Becoming a Clinical Supervisor for Psychotherapists

People don’t quit jobs, they quit bosses

⧖ 13 minute read

 

It can be intimidating for a therapist when they first become a clinical supervisor, and it often brings up old feelings of imposter syndrome. Supervising trainees is a responsibility that should be taken seriously; we’re not just overseeing another counsellor’s caseload, we are also in a position of power and influence as a supervisee develops their therapist-self. It’s normal to feel a bit overwhelmed by this role change.

Here, I focus on the essence of what the clinical supervisor role is and the insights that were most useful for me as I made the change. Merely having been a supervisee does not mean you know how to be a good supervisor. Merely being technically skilled or “good at therapy” does not mean you will be an effective educator. New supervisors often make these assumptions, and supervisees and their clients suffer because of it. Below I cover:

  • The purpose of clinical supervision

  • What trainee therapists want from their clinical supervisors

  • Interview: Insights from a psychologist as he concluded 35 years of clinical supervision

  • How I approach supervision

  • Becoming a manager (of people and admin)

Clinical supervision exists to:

  • Protect clients

  • Improve the ability of therapists to provide value to clients (e.g., improve supervisee’s practice and identify areas for training)

  • Discuss individual cases in depth when needed

  • Assist supervisees in managing the personal and professional demands created by the nature of doing therapeutic work, especially when working with clients who have complex and challenging needs 

  • Provide an environment in which supervisees can explore their own personal and emotional reactions to their work

  • Provide feedback to trainees on their clinical skills and development, separate from any managerial concerns

Ensure you understand the roles and responsibilities of being a clinical supervisor as it is uniquely defined in your local jurisdiction. You should be thoroughly familiar with your local community and emergency services.

Preferred Qualities in Clinical Supervisors

Now that we have an idea of what the role entails, we can benefit from reflecting on the qualities new therapists are looking for in their clinical supervisors. None of these should be a surprise, similar to the characteristics of effective therapists. The following was described by Gerald Cory in his book Clinical Supervision in the Helping Field. The main characteristics that students are looking for in their supervisors include, in order of importance:

  • Openness to discussion

  • Availability

  • Ability to offer support

  • Understanding

  • Ability to provide meaningful feedback

  • Expertise

  • Flexibility

  • Empathy

  • An ethical practice

To be a good clinical supervisor, I suggest the following also matters:

  • The importance of trainees being able to feel safe with a supervisor and trust them 

  • Humility, which is a foundational characteristic I look for in all of my relationships. 

  • A supervisor who is calm and well-grounded, who seems to have done a lot of their own ‘inner work’

  • Someone who pushes me to reflect on countertransference 

  • Someone who can join me in my primary theoretical orientation, aka step away from their own, even suggesting we reconsider a case from additional perspectives when relevant (so, they’re widely knowledgeable and not a zealot)

  • A supervisor who is direct and honest with me and who wants the same in return, while still being warm and compassionate

I encourage you to consider the traits above and what was most impactful for you as an early career therapist, and aspire to act enact that as often as you can.

Interview: Insights after 35 years as a Psychologist

I had the great fortune during my residency hours to be supervised by a wonderful person near the end of their career, who spent decades supervising counsellors. I’ll call him W. I was able to interview W when I began supervising students myself, inquiring about how he views supervision and how to do it well. Below I share some of his insights:

  • W often reflected on the following questions, which served as ‘guiding lights’ for him during supervision hours:

    • “What can I do to help you be your best during your current stage of development?”

    • “What does this trainee most need from me currently?” W also asked these questions to his supervisees when appropriate

  • At this point in a trainee’s career we’re focusing on application—education was a prior step

  • While a supervisor does use clinical skills to attune to the trainee, supervision is not therapy

  • Supervisors have a dual role in relation to supervisees: to be humane while also ‘gate keeping’. Depending on the trainee’s stage in licensing, we were either writing evaluations for their grad school or for the local licensing body for psychologists. Part of that was giving input about the supervisees readiness for independent practice

  • Maintain a strengths-focus and ask myself “how would I like to be treated?” W was a strong believer in this, and he balanced it with gentle, persistent feedback when needed

  • Fragility vs feedback: supervisors need to balance how much feedback they’re giving with how supportive they’re being. This can be tricky given the volume and depth of feedback supervisors sometimes have to give, so the better your relationship, the more workable this balance is

  • When deciding if or how much feedback to give in a moment, I ask myself: was the action the supervisee took unethical? Unsafe? Or simply different than how I’d do it?

