigating complex social workplace relationship dynamics, underscoring the need for research within this domain. Several studies suggest that a heightened rejection sensitivity informs job performance and job turnover (Berenson et al., 2009; Bosk et al., 2020; Day & Porter, 2018), indicating that rejection sensitivity may be an important but underexplored domain for understanding variation in workplace performance in general and the implementation of mental health services in particular. Limited work in other domains indicates that workers with higher rejection sensitivity exhibit slower task performance and attentional avoidance (Berenson et al., 2009). Business school faculty with a heightened rejection sensitivity were less likely to draft manuscripts, produced a lower number of publications, and were less likely to use positive coping strategies than their colleagues (Day & Porter, 2018). Bianchi et al. (2015) establish a relationship between higher rejection sensitivity and burnout, noting that even when controlling for depression and anxiety, teachers with a higher rejection sensitivity were at 119% increased risk of burnout over a 21-month period. Similarly, a prospective study of hotel workers found that rejection sensitivity mediated the associations between attachment anxiety, future stress, and burnout (Ronen & Baldwin, 2010). Rejection sensitivity is also associated with turnover. Among front-line workers in a mental health agency, those with a heightened rejection sensitivity were more likely to report their desire to leave their organization within a year (Bosk et al., 2020).

Taken together, this research identifies how rejection sensitivity is not confined to private life; rather, its impact reverberates in the workplace, where relationships may play a key role in organizational functioning and service provision. Given how robust rejection sensitivity is as a relational construct, it is critical to understand its role in the workplace and how to mitigate potential relational challenges that may arise as a result. This is particularly true in the context of mental health services, where the emotional content of the work is often high and coordinated team approaches to treatment necessitate relational skills with colleagues as well as clients.

A recent focus on the need to provide trauma-informed care (TIC) in mental health services further reinforces the enormous importance of relationships to promote behavioral change. Front-line workers who provide mental health treatment and TIC require relational skills and the ability to manage relational challenges from clients to be effective. Therefore, front-line workers’ capacity to tolerate rejection from clients, build strong supervisory relationships, receive feedback, and ask for help in complex cases and when managing difficult clients is essential. Yet, we know little about how rejection sensitivity may impact the provision of supervision, supervision quality, feedback-giving, and feedback-seeking in mental health services.

1.3. Supervision

Supervisory relationships, goal-directed feedback-giving, and goal-directed feedback-seeking are one area of organizational life that may be particularly impacted by negative interactional patterns that result from a heightened rejection sensitivity. A supervisory relationship in the context of mental health services provision can best be described as a relationship about a relationship about other relationships (Fiscalini, 1985). Strong supervisory relationships, feedback-giving, and feedback-seeking all require trust and repeated experiences of positive interactions to be successful, processes with which rejection sensitivity is likely to interfere. The extant literature clarifies the important role that these constructs play in shaping organizational outcomes in general, and within mental health services in particular.

High-quality supervisory–supervisee relationships influence staff retention, especially in settings like mental health and child welfare agencies that struggle to maintain a stable workforce (Griffiths et al., 2019; Lietz & Julien-Chinn, 2017; Travis et al., 2016). While supervision itself is a diffuse concept, high-quality supervision is generally defined as an organizational process including direct observation, role-playing, giving goal-directed feedback, and modeling (James et al., 2008). Quality rather than quantity of supervision improves retention and performance, particularly for staff working with severely mentally ill clients or those with complex needs (Julien-Chinn & Lietz, 2015; Schroffel, 1999). Supervisors who are empathetic, accessible, and laudatory can mitigate staff disengagement and facilitate positive professional development (Kavanagh et al., 2003). In a parallel process, when supervisors attend to the workplace’s socioemotional milieu and devise ways to minimize or manage negative exchanges, they not only foster positive interactions among workers, but they also promote positive interactions between the supervisee and the clients they serve (Dill & Bogo, 2009; Noelker et al., 2009). Further, high-quality supervision supports front-line staff in their ability to strategically control their attention by focusing on the most important aspects of their work to advance long-term goals (Ayduk et al., 2000). This proactive focus on honing skills is fostered through supervisory support (Kammeyer-Mueller et al., 2013). High-quality supervisory relationships have therefore been linked not just to improved organizational and implementation outcomes but also to improved client outcomes (Bambling et al., 2006; Bostock et al., 2019; Bradshaw et al., 2007; Wilkins et al., 2017).

High-quality supervision has also been linked to the successful implementation of mental health services, influencing a variety of outcomes such as model fidelity and treatment adherence (Bearman et al., 2013, 2017; Schoenwald et al., 2013). Recent efforts to manualize and test models for clinical supervision reflect the potential impact of supervision to facilitate the successful deployment of evidence-based interventions in community-based mental health settings (Choy-Brown & Stanhope, 2018).

