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
alliance, and progress measurement. Since the information and skills for all these topics is complex, I will do my best to keep it as clear as possible. This information aims to improve existing clinical supervision practices.
increased anxiety, and was sometimes accompanied by negative responses from clients, other clinicians, and managers.
art, science, engineering, and humanities. He saw art as science and science as art – most clinicians recognize these combinations in their own clinical work. I will simply note a list of documented attitudes, values and behaviors that DaVinci mastered. Here is the list. Courage may be needed to move off your comfort-path.
cognitions and emotions from the past, we need to move to the present moment and be there in calmness and safety. Of course other interventions are required when psychosis, intoxication, or extreme emotional dysregulation occur; meditation is not the recommended response in these conditions. One of the best ways to introduce your clients to meditation is to simply allow a gentle focus on the breath, just as it is. Relaxation-focused manipulation of the deep breath, especially for client with untreated trauma and polyvagal complications, may lead to the opposite effect – stimulating anxiety. Once your client can focus gently on her/his breath and benefit from brief exposures, he/she may be ready for brief meditations.
hold your head in a relaxed and level position. Now loosen your jaw and notice. Practice releasing any tension that you may be carrying in your throat. Let it go very gently, and open up your throat. Now bring attention to the area of your heart center, and imagine a warm, glowing, gentle inner light there. Notice the feeling. Allow it to nurture you. To end simply be with your natural breath; after a few breaths, allow it to bring you to full attention. This meditation is over.
positive thoughts and emotions. When we get stuck in negative cycles of thinking, feeling and doing our right brain and limbic area dominate. A very old mindfulness belief is that you are not your thoughts, your emotions, or your behaviors; these parts of you are simply associated with your life experiences. When a client learns to defuse a though it means they have changed its linguistic structure and removed it from being cemented into their CABs, or cognition-affect-behavior cycles. In all good therapies, especially Cognitive-Behavioral Therapy and various mindfulness therapies (MBCR, DBT, MBCT, MBRP, ACT), helpers often work on truth-analysis of unhelpful, repetitive, negative thoughts patterns – especially those embedded into CABs cycles of ineffective experiences. Self-medication, isolation, and avoidance are commonly associated with these realities. Sometimes this work includes meta-cognitive analysis regarding your thoughts about your thoughts or the patterns of your thoughts. The clear logic is that the words we often tell ourselves in times of stress or fear are NOT often true. Of course, if indeed you are seriously endangered best to allow your limbic brain area to save your life. The list below will note various approaches used to defuse thoughts from our experience of being, our CABs cycles.
example: “I am so worthless” helps solidify your brain plasticity about personal meanings and images. Try this: “Sometimes I feel worthless” or “When really bad things happen, I can feel worthless” or “My unpleasant feeling can relate to feeling less worthwhile.”