Supervision: the good, the bad and the ugly.

What is good supervision? This was a question asked following my last post on the reasons therapists avoid supervision.

And it’s a good question. Because not all supervision provided is good supervision. Some supervision is an excellent growth experience but some can be harmful, permanently scarring even.

Good clinical supervision is important for all therapists but especially for inexperienced therapists, because it assists these therapists to turn their academic knowledge into interventions that can change people’s lives.

Supervision is something that is often assumed as a skill by therapists based on the belief that anyone who has been supervised can be a supervisor. This means there are therapists out there who, based on this mindset, provide supervision without ever having any formal training in supervision.

While the requirement from AHPRA for supervising psychologists for training programs and endorsement pathways to become board-approved supervisors was met with some resistance when it was rolled out, I believe it was a positive and necessary step forward to ensure psychologists begin their supervisory careers with a clear outline of what good supervision entails.

This is because good supervision is a unique set of skills that are differentiated from clinical skills, case management and consulting.

Good supervision, as defined by the APA involves 8 domains of competence:

  • competence in supervision
  • the supervisory relationship
  • professionalism
  • assessment, evaluation and feedback
  • competence in diversity issues
  • ethical considerations
  • legal considerations
  • regulatory considerations.

When I completed my Psychology Board of Australia supervisor training in 2017, I recognized that I hadn’t always received supervision that covered all of these 8 domains (please note the 8 core competencies of psychologists as outlined in PBA supervisor training are different to the supervision competencies stated above).

Although many of my supervisors were excellent clinicians, I recognize that some had operated from a purely case management approach. This can happen due to the tendency of junior therapists focus on immediate casework but also the supervisor’s preference for direct clinical work and avoidance of deeper process issues or other things they may avoid in their own therapeutic work.

The most important elements of the supervisory relationship is safety and trust issues. A supervisee needs to be able to feel safe to talk about areas of weakness, concerns about the therapeutic relationship with clients and interpersonal issues that may be impacting their relationship with clients.

Supervisees should also feel safe to provide feedback about ruptures or concerns in the supervisory relationship. This means that supervisors must create a space that is safe for supervisees but also be skilled at giving feedback about what they see in a way that is clear, honest and timely. Countertransference and process issues are part of the supervision.

Vague or unexpected attacks of negative feedback are very unhelpful. Some therapists I know have had their confidence damaged over the longer term due to blindsiding supervisor feedback given during their early career. Had the same feedback been given in a timely and congruent way, it would have provided the therapist with opportunities with opportunities to improve their deficits and not be the scar they’ve carried in their journey as a therapist.

One of the things that helps improve a supervisor’s ability to provide assessment and feedback of a therapist skills is direct observation of therapeutic work such as video or audiotapes of sessions. Often this is the most avoided or disliked aspect of supervision by supervisees who cite all sorts of reasons for this from their own social anxiety, to their client’s privacy or that it isn’t conducive to private practice settings. Know that if you are being offered this by a supervisor you are getting the best opportunity to improve.

Unfortunately, at the ugly end, supervision can also include the kind of major ethical breaches sometimes also seen in therapy such as inappropriate relationships including providing therapy as well as supervision, sexual harassment, poor boundaries, and generally poor professionalism. I hope that no one reading this has experienced these issues, but if you have please know that it wasn’t your fault. Good supervisors are like good therapists. They respect the power differential and want to nurture healthy and boundaried relationships with their supervisees.

How to find a good supervisor:

A good supervisor is formally trained in supervision and offers expertise in the 8 areas of supervision competence.

Good supervisors provide a safe place to disclose difficulties, identifies countertransference and process issues.

Good supervisors provide honest and timely feedback and are willing to involve opportunities for more direct observation and assessment.

Good supervisors have appropriate boundaries and don’t blur therapy and supervision or any other type of relationship.

And remember, supervision is a professional development tool available to you at any point in your career. It’s not just for developing therapists.

Good therapists seek opportunities to develop their therapeutic abilities. Quality supervision assists with this goal.

It can even save or increase the longevity of your career by minimising the risk of ethical breaches resulting in stressful complaints processes and assisting you to prevent burnout by having a regular assessment of your needs for self-care.

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