Cummings photo

From left to right: Adam Pierce, Constance Heidt, Jessica Campori, Annik Mossiere, Jorden Cummings, and Megan O’Connell

In the Fall 2015 semester we completed a graduate course in clinical supervision. We discussed the purpose of clinical supervision, ethical and legal issues, theoretical models, countertransference and interpersonal variables impacting supervision, evaluation and feedback, how to build specific trainee skills, working with impaired trainees, and supervisor self-care.

A frequent reaction for all of us (including experienced supervisors such as the instructor and an auditing colleague) was of feeling overwhelmed by the sheer number of recommendations for best practices in supervision. Each week, our readings provided additional suggestions and evidence for ways we could provide effective supervision. We suspected our overwhelmed feeling was likely not unique to us, and we began to worry that formal training in supervision might ‘scare off’ future clinical supervisors. Clearly, best practice was aspirational, but there must also be supervision practices that are simply “good enough.”

Over the course of the semester we compiled our own list of “good enough” clinical supervision ingredients: A list of what we considered the basic core components of competent and responsible supervision. We distilled these into 5 basic components: support, trust, respect, time, and investment.

The components of “good enough” clinical supervision

The first 3 components of “good enough” supervision relate to the working alliance between supervisor and supervisee. This relationship is an essential base for clinical supervision.

1. First, this relationship should be supportive. That is, the supervisor should be interested and motivated in teaching the supervisee, in a manner that makes the supervisee feel heard, encouraged, and capable. In a supportive supervisory relationship, supervisees should feel comfortable to discuss clients, including both personal and clinical challenges that arise when working with clients, and ask questions as needed.

2. Second, this relationship should involve bi-directional trust. Supervisees should know that the supervisor will teach them the skills needed to perform ethical and effective clinical work. Supervisors should actively work to create a safe, professional, and inviting environment for open and challenging discussion of supervisees’ training.

Supervisors should be especially aware of their own possible discomfort with difficult conversations, (e.g., regarding difficult feedback or boundary setting) and rather than avoiding such discussions actively work to reduce the impact of their discomfort on their supervisory practice.

The supervisor should use self-disclosure, as appropriate, to demonstrate this bi-directional trust and encourage and welcome ongoing feedback from the supervisee regarding the supervisory relationship to help mitigate supervisee tendencies towards non-disclosure.

3. Last, the supervisory relationship should be marked by bi-directional respect. This includes being willing to provide constructive feedback to supervisees, and likewise, to be open and receptive to receiving constructive feedback from supervisees as well.

4. “Good enough” supervision also involves devoting enough time to supervision. We believe that the “right” amount should be determined by asking oneself: 1) Is client safety ensured? and 2) Is my supervisee receiving adequate and developmentally appropriate feedback to enable learning the basic skills needed? If the answer to either of these is “no,” then more supervision time is likely required. Supervisees also need to feel adequately supported in their clinical role, in order to facilitate trainee growth and the working alliance discussed above.

5. “Good enough” supervision requires investment on behalf of the supervisor. This includes providing the supervisee with clear expectations at the start of the supervisory relationship, fulfilling the requirements of the trainee’s placement (such as using the institutions evaluation form and teaching the expected skills), and providing supervision that is developmentally appropriate for the supervisee.

Conclusion

The first three components of clinical supervision were deemed essential to balance power differentials inherent in this delicate working relationship. Providing supervision that is supportive, trusting, and respectful creates an open and collaborative learning environment. This foundation sets the stage for the relationship to thrive.

Although likely more challenging to enact, the last two components of time and investment are critical: they not only create a platform for supervisors to provide “good enough” supervision, but also enrich the quality of the learning experience. From our perspective, “good enough” supervision establishes these core components of competent and responsible supervision. Although we appreciate the aspirational nature of best practices in clinical supervision, we suggest maintaining a core of ‘good enough’ supervisory practices to sustain us during ‘lean times.’