Nice But Not Necessary—And Other Clinical Supervision Myths Part One

Although regular clinical supervision is a pre-licensure requirement, once licensed, a therapist in Massachusetts can practice without regular clinical supervision. As a PhD student steeped in learning about, from, and through receiving and providing clinical supervision, I find the idea of not receiving supervision, especially related to self-of-the-therapist issues, concerning and rather sad. Do we ever stop growing, changing, and learning? Is there some after-licensure miracle that makes us impervious to our own demons, flaws, biases, and blind spots? Can we give an infinite amount of support to others without replenishing our own tanks? Nope. My husband, an LMHC who works in a community health center, practices without regular clinical supervision, as it is not required and hence not prioritized in a medical setting. Even as an experienced individual therapist, I watch him struggle under the weight of carrying his clients’ pain, with remaining empathetic and creative without burning out, and facing his own struggles without projecting them onto his clients. It doesn’t seem fair or right that he, and other therapists -- regardless of their time served -- are doing this critical work on their own, without structured support.

We know that therapy is called a practice because we are ACTUALLY PRACTICING; it is not an us versus them sport, we are not gods, and we don’t have access to a magical world of right answers or processes. Yet, we wield immense power as we hold and support vulnerable others through trauma, loss, and a variety of difficult life circumstances. When we do this work—wield this powerin isolation, it’s not just unfair to us; no matter how hard we try and how good our intentions, we are also potentially putting our clients at risk. Working with vulnerable populationscarrying high client loads and receiving minimal if any clinical supervisionseems especially fraught with the potential for unintentional harm.

Is anyone reading this thinking, “Not everyone needs regular supervision forever! I may like it but I don’t need it”? It’s ok if you are. I’ll be frank, I’m imagining myself in ten (five) years saying just that; heck, some weeks I say that now! Many of us have not received ongoing effectivelet alone transformativesupervision. The kind that builds your confidence and curiosity, feels fundamentally safe, and yet pushes you past where you are comfortable, forces you to face your impartiality, your Family of Origin/ego/defenses etc., and then holds space while you cry, rage, and grow. You know, the kind of support, compassion, and dedication we as therapists provide to our clients. Also, power is a trickster; we only have to look as far as our current political climate to see this; are therapists somehow immune to power’s charms? I also think: nope.

When I was an executive and a consultant, like a therapist, I had a lot of power: it was my job to go into a crisis, assess situations and relationships, facilitate the development of goals and plans, guide others, and provide expert opinions. The pressure and responsibilities I carried demanded that I believe my thoughts and decisionscritically examined, well researched, and aligned with my strong valueswere well-intentioned, selfless, and right. I preached collaboration as critical to success, but was privately convinced that I alone had the answers. I insisted to others that “making mistakes” was essential to learning and growing, but was terrified of making my own or being “found out”. I surrounded myself with people who reinforced this false self and skillfully silenced anyone who dared to question it, all the while convinced I was doing the opposite. I was the benevolent fixer and the authority, and was convinced there was no room for me to be uncertain, weak, or vulnerable. I didn’t share my inner fears and doubts with anyone, I could barely acknowledge them myself. The more expert I became, the more I  believed, without a shadow of a doubt, that I did not need supervision or a second unbiased opinion and looking back, I most certainly did.

This experience has made me especially sensitive to the critical work of exploring and managing my own issues with power. In my therapist and supervisor roles the potential to fall into similar trapsisolation, hubris, denialfeels very strong. Perhaps I am an outlier, particularly sensitive or prone to insecurity and power struggles. Or perhaps power, especially in the hands of those who are passionately well-intentioned, has a particular way of making us believe our own hype. No matter where you land on the spectrum, I see it is a fascinating and important theme to explore, ideally in safe and effective clinical supervision.

For those of you out there practicing without dedicated clinical supervision, do you ever fear showing your own fears and insecurities? Do you ever wonder if maybe you are overconfident? If maybe you have done or said something wrong? If maybe you were projecting your own biases onto your clients? If you do, where do you go? Do you go to peers with similar values who may inadvertently support your perspective or do you consult with someone with whom you often disagree? What do you do with the burdens you carry? If you don’t wonder these things, what makes you so confident and why?

For those of you out there practicing with effective clinical supervision, what makes it effective? Do you have any advice for others who are seeking same?

Stay tuned for Part Two which includes interviews with recent MFT graduates.

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