Supervision and supervisory relationships, like all relationships, are best understood as transactional in nature, shaped by the supervisor, supervisee, and the larger organizational environment in which they are embedded. Because supervision is composed of complex, dyadic interactions, both supervisors and supervisees influence relational quality and supervision effectiveness. More disengaged supervisees can negatively affect the quality of supervision and the supervisory relationship, and vice versa, more disengaged supervisors can also negatively affect the relationship. As a relational construct, supervision may be particularly sensitive to the relational limitations or challenges of one party. Therefore, it is important to understand the role that relational capacity plays in shaping supervisory experiences.

1.4. Feedback-Giving and Feedback-Seeking

Feedback is one mechanism by which supervision likely promotes improved client outcomes. Feedback can enhance performance by encouraging staff to learn from their mistakes (Crommelinck & Anseel, 2013). Work with dysregulated clients—often a symptom of complex trauma (Cook et al., 2003), can also be dysregulating for staff (Bosk et al., 2020). Provision of high-quality feedback can support staff in their ability to self-regulate and co-regulate clients who exhibit high levels of affective and behavioral challenges (Bickman et al., 2011), and in doing so, improve client outcomes. Feedback is a key component in implementing many manualized evidence-based treatment programs because it is used as a tool to shape practice and the delivery of effective interventions (Bearman et al., 2013). While supportive high-quality feedback is associated with increased job satisfaction and improved job performance (Anseel & Lievens, 2007), feedback is a dimensional and dynamic construct that does not always have a particular direction or effect.

Both clinical and administrative supervision require supervisors to “walk [a] tightrope” to balance workers’ empowerment, trust, and autonomy with ensuring that clients’ needs and organizational mandates are met (Bogo & Dill, 2008, p. 153). This balancing act requires that supervisors give constructive feedback or relay information that a supervisee may not want to hear or find highly critical. A heightened rejection sensitivity, therefore, is likely to interfere with either of these processes. Accordingly, feedback can be a double-edged sword. Kluger and DeNisi (1996) demonstrated that feedback significantly improved performance for most workers, but in more than one-third of the cases studied, it reduced performance. Brett & Atwater (2001) found that negative performance feedback (i.e., ratings that were low or lower than expected) was often perceived by supervisees to be inaccurate or not useful. Instead of raising staff awareness, negative performance feedback primed reactions like anger and discouragement, thereby eliciting negative emotional reactions that may interfere with feedback acceptance and use.

For feedback to effectively improve supervisee performance, and in turn, client outcomes, supervisors must understand the relationship between the emotional experience of receiving feedback, how the supervisee will use the feedback, and their role in mediating the delivery and processing of feedback (Sargeant et al., 2008). It stands to reason that front-line staffs’ internal relational capacity may influence these processes. Hepper and Carnelley (2010) found that adults’ attachment orientation shaped their experiences with seeking and receiving feedback. Individuals with a secure attachment style (e.g., those with positive mental models for themselves and their relationships), generally sought out positive feedback and were able to utilize it for enhancement (Hepper & Carnelley, 2010). In contrast, those with an insecure attachment style (e.g., those with negative mental models for themselves and relationships) were more likely to seek out negative feedback, which served to maintain negative interpersonal and intrapersonal expectancies (Hepper & Carnelley, 2010).

1.5. Relational Capacities and the Supervisory Relationship in Trauma-Informed Care

Exploration of the relationship between workers’ relational capacities, experiences with supervision and feedback-seeking, and feedback-receiving is important given the considerable relational demands of effective mental health service provision, particularly in the context of trauma-informed care. Bosk et al. (2020) demonstrated that front-line workers with a heightened rejection sensitivity are less likely to endorse the principles of trauma-informed care and are more likely to report an intent to turnover in organizations transitioning to this mode of practice. This work asserts that workers’ relational capacities may influence their ability to deliver specific trauma-informed models whose effectiveness hinges on the relational skills of front-line staff. Accordingly, how relational capacity interacts with supervisory experiences, feedback- seeking behaviors, and feedback-receiving behaviors may be an important but overlooked component to consider when examining the effectiveness of both supervision processes and implementation outcomes, particularly in trauma-informed programs. In this study, we ask the following questions: (1) Does rejection sensitivity influence the supervisory relationship? (2) Does having prior training in trauma-informed care, and worker attitudes toward trauma-informed care influence perceptions about supervision and feedback-seeking and feedback-receiving behaviors?

