by David J. Powell, Ph.D.

What is clinical supervision?

Supervision is a disciplined, tutorial process wherein principles are transformed into practical skills on four overlapping foci: administrative, evaluative, supportive and educational. Bernard and Goodyear (2004) define supervision as "an intervention provided by a senior member of a profession to a more junior member. This relationship is evaluative, extends over time, and has the simultaneous processes of enhancing the professional functioning of the person(s); monitoring the quality of professional services offered to the clients that they see; and serving as a gatekeeper of those in the profession."

Let me unbundle these definitions. First, supervision must be disciplined, which means there needs to be a regularly scheduled time for supervision, clear expectations, and, I go so far as to say, a written agreement or contract between supervisor and supervisee(s), stating that will happen in supervision. Second, supervision is a tutorial that begins with what the counselor needs to know, based on an Individual Development Plan for all staff. The most important question a supervisor can ever ask (as well as counselors to clients) is "What do you want (from our time together), and how can I help you?" Counseling and supervision is not about what you want but what the counselor/client wants for themselves. We begin with their stage of readiness for change.

Rationale for supervision

The definition also states that supervision addresses administrative, evaluative, supporting and educational/clinical issues. There are many benefits to quality clinical supervision:

Administrative benefits: ensuring 1. employees follow agency policies and procedures, evaluative job performance tools, a risk management tool that increases an organization's ability to respond to risk, thereby reducing liability.

Clinical services benefits: addresses the 2. counselor's core functions, provides a mechanism to ensure quality clinical care, case conceptualization, treatment strategies, and planning.

Professional development benefits: a 3. forum for enhancing clinical practices, emotional support, improvement in critical thinking, and intellectual stimulation.

Workforce development benefits: a 4. tool for recruitment and retention of staff, improve staff morale and motivation, and promoting counselor wellness.

Program evaluation and research 5. benefits: a mechanism for data gathering and information retrieval to enhance clinical care.

Functions of a clinical supervisor

A clinical supervisor fulfills many roles, including being a primary link between clients, front line staff and management, interpreting and monitoring compliance with agency goals, policies and procedures and communicating staff needs to senior management. A clinical supervisor is a teacher, assisting in the development of counseling knowledge and skills, determining counselor strengths, and promoting self-awareness. A supervisor is a consultant, monitoring performance, providing alternative case conceptualization, oversight of staff work, and professional gate-keeping. Further, a supervisor is a coach and cheerleader, promoting staff morale, and assessing needs. A supervisor mentors staff, serving as a role model for professional development, training the next generation of personnel.

The central key to effective supervision, as well as quality counseling, is the relationship. Counselors don't care how much you know until they know how much you care. You can tell a lot about an organization by the quality of the rapport and relationship between the supervisors and staff. Is this a trusting organization? Does management trust staff or do they micromanage personnel? Does staff trust senior management?

Central principles of clinical supervision

Clinical supervision enhances the quality of client care, improves efficiency, increases workforce satisfaction and professionalism, and ensures that services provided to the clients are legal and ethical. The central principles of supervision are:

1. Clinical supervision is an essential part of all clinical programs. The primary reasons for supervision are to ensure quality care, and to enhance clinical skills and development.
2. Supervision enhances staff morale and retention. The better the supervision, the better staff will feel about their work.
3. Every clinician, regardless of level of skill and experience, needs and has a right to clinical supervision. In addition, supervisors need and have a right to supervision of their supervision.
4. Clinical supervision needs the full support of agency senior management. In lean financial times, typically training and supervision are the first things to be jettisoned. Thus, executive management must be committed to an ongoing system of supervision, in good and difficult times.
5. The supervisory relationship is the crucible in which ethical practice is developed and reinforced. Ethics are not learned in the classroom. They are learned in everyday life when answers about what to do clinically may be elusive.
6. Clinical supervision is a skill in and of itself. Most get promoted into the role of supervisor because they are good counselors. What they didn't tell you is that it is another whole body of skills and knowledge.
7. Supervision in substance abuse treatment most often requires balancing administrative and clinical supervision tasks. Thus, if someone is both the clinical and administrative supervisor, there is inherently a potential conflict of interest. Why should I tell you I don't know what I am doing when you could fire me? Balancing these two roles is essential.
8. Culture and other contextual variables influence the supervision process. Supervisors need to continually strive for cultural competencies. For example, approximately 70-75% of the clients we treat are male; 70% of the counselors are female. 80-90% of the counselors are Caucasian. So, understanding the unique needs of each client is an important aspect of clinical supervision.
9. Successful implementation of evidence-based practices (EBP) requires ongoing supervision. Often, we train staff in an EBP without a system to monitor whether staff understands or utilizes the EBP. First establish your supervision system, and then teach EBPs.
10. Supervisors have the responsibility to be gatekeepers for the profession. There are some staff who should be working at McDonalds instead. One of the difficult roles of a supervisor is to counsel some out of the field.

The state of the field

The realities of the field are that many agencies do not adequately invest in clinical supervision. According to a study by the University of Georgia, 2009, both supervisors and counselors are only moderately satisfied with the quality of supervision. Both report high levels of burnout, stress, and high intentions to leave their current employment, seeking to find better pay and promote-ability elsewhere. However, neither clinical supervisors or counselors are optimistic that there are other employment opportunities out there. Supervisors are more satisfied with what the are doing than their supervisees. In other words, we think we're doing a better job than those we supervise.

The mental health field, over the past thirty years have moved to more direct observation of counselors. This can be through videotaping, one-way mirrors, or sitting in a counseling session and observing the counselor counseling. Unfortunately, the substance abuse field is lagging well behind the mental health field in doing direct observation. According to the University of Georgia study, the primary methods of supervision in the alcohol and drug abuse field are still verbal report-outs by the counselor and case consultation, without the supervisor directly observing the counselor in action. Thus, what the supervisors get is in the eyes of the beholders. It is essential the field move to do more direct observation in supervision.

Conclusion

In subsequent articles, we will explore how to establish a sound clinical supervision system for an organization.

For further information, contact David Powell at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .