Can Effective Supervision Prevent Harm in Therapy?

Philip Cox’s recent article on harm in therapy got me thinking about the value of the supervision I seek, and my relationship with my supervisor. I like the notion that the word supervision literally means “over-view” and I can picture my supervisor in a little helicopter, observing the wider picture as I manage the finer details on the ground.

So what is the purpose of supervision? For me, the supervisory relationship serves several functions.

Firstly, I have a trusted and confidential space to discuss my work with clients, which feels like an essential counterbalance to the isolating nature of the work which is so often talked about in the profession. It is in itself a form of self-care.

Secondly, I find the strength of the relationship provides a solid platform on which I know I can stand when I need to. I feel confident it will not break beneath me. This security gives me the courage to co-create new platforms with my clients, on which they too can stand and experience safety within the relationship. Being part of this solid base for my clients feels possible because I am anchored by my own firm footing in supervision.

Thirdly, the trust I have in my supervisor helps me in a number of ways. Through talking about client work and other areas of my process openly, I have allowed myself to become vulnerable, and at no point have I ever felt judged. This mirrors beautifully the function of the therapeutic relationship and allows me to bring whatever I need to discuss to supervision, even times when I feel I have made mistakes in my work. The transparency allows us to shine a light on areas of my work that we might otherwise miss, and to raise anything to my awareness which might impact on the work. I value my supervisor’s willingness to challenge me, and to be challenged; I find the parts of the work where we each hold different perspectives the most illuminating of all – there is always so much to learn and to take forward into my practice. Parallel process fits nicely into this area of working within the relationship; it is a fascinating phenomenon and, I find, rich with data about myself and my relationships with clients.

Do I disclose all my thoughts and feelings about the work to my supervisor? Well, I try to, but there will always be things outside of my awareness which don’t become immediately apparent. As my supervisor gets to know me better, he becomes even better placed to spot my shadow material as it emerges and bring to my attention anything I might not have seen. I try to make a point of accepting the observations he makes curiously and non-defensively, even if I do not recognise what he is saying. I find this work exciting and engaging.

A good supervisory relationship doesn’t make harm occurring in client work an impossibility. It would be arrogant and naive for any therapist to assume they do not have the potential to do harm for any reason. But I do think that supervision is an important safeguard against harm. When we have a trusted relationship, a space to explore every aspect of ourselves and our actions towards clients, we have a safety net – the opportunity to catch areas of the work which could become problematic before any harm occurs.

I think this is as true for very experienced practitioners as it is for those at the beginning of their career. Certainly the nature of supervision for a practitioner with forty years experience is likely to differ from that of a student or newly qualified therapist, but all therapists require support, and of course, we are all vulnerable to the emergence of shadow material – supervision is an important part of managing this throughout our career.

 

 

 

4 thoughts on “Can Effective Supervision Prevent Harm in Therapy?”

  1. I think a valid question is also whether supervision can in itself cause harm.

    It bothers me that a therapist is potentially discussing intimate details of dilemmas in a client’s care and relying on advice and an outside perspective from someone with whom the client themselves has no contracted arrangement or say in the matter. The therapist chooses a supervisor who is a good fit for them – it does not autmatically follow from this that the supervisor is also a good fit for the therapist’s clients or holds their perspective in mind.

    The arrangement is really intended more for the protection and self-care of the therapist, and any benefit for the client is a byproduct of this rather than the primary aim. One scenario where the client is harmed which I’ve seen this described multiple times on other people’s blogs is that a therapist gets in above their head with a client who has disordered attachment, especially anxious-insecure or disorganised attachment, starts to blur boundaries and overcommit and then on seeking advice from their supervisor pulls back and sets much firmer boundaries or even terminates with a client, creating abandonment trauma in the process.

    Is it possible that having supervision in place might in some cases even encourage a therapist to push past the limits of their competence?

    I think it is also a problem if the therapist does not “own” their boundaries, perhaps because of their own conflict aversion, and more or less hides behind the boundaries of their supervisor or professional body, giving the impression to the client – regardless of whether the therapist says it outright – that they could/would offer more (particularly things like physical touch or greater out of session contact) if only it were not for externally imposed boundaries, and creating a false hope which can also be harmful. (As an aside I wonder if Kohlberg’s and Piaget’s stages of moral development in children might be applied to this scenario).

    Liked by 1 person

    1. Thank you for this comment. I agree that, while the focus of this blog post is on effective supervision, ineffective or poor supervision
      can have a harmful effect on therapy. I have known of cases where supervision has been a contributory factor, particularly with boundary changes.
      A good supervisor will almost never take a commanding role, and only really when there is a serious ethical concern. If a therapist is hiding behind their supervisor’s boundaries that is certainly unhelpful. I think you are right that a therapist who is struggling with boundaries may change those boundaries on the advice of a supervisor and that this course of action could cause a great deal of damage to clients. This highlights that education about the importance of clear and consistent boundaries has to be a priority at all levels.
      There are many complexities which I don’t cover in this post and you have raised a few. I think for me, supervision is first and foremost about exploring my feelings, responses and interactions with my clients and an advisory element is fairly minimal, so a supervisor who has an understanding of me and my process is important. I understand though that supervision sometimes takes on a more overtly guiding role and it could be useful to further explore the diversity in supervisory experiences, and how differing styles and functions impact on the clients, who, as you say do not get a say in the choice of supervisor. Supervision should be enhancing the client work. When it is contributing to harm, there is a big problem.

      Liked by 1 person

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