Supervision: the clinician is also part of the clinical work

Supervision has been an important part of my professional life, both as a supervisee and as a supervisor. Over the years, I have come to see supervision as something much more complex than teaching clinical skills, discussing cases or ensuring that interventions are implemented correctly.

In many ways, I approach a supervisee with the same curiosity that I bring to a clinical case.

This does not mean treating the supervisee as a client. The relationship, responsibilities and objectives are different. But the principles that guide my understanding of human behaviour remain remarkably similar.

When a clinician struggles to implement an intervention, avoids a difficult conversation with a parent, becomes defensive when receiving feedback or repeatedly makes the same clinical decisions despite supervision, I am interested in understanding why.

It is tempting to interpret these behaviours as a lack of knowledge, motivation or professional maturity. Sometimes knowledge is indeed missing. But often the explanation is more complicated.

• What is the clinician trying to achieve?
• What are they trying to avoid?
• What consequences are maintaining their behaviour?
• What aspects of the environment are making effective clinical practice more difficult?

These are questions I would ask when trying to understand a client's behaviour. I see no reason not to ask them in supervision.

One of the things I find particularly interesting is how much a clinician's personal history influences their professional behaviour.

Some supervisees find it extremely difficult to disappoint a family. Others struggle to acknowledge uncertainty, ask for help or admit that an intervention is not working. Some become overly dependent on instructions, while others experience guidance as criticism.

These patterns do not necessarily reflect poor clinical competence. They may reflect learning histories, expectations, insecurities and ways of responding that have been reinforced over many years.

And they inevitably enter the therapy room.

A clinician who is uncomfortable with conflict may struggle to establish boundaries. Someone who needs to feel competent may find it difficult to recognise mistakes. A supervisee who fears negative evaluation may focus more on performing well during supervision than on developing clinical judgement.

Understanding these processes changes the way I supervise.

Giving more instructions is not always the answer. Neither is providing reassurance, correcting every mistake or making decisions on behalf of the supervisee.

Sometimes, these responses can unintentionally maintain precisely the difficulties we are trying to address.

I have also learned that supervision can evoke strong emotional reactions on both sides. Feedback can generate anxiety, frustration, shame or resistance. Supervisors are not immune to these processes either. We may become impatient, overly directive or reluctant to address difficult issues.

I find it important to examine my own behaviour in these situations. Am I providing the support this clinician needs, or am I responding to my own discomfort? Am I helping them develop independence, or am I making myself indispensable?

This is perhaps one of the most challenging aspects of supervision: recognising that the supervisor is also part of the environment influencing the supervisee's behaviour.

There is a delicate balance between support and accountability. Supervisees need to feel safe enough to acknowledge uncertainty and mistakes, but they also need to experience the responsibility that comes with clinical practice. Too much criticism can produce avoidance and defensiveness. Too much reassurance can prevent independent decision-making.

Neither is particularly helpful.

For me, good supervision involves creating conditions in which clinicians can examine their own behaviour with curiosity rather than defensiveness, accept feedback without experiencing it as a threat to their identity, and gradually develop the confidence to make decisions they can justify clinically.

This takes time. It also requires accepting that professional development is rarely linear.

I have supervised highly knowledgeable clinicians who struggled to translate their knowledge into practice, and less experienced clinicians who demonstrated remarkable sensitivity, flexibility and clinical judgement. Technical knowledge matters enormously, but it is only one part of becoming an effective clinician.

What continues to interest me most is the development of clinical thinking: the ability to question assumptions, tolerate uncertainty, recognise one's own influence on a situation and adapt when the evidence suggests that something needs to change.

Ultimately, I do not think the purpose of supervision is to produce clinicians who think like their supervisor.

It is to help them become clinicians who can think independently, recognise when they need support and remain open to learning.

And perhaps the same principle applies to supervision as it does to therapy: our success is not measured by how much someone continues to need us, but by what they become capable of doing without us.