Introduction
In this post, I wrote about my view that responsible practice requires one to be in one’s own treatment.
I believe something similar about supervision.
Psychotherapists arrive at the practice of psychotherapy from a variety of professions, after a variety of trainings. In New York State, where I’m licensed as a clinical social worker, once I got my license, I was presumed competent to practice, subject only to the requirement that I complete a small number of “continuing education units” each year, starting four years after my licensure. I believe this to be true of psychologists, mental health counselors, marriage and family therapists, creative arts therapists, and so on.
This strikes me as tragic.
I don’t know how to do this work without constant supervision – and supervision of every sort. I participate regularly in one-on-one individual supervision, both as supervisor and supervisee; I participate regularly in peer supervision; I co-lead an ongoing group supervision; and, I often participate in group supervision as a participant and not a leader. Each of these situations, each of these roles, brings different benefits. Each, to my mind, adds immeasurably to my practice. And without any one of them, my practice would suffer – as would my life.
The importance of supervision
The practice of psychotherapy – the process whereby we sit in a room with another person, or couple, throuple, or family – and engage in a back-and-forth process of talking and listening – inevitably gives rise to a bit of a “reality distortion field.” The people engaged in the treatment create an entity between them that is “the treatment” and, for the most part, tend to agree on just what it is. They may have different feelings about the treatment, but (absent psychosis) they tend to feel they are embarked on a journey together. The thing about journeys taken together, though, is that they often look different to the people who are on them than they do to those who are watching the journey. They often feel different to the people on them than those watching might imagine. In a theater, every seat has different sightlines, has a different view. Same on a bus, or in a car. This phenomenon exponentially increases in therapy.
This is where supervision comes in: I make it a point to discuss every one of my patients with colleagues from time to time. Often – more often than not – my colleagues hear something in my description of the work that not only had I not heard/seen, but that comes as a genuine revelation to me. As you embark on your career in private practice, I urge you to incorporate as much supervision in your schedule as you can tolerate, both in terms of hours and in terms of money. I promise: you’ll find it repays your investment in spades – in clinical benefit with your patients, in referrals, in personal and professional development, and in deepening social relationships within the field. It’s a no-brainer: get thee to a supervisor.
Some of the benefits of supervision
Clinical insight
Early in our careers, the government (state, province, country, whatever) requires us to get supervision. Therapists aren’t in a guild. We don’t “apprentice.” But we understand that school can’t teach us everything we need to know to serve our patients. Rather, we need the clinical insight of experienced, sophisticated practitioners to help steer us in the right direction.
I don’t know of anyone, in any field, who is done learning, or who possesses comprehensive insight that can’t benefit from an outside perspective. Therapists, especially. We each practice with a particular style, informed by a set of theoretical perspectives. Some of us are supportive. Others practice psychodynamically, or psychoanalytically. Some, behaviorally. And then, even within those theoretical perspectives, there’s lots of variety. (My practice tends to be pretty classically Freudian, with a contemporary slant, informed especially by insights from Anna Freud, Donald Winnicott, Stephen Mitchell, and, more recently, Mark Solms.) It can be super-helpful for me to hear from a more Kleinian colleague, or one who is deeply immersed in the thought of Jean Laplanche, or Jacques Lacan.
Talking with a colleague who hasn’t been in the room for the entirety of the treatment alone brings benefit. But add another clinical perspective, and I learn a lot!
Supervisors ask good questions, offer good suggestions, that expand my technique, shed new light on thorny challenges, and generally deepen my thinking. This all can be enormously helpful – to me, and to my patients.
Ethical safeguard
Humans are vulnerable. Therapists are vulnerable. Patients are vulnerable. A seemingly minor oversight or ethical blunder can lead to significant harm to the patient (and personal, or even, occasionally, legal repercussions for the therapist). A good supervisor serves as a second set of eyes, and a sort of insurance policy against malpractice. Not “malpractice,” in the legal sense (although yes, that too). But malpractice in the sense of failing to do everything we can for our patients. To my mind, that’s a far more present danger than malpractice of the legal persuasion.
Emotional support and companionship
I often hear people say that therapists have an “isolated” profession. Certainly, that’s possible. I have colleagues who are isolated. But isolation is an option, not a condition, of practice. I find it nourishing to talk with colleagues about my work. I do it often, with peers, supervisees, supervisors, and my analyst. I find all of those folks’ companionship in my practice vital.
Networking and referrals
Good supervisors refer to good supervisees. Good supervisees refer to good supervisors. ‘Nuff said.
The Practicalities: Finding and Working with a Supervisor
Given its importance, how do you go about finding a suitable supervisor? Here are some pointers:
- Credentials and Expertise: Look for someone who not only has the credentials but also specific expertise in your areas of interest.
- Compatibility: This is a professional relationship but also a deeply personal one. Make sure you are comfortable with the supervisor’s style, approach, and feedback mechanism.
- Financial Considerations: Supervision is an investment. However, it should be affordable. Many experienced clinicians offer a sliding scale, and some might even provide low-cost supervision for new therapists.
- Frequency and Format: Decide how often you will meet and in what format (one-on-one, group, peer). Each has its pros and cons, and a mixture is often the most beneficial.
- Confidentiality: Ensure that the supervisor you choose respects patient confidentiality as much as you do. Always anonymize patient information when discussing cases.
Conclusion
Supervision is not just an optional extra; it’s a cornerstone of responsible, effective practice. And it is not just a one-off activity but an ongoing requirement. In my experience, the therapists who prioritize supervision are often the most competent, ethical, and successful in their practice. As you embark on or continue your career, heed this advice: Make supervision a non-negotiable part of your professional life. It’s not just your practice that will benefit; it’s also your personal well-being and, most importantly, the well-being of those who entrust us with their mental health.
AI note: I used both Claude and ChatGPT to suggest “excerpts” for this post – the summary of the post on the front page. Neither did a great job, but I modified Claude’s suggestion somewhat. I asked them also to suggest an image prompt for an accompanying image. ChatGPT skipped the prompt, and just gave me an image (one I didn’t like). Claude gave me a prompt, which I gave to ChatGPT/DallE and to Midjourney. Midjourney won. The prompt was “A group of psychotherapists in discussion during a supervision session.”
