Julie A. Jacobs, Psy.D., J.D.
Supervision is a vital part of training as a mental health provider, and some amount of supervised experience is required for almost any mental health credential. However, students and trainees don’t always have positive supervision experiences, and there is not a lot of information in our training programs about how to effectively use supervision to improve our performance as clinicians. This article will briefly discuss some basics of how to be a good supervisee and get the most out of this essential part of your education and training as well as how to help manage the risks of supervision. You can learn more about supervision (and earn CE credit) by viewing our On Demand Webinar called “Ethical and Risk Management Issues in Supervision” – presented by Carol Falender, Ph.D., Edward Shafranske, Ph.D. – follow this link for more information: https://beacon360.content.online/xbcs/S1537/catalog/product.xhtml?eid=7178
Supervision for licensure takes place very early in one’s career, and it can be an intimidating experience to expose yourself to the judgment of others when you are just starting to learn a skill. In order to get the most benefit from your supervised experience, it is important to be open to feedback and criticism from your supervisor. Feedback from supervisors presents major opportunities for learning and growth as a professional that are not often readily available once you are practicing independently. Try to remember that the care of your clients is the first priority of your supervisor, so while some of the feedback you receive may be difficult to hear, the focus is on ensuring that your clients get the best possible care.
In addition to being open to feedback, it is also important to be open to new experiences. For example, you may think that you never want to facilitate groups, but if you have the opportunity to try while you are under supervision, be open to the experience and trust that you may learn something valuable (even if that lesson is just confirmation that you don’t want to facilitate groups!). Exposing yourself to new client populations or new kinds of interventions is one of the main benefits of supervised experience, so be open to pushing yourself to try new experiences in a safe setting.
Not all supervisors are good at clarifying expectations and goals for supervision, so it may be up to you to be intentional in how you approach supervision. Ideally, you and your supervisor will have a clear supervision contract that outlines goals and expectations for the experience, but this is not always the case. Before you begin your supervised experience, think about what your goals are for supervision – what populations do you want to learn about, what interventions are of interest to you, what are you hoping to get out of the experience? Once you have identified your personal goals for supervision, share them with your supervisor and create a plan that will help you achieve those goals. Don’t just let supervision happen; be intentional about what you want to get out of the experience and partner with your supervisor to make it happen.
Throughout your supervised training, continue to be intentional about each supervision session. As you gain experience, your goals and needs will change, so be sure that you use each supervision meeting effectively and modify the structure and content of supervision as needed. In addition, it can be helpful to keep your own notes about your supervision sessions. Identify what topics were discussed, questions that were addressed, new or modified learning goals, and your own assessment of your strengths and weaknesses. Keeping records about your supervision and your reactions to it can help you be more focused and intentional throughout the experience.
Supervision is most effective when you are willing to share your struggles, not just your successes. Be honest about your reactions to difficult clients, your fears about clinical work, and your judgments about the people with whom you are working. While it is often easier to sugar-coat your experiences, you will learn much more by being honest about the challenges you are facing in your early clinical interactions. It is equally important to be honest with your supervisor about your reactions to supervision. If something is not working for you, talk about it. If something is not clear to you, ask about it. Being honest can sometimes be one of the hardest parts about supervision, and being honest often requires courage.
Be willing to bring up difficult topics in a respectful, clear manner. If there is an issue with your on-site supervisor that you don’t feel able to bring up with him/her directly, find the courage to talk to someone in your training program about the issue so that it can be adequately addressed. It can also take courage to be willing to face criticism, so be brave enough to bring up the difficult clients and challenges you are facing.
Not only may you need to be courageous in dealing with your supervisor, you may also need to display courage in your clinical work. The so-called “imposter phenomenon” is quite real, and most mental health trainees feel like they are faking it when they first begin to engage as clinicians. The truth is, you won’t gain confidence as a therapist until you have experience, and you can’t get experience without having the courage to show up and do the work. You will certainly make mistakes, but the whole point of supervision is to allow you to make those mistakes in a setting where the harm that is caused can be minimized.
You should strive to be well prepared for your supervision experience before it even begins. Spend time researching the program/site where you will be receiving supervision so you can understand what they do, who they serve, and how the professionals there work together. Learn what you can about your supervisor – his/her experience, supervision style, and specific areas of expertise. Knowing more about your site and your supervisor can allow you to develop realistic and appropriate goals and expectations for the supervision experience.
