Supervision for mental health professionals
I am a BACP Snr. Accredited psychotherapist, and have been a supervisor since 2006. I offer clinical supervision to psychotherapy practitioners, and students and to members of other professions (e.g. social workers, GPs, managers). I use an active and dynamic model that draws on psychodrama and Gestalt supervision theories, among others. Good quality supervision should be able to attend to process, not just to content, which is where modalities such as Gestalt or Psychodrama can be useful. I work within the framework of Interpersonal Neurobiology (IPNB), and aim for my supervisees to consider this framework for their clients, and for their own development.
Clinical supervision is mandatory for accredited counsellors and psychotherapists, and other accredited mental health professionals. It is strongly recommended also to non-accredited practitioners who are actively seeing clients. The purpose of clinical supervision is to support practitioners in their clinical work, to ensure that they remain healthy and balanced over time, and do not suffer from burnout. By extension, supervision contributes to clients’ safety, and to therapeutic efficacy.
Good quality supervision should cover all areas of practice, and must not be restricted, or limited to discussing only clients, or client work. Among other things, good quality supervision should offer support, validation and encouragement, opportunities to discuss and explore client work, exploring and dealing with ethical issues, debriefing, opportunities to explore any personal issue that might impact on the practitioner’s work, mentoring, opportunities to deal with any difficulties in the supervision relationship, information and learning, suggestions for reading and professional development, support for accreditation, opportunities to discuss professional issues, and plenty of ongoing challenge.
It is not necessary for the supervisor and the supervisee to practice the same modality. But it does help to have values and principles in common. It is especially important that they have a shared understanding of what therapy is for.
I am probably not going to be a suitable supervisor for therapists who believe their job is to help clients manage symptoms, and who practice symptom management modalities (e.g. CBT, EMDR, EFT [tapping], biofeedback, or hypnotherapy).
I am likely to be more suitable for practitioners who understand psychotherapy as a process that helps restore people to healthy development. The closer my supervisees’ and my values are, and the more honest and open the relationship, the more useful and satisfying supervision is likely to be.
Psychotherapy is not a ‘faith-based’ profession. Practitioners should have a coherent approach to their practice, and the ability to explain to themselves and to clients how they work, why they work the way they do, and how the modality they practice is meant to help their clients’ concerns. Among other requirements, Accreditation processes require practitioners to be able to explain what they do in their work, and why they work the way they do. Supervision helps psychotherapy students, beginner psychotherapists, and even experienced practitioners develop a coherent framework, and an understanding of their therapeutic approach. Therapy must be effective, and it is therapists’ responsibility to ensure they do everything in their power to ensure that it is. If it is not effective people continue to suffer, which impact on everything and everyone in their life.
Therapists must have a clear understanding of what they can and cannot do, and must only practice within the boundaries of their competencies. For example, a therapist trained to work with individuals cannot offer relationship or family therapy. Relationship and family therapy require specialist training.
Therapists need to have a good understanding of neurodiversity, so they can offer appropriate service and referrals where this is necessary. It is therapists’ responsibility to update their knowledge through regular CPD activities.
Therapists must be able to extend empathy and a non-judgemental attitude (unconditional positive regard) to all their clients. Therefore, therapists need to be aware of their own prejudices, and exclude from their practice client groups, or individuals towards whom they might harbour prejudice. It is expected that therapists reflect upon and explore their prejudices to prevent blindspots, Therapists are not supposed to be ‘everything to everyone’. They must understand their limitations and either work to broaden the scope of their abilities, or refrain from working outside those limitations.
It is unethical for therapists to dictate to clients how often to come to therapy, or how many sessions they should have. Where services offer only a set number of sessions, it is important to explain to clients that this is just an organisational limitation, and not an expectation that clients will be ‘fixed’ in this number of sessions, or that this number f sessions is all they need. In private practice therapy is usually open-ended. It is always clients’ decision how often to see their therapist.
There has never been any evidence that there is any relationship between a particular interval between sessions, or a particular number of sessions, and therapeutic outcomes. Therapists in private practice who charge for their services must be respectful, and mindful of the fact that people have unique financial, and other life circumstances that impact on how often they can attend sessions.
Without changes to the brain, there will be no significant psychological change. Psychotherapy’s job is to facilitate changes to clients’ brain architecture (connectivity). Therapists cannot wire the brains of adult clients directly. It is important to remember that each client would require a different amount of time between sessions to process information, and wire their own brain. It is therefore nonsensical, and unhelpful for therapists to dictate to clients how often to attend session.
Conventions such as the ’50-minute hour’, or ‘6-session’ blocks have emerged as a result of what American medical insurance companies were prepared to pay for. They have nothing to do with anything clinical. These have become conventions in the profession, but they do not necessarily serve clients.
If a supervisee insists on dictating to clients how often to come to therapy, or for how long, they should be able to provide a good reason for why they do this. I always suspect that therapists who do this, do it to meet their own financial or esteem needs. All therapy relationships must be regulated by the needs of clients. I therefore do not support dictating to clients how often, or how many sessions to attend.
Practitioners must be prepared to engage with their own development and their own issues in supervision, and be committed to working towards increasing their self-awareness, maturity, integration, or self-differentiation (See Murray Bowen’s Scale of Self-Differentiation in the Resources section). The more integrated, differentiated and self-aware therapists are, the more they will enjoy their work, the safer and more effective their client work will be, and the more they will remain safe from energy drain, or burnout and from secondary-traumatisation.
Practitioners must be able to demonstrate a growing ability to question, reflect and think independently, while maintaining a firm grasp of professional ethics. Supervision supports reflexive practice, and continuous development of these skills.
No one is ‘perfect’, or ‘issue-free’, and therapists are no exception. It is unethical for therapists to ask their clients to go through a journey they themselves are not prepared to go through. Clinical supervision offers the opportunity for therapists to monitor, and engage with their own personal issues, which will inevitably surface in the course of their work with their clients. Therapists who do not engage with their own personal work regularly, risk blurring the boundaries between their own, and their clients’ issues. This can lead to a loss of perspective and objectivity, and can therefore compromise effectiveness. It can also be risky both for the client’s, and the therapist’s wellbeing.
While supervision is not the same as personal therapy, personal issues can and should be raised, discussed and processed if they present themselves in the course of the supervisee’s client work. It is not only appropriate, but essential for therapists to engage with their own therapy from time to time. Occasionally, where necessary and appropriate, this would be prompted by the supervisor.
- Supervisees’ level of engagement with the supervisory process would determine its usefulness.
- I trust that my supervisees are honest, and know what issues they need to bring to supervision. Supervisors cannot be responsible for what supervisees do not disclose.
- Therapy students on placement who are experiencing supervision for the first time, will learn what supervision is, and how to use it.
- Supervision supports the ongoing development of the therapist as a practitioner, and as a person.
- The relationship between the supervisor and the supervisee is professional and confidential.
- Important information on supervision is available on the BACP website.
- To see me for supervision, qualified practitioners need to be registered with a professional association, and have professional indemnity insurance.
- I prefer to work face-to-face, but I can do supervision by zoom if a supervisee cannot see me in person.
In addition to regular clinical supervision contracts, I offer individual and group supervision to organisations in other fields. Currently, I offer training and supervision to managers in the Learning Disabilities sector.
My supervision sessions run for 90 minutes, and I charge £85 per session.
Fees are payable at the end of each session by card, cash or bank transfer.