Monday, August 26, 2013

Two Kinds of Supervision

Supervision is at the heart of teaching and learning how to be a mental health professional. Therapy brings about change through a special kind of "helping" relationship, and we learn to foster and harness that kind of relationship through our relationships with supervisors.

We all receive supervision throughout our training, in graduate school, and leading up to licensure. However, ethical guidelines require that we continue to make use of supervision - or consultation, supervision's less hierarchical cousin - throughout our careers. Unfortunately, not all agencies that employ mental health professionals make supervision a priority, and not all supervision is created equal.

Indeed, there are two main categories of supervision that professionals receive once they have graduate and are out in the field:

1) Administrative Supervision

Administrative supervision is perhaps the most readily-available kind of supervision. It focuses on ensuring that workers are meeting requisite standards and following established protocols. An administrative supervisor is concerned with how programs are operating, whether workers are showing up on time, presenting themselves professionally, and completing all the paperwork needed to keep the agency in business. Administrative supervisors are also typically responsible for things like performance evaluations.

2) Clinical Supervision

Clinical supervision is what most of us think of when we think about supervision. This is the kind of supervision that focuses on the clinical work: how we understand what is going on for our clients, how we can connect with and help them, and what might be getting in the way. It helps us recognize and think about what may be going on underneath the surface of our clinical encounters. It gives us a place to express our own feelings, identify our own biases and issues that may be triggered in our work, so that these things don't "leak out" when we're with a client. It may help us recognize a need for more self-care, or our own therapy. It helps us develop a deeper understanding of theory and practice so that we can intervene more skillfully.

Most agencies provide administrative supervision as a matter of course. Whoever is your "boss" is probably technically providing administrative supervision. When licensed supervisors are available, many agencies will provide clinical supervision for employees working toward licensure. After all, agencies typically benefit from this arrangement, both because they are more competitive when vying for the best new graduates, and because they stand to receive added reimbursement for services provided by licensed professionals. Of course, there is not always a supervisor available who has the kind of license an employee needs for their own licensure. When this happens, the employee may be able to negotiate with their employer for an appropriate supervisor to be found in another program, department, or even outside the agency. However, sometimes it is necessary for newer graduates to find and pay for their own outside clinical supervision.

Logistically, it is easiest when your administrative supervisor (your "boss") also provides clinical supervision. Practically, however, this is not always possible...or even desirable. It may be that your boss has a different kind of license than you need, or that the agency does not prioritize clinical supervision, or that your boss's area of expertise is not quite what you need. You may have reservations about revealing difficulties to the person who will be completing your performance evaluation. Or you may benefit from the perspective of someone who has a little more distance from the program or agency setting.

I was grateful in my early years of practice to have a clinical supervisor who was removed from the program where I worked, who could stand outside the politics, and who was supportive of me, rather than another agenda. I left a different job because my supervisor took expression of emotion during supervision as a reflection of my sessions with clients, rather than as a healthy way of ensuring my emotions did not enter into my work with clients. Currently, I have a supervisor who is better able to blend administrative and clinical. Thus, my experience suggests that much depends on the supervisor, and the setting.

What has your experience been? How have you experienced supervision at its best and at its worst? How have administrative and clinical supervision been combined or separated for you? What recommendations would you make to agencies and the profession as a whole?

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