Expectations and Goals in Clinical Supervision
What are your expectations about what will happen in your clinical supervision, and what you will get from it? Are you able to identify your greatest needs to meet in the process? How do you name the short-, medium-, and long-range goals that you will attempt to achieve in supervision? These questions are important to answer, and fortunately you do not have to consider them alone.
The importance of a robust working alliance
Many mental health helpers are aware of the burgeoning research showing that, regardless of therapy modality used, the counsellor-client relationship is one of the most important factors in achieving successful outcomes for the client. The same is true of the working alliance between the counsellor-supervisee and the supervisor.
Keithia Wilson and Alf Lizzio (2009) cite research (Barnett, Doll, and Younggren, 2007, and Milne and Westerman, 2001, both in Wilson & Lizzio, 2009) to assert that the collective evidence from a range of studies shows that the quality of the supervisory relationship in the formative stages of a supervisee’s professional development has a longstanding effect on them; that effect can stunt as well as enhance supervisees’ growth. Moreover, we can view the quality of the supervisory relationship as both a foundational intervention in its own right and also a tool for enabling more specific supervisory methods and interventions (Kilminister & Jolly, 2000, in Wilson & Lizzio 2009).
As a supervisee, you are likely to be aware that a trusting, collaborative relationship will help you to experience the supervision space as a safe learning environment, one in which you can openly discuss your work, bring up fears about your competence and limitations, and generally be supported to experiment with new strategies, techniques, and behaviours (Wulf & Nelson, 2000).
Thus in order to most validly identify expectations, needs, and goals, Wilson and Lizzio urge supervisor and supervisee to collaboratively answer four pivotal questions, framing them in the context of an effective working alliance:
- What learning goals shall we pursue?
- What approach to learning suits our circumstances?
- What type of relationship will work the best?
- What management processes do we wish to establish? (Wilson & Lizzio, 2009).
We consider each in turn.
What learning goals shall we pursue?
When you take your seat in the supervisor’s office, what happens next? Do you whip out a carefully prepared list of concerns to bring up, or are you more likely to just “wing it,” figuring that on the day you’ll know what you should spend your time on? Admittedly, supervisions can be “hijacked” by a therapy session that didn’t go to plan, or which brought up new counsellor concerns, such as we posed with Jana in the introduction. In terms of the medium- and longer-term supervisory alliance, however, you are best served by identifying goals in an overarching way and then creating with your supervisor an initial contract that addresses them, with an eye to achieving specific outcomes.
Some goals will need to be pursued before others, different goals will be of varying lengths, and some will not even come into view until you have moved on in your development as a counsellor. Together, you and your supervisor will need to identify goals as you begin work together and then at intervals throughout the supervisory relationship.
What are the options for the types of topics/goals you might work on? If we go back to the purposes of supervision (above) of enhancing your professional knowledge and skills, integrating research and theory with skills, monitoring the quality of services offered to your clients, and supporting you (generally) and your capacity to self-reflect, self-evaluate, and self-develop (specifically), several categories emerge:
Process (intervention) skills
These could be defined as what counsellors do in their sessions, from requesting information, reflecting, role playing, and confronting to supporting. Also called “technical competence”, a goal in this area might be expressed like, “I learned about subpersonalities during my training, but now I have a client with internal conflict who would probably benefit from this technique, and I don’t feel confident to use it. Can you help me get some practice with it so that I can use it with that client?”
These involve your cognitive processes and include sometimes out-of-awareness behaviours, such as identifying client concerns, discerning predominant client themes, designing interventions, and planning future sessions. Also referred to as conceptual competence, this category allows you to conceptualise your practice and explicate underlying principles that inform interventions.
A goal here could be something like, “I’m aware in a general way that many of my senior clients are being impacted by the new aged care requirements, but I don’t really understand them or how to think about them in relation to client concerns. I’d like to get a handle on the whole issue”. Skills of systemic competence might fall into this category, as you manage the context of professional practice, working relationships, and organisational dynamics, but some authors (e.g., Lizzio & Wilson, 2002) put them into a separate category, given the huge impact they can have on a counsellor’s practice.
