Clinical Supervision

What is clinical supervision?

Clinical supervision is different from managerial supervision. It is a regular meeting of about an hour, where people who work with clients and service users reflect on their practice with a skilled and trained professional, who is independent of the hierarchy of the organisation.
Supervision has three main functions: supportive (offering a safe, nurturing space for supervisees to recharge batteries and be validated for good work); educative (to develop professionally and learn new approaches or skills); and normative (to ensure ethical and professional good practice).

What is the benefit of supervision to clients / service users?

The aim of supervision is to improve work with clients. Clients benefit from working with reflective practitioners for a variety of reasons. Problems with the relationship between workers and clients are resolved in supervision. Ethical decision-making is carried out with a trained and experienced professional. New methods, tools and ways of working can be absorbed in supervision and taken forward in the client-work.
Monitoring supervisees’ practice also ensures that clients are worked with fairly and according to best practice. In fields where there is a great deal of one-to-one work with clients, supervision is essential to provide a witness to the work and a sounding board for decisions.

What is the benefit of supervision to supervisees?

Front-line workers often get very little guided reflective time to explore their work with clients. They sometimes feel overwhelmed by the responsibility inherent in the work. Some workers also find themselves suffering from vicarious trauma and burn out.
Supervision reduces or eliminates these risks. Sharing the responsibility of client work with an independent practitioner is a great relief. Talking about your practice in a non-judgemental space helps to address worries and concerns before they develop into problems. In addition, supervisors assist their supervisees in dealing with traumatic information, stress and managing workloads.
The supportive function of supervision means that supervisees are validated for their good work, and have a clearer idea of their particular strengths and talents. This validation is just as important as identifying areas of development. Within teams, this validation is rare, as there may not be a witness to the work, or a process of giving regular feedback about successes with clients.
A good supervision session will contain several moments of realisation, some significant learning and a feeling of having recharged batteries. Many supervisees greatly look forward to their monthly sessions, and enjoy the process of reflecting on their work and resolving worries and doubts.

How does supervision help employers and organisations?

Organisations who use external supervisors quickly notice the benefits to staff. Sickness is reduced, and competence is increased. In addition, disputes within staff teams can often be resolved in the supervision setting, meaning that they do not spill over into team dynamics.
The process of recording a rationale of ethical decision-making in supervision also provides a paper trail that can protect staff and organisations from legal difficulties, providing the supervisee is using supervision correctly, and bringing ethical concerns to sessions for discussion.

Who uses supervision?

All registered therapists in the UK must have regular supervision of their client work. The NHS also requires that allied professionals such as occupational therapists and physiotherapists use clinical reflection in their work.
Many other fields are now also seeing the benefit of this practice. Likely supervisees include youth workers, mental health or domestic violence support workers, advocacy workers, social workers, teachers and other health professionals, including general practitioners and nursing staff.
In addition, people who work with traumatic information such as barristers, probation workers, sexual crisis teams, refugee support workers and so on all benefit from regular supervision sessions.
Finally, many managers use clinical supervision to reflect on topics such as staff management, relationships with trustees and senior managers and organisational decision-making. Managers who use consultative supervision find that they suffer less stress, less vicarious trauma and less conflict with colleagues. In addition, they find that the decisions they make in supervision, by utilising an independent sounding board, are good solution-focussed choices.

What might a typical supervision session cover?
Supervision sessions will usually include the following elements.

1. A good supervision focus or question is identified. This may be a client issue, an ethical concern, a feeling of stress, a collegial relationship, problems with managing workloads and so on.
2. The supervisor guides the exploratory space of the session. She asks relevant questions, clarifies and assists the supervisee in getting to the root of the problem, and to begin looking for solutions. Possibly, the supervisor will bring additional information, knowledge or resources to this exchange, if needed.
3. The supervisee makes choices about how the information gained will change their practice, or how they will address an issue, if it still seems to be a problem. The supervisor will ensure that these decisions are ethically sound and helpful to clients and organisations.
Often, the session will feel light and easy. Supervision is meant to be a serious but enjoyable practice. Most sessions involve laughter and a mutual feeling of fascination and interest in the issue being discussed.

What does an effective supervisory relationship look like?

A good supervisory relationship is essential to the process. A supervisor should be someone that you respect and trust, and enjoy working with. You will need to feel that you can take even embarrassing worries to supervision, and be treated with calm acceptance.
Although the supervisor will need to be qualified and experienced, particularly in their own field, you should never feel that they have all of the power in the room. Your own expertise and your relationship with your client are important.
Finally, a good supervisor does not constantly offer solutions, but generally trusts you to find your own. However, she will also offer relevant information and ask challenging questions if need be, in a general climate of mutual respect and warmth.
As with most relationships, supervision alliances build over time. It is normal to feel anxious presenting your work (and especially your worries about the work) to a stranger at first, but as they assist you in resolving problems and supporting you personally, the outcome is an increasingly safe relationship of trust.

What is the supervisory confidentiality arrangement?

All supervisees need to be sure that their information will not be shared without their knowledge with employers or anyone else, including other supervisees. The confidentiality agreement is therefore absolute.
The only exception to this agreement is where the supervisor feels that:
A. A client or other member of the public would be placed at a risk of serious harm, if the supervisor did not share relevant information with relevant agencies or;
B. If a supervisee were acting in a way that was likely to cause serious harm to a member of the public, and that they were refusing to change this behaviour.
In both of those (very rare) situations, the supervisor would discuss possible ways of extending confidentiality with the supervisee, and ideally arrange a mutually comfortable solution.