Clinical Supervision in the 21st Century: a Place Of Fear Or Love?

Professor Colin Feltham will be chairing our Conference on Supervision which takes place in Brighton on Saturday 29th April. In this article he shares some of his ideas on the practice of supervision in the UK. Whether you are a Counsellor or Psychotherapist who attends supervision regularly, or a Clinical Supervisor yourself, we hope you will find both Colin’s article and the Conference day enlightening and enriching. Our other speakers at the Conference are Robin Shohet and Dr Helena Hargaden.

Counselling in the UK has an almost 50 year history, and clinical supervision almost as long. Psychotherapy has a longer history and yet (at least in UKCP terms) a less clear relationship with supervision.

Supervision has always been well supported and promoted by BACP, indeed to the point of being mandatory. Counsellors – or as far as we know the majority of them – deeply appreciate the support and challenge provided by supervisors in examining their work, exploring its many nuances, prompting discussion of ethical and technical issues, deepening professional depth and trust, and underlining the safety of clients.

Traditionally, counselling supervision has been facilitative and exploratory rather than anything suggesting authoritarianism. While supervisors have a role in safeguarding clients and overseeing professional norms, they do have a slightly ambiguous position, and it is not unreasonable for counsellors and therapists – particularly in trainee and early career stages – to have some anxiety about how they are perceived. We learn from some research that many practitioners harbour longstanding personal problems of their own and/or encounter life problems that trigger anxiety in the midst of therapeutic practice. Hence, wariness can enter the supervisory space. Optimally, however, the supervisor-supervisee relationship will always manifest in low-anxiety and high-trust dynamics.

A modern look at clinical supervision

Given the development of clinical supervision, it is perhaps time to take a new perspective on it in the 21st century. A full picture shows that those party to all counselling and psychotherapy can include not only the client and practitioner but trainers, supervisors, and the personnel of professional bodies, employers and others. These all influence supervisory dynamics, albeit it from a distance and to varying degrees and may potentially stimulate conscientious reflection or increase defensiveness.

Training in clinical supervision

Supervision training at its best looks at the multifaceted supervisory relationship, theories of therapist development, essential ethical and legal knowledge, client protection and practitioner support, nuances of supervision according to different therapeutic orientations, varieties of supervisory format (individual, group, Skype, etc.), service contexts, working with difference and diversity, using creative techniques, and so on.

Covered less well in training are the topics of research awareness and critical thinking. Necessary distinctions made between supervision and teaching may have unintentionally steered the supervision field away from the benefits of alerting supervisees to emerging research findings, fresh theoretical developments, and queries about the limitations of some approaches. This isn’t to say that supervision should be inappropriately turned into a tutorial format, but that its potential for helping some supervisees to update their knowledge and challenge their thinking might be better recognised.

Attitudes differ but different therapeutic approaches variably emphasise self-awareness or technical competence. A key question is the extent to which all supervisors can oversee and facilitate exploration of supervisees’ relevant emotional worlds, unresolved issues or moment-by-moment awareness, say, and/or assessment abilities and technical range. In other words, should we expect supervisors to be more or less orientation-specific or competent to supervise practitioners from quite different approaches (e.g. person-centred, psychodynamic, CBT, long-term and short-term). Currently training honours traditional limitations, but we should be able to ask whether supervisory training should be standardised. However, the somewhat differing norms of BACP, UKCP, BPS and others can make this challenging.

The changing needs of supervision

Certain under-examined themes also deserve attention. For example, BACP’s mandatory requirement creates dilemmas of power which should be examined. Lines between supervision and personal therapy deserve further attention. The needs of practitioners at different stages of their career call for our attention: these extend from trainees who do not necessarily know how best to use supervision, and how to assertively ask for what they need, to highly experienced practitioners whose needs are likely to be quite different. Therapists working in private practice have different needs from those working in the NHS, for example; and those with high caseloads which may include high turnover, or clients with complex needs, can face quite different challenges from practitioners with small caseloads.

Understanding the changing needs of counsellors as they go through their careers is vital to the supervision process.

Just as individual practitioners face ongoing, complex and subtle demands, so supervisors in supporting them do their best to facilitate exploration in trusting relationships, balancing direct interpersonal factors against institutional influences, triadic dynamics, clinical choices and layers of ever-shifting theoretical development. Supervisors have to balance sensitive relational support and stimulation with ethical decision-making.

Developing the profession

Arguably, the supervisor community, along with a loose-knit community of trainers, is the closest thing the counselling and psychotherapy profession has to an on-the-ground, responsible body of practitioners able to take the profession forward. For this reason, courses, workshops and conferences focusing on supervision offer a crucial opportunity for dialogue, networking, cross-fertilisation and taking the profession forward.

Paradoxically, while counsellors, therapists and supervisors naturally focus on immediate practice needs, attention also has to be given to fundamental and recurring questions of what mental health is, and what changes may occur in our understanding of mental health problems, their causes and remedies. Supervisors and supervisees are not working together, with money changing hands, simply to effect a feel-good relationship. The enterprise is there in order to enhance clients’ mental health (or increase insight, resilience and consciousness) and there may be different, even better ways to help achieve this. UKCP, for example, allows for CPD activity and collegial consultations to work in ways similar to supervision. It may be that some practitioners might benefit from greater immersion in relational depth in supervision, while others would benefit from intensive tutoring in ethical and legal developments. We do not currently know how to make such calculations but by meeting together and openly discussing them we might make due progress.

Similarly, we could discover that swathes of mental distress originate in oppressive socioeconomic circumstances and consequently decide that supervision could be an ideal place for investigation of a politics of distress and a more politically informed practice. The point is that things change, new knowledge emerges, and arguably we should not allow our comfortable traditions to impede discovery in the interests of better mental health. Love of learning ideally outweighs fear of the new. And, to cite a well-known piece of reframing, when the situation is hopeless but not serious, supervision can be a place where humour works to gain new perspectives.

This article was written by Colin Feltham who will be chairing our conference on clinical supervision.

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  1. 5kapks.com on 2017-05-20 at 9:04 PM

    Whether clinicians are already supervisors or hoping to become one, they can prepare for the role by developing familiarity with the literature on the supervisory process, including the new ASHA documents on supervision.

  2. Brighton Therapy Partnership on 2017-09-27 at 8:12 PM

    We feel the above comment needs clarifying: ASHA is the American Speech-language Hearing Association. Some of their documents on supervision may be helpful to North American colleagues, but in the UK (where BTP is located) there is no direct equivalent. UK Practitioners looking for information on Supervision should check with either their original training organisation or their accrediting body (e.g. BACP, UKCP, BPS, etc), or independent supervision training bodies such as the Centre for Supervision and Team Development (run by Joan Wilmot and Robin Shohet in London, and by Peter Hawkins in Bath).

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