What is clinical supervision?
Clinical supervision is a relationship between two therapists in which one (the supervisor) provides an opportunity for the other (the supervisee) to reflect upon their work with an aim of maintaining and improving the supervisee’s standard of work. Throughout the history of psychotherapeutic practices clinical supervision has been present in one form or another (Hess, Hess & Hess 2008). In this blog we are going to look at clinical supervision in terms of its underlying philosophy, and implicit in this is why it is important.
Two underlying philosophical assumptions to clinical supervision
1) Supervision is colleague facing but client orientated. By this we mean that the clinical supervisor is in-relationship with their supervisee, their colleague, but the aim of the process is to benefit the client. Different schools of clinical supervision may take different approaches to this, with some limiting clinical supervision discussions to talking purely about clients. Others take a much more holistic approach which may encompass discussions of training needs and a degree of pastoral care.
2) What clinical supervision is not is as important as what it is. By which we mean that there are limits and boundaries to the role of clinical supervisor and maintaining these is vital.
Clinical supervision – Client orientation
Under the philosophy of client orientation, clinical supervision has two primary roles.
- Aiding the supervisee to be the most efficient therapists they can be. This represents the bulk of clinical supervision interactions. The supervisor is there to aid the supervisee in helping the client achieve their goal. To this end the supervisor needs to establish a collaborative relationship with the supervisee in which they can promote: awareness, skill and knowledge.
- The supervisor acts as a bulwark against decline in the supervisee and reduces subsequent risks to client safety. Therapists by the nature of their work are at risk of taking on emotional burdens which may lead to burn out (Faber 1990) or experience transference issues which may lead to the violation of boundaries (Hartmann 1997) and even misconduct (Strasburger, Jorgenson & Sutherland 1992). Part of the supervisor’s role is to help prevent this from happening. Primarily this is achieved through encouraging emotional awareness and highlighting possible trends, challenging these and supporting changes which prevent them. Should these prove unproductive it ultimately falls to the supervisor to act in the client’s interest to prevent abuse by raising concerns with regulatory bodies or even the authorities in the most severe cases.
Clinical supervision – boundaries and limits
There are limitations and boundaries upon what may be done within supervision. These may vary with individual organisations rules and regulations but are likely to include the following
1) Clinical supervision is NOT therapy. There are superficial similarities between therapy and supervision but there are definite differences. There is a potential blurred line where reflection on case experience can drift into personal therapy and this needs to be avoided. If therapy is required a supervisor will direct the supervisee to locate an appropriate therapist. This prevents a dual role occurring.
2) Clinical supervision is NOT training. There is undoubtedly some element of teaching and mentoring which can occur within clinical supervision. However, the explicit teaching of techniques and approaches which the supervisee was not previously familiar with is too far away from the core of supervision, and runs the possibility of both dual roles occurring and poor teaching. Rather, the supervisor aids in reflection on currently held technique to help refine it or help with identifying training needs.
Clinical supervision exists to help therapist make the most of their skills and training and to help protect them, and by extension their clients, from the dangers inherent in the profession.
Farber, B. A. (1990). Burnout in psychotherapists: Incidence, types, and trends. Psychotherapy in Private Practice, 8(1), 35-44.
Hartmann, E. (1997). The concept of boundaries in counselling and psychotherapy. British Journal of Guidance and Counselling, 25(2), 147-162.
Hess, A. K., Hess, K. D., & Hess, T. H. (2008). Psychotherapy supervision: Theory, research, and practice. John Wiley & Sons.
Strasburger, L. H., Jorgenson, L., & Sutherland, P. (1992). The prevention of psychotherapist sexual misconduct: avoiding the slippery slope. American Journal of Psychotherapy.