quote:

Originally posted by Serena:
Hello,
I am a graduate student and havea question about supervision. Do you think supervision & consultaion should be mandatory? If yes why, and if no why. I am not having any luck finding any information and have a debate for class.
Thanks so much a future counselor

Hi Serena
I saw your post and thought I would reply from a client perspective on this question. For me yes, mandatory supervision in practice. I know that my t although vastly experienced has on-going supervision sessions, mandated by her training body, she also has to fulfil so many days a year continued professional development. This is also never mind the fact she supervises students in training, teaches, practices. It says to me that she is interested in her own development, does not think she knows it all, takes care of her own stuff so she can take care of her clients stuff in the best possible/most effective manner. It also shows that someone like t wants to keep up to date,informed etc.
Just some thoughts from a client viewpoint

Thank you so much and what a great perspective you have. It sounds like the t you have is professional, caring, and is giving back to the counseling profession.
thanks!!

Hi Serena,
Welcome to the forums. I'm from NY and I know that you are required to put in 3000 supervised clinical hours before you can set up an individual licensed practice. I am all in favor of it and think that having that as a continuing requirement is a good idea.

I think one of the most important factors in therapy is that it remains about the patient's needs and feelings, but it can be difficult for the therapist to do so, especially when they're starting out because being human, they will have their own triggers, sensitivities and blind spots. I think that human beings can only know ourselves in relationship, so it's important for a therapist to have a relationship in which they can observe their own unconscious stuff and work at keeping that out of the mix so that the therapeutic field is kept clear for the patient. I find it very encouraging that you are asking this question.

I think that a therapist thinking they are always capable of seeing clearly on their own is dangerously arrogant and could lead to real damage for a client.

AG

i dont know what i think about it for sure. my T had to do 4000 supervised hours before she could practice on her own. she has been practicing over 20 years now but she doesnt have any supervision anymore. she does come across as arrogant maybe, or at least sure of herself, when she says she knows the other Ts around here and there arent any whom she feels have the skill set necessary to truly help clients with longer-term psychotherapy needs. (i live in a very rural area -- its an hour-plus drive to the nearest big town, and 2+ hrs to the nearest metropolitan city.) i have to say that i know of several people who have tried other therapists in this area before finally settling with her, because she makes a difference. so my T may actually be right -- who would supervise her in this rural area if they all have less experience or skills than she does?

and yet, who is there for her to bounce things off and keep herself in check? that part is occasionally disconcerting to me. couldn't she maybe meet with a supervisor online?

but i have a hard enough time with disclosure to T as it is, without worrying that she is talking about me to a supervisor whom i dont know. so in that sense i feel more secure that she isnt talking to anyone.

just some random thoughts.

I say yes for supervision. There is no doubt their will be issues related to boundaries, transference and countertransference. I believe having structured guidance is critical.

quote:

IMO, those who know their limits and worked through their own sh*t will be more likley to seek supervision consultation anyway, while those who are not the best therapists will refrain anyway out of fear of criticism etc. And of course-unethical ones can just lie or hide things.

Xoxo,
This feels like you just made the argument FOR mandatory supervision. I do think that the better therapists who have worked through their stuff will seek it out when they need it, so making it mandatory does not change a thing for them. Unethical ones are a problem either way, but there is an outside chance that a supervisor may be able to pick up on something "off" if they are lying. Slim chance I know, but better a slim chance than none. As for the ones who are not the best, isn't the point to get to the unconscious stuff? And most people, even therapists, aren't good at hiding that. If supervision isn't mandatory, they NEVER have to go. But if it's required, isn't there more of a chance that problems will come to light?

I totally respect the need for therapy to be a protected private place for the patient and I understand your concerns that dropping a supervisor into the mix might complicate things even more, but I do think that many abuses in therapy grow out of the fact that it is such a closed, hermetic environment and one in which the patient is at a disadvantage.

I don't know, maybe a good compromise would be to make supervision optional, but the disclosure to patients of whether a T/P engages in supervision or consultation would satisfy both our concerns.

For example, I have no idea whether or not my T uses supervision or consultation. But I have never seen him display behavior that has made me concerned that there was significant countertransference going on. Frankly, the only countertransference I know about is the stuff that he has voluntarily expressed to me. He has also obviously worked through his own issues and pays close attention to keeping his stuff out of the room. So no biggie. But if I was concerned, it would be nice to know there was an independent way to know whether or not he was using those resources.

But I grant it's a tough problem and there is considerable tension between the need to contain the dyad while allowing enough outside scrutiny to protect a client from incompetence.

AG

I don't really want to get into it much, but I'll just say that I wholeheartedly agree with supervision and consultation. *Proper* supervision doesn't mean changing a therapists' way of being around a client, but it's simply a way of having the therapist reflect more upon their own experiences with the client and the reactions that come up for them in a way to help them find their own conclusions about things, much like many Ts ask of us. Of course, I'm sure there are supervisors who are far too overbearing and force their own views upon those that they supervise.

I think a T should seek consultation at any time during their career. There have been times where I know I would have been relieved to know that my T was seeking consultation. Also, I don't think I could ever work with a T who has never been in therapy, and I (in my very humble opinion) think there shouldn't be a single T in practice who hasn't had to work through their own stuff first. I think it should be mandatory for anybody in clinical practice.

Anyway, there's a lot more I could say on this subject, but I know I'd go off on too many tangents.

