Supervision at union square psychotherapy explained

Supervision at Union Square Psychotherapy

I've read about supervision on your website. I've never heard about supervision when it comes to psychotherapy before. What is it?

Psychotherapists and psychoanalysts often participate in a process called supervision. It may be provided individually, one-on-one. It may be provided among peers in a group. Or it may be provided by a senior clinician to a group in group supervision.

In a clinical context, the word supervision means something very different from its conventional meaning. Good supervisors in a clinical context do not tell their supervisees what to do. They are not typically the boss of their supervisee. In fact, at Union Square Psychotherapy, it is a policy that supervisors not be the boss of supervisees — precisely to protect the supervisory relationship.

So what is supervision in a clinical context, if it's not what I usually imagine?

Supervision is effectively consultation. In one-on-one individual supervision, a clinician discusses one or more of their treatments in detail with their supervisor.

Does this mean that what I say to my therapist isn't confidential?

No, not at all — for two reasons. First, when presenting a case in supervision, clinicians typically obscure identifying details of the patients they're discussing, so as to avoid making them identifiable. Second, even were a patient to be identifiable, the supervisor is, like the clinician, bound by the same ethical and legal responsibilities of confidentiality.

So what actually happens in supervision?

The answer depends on the clinician, the supervisor, and the treatment being discussed.

Sometimes a clinician will bring what is called process — or a process recording — to supervision. This is an after-the-fact, reconstructed transcript of a session. A clinician might sit down after a session and write what they remember, verbatim, of what was said. Of course, this is not the same as an actual transcript, because it comes from memory — memory that is often uninformed by notes, since most clinicians do not take notes during sessions. If a clinician brings process to a supervisory session, they might read through the session aloud and then discuss it with their supervisor.

Alternatively, a clinician might simply present a treatment: spend a few minutes describing the patient — demographically, genealogically, in terms of what brought them to treatment, and in terms of what has happened since. The clinician then offers a brief account of the current dynamics: the subjects being worked on, the feelings being worked through. The supervisor sits with the clinician, trying to help them make meaning of all that is going on — trying to make sure the clinician isn't missing something obvious, whether that's something the patient is communicating or something the clinician themselves is feeling or thinking.

We all have blind spots. And relationships — even those between patients and clinicians — can reproduce blind spots or problematic dynamics from either person's prior life. This can happen in ways that even the most vigilant, thoughtful, and experienced clinician might miss in the moment. For this reason, a good supervisor can be essential to a good treatment.

Does the fact that my clinician is in supervision mean they are inexperienced?

Not at all. At Union Square Psychotherapy, all of us — including our supervisors — are in supervision. In the same way that one cannot be a good psychoanalyst or psychotherapist without participating in their own psychotherapy or psychoanalysis (at least so we believe), it is hard to practice responsibly without regularly talking about your work in supervision.

That said, many of our clinicians are at the front end of their careers. Some are not yet licensed to practice without supervision. In New York State, clinicians are typically required to accumulate two to five years — and as many as two to three thousand hours — of clinical experience before the state considers them qualified to practice independently.

Regardless of where a clinician is in their career, at Union Square Psychotherapy we ask all of our clinicians to participate in supervision and in their own personal treatment. It is one of the things we believe makes the work worth doing.