    • These 2 points above are useful for anyone, but W was highlighting them for me in that interview. He knew I could be too direct with feedback and a bit rigid in my approach or questions. It’s a good example of his style: straight to the point while still being warm and well-intentioned.

  • Narrow (closed minded, only my orientation is good etc) vs curious 

  • Supervisors don’t have to be, or seem like, experts in everything

  • W respected himself while also laughing at himself, we’re allowed to make mistakes

  • Don’t try to seem ‘elevated’: let supervisees see your mistakes, self-disclose that we all struggle and are human. I’d add to use your discretion in this: we want our trainees to continue seeing us as competent, and we don’t want to disclose things to try and get them to take care of us in some way—fairly similar to self-disclosure with clients

  • Supervisors shouldn’t try to clone themselves; instead, help your trainees be unique, authentic versions of themselves


My Thought Processes during Supervision Hours

We should respect our own time and that of our supervisees. I ask my supervisees to be reflective and show up to our weekly supervision hour with a prioritized to-do list. If a trainee can’t think of valuable ways to use supervision time that’s a pretty large red flag for me—particularly if they’re clear about the purpose of supervision (which they are, because we went over it at the beginning). I highly recommend you discuss expectations at the start of a new supervisory relationship: talk about yours and ask about theirs.

I start discussing the importance of feedback from day 1, that we all make mistakes and the more open we can be about them, the more we can learn. I continue by saying that as we build trust I hope they can bring their mistakes to me, and that I won’t hide my mistakes from them. The more I do so, the more my supervisees reciprocate. See Kim Scott’s Radical Candor for a thorough discussion on how empathy and humility contribute to leadership and feedback. Ask your trainees for feedback on yourself as a supervisor, if they’d prefer you to do anything differently, and so on. Do this semi-regularly, and certainly ask for feedback as the trainee finishes their time with you (e.g., at the end of their internship). Similarly, use ongoing, formative feedback with supervisees. The final feedback they receive from you should not be a surprise.

Supervisors need to get real data of supervisees with clients—direct observation at regular intervals and with a variety of clients. This can be live observation or via video or audio recording. It’s common and too easy to simply rely on the supervisee’s narrative account. These accounts are biased and, like all of us, trainees have blind spots. If a trainee has a poor grasp of what the problem is or why it’s occurring in their session, it’s unreasonable to expect them to accurately identify and articulate the problem to me. It’s similar to being colorblind: that way of perceiving the world would have always seemed normal, so I wouldn’t think it’s an issue—until I speak carefully with others about their perceptions. Anyway, for these and innumerable other context specific concerns, the most efficient way for a supervisor to notice them and help the trainee is to observe sessions.

Supervision and Case Consultation

Initially, I created lists of questions and prompts for myself for when supervisees brought me questions about case consultations:

  • I generally start by simply asking the supervisee to tell me about the case, while the casenote or client file is between us so we can both leaf through and point at things

  • “Are there any safety concerns?” (Suicide, CFS, DV)

  • “Is this time sensitive for any reason?” (Do we have time to reflect, research, or consult another practitioner if relevant?)

  • “Are there children involved in the case?”

I ask the above questions to orient myself and to ensure I don’t miss something important, then I move on to things such as:

  • “What did the client say that they want?” Or, “What is the client’s stated goal for therapy, and what did the client write on their intake?” Here I’m seeking clarity and watching for any differences between what the client said they want and what the supervisee thinks the client should do.

  • What does the supervisee think the best course of action is and what’s their rationale?

    • Is there any reason their suggested action would be unethical, or a seemingly poor choice? 

  • Are the supervisee’s questions for me about the case reflecting developmental or behavioural growth? Should I ask the student to think, reflect, and research on their own, or should I simply provide them with an answer? (Watch for dependence)

  • Whose needs are we prioritizing? Focus on the most vulnerable person, typically the client, keeping in mind that the supervisee is generally more vulnerable than the supervisor

  • Are there any legal or other ethical concerns?

  • Would this question or discussion be useful to bring to our group supervision? 

  • After consulting about a tough case, I’ll ask a supervisee “What do you need?” For example, self-care, to (re)set a boundary, training, resource, etc


Examples of a few more context dependent questions

  • “When the client brings that up again next session, how could you respond differently?”

  • “Do you feel like that intervention was the best one for the client in that moment? How else could you have approached it?”

