Clinical Supervision

Table 1 Individual Clinical Supervision Benefits of Individual CS

Challenges of Individual CS

 Full attention on the skill development, strengths, challenges and professional enhancement of the individual supervisee

 Plenty of opportunities for developing the working alliance as well as teaching, mentoring, sharing of wisdom with supervisee

 More time and potentially safer environment in which to explore supervisee’s interpersonal dynamics with clients and the impact of the work upon him or her (e.g., counter-transference issues, secondary trauma, compassion fatigue, burnout)

 Very appropriate to particular theoretical orientations, such as psychodynamic and object-relations models, which emphasise transference/counter-transference issues and containment, as provided within the safe haven of the supervisor-supervisee relationship

 Supervisee can organise the time and has the opportunity to review more of his or her work with the supervisor

 Less exposure to peers and competition, which may have a negative effect on a supervisee

 Higher level of clinical accountability

 Potential for supervisee to feel intimidated by the supervisor, with no one else present to observe, or break up the intensity of the one-to-one focus

 Potential for supervisee to feel exposed, especially if the supervisor is also the line manager

 More of an opportunity and perhaps tendency to focus on the personal experience of the supervisee within the context of the work, which may be uncomfortable, or feel intrusive for some supervisees (also, boundaries can become blurred in negotiating appropriate levels of personal exploration)

 Limited possibilities for some types of teaching that require a group (e.g., role plays of families)

 No input from others outside the dyad

 No opportunity for supervisee to compare self with others, or gain support from peers

Table 2 Facilitated Group Clinical Supervision Benefits of Facilitated Group CS

Challenges of Facilitated Group CS

 Learning from each other’s practice examples and ways of working

 Self-confirmation in giving feedback

 Shared responsibility, which takes some load off the supervisor

 Supportive environment for the supervisees

 Opportunities for role play and other action techniques

 Offers a range of ideas, experiences and perspectives

 Input and feedback from peers

 Can reflect the therapeutic context being supervised (i.e. parallel process)

 Provides enough difference to avoid consensus collusion

 Less expensive and time consuming than individual supervision

 Opportunities for personal growth via group dynamics

 Supervisor can check out whether group members share concerns without seeming critical, or possibly shaming a supervisee

 Supervisor must be skilled in working systemically with groups and must be able to facilitate whilst also supervising (dual tasks)

 Supervisor’s anxiety about his or her own competence may pose a barrier, as there is greater exposure of the supervisor’s abilities and experience

 Supervisees’ anxiety about their levels of competence may cause reluctance to participate in the group (or to engage passively and silently)

 Less time for each supervisee, as the group must balance the needs of each member

 Group needs to have a high level of trust in order for participants to feel safe

 Potential for overload of ideas, or confusion about which ideas to use

 Enough similarity must exist between group members to have some overlap of ideas and perspectives (e.g., shared client group; general theoretical approach, or practice principles)

 Important to clarify purpose and needs of supervisee presenting a case, or that can get lost in the group process

Table 3 Peer Group Clinical Supervision Benefits of Peer Group CS

Challenges of Peer Group CS

 Each group member can offer and receive wisdom, experience and ideas from the group (i.e. enjoy both ‘teacher’ and ‘student’ roles)

 Shared influence and responsibility regarding how the group is run

 Group-owned: Success of the group is dependent upon how group members exercise their responsibilities

 Avoids the chance of getting stuck with an unwanted supervisor

 Can be mutually agreed membership

 Opportunities for personal growth via group dynamics

 An alternative to line manager providing clinical supervision

 Participants as equals encourages lateral help and peer support

 Group members may avoid challenging a member in order to prevent anxiety

 Group must agree on structure, format and roles and keep to these in order to offset the absence of a designated leader, or facilitator

 In an effort to support and empathise, one view may be reinforced rather than alternatives being offered (i.e. consensus collusion)

 Potential for unconscious designation of more experienced/skilled member as de facto supervisor

 Success is dependent upon how group members exercise their responsibilities

 Mutual trust, openness and respect are essential and this takes time. Usually requires that the group remain a closed one, at least for a period of time

 Competition, defensiveness and criticism between peers can occur

 Need for all members to be aware of and to address group processes, especially if they get in the way of group functioning

 Clinical case discussion frequency, depth and intensity is limited by the time available and the number of members participating in the group