We first hypothesized that higher rejection sensitivity would be associated with negative staff perceptions about the supervision they receive, less feedback-seeking behaviors, and more negative perceptions of job feedback. We also hypothesized that staff with previous trauma training and who endorsed principles of TIC would be more likely to have positive feelings about the supervision they received, engage in more feedback-seeking, and rate the feedback they received as higher in quality. To our knowledge, no previous study has examined these relationships in general or in mental health services in particular. The goal of this work is to build theory about the role that relational constructs play in organizations that provide mental health services.

2. Material and Methods

2.1. Data

Data were collected from front-line staff, supervisors, and administrators of three mental health agencies with both outpatient and residential programs as part of a larger study investigating the implementation of trauma-informed care. Survey data reported here represent the first wave of a longitudinal project, and thus are cross-sectional in nature. Selected agencies were beginning to implement the Attachment, Regulation, and Competency Model (ARC), a trauma-informed intervention, into either their substance use treatment programs, parent–infant mental health programs, or both. Prior to each agency’s ARC training, staff were administered an original survey, measuring constructs related to implementation processes and outcomes such as job performance and satisfaction, organizational conditions and support, beliefs and attitudes about TIC, and staff relational capacities. The survey consisted of validated measures assessing these different domains. Participants received an electronic link to the survey via email and accessed the survey using Qualtrics. The study was approved by the lead author’s University’s Institutional Review Board.

2.2. Participants

The sample was drawn from 373 staff members from the three mental health agencies. All staff members at each agency were invited to join the study. To encourage broad participation, concentrated efforts were made at relationship building with the agency and staff, including pre-survey outreach and information sharing with the agencies and their staff. Staff were also offered protected time at work for data completion and were reassured that responses were voluntary and confidential from their employer. Participants were excluded from the final sample if they were missing responses to any of the variables in our final analyses, resulting in 156 respondents. Descriptive results are presented in

Table 1. Sample Descriptive Statistics.

	Mean or % (n = 156)	SD	Min	Max
Job Feedback
Job Feedback Overall	3.72	1.22	1	6
Job Feedback-Seeking	3.69	1.19	1	6
Feelings About Supervisor	3.13	0.62	1	4
Rejection Sensitivity	2.62	0.72	1	6
Sex
Male	16.7 (26)
Female	83.3 (130)
Race
White	58.3 (91)
Non-White	41.7 (65)
Hispanic
Hispanic	21.2 (33)
Not Hispanic	78.8 (123)
Education Level
Completed HS or GED	6.4 (10)
Some College	10.3 (16)
Completed College	23.7 (37)
Some Masters	5.1 (8)
Masters Completed	51.9 (81)
Completed PhD or Equivalent	2.6 (4)
Annual Income
<$20,000	2.6 (4)
$20,000–$40,000	34.6 (54)
$40,000–$60,000	41.7 (65)
$60,000–$80,000	14.1 (22)
$80,000+	7.1 (11)
Trauma Knowledge
Prior Trauma Training	53.8 (84)
No Prior Trauma Training	46.2 (46.2)
ARTIC Overall Score	5.48	0.80	1	7

below.

Participants mainly identified as female (84%). The sample represented a diverse set of respondents: 15% identified as Black, 3% Asian, 6% as biracial or multiracial, and 58% as White. For a separate question on ethnicity, 21% identified at Hispanic. For the purposes of this study, race was dichotomized as White, Non-Latino, and Non-White. A score of “1” indicated White, non-Latino while a score of “0” indicated non-White staff. A range of educational experiences was also recorded: 6% of participants completed high school or their GED, 10% completed some college, 24% graduated from college, 5% had received some masters training, 52% had completed their masters’ degree, and 3% had completed their doctorate. Staff positions included clinicians (40%), program managers (25%), residential associates or front-line staff (16%), childcare workers (4%), supervisors (2%), case managers (1%), and other support staff (12%). Participants reported a range of incomes. Two percent of participants reported income of less than $20,000, 35% between $20,000–40,000, 42% between $40,000–60,000, 14% between $60–80,000, and 7% made $80,000 or more.

2.3. Measures

2.3.1. Dependent Variables

Two different dimensions of feedback were measured: (1) perception of feedback from supervisors and (2) self-report of feedback-seeking, using the Job Demands scale developed by Preston (Preston, 2013; 2015). The Job Demands scale consists of eight items that are scored using a Likert-type scale ranging from 1 (never) to 6 (always). The scale represents a mean score across items and has high internal validity with a Cronbach’s Alpha of 0.89 (Preston, 2007). Perception of job feedback was assessed through participants’ ratings of four of the items. The statement “I am made aware of how effective my strategies are for completing the work duties of my job” exemplifies the kind of statements that compose this sub-scale. Feedback-seeking was assessed by rating the other 3 items using the same process. The statement “I actively seek information on the effectiveness of my strategies for completing my work duties” is representative of the types of statements that make up this sub-scale. In the final analyses, 156 participants completed the scale, resulting in a Cronbach’s Alpha of 0.91 for perception of feedback and a Cronbach’s Alpha of 0.94 for feedback-seeking behaviors.

