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Clinical Supervision

Clinical Supervision

How does clinical supervision work, and how do we as counsellors know it works?

One of the most challenging aspects of clinical supervision may be in its definition. As practicing counsellors and therapists, we all know what clinical supervision is, right? Perhaps a wiser guess is that we might not quite all be on the same page- especially if you are in private practice.

Clinical supervision often suffers from a distinct lack of clarity around what it is, its purpose, how supervision sessions are structured, and what theories, strategies, as well as assessment methods are likely to be utilized. For many supervisees it can be a lot like walking into an unmarked landscape.

Although supervision has been largely in place for trainee therapists for the past 100 years, the Code of Ethics and Practice for Supervisors was not implemented until the early 1990’s. It is still a largely evolving field, and important questions persist. Is there solid evidence that supervision is valuable and necessary, regardless of age, stage and experience? What evidence exists to demonstrate its usefulness? Where is the evidence that its credibility and public safety are ensured? Who guards the guardians?

Supervisors are deemed the guardians of our profession. Supervision is intended to be a system that monitors counsellors clinical  development, and then the on-going clinical development and professional development process in the service of others as a system of  checks and balances. Rules and regulations, alongside of supervision, are in place to try to guide individuals with less aptitudes for counselling towards other vocations before they apply for their credentialing. Yet, it still remains a far from fool proof system so more effort is required on this important front.

As supervisors and counsellors, we conduct our personal lives alongside our professional lives- a factor that inevitably informs and affects our work with both clients and supervisees. We need to be able to discuss our work with others to ensure that adequate boundaries are kept in place, at the very least, and to further ensure that we are not becoming too entangled and confused.

Our humanness means that we can get things wrong and we all have blind spots that require attending to. Supervision is a counterbalance to over familiarity that can seep in to our work with passage of time, along with jadedness or cynicism. Sheer client work volume may affect our memory capacities or accuracies.

Perhaps one of the biggest motivators for supervision comes from the example of all those professions who do not have it integrated within their practice. The media and professional literature regularly remind us that medical doctors experience high alcohol and suicide rates, and burnout. Media reports are riddled with stories of soldiers returning from warzones with PTSD. Many of Canada’s homeless people are former members of our Armed Forces. This might suggest that having supervision is, at a basic level, economically a very sound proposition. Moreover, as counsellors are exposed daily to high levels of client distress, we require regular opportunity to explore, examine, and release its vicarious impact as a means of ensuring fitness to practice and care of self; both of which speak deeply to the maintenance of ethical foundations.

Keeping it refreshed and safe is important for counsellors and supervisors alike. As a Clinical Supervisor, I find these themes well reflected in Leonard Cohen’s Anthem- "Ring the bells that still can ring/Forget your perfect offering/There is a crack in everything/That’s how the light gets in."

Motivations and the mission associated with seeking supervision include:

  • Meeting ethical requirements (i.e., it is a requirement for any counsellor in client contact).

  • Supervision checks that the therapist is coping well and continuing to be effective. (Self-care is essential for any counsellor as well as the client's therapeutic journey.)

  • Supervisory meetings allow time for true reflective practice to occur. (The counsellor is supported to explore their own motivations, personal conflicts, and possible relational issues.)

  • It can help identify the therapeutic goals, which may differ from, but should complement, the client’s desired outcomes.

  • Supervision can excavate hidden issues going on, and help them to be examined in the open without prejudice, with the neutral person, the supervisor.

  • Supervision is an opportunity to hypothesize (“brain storm”) from a case conceptualization perspective. New or alternative perspectives can be identified and explored.

  • The supervisee is seeking new information, different approaches, or new therapeutic models.

  • Needing refreshment. Supervision should be an energizing experience that helps the therapist to be able to be fully present, and to be able to offer presence, in the counselling room.

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