We can’t separate supervision from employment anymore
Clinical supervision makes or breaks therapist development. While plenty can go wrong with bad clinical supervision, there is plenty of evidence that good clinical supervision makes things better. As those who have had a mix of both kinds of supervision can agree, good supervision can make the work experience much more enjoyable, productive, and potentially keep you in your job longer. It should be no surprise that bad or minimal clinical supervision pushes us out of jobs—or at least leads to higher employee burnout and turnover (Knudsen, Ducharme, & Roman, 2008). So why are we still having bad experiences in supervision?
Employers see supervision as a box to check
When supervision is treated as a necessary obstacle to meet the requirements to keep prelicensed employees meeting the letter of the law, it is reflective of a workplace culture that is not interested in developing therapists, but in developing the bottom line for fiscal outcomes. Whether this be in agencies where the prelicensees are paid or not, the experience with the quality of supervision is transferred in a parallel process to clients. Furthermore, when clinical supervision is usurped by job or administrative supervision, it further degrades the quality time of clinical development that is necessary for therapists to further expand their clinical skills.
Employers stop checking the box when it’s not required—and it’s killing mental health services
Silva et al (2016) defined early career therapists as those within the first five years of their clinical practice. While this might be longer than it takes some therapists to get licensed, it’s important to recognize that despite passing licensing exams, many therapists may not be prepared to handle delivering clinical services or navigating the complex responsibilities of independent practice in either agency work or running their own business. Agencies, especially those in community mental health, are often needing qualified (not necessarily quality) supervisors to fulfill the regulatory requirements of employing prelicensed therapists and can sometimes be desperate to fill the positions.
What happens next is the survival of the middle. While supervision and employment underperformance hopefully get rid of bad therapists, these work environments also push out top performing therapists as well. When the performance bar gets set too high, therapists who care about their work sacrifice their time and own self-care to meet burdensome job requirements. After they leave this work for greener pastures, the people rising up through the system are mid-level performers. But average therapists moving ever up the employment chart does not create better environments, in fact it may contribute to a stagnation of the use of new ideas, resourcefulness, and up-to-date advancements in the field. It can contribute to the “it’s always been done this way” approach that stifles and contributes to the problems that we are talking about in the first place.
But it goes further than that. Knudsen, Ducharme, & Roman identified that supervisors who encouraged independent decision making that the employees reported higher job satisfaction, better employment retention, and lower levels of burnout. For agencies and treatment centers to truly be using the evidence-based practices that so many are happy to be advertising as a way of getting clients in the door, they should also be implementing evidence-based best practices with their workforce. But as long as we continue to look at providing supervision, or worse—sending therapists out of the business to get supervision—we will continue to see this stagnation in our field.
Knudsen HK, Ducharme LJ, Roman PM (2008). Clinical supervision, emotional exhaustion, and turnover intention: A study of substance abuse treatment counselors in the Clinical Trials Network of the National Institute on Drug Abuse. Journal of Substance Abuse Treatment; 35, 387–395.
Silva, A. E., Newman, D. S., Guiney, M. C., Valley-Gray, S., & Barrett, C. A. (2016). Supervision and mentoring for early career school psychologists: Availability, access, structure, and implications. Psychology in the Schools, 53(5), 502–516.
Kurt, some great thoughts here. I appreciated your citations supporting your conclusions. Could not agree more.