Feelings about the supervisor were measured using a 12-item composite scale composed of five items from Koys and DeCotiis’ (1991) Social Provisions measure and seven items from Karimi and colleagues’ (2011) Assessment of Supervision scale. Responses to the items utilized a four-point scale ranging from 1 (strongly disagree) to 4 (strongly agree). The scale has high internal validity, producing a Cronbach’s Alpha of 0.91 (Karimi et al. 2011). Feelings about supervisor were assessed by statements such as, “I can depend on my supervisor to help me if I really need it” and “I feel a strong emotional bond with my supervisor.” 156 responses were included in the final analysis with mean scores. The composite feelings about supervisor scale demonstrated excellent internal consistency (Cronbach’s Alpha of 0.92). A principal components analysis of the 12 items supported a single unidimensional structure; the first component had an eigenvalue of 6.91 and accounted for 57.6% of the variance, with all item loadings ranging from 0.73 to 0.84 and communalities from 0.42 to 0.70. No item showed appreciable improvement in reliability if removed, so all items were retained.

2.3.2. Independent Variables

Rejection sensitivity was measured using the Rejection Sensitivity Questionnaire, Adult version (A-RSQ), an 18-item scale that measures the cognitive-affective processes of how rejection-prone one is to situations and experiences (Downey & Feldman, 1996). Based off the original Rejection Sensitivity Questionnaire, the A-RSQ had a high internal reliability (a = 0.83) with items loading at 0.30 or greater (Downey & Feldman, 1996). Among the 156 participants in our sample, the A-RSQ resulted in a 0.84 Cronbach’s Alpha.

In addition to demographic characteristics, two other variables were included as covariates in the final models. Participants’ previous training in trauma-informed care was assessed using the question, “Have you previously been trained in trauma-informed care?” A score of “1” indicated staff had previous training, while a score of “0” indicated staff did not have previous training. Identifying whether respondents had previous training in TIC is necessary for understanding whether they had prior exposure to mental health interventions that emphasized relational frameworks, thereby influencing their receptivity to supervision.

Additionally, participants’ beliefs and attitudes about TIC were assessed using the Attitudes Related to Trauma-Informed Care (ARTIC) scale. This measure comprises seven domains including (1) identifying the cause of problem behavior/symptoms, (2) staff responses to problem behavior, (3) staff on-the-job behavior, (4) feeling of self-efficacy at work, (5) reactions to the work, (6) staff members’ personal support of TIC, and (7) perception of system-wide support of TIC. The ARTIC has an internal reliability of 0.93 (Baker et al., 2018) and performed well with our participants, resulting in a Cronbach’s Alpha of 0.94. Attitudes and beliefs about TIC are important to consider in relation to perceptions of supervisor, feedback-seeking behaviors, and feedback-receiving behaviors because TIC provision requires intensive relational engagement to be effective.

2.4. Analytic Approach

We conducted ordinary least squared regression analyses to investigate the relationship between rejection sensitivity and the three dependent variables measuring the supervisory relationship, specifically perception of job feedback (model 1), job feedback sought (model 2) and feelings about supervisor (model 3). All analyses were completed using IBM SPSS version 29.

To test whether rejection sensitivity is associated with job feedback outcomes, “Perception of Job Feedback” (model 1a) regresses job feedback on rejection sensitivity. “Job Feedback Sought” (model 2a) regresses job feedback-seeking on rejection sensitivity. Each successive model (model 1b-c and model 2b–c) progressively adds more covariates to estimate the strength of the relationship and whether it changes once demographics are added (models 1b and 2b) and previous trauma training and feelings about TIC (ARTIC score) are added (models 1c and 2c). To test whether rejection sensitivity would also be associated with “Feelings about Supervisor,” model 3a regresses feelings about supervisor on rejection sensitivity. Models 3b-c add the same covariates as above to test the strength of the relationship. For the final models 1c, 2c and 3c, we included agency as a fixed-effect factor control to partial out between-agency variance. This approach removes mean differences across clusters and was in keeping with our data partnership agreements which precluded cross-agency comparative analyses.

Given only three clusters, and agreements prohibiting cross-agency comparative analyses, multilevel models were not appropriate or permissible. Instead, we included agency as a fixed-effect factor to partial out between-agency variance. This approach removes mean differences across clusters and is recommended when the number of clusters is very small. Results were substantively unchanged.

