Core Elements in Clinical Supervision
In addition to what supervisors bring into group supervision and clinical training, the list below will be used for discussion about YOUR supervisory role. The order of content below is generally random. The content noted applies to clinical supervision; it could also apply to doing effective therapy. The skills and knowledges here make up a toolbox for effective clinical supervision. That said, it cannot include everything.
- DO NO HARM in all supervision modalities (individual, group, education/training)!
- Know your code of ethics, especially sections relating to clinical supervision, education/training, clinical relationship, and the role of technology.
- Understand how the past becomes the present – your own attachment and developmental history and experience. Your own “dragons.”
- Know how to use strong empathy and therapeutic alliance/relationship skills.
- Face the reality of co-occurring conditions in clinical practice. Even if your role is dealing with “the walking well,” there are most likely co-occurring conditions if not diagnoses.
- Know how to use and supervise 2-3 evidence-based therapies ( BT, CT, CBT, CBT-M, Process-Based CBT, DBT, DBT-S, MBSR, MBCT, MBRP, ACT, Narrative and Solutions-Oriented approaches, etc.
- Recognize that the EBTXs are the science behind the art of therapy. Client and supervisee progress require both art and science.
- Experiment with creativity – but do no harm.
- Know how to use restructuring and reframing.
- Understand the science behind client-matching variables. Recognize the impact of anxiety, depression, trauma, addictions, etc.
- Do your best to use a bio-psycho-social-spiritual model. Pay attention to preferences of people you supervise. Never impose a narrow focus.
- Consider Quintiliani’s “neurotherapy” by using cognition, affect, behavior, sensory experiences (see, hear, feel,, etc.) as well as intuition, spirituality and relational variables and conditions. Refer to the Attachment-CABS-VAKGO-IS-Rels model.
- Study more neuroscience and how it relates to cognitive and behavior change and the human mind-body system.
- Learn and use effective emotion regulation skills and practices.
- Focus on the impact of cognition (thoughts and deep structures), emotion, behavioral conditioning, social justice, marginalization, trauma (especially pre-verbal), addictions (include pesky cellphones), and mindfulness.
- Observe! Observe! Observe! (direct observation of the work) and Respect! Respect! Respect!
- Remain fully aware of possible transference and countertransference processes, especially projective identification.
- Know that context, personal aspiration, and personal values matter.
- Recognize parallel process from therapy to supervision and back again.
- Know that in most states the supervisor is 100% responsible for the actions of the people they supervise, even if those actions were not recommended or are unknown to you.
- Know how to use compassion in practical ways, especially with defensive ego-protective patterns in people.
- Never make identifications of the whole person as their clinical condition of diagnosis. In fact, add much more to the individualized interventions.
- As you observe and respect be a good mentor to motivate, but never forget client protection is the first priority. Their progress is a second priority.
- Know your roles: hire, fire, oversight, evaluate, train, support, organize, coordinate, and DOCUMENT. Know abut all HIPAA and 42 CFR Pt 2 requirements.
- Always use a written supervision contract/agreement, and recognize informed consent aspects as well as due process in it.
- In co-occurring work, seek a role for 12 Steps and/or peer recovery support.
- Keep strong BOUNDARIES in all aspect of this work.
- Pay attention to learning styles.
- Some of the work is a form of palliative care, in that counseling and therapy sometimes deal with life-or-death issues. It is a form of sacred work.
- Know about duty to warn and protect – and its various implications.
- Supervision (like therapy) needs to be structured but not rigid.
- Recognize that generic “talking” has very little empirical support for supporting change in serious co-occurring disorders.
- Be capable in dealing with conditions of potential suicide, self-harm, and harm to others.
- Supervision needs to be based on an agreement, a professional development plan, and change-oriented interventions, techniques, and processes. In the final analysis, the supervisor is in charge – final decision making re. competence of supervisees and protection of others.
- Look after your own self-development as lead clinicians and supervisors.
- All may fail if you do not attend to your own SELF-CARE and the self-care of the people you supervise. Etc.!
Be well and reduce suffering!
Anthony R. Quintiliani, PhD., LADC
From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton Sangha
Author of Mindful Happiness