Effective Clinical Supervision

Perhaps other than the mental health status of the therapist and her/his ethical clinical skills, there is no more important variable in successful clinical work than effective CLINICAL supervision.  I emphasize “clinical’ because in today’s bureaucratic systems, so much supervision tends to be about required procedures like utilization level, reporting requirements, and documentation for services rendered. There is nothing wrong with including these areas – as well as ethics and liability reduction – but this is NOT pure clinical supervision. In my over 35-year career as a clinical supervisor I have tried to maintain a few guidelines to keep my clinical oversight on target: good clinical supervision and at least adequacy in other areas bureaucratic practices. I have emphasized three areas of supervisory practice: the relationship, the balance between task-maintenance activities, and the “Triadic Model” of supervision. The ultimate importance of the supervisory relationship is obvious; it parallels a good clinical alliance between therapists and their clients.  Balancing task activities (bureaucracy) and maintenance activities (psychosocial support for the helper’s emotional health) is an ever-present challenge for clinical supervisors. The Triadic Model of clinical supervision, above all other approaches I have used, has in my opinion resulted in the best outcomes for me, my supervisees, and their clients.  This model integrates three areas of supervision: teaching evidence-based therapy skills (so you need know them), ethically matching such clinical skills to the supervisee’s abilities and their individual client’s conditions, and the emotional functioning of the supervisee (perhaps the single most important variable of all). With this as a foundation, I will now review what current research has to say about effective clinical supervision.

Effective Clinical Supervision includes:

1. Advancing the personal and clinical growth of the supervisee;
2. A positive working alliance in the supervisory relationship;
3. Establishing effective empathy with reflection as a way to develop a “secure base” for the supervisee;
4. Mutually-derived supervisory goals and processes;
5. Encouraging supervisee autonomy and self-direction within limits;
6. Attuned attention to the supervisee’s needs;
7. Open, non-defensive clinical discussion about clients, their clinical conditions, skills, ethics, etc.
8. Clarity in the supervisor’s clinical and interpersonal competence;
9. A reality that the supervisor is skilled in several evidence-based therapy practices;
10. Mutual respect and comfort in the process;
11. Careful exploration of personal issues that may impede client and supervisee progress;
12. Very selective self-disclosure related to client and supervisee outcomes;
13. Ethical practice with clients’ interests and liability reduction in mind;
14. Multicultural competence;
15. Good clinical case formulations;
16. Understanding and being able to deal with transference and countertransference processes;
17. Clinical demonstration and role play of effective clinical skills, including the alliance;
18. Practical and useful scientific viewpoints about therapy – knowing the clinical literature;
19. Direct meaningful feedback to the supervisee regarding their progress or lack thereof;
20. Formal evaluation based on goals of the supervision; and,
21. Periodic supervisory supervision of the clinical supervisor.

Ineffective Clinical Supervision Includes:

1. Any number of deficits related to the effectiveness characteristics noted above;
2. Weak supervisory competence (clinical and supervisory);
3. Devaluing and depreciating supervisory practices;
4. Poor supervisory relationship;
5. Weak clinical case formulations;
6. Over-dependence on task/administrative activities in supervision;
7. Poor skill as a trainer and therapist – not knowing what works best and why; and,
8. Supervisor’s mental and emotional issues (especially personality, traumatic, mood, and addiction problems) that impede clinical development of the supervisee.

Note: By listing the ideal conditions of effective clinical supervision, I in no way imply that I utilized ALL of the positive characteristics in my own clinical supervision. That said, however, I know I utilized many of them as a conscious and mindful supervisory practice.

This post is based on many supervision practice and research sources. For a comprehensive review of research on clinical supervision refer to Ladany, N., Mori, Y. and Mehr, K. E. (January, 2013). Effective and ineffective supervision. The Counseling Psychologist, 41(1), 28-47

By Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont

Author of Mindful Happiness  

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