3. Results

3.1. Perception of Job Feedback

Across all three models, higher sensitivity to rejection was associated with a worse perception of job feedback, p <0.01 (see

Table 2. Ordinary Least Squares Models for Perception of Job Feedback & Job Feedback Sought. Values shown are unstandardized betas with (SE) in parentheses.

	Model 1: Perception of Job Feedback			Model 2: Job Feedback Sought
	(a)	(b)	(c)	(a)	(b)	(c)
Rejection Sensitivity	−0.38 ** (0.13)	−0.35 * (0.14)	−0.34 * (0.15)	−0.25 1 (0.13)	−0.27 2 (0.14)	−0.30 * (0.15)
Female		0.09 (0.27)	0.05 (0.27)		−0.20 (0.27)	−0.23 (0.27)
Non-White		0.26 (0.26)	0.31 (0.26)		0.29 (0.25)	0.30 (0.26)
Hispanic		0.48 (0.30)	0.51 (0.30)		0.40 (0.30)	0.42 (0.30)
Education Level		−0.004 (0.08)	−0.04 (0.08)		0.13 (0.08)	0.13 (0.08)
Annual Income		0.14 (0.10)	0.10 (0.10)		0.00 (0.10)	−0.01 (0.10)
Prior Trauma Training			−0.31 (0.21)			0.00 (0.21)
ARTIC Score			0.10 (0.14)			−0.14 (0.14)
R-Squared	0.05	0.08	0.10	0.02	0.05	0.07

* p < 0.05; ** p < 0.01; ¹ p = 0.06; ² p = 0.052; Final models 1c and 2c also control for agency fixed effects.

). “Perception of Job Feedback” (model 1a) demonstrates that greater rejection sensitivity is associated with a worse perception of received job feedback (β = −0.38, p < 0.01). This model accounts for 5% of the variance. When demographic co-variates are layered into the model (1b), higher sensitivity to rejection is associated with worse perceptions of received job feedback (β = −0.35, p < 0.05), with 8% of the variance explained. Finally, layering in previous trauma training and attitudes and beliefs about TIC (represented via the ARTIC score), the full model, (1c), demonstrates that a higher rejection sensitivity continues to be associated with worse perceptions of job feedback (β = −0.34, p < 0.05), with 10% of the variance explained. Model 1c also controlled for agency fixed-effects which left the results substantively unchanged.

3.2. Feedback-Seeking

Across all three models, a heightened rejection sensitivity is associated with less job feedback seeking, see “Feedback Sought” models 2 a-c for OLS results (see Table 2). Model 2a shows that higher rejection sensitivity was not significantly associated with lower job feedback-seeking (β = −0.25, p = 0.06), with 2% of the variance explained. Model 2b layers in demographic variables and the association with rejection sensitivity remained non-significant (β = −0.27, p = 0.052). In the full model (2c), also controlling for agency fixed effects, higher rejection sensitivity was significantly associated with lower job feedback-seeking behavior (β = −0.30, p < 0.05), with 7% of the variance explained.

3.3. Feelings About Supervisor

“Feelings about Supervisor” models 3a–c (

Table 3. Ordinary Least Squares Models for Feelings about Supervisor. Values shown are unstandardized betas with (SE) in parentheses.

	Model 3: Feelings About Supervisor
n = 156	(a)	(b)	(c)
Rejection Sensitivity	−0.16 * (0.07)	−0.15 * (0.07)	−0.07 (0.08)
Female		−0.16 (0.14)	−0.15 (0.13)
Non-White		−0.004 (0.13)	0.04 (0.13)
Hispanic/Latino		0.01 (0.15)	0.04 (0.15)
Education Level		−0.01 (0.04)	−0.05 (0.04)
Annual Income		0.13 ** (0.05)	0.11 * (0.05)
Prior Trauma Training			−0.04 (0.10)
ARTIC Score			0.20 ** (0.07)
R-Squared	0.03	0.10	0.16

* p < 0.05; ** p < 0.01; Final model 3c also controls for agency fixed effects.

) regress feelings about supervisor on rejection sensitivity. Model 3a shows that higher sensitivity to rejection was associated with worse ratings of feelings about one’s supervisor, (β = −0.16, p < 0.05), with 3% of the variance explained. Model 3b shows rejection sensitivity continuing to be significantly associated with feelings about supervisor (β = −0.15, p < 0.05) after the addition of demographic controls. In this model, the higher one’s income, the more positive feelings about their supervisor were endorsed, (β= 0.13, p < 0.01) with 10% of the variance explained. The full model, however, (3c), which layers in previous trauma training and one’s ARTIC score as well as agency fixed-effects, sees rejection sensitivity no longer significantly predicting feelings about supervisor. The positive association between annual income and positive supervisory feelings is retained in this model, (β = 0.11, p < 0.05) with 16% of the variance explained.

