Supervision vs. therapy, superficially supervision and therapy may appear to be the same thing, and it is very easy for the two to become confused in the mind of the supervisor. The simple answer to this is the old refrain ‘maintain boundaries’ but maintaining boundaries is difficult without clarity of what those boundaries are. In this blog we will examine the key similarities and difference to help establish and maintain appropriate boundaries.

Supervision vs. therapy – Similarities

1)    Collaboration – both therapy and supervision are essentially collaborative processes.  They are both focused upon a goal, what this goal is may vary considerable, but in both situations, it is wise to have such a goal and have it explicit so that both parties can work towards it.

2)    Intimacy, rapport and non-judgemental attitude – there are certain attitudinal commonalities between the therapy approach and the supervision approach. Both practices require a degree of intimacy and rapport in the exchange of information, one which can only truly be achieved by adopting the Rogerian stance (Rogers 2012) of acceptance of who the client or supervisee is without moral judgement of their ways of thinking and behaviours. This is often more challenging in supervision when models of work and schools of therapy can provide a framework which acts almost like a moral stance.

3)    Confidentiality – As with point 2, the maintenance of confidentiality is a basic requirement of both therapy and supervision as the protection it provides facilitates open discussion. It is worth noting that with both disciplines there are times when confidentiality may be breached.

4)    Reflective space – Both Supervision and therapy encourage reflection and provide a space in which this can be done.

5)    Theoretical underpinning – Both therapy and supervision have a theoretical underpinning which may be shared. A school of therapy which employs a solution focused model (Nunnally 1993).  is likely to use solution focused approaches in supervision, just as Rogerian counsellors (Rogers 2012) are likely to use Rogerian approaches in supervision and Cognitive Behavioural therapist (CBT) (Friedberg, Gorman, & Beidel 2009) will supervise to both reinforce the CBT model and use it to overcome challenges.

Supervision vs. therapy – Differences

1)    Outcomes – Perhaps the single most important difference between therapy and supervision are the outcomes they are looking for. Therapy aims to resolve a problem which exists for the individual presenting (i.e. the client) whereas supervision is seeking to improve the quality of therapy, although it may do this by helping the supervisee to resolve specific problems. The therapy goal is usually clearly defined, with an implied or explicit point of remission, supervision by comparison may have multiple goals but is an ongoing process of perpetual improvement.  Therapy is about repair; supervision is about enhancement.

2)    Mental health – Another way in which supervision differs from therapy is that it takes a very different approach to the client/supervisee’s mental health. As previously noted therapy will usually have a defined goal, which most often will be helping the client to re-attain healthy equilibrium, either in general or in relation to a specific problem. However, supervision takes a more relaxed ’monitoring’ approach to the supervisee’s mental well-being, only raising issues if they are likely to impact upon patient outcomes or result in burn-out. Therapy is actively seeking mental health, supervision acts as a preventative against the decline in mental health.

A clearer understanding of the issues which make supervision and therapy both similar and different should enable the supervisor to maintain their supervisory boundaries and thus be a better supervisor.

Supervision vs. therapy -References

Friedberg, R. D., Gorman, A. A., & Beidel, D. C. (2009). Training psychologists for cognitive-behavioral therapy in the raw world: A rubric for supervisors. Behavior Modification, 33(1), 104-123.

Nunnally, E. (1993). Solution focused therapy. In Casebook of the brief psychotherapies (pp. 271-286). Springer US.

Rogers, C. (2012). Client Centred Therapy (New Ed). Hachette UK.

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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.

1. 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.
2. 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.

Matt Krouwel is a hypnotherapist with over 15 years experience as a supervisor in various capacities

references

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.

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