  • “Is there evidence behind the approach you used?”

  • “Are you and the client addressing their treatment goals?”

  • “I remember we spoke about angry clients feeling intimidating for you with a different case a few weeks ago. What was it like for you to sit with this client today, given how angry they were?”

Considering the Therapeutic Alliance

A simple tool that I keep in mind on case consults is the 3 legged ‘stool’ metaphor Scott Miller sometimes uses, pictured here. I generally share this with supervisees early on so it’s easy to reference in discussion.

Each ‘leg’ of the stool is one foundational aspect of the therapeutic alliance, which are all informed and connected by the client’s preferences (the top). Having a structure to think with helps me catch issues I’d otherwise miss or take longer to ‘diagnose’. A trainee with an issue will often not be noticing or articulating what’s causing the issue—because it’s something that isn’t “on their radar” yet. I can’t expect them to bring this up to me directly, especially if the concepts get more abstract.

Depending on the context, I’ll need to impose more or less structure on supervision hours, based on how much we need to get done, how organized the supervisee is, how talkative vs focused they are, and so on. A useful prompt I use with trainees is “ok, so what’s your question for me?”, which I use when a trainee is kind of rambling or giving too much content. I ask it with a smile, and I generally have a good alliance with supervisees, so asking this kind of thing, though direct, is ok for me. It also encourages them to be a little more focused in their discussions in future. As with everything, this is a balance—at times it’s healthy and useful to give space for supervision discussions to wander and explore subjects.

One supervision task that’s worth mentioning specifically is deliberate practice. It is critical for improving therapist outcomes, and it requires a clear recognition of the supervisee’s current level of skill, development, and (ideally) client outcome measures. Tony Rousmaniere goes in depth on this subject in his book Mastering the Inner Skills of Psychotherapy: A Deliberate Practice Manual.

Self-doubt and Improving

When I was a new clinical supervisor, I often felt self-doubt and returned to my habit of over-preparing, of excessively reflecting after finishing my supervision hours for the week. I think this is normal, and I still experience healthy professional self-doubt. A question I frequently used to struggled with was when to let a supervisee be more self-directed and when (and how much) to intervene. Ideally I would just ask a few questions to help them see their current case or situation differently, and they would go from there. I’d wonder things like “how can I be as ‘hands off’ as possible while still having them feel supported and safe?” The last thing I wanted was my trainees to feel micromanaged or like I didn’t trust them. I ask myself questions such as:

  • “Could the supervisee figure this out on their own?” (What does it indicate about their developmental level)

  • “Have they asked me about similar things before (i.e. repetition)? Why might they be bringing it up now, or again?”

  • “What skill am I asking the supervisee to learn? What metaphor could help to illuminate it?” This helps me when I’m struggling to bring my feedback or suggestion to a specific point. Credit to my colleague SW for this one

  • Lastly, “How could I have approached this better?” I routinely sit down and do some recursive reflection to refine my whole supervision process, as I continue to learn and grow

Becoming a Manager

I think Leader, Manager, and Clinical Supervisor can be 3 distinct roles, though sometimes becoming a clinical supervisor means you are suddenly a manager of several people as well. Again, while this is a role that everyone has been on the receiving end of, I assure you many people do a poor job of managing people. It is deceptively challenging to be a ‘good’ manager in the long term. Look into the “Peter principle” if you haven’t heard of it before. Here are a few relevant book suggestions: 

Integrity is perhaps the most important quality in a manager or leader, though don’t forget humility, approachability, trust, and ‘going to bat’ for your team with people in positions of power when necessary (especially when you say you will). Having good intentions while in a management position is good, but being a bit informed allows a person to do a great job without that much extra work. 

Resources for Clinical Supervision

Conclusion 

Some final advice: ensure that as a supervisor, you “know what to do when you don’t know what to do”, and that your supervisees know this for themselves in session as well. We’re all still learning. Some of my colleagues that I admire most are the supervisors who regularly and openly consult their peers about their trainees’ questions, particularly when they do so with the trainee present. It models humility and what different styles of consultation can look like.

Supervision is a nuanced and important task, and eventually we all find our own style. Be careful you don’t project your old needs onto your supervisees now. It’s like the difference between the ‘golden’ rule and the ‘platinum’ rule: be the supervisor the student in front of you needs, not the one you needed back when you were a trainee. What helped me was to keep reading, reflect frequently, and discuss my problems and progress openly with more experienced supervisors. It takes a village to raise a therapist.

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