For the predictor variables across models 1c, 2c and 3c, no collinearity tolerance coefficient was below 0.57, with a range of the others from 0.62 to 0.91, well above the conventional 0.2 threshold indicating potential concern. Variance Inflation Factor (VIF) coefficients ranged from 1.1 to 1.75, well below the commonly used cutoff of 5. These diagnostics indicate no concerns regarding multicollinearity among the predictors.

4. Discussion

In this study, we examined whether rejection sensitivity may be associated with front-line workers’ feelings toward their supervisor, as week as feedback-seeking and feedback-receiving behaviors, among staff in three mental health agencies. We hypothesized that a heightened rejection sensitivity, e.g., how prone one is to feel intensely dejected or hypersensitive to interpersonal experiences, would result in overall poorer perceptions of supervisory quality, less feedback-seeking behaviors, and poorer perceptions about received job feedback.

Our first hypothesis was largely supported. Heightened rejection sensitivity was associated with less favorable perceptions of job feedback, fewer feedback-seeking behaviors, and negative feelings about one’s supervisor. This finding provides further evidence to advance the theory that attachment-related constructs are associated with organizational processes, particularly as they relate to interpersonal outcomes. The negative association between higher rejection sensitivity and job feedback-seeking is likely related to how rejection sensitivity acts a defensive motivational system. Workers with a higher rejection sensitivity may be less willing to seek feedback as a strategy to avoid receiving information that could be interpreted as dismissing or undermining their competence as staff or their place within the organization. Further, frontline workers with a higher sensitivity to rejection may be more likely to perceive any neutral feedback as negative, and, in doing so, assess its quality as useless or unhelpful. Cognitive distortions related to rejection may then spur a reinforcing cycle—neutral feedback or constructive criticism is experienced as threatening, making a worker both less likely to seek feedback independently and more likely to dismiss its contents.

Avoidance of feedback or challenges with making use of more critical components of feedback have the potential to negatively impact the quality of mental health service provision. Mental health services in general, and therapeutic interventions for clients with complex trauma histories or serious mental illness in particular, often require regular consultation and collaboration to be effective. Workers, especially those that are inexperienced, are more likely to need supervision to augment their training. When staff are unable to make use of supervisory feedback, they may not consider all dimensions of a case or miss critical aspects for intervention. Further, staff with a higher sensitivity to rejection may be more prone to respond ineffectively or invite dysregulated responses from highly traumatized clients (Bosk et al., 2020). Because relational challenges are an expected part of mental health treatment for clients with complex trauma, staff with a heightened rejection sensitivity likely need more support in therapeutically managing these interactions; at the same time, they are less likely to seek it out or utilize it when provided. In these situations, a parallel process may emerge in which highly dysregulated clients reject or dismiss their workers or therapists, who in turn then reject or dismiss the feedback they receive (or have the opportunity to receive) from supervisors. Future research is needed to better elucidate the ways in which staff’s heightened rejection sensitivity intersects with organizational supports to impact client outcomes.

The role education plays in feedback-seeking behavior was an unexpected finding. Participants in our sample with higher levels of educational attainment were more likely to seek job feedback. It is possible that those with higher levels of educational attainment were more likely to be in positions that required them to seek more feedback (e.g., providing therapeutic services to highly traumatized populations) or in which feedback was structured into the position or normalized as an implicit part of the job. It is also possible that education serves as a proxy for clinical knowledge. Prior knowledge about the multiple effects and expressions of complex trauma alongside the need for support in managing these complex issues may increase staffs’ motivation to seek out feedback to improve performance.

The positive association between higher levels of educational attainment and feedback-seeking behaviors suggest that all staff at mental health agencies, no matter the position, might benefit from increased knowledge about secondary traumatic stress, complex trauma, and universal supervision. As mental health agencies adopt TIC, there is a recognition that all interactions with a client have the potential to be trauma-inducing if not managed correctly (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014) and that TIC principles should be infused throughout the organization rather than confined to clinical encounters or treatment (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). Creating structured opportunities for non-clinical staff to receive feedback within mental health agencies may mitigate differences in feedback-seeking between those with higher and lower levels of education and is also consistent with new guidelines for the provision of TIC. Accordingly, a culture of giving and receiving feedback as an expected and normative part of the work of mental health agencies has the potential to improve organizational readiness to implement TIC.

