The vast majority of clinical supervision research focuses on the interaction between the client and supervisee. More expansive models of supervision will also look at contextual factors, such as the relationship between the supervisor and supervisee (for example, the Hawkins & Shohet Seven-Eyed model of supervision). However, even these more expansive models fail to fully address the entirety of contextual factors that look at the entire relationship between the supervisee and their role in the workforce.
Part of this discussion is regulated in statue and regulation by dictating what must be discussed in clinical supervision. Mostly this is limited to client outcomes, interventions, and case conceptualizations. Depending on the agency or practice, this time may also have time focused on job-related tasks, such as completion of documentation, productivity quotas, or other administrative issues, including client billing. During these discussions, discussions of client finances, socioeconomic status, billing status, and more will be discussed, with many being discussed as clinically relevant material. However, one thing that is largely ignored and missed entirely in these discussions is the role that the finances play with the supervisee and the employer/agency.
Many theoretical models either directly or indirectly consider the discussion around finances as an important information gathering part of the therapeutic process. These same models will also discuss the parallel process and enactment that happens between therapist-client that also happen between therapist-supervisor. But rarely does the discussion of finances extend into this discussion. How has this developed?
Clinical psychotherapy with roots in psychoanalysis has been focused on the client, what we do to the client, and what we hear from the client. These roots have steered the entire field away from recognizing that the person sitting in the therapist’s chair has an impact on the clinical outcomes, at least until more recent decades. Clinical supervision’s roots have embraced a similar step here, but has failed to recognize the dynamic that the employment dance adds or subtracts to this situation. When the supervision issues do discuss workforce issues, the responsibilities are often shifted on to the supervisee in terms of burnout, lack of productivity, and other blame-shifting dynamics that do not address the systemic issues that workforce problems create.
We recognize the impact that underpayment, poverty, and chronic stress has on our clients, so why don’t we do the same for our supervisees? The answers are in the dirty secrets of the industry: it’s easier to maintain the system than to address the issues head on and raise the tide for all boats to float. Addressing the dynamics of employment issues that affect clinical supervision and, therefore, the impacts on client outcomes, means that we have to address that underpaying (or not paying) supervisees potentially impacts the supervisory relationship and the therapeutic relationship with clients. As supervisors, employers, and agency directors are reluctant to admit, addressing these systemic issues means changing business models that have long relied on taking advantage of one vulnerable population to provide care for another. These business issues and their clinical impacts don’t train better therapists, they provide an anchoring effect that lowers the value of the services provided, especially when compared to the costs to meet the requirements of a master’s or doctorate degree to be in the position in the first place.
Agencies that underpay or don’t pay their workforce will use a variety of explanations to defend their position and maintain the status quo. These explanations range from “it’s a passion population” or will tout the benefits of flexible work hours or less restrictions than actual jobs or will be outright playing to guilt by exclaiming that “no one else will provide these services”. These plays to emotion don’t take into account the financial needs of the people providing the labor or the larger workforce and continue the cycle of only allowing volunteers that are financially well-off enough to work for free in the first place, which then means that therapy is being provided by the rich and does not necessarily become a truly diverse representative workforce.
Not addressing the money issues for therapists in training, and those agencies that take advantage of it, continue to contribute to the barriers for many people to enter into a sustainable workforce. This rhetoric cheapens therapy and contributes to the poverty mentality that many therapists develop, at least for some amount of time during their career. These issues creep into client care through poorer interventions, burnout, or outright unethical acts in coping or dealing with the stresses of the situation.