In my work over the past 40-plus years as a clinical supervisor, I’ve come to see how my role must shift as supervisees move through different stages of their learning. I’ve found that clarifying these different roles—teacher, guide, gatekeeper, consultant—helps me tailor my work with my supervisees to encourage them to discover their voices, skills, and styles.
At the first stage of a supervisee’s development, the clinician is painfully aware of her inexperience. She “only knows what she doesn’t know.” She usually says she’s doing okay only because to admit her insecurity would, in her eyes, confirm what she thinks everybody is already thinking about her. She worries about Doing It Right. Her clinical goals are often vague and idealistic. Like her clients, she can get swept up in the crisis of the moment.
What do you do? You help her feel welcomed and safe. You set realistic and clear expectations—ones that are usually a bit lower than her own. You gently begin to set boundaries so she can do the same with her clients. You try to help her sort out her own problems from her clients’ problems and realize what she can control and what she can’t. You spend time assessing her skills and learning style. You give her positive feedback to offset the criticism she lays on herself.
This stage of supervision poses several challenges. If the clinician remains intimidated or continues to put up the “I’m okay” front, you essentially have no supervisory relationship. If you can’t help her relax and trust you, she’ll be saying one thing (that Mrs. Jones is doing well) and possibly doing another (taking crisis calls from Mrs. Jones 12 times a day), and your ability to provide quality control is shot. If she feels she can’t come to you for support, she’ll bond with her peer in the next-door office and use her as the de facto supervisor, or talk to no one and remain isolated and overwhelmed. Openly, but delicately, you need to talk to her about her fear and normalize it. Use self-disclosure to offset the distorted impression that you’ve never been anything but fully confident and in control.
The danger at this stage is that her fear will stop her in her tracks, and she’ll decide that she isn’t cut out for doing therapy, or she’ll blur her personal and professional boundaries. So you need to set the limits and help her understand the clinical rationale, rather than merely scolding her. Treat her the way she needs to treat her clients.
If you do a good job and lay a strong foundation, supervisees will naturally grow into the next stage—in which the developing therapist “doesn’t know what she knows.” At this stage, she’s being a better therapist than she realizes. She can define specific behavioral goals, but the steps to achieving them can still seem elusive and mysterious to her.
This clinician started out overwhelmed, but within six months of starting supervision, her questions are shifting from “What form do I use?” to “How do I handle my own discomfort when my client talks about sexual abuse?” She’s beginning to see and become curious about her clients’ larger patterns, which her anxiety kept her from seeing before. Feeling less insecure, she can begin to relax and share more of herself.
At this point, you do less direct teaching and more guiding. Encourage her to pursue her hunches. Begin to help her see that she doesn’t need to fix all the client’s problems, but can focus on and help change those exhibited right there in session.
This stage of oversight is a good time for group supervision because the clinician is no longer worried about sounding stupid in front of more experienced peers. She no longer tries hard to be the supervisor’s “good child” and avoid disapproval; for a time, in fact, she becomes more deeply dependent upon the supervisor, more genuine, less self-conscious.
For less experienced, “good-child” clinicians, the increased intimacy of the therapeutic relationship can be seductive. As they hear the backstory of their clients’ lives, they may feel for the first time what it’s like to have others trust and appreciate them. And for some therapists, this can become a real danger. Relationships with clients can go on and on because the client’s dependency is unconsciously or subtly encouraged.
As the supervisor, you need to stay alert and focus on helping supervisees see these patterns across their caseloads. Ask the hard questions and help clinicians separate their clients’ therapeutic needs from their own. Most of all, you need to be sensitive to the parallel process, and ask yourself if clinicians are, in fact, merely replicating what you may be inadvertently doing in the supervisory relationship: encouraging their dependence upon you because of your needs and fears of losing the control or intimacy of the relationship. At this stage, it’s important to look at your own patterns with your own supervisor.
This is the stage at which the growing therapist “doesn’t know what she doesn’t know”—she thinks she knows it all—and it’s your job to disabuse her of this illusion. She has soaked up your ideas and perhaps even your style of therapy, but is beginning to develop her own. She gets a bit cocky and loose, and starts pushing the boundaries.
This is the most dangerous of the stages because the clinician is blind to her own limits. She feels powerful, and will try to treat anybody for anything without telling you about it unless you pin her down. She’s impatient with clients who don’t want to change. She feels invulnerable. It’s during this stage that clinicians might rationalize having sex with their clients. They can overidentify with the adolescents they see, encouraging them in sessions to let it out and tell their parents how they really feel. Anger and confrontation, once scary, become their modus operandi of change.
As a supervisor, you need to support these therapists’ increasing skill and independence, yet monitor them carefully, and set and enforce clear boundaries. But this can be a difficult time. This is the stage in which your own history of separation and loss mingles strongly with your professional role, and when, if you push too hard, you create a power struggle, and the clinician may decide to walk.
Channel their restlessness and power. Let them supervise the interns or represent the team on an agency personnel committee. Encourage them to enter a three-year certification program in a new modality that’s different and enticing. Avoid destructive fights by valuing their strengths and helping them find creative ways to express them.
If during the previous stage you and your supervisee were both honest and straightforward and could repair any rupture in the relationship, you both will come to respect each other’s styles and strengths. You’re approaching becoming peers. This is the stage when the clinician “knows what she doesn’t know.” She recognizes and acknowledges her blind spots and will come to you to recruit your strengths.
This can be a good time for the relationship, one of mutual respect and comfort. The danger of this stage is boredom. The clinician is doing good work, but she may not be as creative and curious as she once was.
As with all the other stages, you set the pace. You’re the role model. Your job is to avoid the undertow of stagnation. Move toward your own anxiety in supervisory sessions. Continue to ask the hard questions and encourage risk-taking. Begin training the clinician to be a clinical supervisor and provide supervision of her supervision. Provide challenges. If you believe that your role is creative and important, then you both will continue to grow. The excitement of supervision is that the work is always in the moment, always right there in the room.
Adapted from the September/October 2007 issue.
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