Demonstrating evidence partially supportive of our second hypothesis, higher rejection sensitivity was also associated with poorer perceptions about supervision quality; however, this association disappeared with the addition of previous trauma training and ARTIC score. A previous study from this data set demonstrated that rejection sensitivity was strongly predictive of an individual’s attitudes about TIC (Bosk et al., 2020). When comparing both the feedback and supervisory models, it is important to note that rejection sensitivity’s relationship to feedback is independent of workers’ ratings of their supervisory relationship. Workers with higher rejection sensitivities can be less open to seeking and receiving feedback at the same time they report stronger relationships with their supervisors. This finding demonstrates that rejection sensitivity is likely one important mechanism in shaping whether feedback is sought and how that feedback is interpreted, independent of supervisory relationship quality. Rejection sensitivity, therefore, may be a critical factor in the ability to utilize supervision to learn from mistakes, attend to how personal experiences shape approaches to cases, and hone skills, thought the relatively low amount of variance accounted for in the final models would indicate that these are complex and likely multiply determined processes. But it remains that it may be important to normalize for both supervisors and supervisees that seeking and receiving feedback can be an emotional experience that may activate deeply held feelings. Discussing feelings, particularly fears, about feedback separate from specific feedback sessions can begin to scaffold staff with higher rejection sensitivities to successfully engage in the supervisory process. Further, supervisors themselves with higher rejection sensitivities may need on-going support in how to approach these issues with supervisees.

These findings hold important implications for determining and supporting the supervisory styles that may be most effective in mitigating challenges in the relational capacity of front-line staff in mental health agencies. More specifically, these findings provide new insight into dynamics related to perceptions of supervision, feedback-seeking, and feedback-receiving behaviors, linking staff’s relational capacity to important components of mental health service delivery in these complex pathways. This research highlights both the role that relationships play in facilitating positive outcomes in these domains, as well as the ways rejection sensitivities, rooted in trauma and loss, may disrupt these processes. For staff with higher sensitivity to rejection and personal histories that may make strong relationships within organizations more challenging to create and maintain, reflective supervision offers a space to consider these effects, particularly as they relate to work with clients (Bosk et al., 2020). Reflective supervision is a relationship-based model that emphasizes the intersection of staffs’ own emotional experience in conducting their work in connection with their observations, interpretations, experiences, and decision-making with clients (Tomlin et al., 2014). As such, reflective supervision explicitly examines how staffs’ personal histories may play a role in their approaches to clients as well as to supervision itself. In this way, reflective supervision may offer one model for counteracting how rejection sensitivity could negatively interfere with refining practice skills.

Further, reflective supervision has the potential to normalize the emotional experience of receiving feedback by facilitating an exploration of how discussing specific patterns or interactions can be activating or dysregulating for staff. The influence of previous training in TIC and positive attitudes and beliefs about TIC demonstrates that education about the importance of strong, secure, consistent, safe, and nurturing relationships with clients can balance out heightened rejection sensitivity as they relate to supervision and feedback-seeking and feedback-receiving behaviors.

For this mode of supervision to be effective, however, supervisors with a heightened rejection sensitivity would have to have a solid understanding of how these relational tendencies impact their ability to provide a safe space for supervision. While further research is needed to identify best practices for supporting staff who have a higher sensitivity to rejection, the positive role that previous trauma training and endorsement of TIC plays in mitigating individual’s rejecting or dismissing tendencies is indicative of how knowledge of relationship-building strategies can strengthen supervision and utilization of feedback.

Current organizational imperatives and structures, however, may make opportunities to provide high-quality or reflective supervision in mental health agencies more difficult to achieve. The advent of the managerial turn in mental health services and social work has resulted in supervision being more focused on the completion of administrative or bureaucratic tasks than case dynamics (Mosley & Smith, 2018; Noble & Irwin, 2009; Wilkins et al., 2017). Accountability pressures and documentation requirements (for billing and/or assessments for grant funded programs) create incentives for organizations to shift the focus of supervision from the process and provision of services or ‘how the work is done’ to the products of work (session notes, bills, assessments, or other agency requirements).

In practice, a focus on managerial oversight has sidelined the discussion of emotions in supervisory sessions (Wilkins et al., 2017). Sidelining emotions may run counter to a supervisee’s expectations for support (Fukui et al., 2014), which in turn, and can undermine the supervisory relationship. For supervisees with a high sensitivity to rejection, the opportunity to bring in the emotional experiences of work is particularly important for reparative interactions with supervisors that have the potential to mitigate feelings of rejection. Further, supervisees with a heightened sensitivity to rejection may be particularly challenged to provide these kinds of reparative experiences for clients without a felt experience of them in supervision. Supervisory surveillance, or a pure focus on managerial oversight, may further exacerbate reactive or dismissive behaviors by supervisees with higher rejection sensitivity because this type of supervision comes with a high potential to include content that will be interpreted negatively (e.g., “This form is late,” or “You missed an insurance filing that needs to be corrected right away”). While these interactions might be relatively benign, they are likely to be more activating for those with a higher sensitivity to rejection, which in turn, could limit feedback-seeking opportunities and further stress the supervisory relationship.

