Beyond the One-Way Mirror
A New Approach to Reviving Public Sector Psychotherapy
By Scott Sells with Cynthia Franklin
It was my first meeting as a visiting supervisor at a local community mental health center in the Southeast. To get some background, I asked the clinical staff what had been the biggest change they'd seen since they'd started at the center. Without uttering a word, John, the senior member of the group, got up and led me down a hallway with dirty floors and off-white paint peeling from the walls. He opened the door of a large room filled with boxes of old files that had a mop and a bucket standing in one corner.
"Why are you showing me a storage closet?" I asked.
"This wasn't always a storage closet," he said dejectedly. "This used to be our one-way mirror observation room."
John then explained that from the 1970s through the mid-1990s, one-way-mirror supervision had been the hub of clinical discussion at the center. The treatment team had met once a week to observe and learn from one another. The phone on the wall—next to the mop and bucket—had been used regularly to call in interventions when therapists were stuck with a case. Clinicians were encouraged to bring in not just parents and siblings, but grandparents, aunts, uncles, neighbors, and friends. Medication was used, but only as a last resort, and the psychiatrist had been a working member of the treatment team.
Then, about 15 years ago, everything began to change. Live supervision was the first thing to go. "Our administrators told us to stop because we couldn't bill for it under managed care. So our one-way mirror observation rooms were converted to storage closets," John continued. "The next thing to go was intense group supervision. Our clinical discussions about stuck cases, usually an hour or more, were whittled down to 30-minute case-note reviews. These days, all our work is done unsupervised, behind closed doors."