Supervision is a term that often causes much debate within counselling and psychotherapy circles. It was once considered to be something you ‘got landed with’ by virtue of being the most experienced practitioner within an organisation. Implicit in this view was that therapy should be conducted in a right way and, therefore, not in a wrong way, and that supervision should be arranged and facilitated by the most senior and most experienced therapist, regardless of their competence, knowledge base, attitude or management skill. This hierarchical view of supervision is possibly reflected in working practices within organisational settings where managers are worried of things going wrong and being the subject of a claim or complaint. The NHS is a case in point whereby supervision is more likely to be for those further down the food chain. Consultants in the NHS are not routinely offered clinical supervision as part of their working arrangements. Whilst some might engage in loose forms of reflective practice listening with their colleagues there is no formal supervision arrangements, certainly not as psychotherapists would understand it.
Some therapists see supervision as a box filling exercise, and something which they are required to undertake, whilst others view it as an opportunity to merge with the person who they like and respect. I recall from my training days when certain trainees would choose their personal private supervisor on the basis that they were similar in outlook and where there was a great deal of deference and admiration. In such cases I was left wondering about the motivations of such individuals in their choice of supervisor.
Clients can also have differing views on how supervision could be defined and what the process entails although they rarely show much interest. When they do they sometimes wonder if their personal material will be discussed with a stranger and consequently if their privacy and confidentiality could be compromised and can, as a result, be defensive about the thought that the therapist is engaging in such a process.
So, how is clinical supervision defined by professional accrediting bodies?
The UKCP defines supervision as a reflective and evaluative process conducted within an articulated working relationship between a qualified or trainee psychotherapeutic practitioner and an appropriately knowledgeable supervisor. The BACP Ethical framework says the following: ‘A specialised form of mentoring provided for practitioners responsible for undertaking challenging work with people. Supervision is provided to ensure standards, enhance quality, advance learning, stimulate creativity, and support the sustainability and resilience of the work being undertaken.’ In Hawkins and Smith 2006 Professor Hawkins defined supervision as: “The process by which a Coach with the help of a Supervisor, can attend to understanding better both the Client system and themselves as part of the Client / Coach system, and by so doing transform their work and develop their craft.”
Clinical supervision is different to consultative supervision and informal reflective practice. Consultative supervision and reflective practice can potentially take place with anyone whereas clinical supervision might typically take place with another therapist who is appropriately qualified, and usually accredited (although a lot of supervision training is not associated with a formal accrediting body). Supervision is now a core component of continuing professional accreditation (cpd) and, indeed, is now viewed as a discipline in its own right with its own training route.
Supervisors should not follow outdated rulebooks
Supervision is not personal therapy. However, it would be naïve to think that the therapist’s personal material is not also relevant within the discussions in a supervision session. I recall from my training days a strict demarcation enforced by some supervisors between what was considered appropriate for the content of clinical supervision and what was considered personal material. I felt at the time that this demarcation to be a bit mechanical, as if the supervisor was following an outdated rulebook. It was almost like the supervisee could not refer in any way to any personal material possibly triggered by client material. Such material was considered to be something that should be taken to personal therapy. This approach, I feel, can be potentially shaming for the supervisee. It is my view that a good supervision session allows for a wide ranging airing of views and should not be restricted to strict mechanical ways of working. Supervisees should, of course, remain open-minded and inquisitive about other options when presented with a view about ways of working in supervision but should also avoid the temptation to hand their authority and accreditation away to others.
I wonder if the work of David Rennie on deference in the client therapist relationship could also be usefully applied to the supervisee–supervisor relationship. Indeed, I often muse if the word supervision almost unconsciously sets up the potential for a narcissist co-narcissist relationship. The supervisee can potentially be approaching the supervisor in the child ego state rather than entering into an adult to adult form of communication or as one professional to another.
Themes of control, management, hierarchy and power are often associated with the term supervision, particularly in periods of formal training. This ethos of deference is probably not that surprising since trainees need the supervisor to effectively approve them during periods of continuous assessment. However, the good trainees will be the ones who form their own opinions and learn to trust their own intuition rather than deferring to another.
Putting supervisors on pedestals is dangerous
Liking your supervisor is perhaps not an all together bad idea but putting them on pedestals is dangerous, as this is when narcissistic co-narcissistic relationships can take hold. The co-narcissist part of the relationship has the potential for an ego driven supervisor to feel boosted when in receipt of such admiration. When this happens the supervisor can fill the role of being a know-it-all.
A more mature approach to supervision might be to view the process as one professional exchanging unconscious material with another in an open-minded pursuit of different perspectives. In such an open-minded approach it can perhaps be useful to flirt with your hypothesis but not to marry it.
Parallel processing might result when the supervisor and supervisee re-enact in their relationship something that the client is not expressing. This form of projective identification might feel uncomfortable for the supervisee, and might not feel enjoyable, but could ultimately prove very useful for understanding the client better. An example of this might be a client who presents with historical shame and the therapist starts to connect with their own shame with the supervisor. This might be what Margaret Rioch referred to when she wrote about increased self-awareness for both parties. Feeling discomfort might actually be where the crux of the work might be residing rather than the apparent comfort zone when seeking to merge with the supervisor. Working in this way would be difficult if one party has been put on a pedestal by the other.
Role reversal can be useful, as the Gestaltist author Yontef suggests in the Handbook of Psychotherapy Supervision (Watkins, 1997 p158), in the exploration of counter-transference and gaining a different perspective. This can potentially involve the therapist playing the role of their client and acting in an ‘as if’ capacity. The therapist can act as if they are the client in the supervision setting and this way of working can be transformative in helping to realise unconscious material. This way of working might be difficult in a narcissist co-narcissist relationship.
Supervision should be like going on retreat
Rather than supervision, I prefer the terms ‘all vision’ or even ‘independent consultation’ as a process whereby the therapist can explore client material with a professional colleague. Supervisees should not feel like they need to justify their interventions with clients, or have to ponder too long as to whether they are ‘doing it right’. I don’t believe that the supervision consultation should be about right and wrong ways of working but for the exercise to have value it can offer the opportunity for the therapist to gain access to their own blind spots in their unconscious material and to consider other ways of working. Approaching the process in this manner will help protect against the risks associated with the creation of a narcissist co-narcissist relationship.
I like how Lady Diana Whitmore refers to supervision as akin to going on retreat where the therapist can explore client material in an uncensored way. This approach is very different to the tick box exercise when the therapist is required to fulfil professional accreditation and licensing requirements or to satisfy organisational demands. Supervisees attend sessions to stop and listen and to open their awareness. However, for the process to be effective it needs to be a two way process. The supervisor is providing the space for retreat, the holding for retreat and the transpersonal context for retreat, not sharing their own frustrations with their working day or the state of the profession. I like what Houston says (1995, p95) that the supervisor takes the supervisee forward at the right pace toward self-confidence based on reality and toward abundant motivations. This is when supervision is a containing and an enabling process rather than an educational or even neccessarily a therapeutic process.
Hawkins and Shohet devised the 7 eyed model of supervision. See my interview with Robin Shohet.
The 7 eyed model of supervision is:
Eye 1: Focus on the Client
Eye 2: Focus on Interventions
Eye 3: Focus on Client-Therapist Relationship
Eye 4: Focus on Therapist’s Process
Eye 5: Focus on Therapist-Supervisor Relationship
Eye 6: Focus on Supervisor’s Process
Eye 7: Focus on Wider Context