Mental health agencies face multiple countervailing pressures to support and surveil their staff and to maintain compliance with external regulations, all of which create structural disincentives to provide supervisory experiences that engage workers with how their own personal histories, subjectivities, and experiences influence their interpretation of case material and their provision of mental health services. To create strong supervisory structures, organizational conditions and regulatory environments must view a focus on process as equally important to accountability and client safety as administrative concerns.

Limitations

This study, while the first to look at rejection sensitivity, perceptions of supervision, quality of feedback, and feedback-seeking behavior, has several limitations that must be considered when interpreting the findings. First, as the first wave of staff surveys from a larger planned longitudinal effort, the data are cross-sectional in nature, thus limiting capacity for causal inference or exploration of direction of effects for what are complex and likely multiply determined and reciprocal work relationship processes. Second, the core constructs do not have multiple reporters or observations from others and represent the perceptions of the same respondents and thus are vulnerable to shared method variance. No trained interviewer was present to assist participants in areas related to clarity of the questions.

Despite strong workplace supports for protected time for staff to complete measures and relationship building liaison efforts with the organizations, participation was voluntary and the survey instruments were broad and time consuming for already taxed frontline workers, and not all staff participated, and among those who did not all completed all study measures. This raises the potential for self-selection bias in staff participation that could influence broader generalizability of our findings. In data available upon request, the final analytic sample with complete data was compared to the staff who completed some but not all of the survey measures. The analytic sample did not differ significantly from the other staff across gender or racial composition, Hispanic ethnicity, level of education, income, or whether they had prior training in trauma informed care. Importantly, they also did not differ in reports of job stress or their overall ratings of feelings about their job, indicating similarly situated workplace experiences. This gives us greater confidence that self-selection bias was not a major factor in the results, but these comparisons were not possible with those staff who did not complete any data responses, and thus caution is warranted.

Additionally, there is no way to currently impute whether rejection sensitivity, perceptions of supervision, and quality of feedback match the actual practice of feedback-seeking behavior that staff report. Future research examining multiple reporters regarding actual supervision received would be helpful, as would a larger comparison of potential agency clusters that would allow for examination of potential nested multi-level effects across and within agencies. Finally, given sample size constraints and sample composition, we elected to dichotomize race, which limits our ability to speak to greater potential nuance in those workplace experiences or associations.

5. Conclusions

This is the first study to examine whether workers’ relational capacities, as expressed through a heightened rejection sensitivity, may be one factor associated with the likely multiply determined perceptions of supervision and quality of feedback as well as feedback-seeking behaviors. We found that staff with a higher sensitivity to rejection were both less likely to actively seek feedback about their performance and, when feedback was received, were more likely to rate its quality as poor. Results suggest that staff with higher sensitivities to rejection are also more likely to perceive their supervisor and the supervisory relationship negatively. This effect disappears, however, when a worker’s openness to TIC and their previous training in TIC are considered. Workers who endorse the tenets of TIC and have prior experience in its provision are more likely to perceive the supervisory relationship as strong regardless of their sensitivity to rejection. These findings speak to the robustness of TIC as a framework for practice in mitigating potential relational challenges in organizational interactions and implementation processes.

These findings also support a more extensive focus on the role staff’s personal and relational capacities may play in organizational dynamics and supports. This is especially true for mental health service provision in general, and for TIC in particular, for which the ability to form strong relationships and seek and receive constructive support likely impacts the quality of services. While supervision is often considered a core part of mental health training and a critical component of ensuring quality in clinical practice (Choy-Brown & Stanhope, 2018), there remain considerable gaps in our knowledge of what supervisory practices best support staff and are most likely to improve client outcomes (Choy-Brown & Stanhope, 2018). This study speaks to the likely dimensional and transactional qualities of supervision and feedback. Recent research suggests that there is wide variation both in the availability and quality of supervision in mental health services. These observations are often accompanied by calls to make supervision more accessible and effective. Efficacy may depend in part not only on the skills of the supervisor but also on the relational capacity of both the supervisor and the supervisee and the extent of mitigating strategies, like reflective supervision. When these dynamics are an explicitly understood and anticipated, staff can be better supported, and practice improved.