Creating the Context for Effective Supervision

Particular requirements must be met in order for clinical supervision to bear fruit for workers and the organisations employing them. Specifically, clinical supervision should: (Click on each point to expand or collapse)

1. Be accessible, regular and consistent

Generally, clinical supervision sessions must be held on an ongoing basis, at regular intervals and for a prescribed duration, with the terms of the relationship negotiated via contract between the supervisor and supervisee(s), within the bounds of the employing organisation's policies and protocol. Common practice for individual supervision is a 60 to 90 minute session held either weekly, or fortnightly to monthly; but supervisees will differ in their needs, according to their experience levels, their caseloads and other such variables, so one cannot state categorically what is best for particular workers in a particular context. Facilitated groups and peer group meetings may be less frequent, in general, than individual supervision, but they usually involve longer sessions to accommodate the larger number of participants.

A safe, comfortable, private and professional space in which to conduct clinical supervision sessions is a necessity and its importance should not be underestimated. Public meeting spaces such as cafes or open office spaces are not only inappropriate, but potentially undermining of the supervisory process.

2. Involve a clear two-way contract, preferably written

The contract between the clinical supervisor and the employing organisation

Before engaging in clinical supervision, it is imperative that a supervisor be clear on the expectations of organisational administrators in regard to evaluation and feedback from the supervisory process. It is necessary and appropriate that supervisors provide regular reviews of their work with supervisees (e.g., frequency and duration of sessions, modalities and models of supervision, etc.) and evaluations of their supervisees (e.g., developmental progress, areas for further learning, etc.), but within bounds of confidentiality which need to be clearly explained. This is especially important when a supervisor is operating externally, outside the supervisee's particular program or team, or completely outside the employing organisation. Supervisors should familiarise themselves thoroughly with the expectations of the supervisee's program, team or organisation, in order to ensure that they are aiding the supervisee in meeting those standards. Additionally, supervisors must be knowledgeable about the professional codes of ethics to which the supervisee is held accountable, including where it differs from the supervisor's own.

The contract between supervisor and supervisee

Whether it is written or not, stated or not, agreed to or not, there is always a contract. Most supervisors and organisations prefer that contracts be written, agreed upon and signed. They should involve a two-way process, with supervisees actively participating in the development of the particular contract. A standard layout may be used for all supervisees, including the key areas that need to be negotiated. The detail is likely to vary depending on particular needs and in order to reflect the individual relationships and agreement. If the format is group supervision, the contract should be negotiated with all of the group members, but may also include such things as separate learning goals for each participant.

Supervisors and supervisees are advised to refer to the following documentation during the contracting process to assist in creating a clear understanding of what to expect from each other.

Section 7.5 - Contracting

Supervisor and Supervisee Rights and Responsibilities

3. Be seen as a significant part of clinical work, and prioritised accordingly

Ideally this responsibility is shared by supervisor and supervisee, and is reflected in organisational policy and process which ensures that it is valued and supported as a routine aspect of clinical practice.

4. Balance the functions of accountability with support, education and the provision of a safe, reflective space

The tasks performed by a clinical supervisor will depend upon the developmental level of the supervisee and supervisor in any given situation, as well as the model of clinical supervision he/she chooses to adopt.

A number of scholars conceptualise supervisory tasks as falling broadly within three categories: those that are focused on the content and process of a supervisee's work (developmental), those that acknowledge the emotional impact of the work and help the supervisee identify appropriate resources to meet professional developmental needs (resourcing); and evaluative tasks which ensure the supervisee's compliance with standards.

Read 7.6.2 for more about these three functions of clinical supervision and associated tasks

5. Include, over time, attention to different aspects of the work

Such aspects include -

  • The Client's story: context; strengths; challenges, etc
  • Interventions used: purposes, skills, techniques
  • The Worker/Client Relationship: the contract, the stage of the relationship, boundaries; metaphors; emotions; transferences
  • The Worker her-or-him-self: context, preferred model, professional growth and development; agendas; feelings; any counter-transferences
  • The Supervisor/Supervisee Relationship: the contract; parallel process, review; any blocks; positive or negative transference
  • The Supervisor: Preferred models and frameworks; parallel process; the contract; relational issues
  • The Systems: The client's family system; the employing organisation; other agencies; class; culture

6. Utilise methods other than supervisees' reports of the work

It is common practice for supervisors to become familiar with a supervisee's clinical work indirectly via the supervisee's self-report. It is also helpful and appropriate for clinical supervisors to directly observe some of their supervisees' practice, at various phases of the supervisees' development. Observation of supervisee work can be done either in a live session, or via a recorded session. Another option is to have the supervisee transcribe a portion of a session which is then reviewed in supervision.

Table 9 presents four methods of observation, with their challenges and benefits.

NB: Clients need to be informed about the limits to confidentiality, not only as part of the initial client contract, but also when they are being spoken about in supervision, unless there are specific contra-indications. Specific permissions should be requested and granted from clients before any sessions are recorded, or observed live.