Hello, I want to put my opinion in - this is an interesting topic. Clinical supervision is a requirement that needs to be embedded in the work on a regular basis. It is important for a t to have a place to reflect on the experiences - how else to grow? I have had the experience of a t with no clinical supervision, and one who has. I much prefer knowing that my t has a governing body and supervision that holds her accountable and supports her.

I would like to say thank you tall who posted their comments. I think from reading all of them regardless of "mandatory or not" supervision and consultation is a benefit to both therapists/clients/supervisors. In a field where we strive to help others grow and work through their issues it would only be realistic to have our own sounding board. I like the comment she called it "structured guidance" perfect way to put it. There will always be the "bad eggs" but if there is some supervision at least they can be monitored or even removed for the simple fact there is an outside view fromt he profession. Thanks again for all the feedback it was GREAT!!!
Rena

Hi Serena,

So glad you found the input valuable. I'm glad you asked the question as it was a fascinating discussion.

Xoxo,
Really sad you deleted your responses. I had read your last before you took it down but didn't have time to respond. I thought you made some excellent points, especially in the area of unintended consequences that often happen in the wake of mandates, driving costs up for very little benefit. I really think I was viewing the issue from too narrow a perspective; reading what you wrote made me see this from a more big picture stance.

If you wish me to delete your quote, just let me know.

AG

xoxo- because you are deep, and very analytical and intelligent- you have something very special that you bring to this forum. Do not say "too." You are really, really smart. And that is a gift that you freely share with us! Please, trust yourself- what you offer here is truly valued, and truly valuable. I can promise you, that you are a valued member of this group. There may be disagreements, and there may be times when "right and left brain" have misunderstandings or clashes with eachother- but in the end, we are all a part of this group, with all of our different personalities and backgrounds and quirks- (for example, people here accept me in spite of even, my extremely triggering religiosity) and your input, your wonderful and instructive links, and your perspective is deeply valued here. It has helped me, many a time.

Hugs, ((((analytical you )))

BB

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There are already mandates for consultation and supervision in ethics codes and also training institutions and I agree with them.

I would like more information about these mandates from anyone who has links. Are they for consultation AND supervision, or is it a choice between consultation OR supervision? And is it for as long as one practices or only while in training? Are the mandates which have been referred to in this thread applicable for those who practice in all states of the US? Or do you speak concerning the laws in the UK, Canada, or only the US state in which you reside? I want to know because to my knowledge I have never signed any confidentiality-waiver agreement which would allow my T to talk about me outside of our therapy, whether in supervision or by consultation, nor have I signed any waiver regarding her NOT having supervision, and it seems like an issue which a client should be made aware of, and have a choice in, either way. I am pretty sure my T only seeks consultation a small percentage of the time, but I only know this because I have specifically inquired on my own after having many, many sessions, and not because it was something upfront that we discussed in the beginning. In the beginning, I was not even aware that a T could speak about me to someone else without my express permission. That does not seem ethical to me. I thought everything would naturally be strictly confidential between us.

Hi Cipher,
The mandates I was discussing were based on my understanding of NY State Law, which requires a certain number of hours an an intern while getting a degree (don't remember the exact number right now) and once you graduate, you must work for a agency that employs multiple therapist and practice for 3000 hours (this figure is based on memory and may be wrong) with supervision.

Some degree programs require the therapist to attend their own therapy, some do not.

As far as I know, once the supervision period is complete, you are licensed for individual practice and at that point onward, there is no requirement in the law for supervision or consultation, although both are recommended by most professional organizations.

As far as confidentiality, in NYS you have complete confidentiality EXCEPT in cases where the therapist believes that you are a danger to yourself or someone else, OR has knowledge that there is on-going child abuse. In those situations, they are mandated to report the situation to authorities (they have a fairly wide range of discretion as to what constitutes a situation which they must report.)

Releasing information specifically about you to anyone else requires a signed release from you. For instance, in NY State you are required to sign a release for your insurance company before you therapist can discuss your treatment.

However, as far as supervision and consultation is concerned, your therapist is allowed to discuss you without a release as long as NO identifying information is provided. In other words, the consultant or supervisor knows that one of their patients is being discussed, but have no way of knowing whom that particular person is nor would they have access to who the Ts patients are (as even the fact that you are a patient is covered by confidentiality.

So your assumption is correct in that anything between you and your T will not be revealed to anyone whom could connect the information back to you.

If you are interested in finding the rules in your own state, looking up the licensing requirements for therapists is a good place to start. Or ask your therapist, she should know.

AG

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I would like more information about these mandates from anyone who has links.

Well i guess i should throw some links up. There are federal, state/province, and professional laws and codes. Some of these pertain only in the U.S., but some of the links include Canada as well as a variety of professional associations. I don't know too much about the UK, sorry.

People should keep in mind that when multiple laws, codes, or professional standards are involved, often the most conservative-strictest supercedes the others. Here are places/links where you can find most of the information governing psychotherapy practice.

FEDERAL (United States)

Summary of the HIPAA Privacy Rule

STATE

Psychology Laws & Licensing Boards In Canada & the United States

PROFESSIONAL

Ethics Codes

Here's an example of a mandated consultation for a member of his/her professional organization:

quote:

Constant self examination and reflection by the psychoanalyst and liberal use of formal consultation are obvious safeguards for the patient, as well as the treating psychoanalyst.

(I switched the other one for a better example.)

•American Psychoanalytic Association: Principles & Standards of Ethics for Psychoanalysts

Hospitals, training institutions, and mental health organizations will likely, in addition to all of these, have their own set of ethics or codes.

You might have to get more specific information about supervision from the training institutions themselves.