Clinical Supervision: Critical to Best Practice

Associate Professor Maree Abbott - Council Member

Clinical supervision is a collaborative process that is integral to our training and professional development and identity as competent psychologists, whatever our stage of career. All training pathways involve intensive individual (and often group) supervision, which is now mandated as part of our ongoing learning and professional development, once we become registered psychologists.

The Benefits of Regular Supervision

Whether we are interns on placement or experienced psychologists, we will always benefit from collaborative supervision in order to: enhance our clinical skills and practice (e.g., formulation skills), keep us up-to-date with best evidence-based practice, identify blind spots in our skills, countertransference reactions and individual tendencies (e.g., avoiding raising difficult issues; going over time). Supervision is critical in helping practitioners manage ethical issues (e.g., maintaining appropriate boundaries), and in enhancing our reflective practice to better understand the client-therapist dynamic.

Regular ongoing supervision throughout our careers not only enhances our work as professionals but helps us provide a better service to our clients, helps protect us from the pitfalls of poor practice and burnout and helps to protect the public. Best practice clinical supervision provides us with clarity and direction as well as professional connection in the increasing context of isolation for many practitioners in sole practice.

It is no accident that our regulatory bodies and institutions that oversee the development of core competencies and standards include clinical supervision as an essential core component of all training and registration programs. In this respect, clinical supervision provides both a key training function and an ongoing assessment function in achieving set goals at every career stage to achieve our best professional practice. Clinical supervision also acts to ensure quality of care, performing quality assurance and public protection functions. The Psychology Council of New South Wales is involved in the provision and monitoring of practice conditions for some psychologists. This invariably involves conditions for approved, regular supervision and reports assessing the psychologist’s compliance with practice conditions.

The Supervisory Relationship

A caring, supportive, instructive and reflective supervisory relationship based on the attainment of core competencies forms the framework for supervision. While it might be tempting to show our supervisor our ‘best’ ongoing work, it is critical that we place the more challenging cases, issues and aspects of our practice on the agenda. This includes presentations and cases we are struggling with in process or outcomes, discussing any strong countertransference responses (positive or negative) or ways in which we start to respond differently to individual clients. We may be faced with difficult ethical issues like maintaining professional boundaries or dual relationships or working with clients with complex presentations or who are at significant risk. We may be dealing with a range of life stressors and want to make sure these don’t impact our practice. All of these issues are best discussed, understood and actioned with clear guidance from supervisors to avoid negative outcomes for both clients and practitioners.

Engaging with supervision will have the greatest benefits when we are honest, open and non-defensive and when we take a pro-active approach to our learning and professional development. We can do this by taking time to reflect on our recent practice prior to our scheduled supervision session and to write a list of agenda items for the meeting. Reflecting on the following questions can help us decide what to bring to our supervision session:

  • Which cases do I need to discuss in relation to clinical decision making?
  • Am I needing help with case conceptualisation and formulation?   
  • What ethical issues have arisen in my practice?
  • Am I maintaining professional boundaries? Am I blurring boundaries? Am I engaging in dual relationships?
  • Am I having any strong countertransference reactions (positive or negative)?
  • Am I working within my level of competency in terms of my training and experience in client presentations and models of intervention?
  • Am I willing to approach my supervision with an openness to reflect on my work and accept constructive feedback?
  • Am I meeting my goals in terms of development of skills and do I need further training and instruction in any key areas?
  • Are there cases or issues that I would rather avoid bringing to supervision?
  • Are any personal circumstances or stressors potentially impacting my practice?

Reflective Practice

Reflective practice involves a detailed understanding of our clients as well as our professional selves, which helps us make sense of modes of relating and responding in session by both clients and practitioners. Supervision provides us with the space to broaden and deepen our understanding of our reactions to clients and the clinical decisions we make. Times when we have strong countertransference reactions, when boundaries are potentially blurred, when there are ruptures in the therapeutic relationship, all require us to pause and reflect. This allows us to examine and understand the particular situation or dynamic from a variety of perspectives in close detail. The process of reflection can be uncomfortable. Reflective practice requires an openness and honest dialogue in which we intentionally seek to understand differing perspectives and entrenched patterns from a non-evaluative stance. Bringing a mindful attention to our work deepens our understanding and empathy so that we can address and correct unhelpful relational patterns and take responsibility for action. Developing a meaningful understanding of our own and the client’s thoughts, feelings, responses and relational patterns allows us to challenge our assumptions, address difficult issues and modify our behaviour in order to avoid the pitfalls of poor practice. Supervision provides a critical role and space for engaging in reflective practice.  

A Note for Supervisors

Supervisors perform a critical function for the profession in the training and assessment of core competencies for supervisees and in the ongoing professional development and maintenance of best practice for colleagues. Supervisors also provide a ‘gatekeeper’ function for the public in the maintenance of ethical and professional standards. Supervisors should attempt to develop strong collaborative relationships with supervisees and to provide a safe, respectful and reflective space that allows for the training and development of skills and provision of feedback to ensure best evidence-based practice. This involves providing appropriate time and space in busy schedules for regular supervision. Supervisees should feel able to discuss: areas where they feel less competent, difficult issues that arise in their practice, ethical dilemmas they are facing as well as strong countertransference reactions. Supervisors are responsible for providing thoughtful, reflective and practical feedback that is appropriate to the supervisee’s level of experience and stage of training. Setting clear supervision goals, encouraging reflective practice, assessing progress toward goals and identifying needs for further training and skills development are important elements of the role. Supervisors are also required to engage in their own reflective practice, to take responsibility for addressing any ruptures or difficulties within the supervisory alliance, particularly given that they are often responsible for the formal assessment and evaluation of supervisees. Supervisor training is now mandated for beginning and maintaining a role as an effective and competent clinical supervisor. In addition, supervisors are more frequently engaging in their own ‘supervision of supervision’ to ensure ongoing professional development and best practice in this important role.

It is a privilege to learn from our supervisors and to have their support, just as it is a privilege to supervise others, who in turn teach us so much. Supervision is the foundation of our development as competent psychologists and essential to our identity and reputation as a profession.

Readings and Resources

Australian Psychological Society Ethical guidelines on supervision.

Carroll, M., & Gilbert, M.C. (2011). On being a supervisee: Creating learning partnerships, 2nd edition. Victoria: PsychOz Publications.

Falender, C.A., & Shafranske, E.P. (2004). Clinical supervision: A competency-based approach. Washington: American Psychological Association.

O’Donovan, A., Casey, L., van der Veen, M., & Boschen, M. (2013). Supervision (pp. 327-345). Psychotherapy: An Australian perspective. Victoria: IP Communications.

Page, A., & Stritzke, W. (2006). Supervision (pp. 181-198). Clinical Psychology for Trainees: Foundations of Science-Informed Practice. Cambridge: Cambridge University Press.