These refer to the interplay between your personal qualities and your work with clients, and also your ability to form an identity as a therapist. This broad-ranging category encompasses a multitude of issues, from aspects such as separating your reactions from those of your client, through non-defensiveness with clients and supervisor, to dealing with emotions in clients and in yourself. Included here can be skills of self-regulation: the capacity to self-reflect on your practice and learn from your experience. A goal in this area could be something like, “Whenever the husband in my couple client starts talking about how terrible his wife is in bed, I get really anxious and flustered, and feel like I have no idea how to respond. I’d like to figure out what is happening for me so that I can respond differently in such situations”.
This last major category can overlap the others, but is comprised of aspects such as knowledge and adherence to ethical standards and professional standards. In addition, it includes professional behaviours such as being on time for appointments, completing paperwork in a timely fashion, maintaining confidentiality, establishing appropriate relationships with clients, and general professionalism. Lizzio and Wilson’s schema (2002) similarly registers the skill areas of role efficacy, ethical judgment, and personal development.
A supervision goal in this category could be something such as, “I have recently found out that a colleague is engaging ongoing behaviours that fall outside the codes of conduct for our profession as set out by our peak body. I have spoken with the colleague about it and she denies that she is doing anything harmful to the client. She has been helpful to me in getting established and she is an excellent therapist in other ways. I’m not sure how to proceed”. (Pearson, 2004; Wilson & Lizzio, 2009; Australian Institute of Professional Counsellors, 2018)
Note that, while these skills categories provide a reasonable framework for thinking about goals you might set up with your supervisor, they don’t include many skills addressing issues that fail to fall neatly into these domains: for example, issues of transference or parallel process (which we examine in a later chapter), aspects of policies and procedures within a workplace, or challenges such as the effect social and/or political conditions are having on clients which cannot be adequately addressed in counselling. In recent research by the Mental Health Academy (2018), for example, nearly every professional working with Aboriginal people who informed the research noted that Australia’s history of colonisation and oppression of Aboriginal people was “present” in the room in any helping endeavour, but most of the professionals declined to identify means by which that influence could be largely mitigated in session.
Even after deciding which practice challenges you most urgently wish to tackle and setting appropriate goals, you will want to explore how to meet them in terms of learning approaches.
What approach to learning suits our circumstances?
This second question of Wilson and Lizzio (2009) is that of how you, as supervisee, can best learn in your supervision, or put another way: what supervisor roles will maximise your experience and development? While supervisor roles can (should) include those of supporter, challenger, knowledge-extender, and resource-finder, a more useful way to delineate the supervisor’s roles is to talk about the supervisor as teacher, counsellor, and consultant. Which role — and hence, which approach to learning you will be engaging — depends on a number of factors, including how much experience you have in counselling, your personal style of learning, and the purpose of the supervision session.
Supervisor as teacher
Bring your mind back to your training for a moment. Do you recall any sense of awe (or even overwhelm) at the sheer magnitude of knowledge and skills necessary to become a successful therapist? Back then you were undoubtedly happy to have your trainers give you information. Perhaps if you were observed doing role plays or other scenarios, you were glad to be told in a directive way what you did well and what did not go so well. This sort of a didactic approach can be said to be occurring when the supervisor is providing advice on how to address a specific issue. It is often useful to have this sort of a teacher-controlled transmission of knowledge. It emphasises the learner’s (read: supervisee’s) need for instruction, guidance, and support (Person, 2004; Wilson & Lizzio, 2009).
If your supervisor is in this role with respect to you, she or she could be providing answers or instructing you as to learning techniques, ways of applying interventions, and conceptualisations. The question for you is: is that approach best for what you are contracting with your supervisor to do? Perhaps your training was a long time ago, and you are fairly well-seasoned as a therapist. Perhaps your concern in a given session is not an issue where knowledge or theory can be neatly transferred, and you just need to be supported following on from an incident. Let’s look at that role.