7. Encompass modalities other than talking

Techniques used in clinical supervision need not be limited only to verbal representation and exploration of the work. Expressive, visual techniques such as the use of drawing, painting and working with representational objects or sand-play can be highly effective; particularly if a supervisee is feeling stuck and needs to do something different to gain a fresh perspective. Workers who are already familiar with expressive therapy techniques may find it easy and natural to incorporate the ideas into their clinical supervision, while others may require training in these ways of working.

For groups, role plays, sculptures, enactment and reflecting teams or outsider witness groups can generate new energy and ideas for both understanding a case, and moving the work forward.

8. Include a confidential record of supervision with a clear understanding of where and how long this is stored and who has access

What the supervisor records

The types of notes taken by supervisors vary according to theoretical orientation and model of supervisory practice, but the act of keeping records is considered a standard of competent supervision and is a necessary aspect of risk management. Records need to be as clear and transparent as possible, whenever possible. Click here for examples of records that are useful to keep and the tasks associated with keeping them.

NB: These suggestions pertain to reported supervision (as distinct from live supervision, which may necessitate a different or additional type of record keeping).

What the supervisee records

It is common place in training programs for students to keep logs about their clinical work and their interface with their professional development. Mason (2002, cited in Moloney et al., 2007) suggests a format that includes theory, technique, research, ethics, the therapeutic utilisation of the self, supervision and peer consultation as a way to stay rigorous about reflective practice.

Supervisees may find it useful to keep a journal for reflection on their work and the supervisory process.

9. Incorporate regular two-way reviews

As Koocher & Keith-Spiegel (1998) note, the clinical competence levels reached by a supervisee, and ultimately the welfare of his/her clients, are influenced by the supervisee's willingness to acknowledge vulnerabilities and admit mistakes. Clinical supervisors must create a context for mutual honesty and respect.

Everyone has their own personal style in offering feedback. Your style may or may not fit well with your supervisee's expectations. It is important to explore a supervisee's past experiences of helpful and unhelpful feedback and gain perspective on what works best for him or her. This can be highly illuminating for the supervisor, and can help to avoid unnecessary ruptures further down the track.

It is also useful to discuss openly what methods of evaluation will be used and to ask for the supervisee's input in making these decisions. Supervisees will differ in how they are most or least comfortable having their work judged; while this may not be completely open for negotiation, it can help to know and to prepare ahead of time.

Click here for a list of evaluative tasks to be completed by a supervisor

In addition to the supervisor evaluating supervisees, supervisees should be able to give feedback to their supervisor about the quality of their supervision and their experiences of the supervisory relationship. Supervisors should initiate discussion about this in the contracting stage of the relationship as well as actively soliciting feedback from supervisees on a regular basis (e.g., checking in at end of a session or at the beginning of the next one about what was the most or least helpful to the supervisee).

For further information about managing feedback and evaluation read Section 7.9

10.  Honour the supervisory relationship as central to the process, and be prepared to work on any blocks and ruptures

Issues can and do arise that are related to such aspects of the work as:

  • practical problems (e.g., chronic lateness or failure to attend arranged sessions)
  • theoretical or philosophical disagreements
  • parallel processes (e.g., supervisor begins to experience the supervisee in the same way that the supervisee describes experiencing the client), or
  • an area of vulnerability gets opened up for either party

 

It is best for the working alliance of supervisor and supervisee if they are able to address, and resolve, any problems or ruptures which occur in clinical supervision themselves. Where issues remain, a third party should be called into help. Who that third party is, and what role they hold within the organisation, will vary according to organisational protocol, but it should be someone who is in a senior position, who understands the clinical supervision relationship, and who is trusted and perceived as helpful by both parties.

11. Allow for issues of diversity to be raised and dealt with sensitively and competently

One's identity and its meaning in relation to power, status and entitlement may be very significant to the supervision process. Just as gender and power are integral, so too are those factors that uniquely identify, engage, or just set us apart from others. If arranging cultural factors impacting relationships along a continuum, on one end would be the big issues, such as race, ethnicity, religion, gender, sexuality, class and illness, or disability; and on the other end would be the smaller, but still potentially significant differences, existing between families, professions and workplaces.

To follow are three groups of suggestions, from the most general to the most specific, regarding steps toward culturally competent supervision. The first is about taking charge of one's own personal competence; the second about competence within the supervisory relationship; and the third about competence within the supervisor-supervisee-client triad.

7.11.1 Self Review & Personal Action

7.11.2 Creating an Anti Oppressive Supervisory Relationship

7.11.3 Attending to the Supervisor-Supervisee-Client Triad

12. Incorporate professional ethics at a number of levels

See Ethical and Legal Considerations

13. Be provided by clinical supervisors who have the necessary experience, skills and knowledge to meet the demands of the work

See Clinical Supervisor Competencies

14. Incorporate self care skills and the prevention of compassion fatigue

Review the self-care checklist created by staff from the Traumatic Stress Institute in 1966 as a starting base for discussion about self care strategies.

15. Be accountable to the employer, each other and (above all) to the clients