Musings and Articles by CST Associates and Partners
Why is it that some clients find their way into supervision from the beginning, while others barely get a look in?
How do you decide which clients to take to supervision? That sounds like a straightforward question for any of us to ask, as part of good reflective practice. However, scrutinising a question can often be more productive than replying to it – so, instead of giving an answer, let’s look at some of the basic premises underlying this one. I reckon four key assumptions are made.
The first assumption is that deciding which clients to take to supervision must be a conscious, deliberative process. Really? If you say you consciously decide, does this mean they are never unconsciously selected as well? We could get clever (or pretentious) on this point by engaging with neuroscientific findings about the reality of ‘free will’ and so on – but let’s work instead with an ordinary notion we’re all familiar with: the hunch.
They say a hunch is stronger than a guess but not as strong as an intuition. Although we employ ‘the professional hunch’ a lot of the time, we tend to underestimate its true value. Of course, we make carefully considered decisions too, but let’s not overlook the sudden wisdom of our hunches. For example, when it ‘comes to mind’ that I need to take a particular client to supervision, even if I then wonder about what’s going on with me and that person, I’m still not ‘choosing’ to take them for any obvious reason – but this does become clear later in supervision. When a piece of client work is seriously baffling or disturbing, I am very likely to take it, but other clients arrive in the supervisory space without any conscious intention on my part.
The second assumption is that choosing is necessary and unavoidable because it would be practically unworkable to take all your clients. This depends on what kind of supervisory arrangements you’ve devised for yourself. I know someone who runs six to eight therapy sessions a week. She has one-hour fortnightly supervision with me and two-hour monthly co-supervision with a colleague. This set-up means she can fulfil her self-imposed requirement to ensure all her client work is supervised. I admire her commitment, but some therapists might feel over-supervised in that situation.
One of my past supervisees had 15 appointments per week and saw me for one-and- a-half hours every month – ie the recommended absolute minimum* – so several of her clients were never mentioned, let alone discussed. I asked her to write a caseload summary every other month, with a thumbnail description of the work with each client, plus brief queries. With this ongoing information about all her clients, I could request we give some time to certain cases that caught my eye, but which she did not choose or intend to bring. Preparing in advance for clinical presentations of clients is often essential, but I believe it’s just as productive sometimes to bring them ‘unrehearsed’ and ‘unrefined’ – not so time efficient, perhaps, but still valuable for therapeutic insight and learning.
The third assumption is that supervision is always for the benefit of clients, therefore as many clients as possible should be taken to supervision. We assume supervision can benefit clients, and very often we feel it to be the case. In fact, we’re in the peculiar position of believing it’s beneficial, while knowing there is hardly any research evidence to support our belief. It would be more accurate to state that supervision is primarily for the benefit of supervisees. To put it in plain terms: we trust that whatever good stuff a supervisee derives from their supervision sessions, one way or another, it really does get passed on to their clients.
I hope that what you get mostly from supervision is support, understanding, challenge, development and encouragement for yourself, so that you are then well resourced, refreshed and ready to maintain the same or similar beneficence for your clients. If clients do benefit from supervision, it is mostly through a subtle, indirect transmission. The point is this: in order to gain the benefit of the supervisory space for yourself, it’s not a good idea to squeeze as many clients as you can into the room.
The fourth assumption is that clients themselves have no say in the matter. In principle, if they’ve read in your contract that you consult confidentially with a supervisor, any client could ask if you talk about them in supervision. A few practitioners tell some of their clients about their supervisory discussions anyway, and the remote supervisor can become a useful transferential figure. So, in some cases, the client’s own intentional input into the supervision process is central to the work.
What intrigues me is how certain clients leap straight into supervision from their first encounter and settle themselves there for a long time. They may be welcome, but who actually invited them? And then there are clients who suddenly ‘pop in’ while you’re presenting another case. I’m sure some clients unconsciously let the counsellor know they need to be supervised. In this sense, clients ‘bring themselves’ to supervision.
In contrast, people you conscientiously put on your ‘take to supervision’ list may never show up. They ‘get lost in transit’, or you always run out of time. Or, if you do introduce them, you soon find yourself trailing off. In this instance, it’s important to ‘hear’ what that individual’s psyche could be telling you about their absence from supervision. Perhaps some clients unconsciously instruct us not to share anything of their story with anyone. With this in mind, we can invigorate our sense of choosing who we take to supervision – reluctantly or otherwise.
In BACP documents, the figure of one-and-a-half hours per month is always stated as the minimum for accreditation purposes. I’ve met many practitioners who wrongly take this to mean a ‘sufficient’ or ‘correct’ amount.
1. Wheeler S, Richards K. The impact of clinical supervision on counsellors and therapists, their practice and their clients: a systematic review of the literature. Counselling and Psychotherapy Research 2011; 7(1): 54–65.
2. Davies N. Research and literature overview of supervision within the counselling professions. Good Practice in Action 043. BACP 2016.
Jim Holloway is a senior accredited counsellor and supervisor, a partner in Cambridge Supervision Training, and a co-author of Practical supervision: how to become a supervisor for the helping professions (JKP 2014).
Summer 2017 Private Practice 25