Supervisor as therapist
In the therapy role, your supervisor is facilitating your personal growth and helping you explore your reactions to things that have happened in your sessions with clients. For example, in the case of Jana (in the introduction), the supervisor will be facilitating Jana’s examination of what was happening for her as she heard about Carol’s husband being violent with her: not only Jana’s feelings of compassion and concern for Carol — along with a good measure of planning for the ‘what next’ — but also, Jana’s possible shame, guilt, and/or embarrassment at having missed earlier signs that her client was being subjected to violence. As an ethical therapist, one with some experience under her belt, Jana would likely have been questioning her own competence in that she failed to detect the violence. Thus, those reactions — personal but relevant to session material and thus limited — are fair game for processing in the context of working with the supervisor as therapist (Pearson, 2004; Wilson & Lizzie, 2009).
Many supervisees find that they learn best when their supervisor is in the third role: that of facilitator/consultant.
Supervisor as consultant
If Jana’s supervisor facilitates discussion about the session and provides options and alternatives, he or she is functioning more in the role of consultant. When they go on to collaboratively discuss case conceptualisation and further treatment planning for Carol, the supervisor can be said to be utilising a facilitative, rather than didactic, approach. If you have been practicing for a while as a mental health helper and/or if you have high needs for autonomy, you may prefer to have this sort of supervision.
If so, you are backed up by research. Wilson & Lizzio (2009) noted that in a study of graduates getting supervision toward registration as psychologists, the supervisors who used a facilitative approach had supervisees who were less anxious and resistant, with an increased capacity for professional self-regulation. Similarly, a study contrasting supervisor approach before and after counselling sessions found that, when supervision was held after a counselling session, supervisors tended to be more facilitative and there were high levels of learning transfer by the supervisee into their practice compared with supervisions held before counselling sessions, which correlated to a more directive supervisory approach and less learning transfer to supervisees’ practice (Wilson & Lizzio, 2009).
In truth, all of the supervisor roles are likely to be helpful to you at one stage or another, and the most useful question to ask may be that of when and how your supervisor might use each. In addition, you may find it useful to reflect on the balance of theory/practical technique in your supervisions. If the supervisor hasn’t got that right, you are certainly within your rights to ask that you re-focus, putting more time and energy toward whichever aspect has seemed to have too little.
What type of relationship will work the best?
Three words characterise a supervisory relationship which may be considered ideal: support, challenge, and openness.
We can talk about support as the degree to which you as supervisee feel adequate and affirmed as a result of interactions with your supervisor. Your greatest opportunity for professional growth and development as a supervisee happens in the context of a healthy relationship in which you experience the core Rogerian conditions of empathy, congruence, and non-possessive warmth. Assuming that your supervisor is congruent and transparent, releasing his or her perceptions, insights and reactions to you, you can use the relationship to explore your counselling issues with a sense of trust. Of course, the converse is true. If you feel judged, you will be careful to stay on “safe” territory, bringing only your best work and failing to expose areas where you may have been less effective or downright unhelpful (let alone harmful). When you feel valued, you can risk exploring the unknown, knowing that your supervisor’s response will offer you respect and honesty, even if you have to face unhealed or other limiting areas in yourself which may have affected your client work (McEvoy, 1998; Wilson & Lizzio, 2009).
Just like the muscle you strengthen at the gym through challenging it to lift ever-greater weights, so, too, your “counsellor competence muscle” needs challenge in the “workout” of your supervision sessions. We can refer to challenge as the extent to which you feel stretched — perhaps asked to think about things differently — as a result of your interactions with your supervisor. Several points are relevant here. First, while the counselling relationship involves an interaction with two people in which the client’s issues are the focus of attention, supervision is both similar and different. It is similar in that the focus of the supervision is also the client. However, it is different — and this is the second point — in that counselling is a dyadic relationship: two people, with the object of containment, or emotional holding, of the client, whereas supervision is triadic — the supervisor, the supervisee, and the client — and the containment is primarily the holding of you as supervisee in the counselling task, plus an additional layer of containment for the client.