It is also important to be prepared for each supervision session. Bring specific questions and areas for exploration to your supervision meetings so that you can be focused and use your time efficiently. Which clients have challenged you, which ones seem easier to work with, and why? Are there certain interventions that you need to learn more about? Are there certain types of clients that pose more of a challenge? Ask yourself these questions before each supervision session so you can get the most out of your interactions with your supervisor. Of course, you will need to be flexible and willing to discuss things that your supervisor has prioritized, but try also to use your time well and focus your energies on issues and topics that help you improve your skills.
Ideally, your supervisor will serve as a model for ethical behavior with clients, with colleagues, and with you. However, it will sometimes fall to you to identify ethical challenges and to determine how to address these situations. For example, it is vital that your informed consent process includes full disclosure of your status as a supervisee and provides the contact information for your supervisor(s) to all of your clients. Hopefully, the documentation used by your supervision site will clearly outline this information; however, you should be sure to review the informed consent documents to be sure that your status is appropriately disclosed.
Another issue that comes up often in supervisory relationships is that of multiple relationships. The issue can arise with both clients and supervisors. For example, if you are a student obtaining training in a college or university counseling center, it is possible that you may encounter your own peers as potential clients or that you may end up seeing clients in social or educational settings. If this occurs, you should seek supervision on the best way to avoid an inappropriate multiple relationship. Multiple relationships can also become an issue with your supervisor. Sometimes, supervisors can blur the lines in the supervisory relationship. This can happen in seemingly benign ways – your supervisor is looking for a babysitter and asks if you would like to make some additional money as a babysitter – or in more clearly harmful ways such as seeking to engage in a personal or romantic relationship with you. If your supervisor is unable or unwilling to establish and maintain appropriate boundaries, then it will be up to you to proactively and courageously address the situation, either with your on-site supervisor or someone in your training program.
In order to practice ethically, you must also be familiar with relevant laws and regulations that govern your practice. Two areas that may come up for you as a trainee are confidentiality and mandatory reporting/duty to warn or protect laws. It is vital for you to have a clear understanding of how to protect the confidentiality of your clients and the limited circumstances under which you can share confidential information without the consent of your clients. You must also have a clear understanding of your mandated reporting duties in your state, many of which relate to child and elder abuse or exploitation. Ideally, your supervisor will be able to guide you to resources that will clarify these rules, duties, and expectations. If not, you should take the time to familiarize yourself with these rules and laws so that you are practicing in an ethical and lawful manner. A good place to start is often the web site of your state’s licensing board, which may have a link to the relevant statutes and regulations governing mental health practice in your state. You can also find information about record-keeping laws and suggested templates for progress notes on the TrustPARMA web page at https://parma.trustinsurance.com/Resource-Center/Document-Library/Electronic-Health-Record-Templates. Other relevant guidance for psychology trainees includes the APA Ethics Code (American Psychological Association (2017). Ethical Principles of Psychologists and Code of Conduct. Retrieved from http://www.apa.org/ethics/code/ethics-code-2017.pdf), The Guidelines for Clinical Supervision in Health Service Psychology (American Psychological Association. (2014). Guidelines for Clinical Supervision in Health Service Psychology. Retrieved from http://apa.org/about/policy/guidelines-supervision.pdf).
It is true that your supervisor is ultimately responsible for the care of your clients, and the risks associated with being a supervisee are often lower than those of a licensed clinician. However, this is no reason to take your responsibilities as a supervisee lightly. Supervision is a unique opportunity to gain professional experience with the benefit of an experienced clinician working closely with you to provide guidance and feedback at an early stage of your career. While it may sometimes seem like supervised hours are yet another regulatory hoop to jump through, this particular hoop can be extremely beneficial to your growth and development as a professional.
We always hope for ethical and skilled supervisors, but even if you end up in a difficult supervision situation, there is a tremendous amount you can learn by successfully navigating these challenges. The guidance above provides important ways to manage the risks associated with supervision, and following this guidance may be protective of both you and your supervisor as you navigate these risks. Strive to be open, intentional, honest, courageous, prepared, and ethical in your work as a supervisee, and the benefits of supervision can stay with you throughout the life cycle of your career.