Because supervision — even by virtue of its name — suggests an inequality of the roles, there is inherently a power differential; simply, the person with “oversight” responsibility — that is the supervisor — is more experienced than the person seeking the oversight: that is, the supervisee. You are focused on the client, and the supervisor “zooms in” and out, focusing on the client, your experience as supervisee, and also the supervisor-supervisee relationship (McEvoy, 1998; Wilson & Lizzio, 2009). The balance of support and challenge comes to be crucial in defining how you want to “run the relationship”.
The third crucial factor, openness, can be operationalised as the extent to which you believe that your supervisor is relating to you nondefensively and openly in regard to your background, limitations, and opinions. Achieving a workable balance of support and challenge is essential for your client’s outcomes, and also for yours as supervisee. You need sufficient challenge to stimulate development, with enough support to enable you to adequately respond to learning opportunities without retreating in apprehension or shame. It is the supervisor’s job to keep the space open for you to develop safely, exposing your weaknesses as well as your strengths. Your responsibility, on the other hand, is to be proactive in utilising the relationship to voice your fears, difficulties, and inhibitions, and to make mistakes and take risks. While the responsibility for effective outcomes from supervision is shared, that responsibility shifts more to your court as supervisee as you gain experience and grow in confidence (McEvoy, 1998).
In summary, when deciding what kind of a supervisory relationship you wish to set up, the three factors of support, challenge, and openness give rise to these three questions:What type and level of support will be helpful — and what sort might be counterproductiveWhat type and level of challenge you both will most value — and what forms might be counterproductiveWhat type and level of openness will be most helpful (Wilson & Lizzio, 2009).What management processes do we wish to establish?The fourth pivotal question to ask in the initial supervisory session, which sets the tone for subsequent sessions, is that of which processes you wish to establish in order to manage the relationship. You are advised to think carefully about the following aspects:
Purpose. Are you mainly concerned with your professional development, and/or do you want to monitor your quality and accountability?
Boundary management. What sorts of boundary issues will you need to discuss with your supervisor? This could include questions such as confidentiality and dual relationships.
Preparation. What sort and level of preparation is expected? Will you, for instance, be bringing either audio or videotapes of your sessions? Will you be doing transcripts and analyses? Who will be choosing the topics for each session.
Feedback. How will you know when the supervision session you have had is a good one? In other words, how will you evaluate and review the whole supervisory process? (Wilson & Lizzio, 2009).
Critical self-reflection on the part of both you and your supervisor will yield a more precise sense of your preferred approaches. For you, there are questions such as:
- To what extent are you willing to take responsibility for the management of your supervisory process?
- How clear can you be around and your needs and preferences across the various domains of intervention, such as learning goals and relationships
- How might you educate yourself — thus empowering yourself — about the contracting process?
- What type of working agreement do you wish to have?
- In terms of ongoing review, how might you let your supervisor know when you would like to discuss possible changes to your ways of working?
What ongoing processes might you use to review personal development and goal achievement in individual sessions and in supervision overall? (Wilson & Lizzio, 2009)
Editor’s note: This article was adapted from the Mental Health Academy course, Supervision: Maximising Your Sessions.
- Australian Institute of Professional Counsellors (AIPC). (2018). CHCPRP007: Work within a clinical supervision framework: Study Guide 10, Graduate Diploma of Relationship Counselling. Fortitude Valley, Queensland, Australia: AIPC.
- McEvoy, C. (1998). The supervisor-counsellor relationship. Inside out. Retrieved on 19 February, 2019, from: Website.
- Mental Health Academy. (2018). Sitting with Aboriginal clients: Context and strategies. Fortitude Valley: Mental Health Academy.
- Pearson, Q.M. (2004). Getting the most out of clinical supervision: Strategies for mental health counselling students. Journal of Mental Health Counselling. 26(4), 361-373.
- Wulf, J., & Nelson, M.L. (2000). Experienced psychologists’ reflections on pre-doctoral internship supervision and its contributions to their development. Clinical Supervision, 19(2), 123-145.
- Wilson, K., & Lizzio, A. (2009). Processes and interventions to facilitate supervisees’ learning. In Pelling, N., Barletta, J., & Armstrong, P., The practice of clinical supervision. Bowen Hills, Queensland, Australia: Australian Academic Press.
Loved reading the article.